USA vs UK Dentistry – Money and Culture Differences with Dentistry Rising – IC013

Jaz’s Introduction: Hello, Protruserati. I am Jaz Gulati and welcome to this interference cast all about the differences between UK and US dentistry. It’s quite a light hearted interference cast view today with someone very special. Her name is Dr. Bette Robin, and she’s the host of Dentistry Rising podcast. And it’s from podcasting. And her being a dentist actually doesn’t practice dentistry anymore, which is actually interesting. So we’ll discuss that in a moment. But her also being a podcaster in the dental niche, we sort of connected on this software podcasting platform. We joined this weekly mastermind all about communities and online courses. And we’re both part of that. And what are the odds that two dentists, who podcast who re also interested in running successful online courses were eeting together. So that’s what he story of how I got to meet Dr. Bette Robin. And then I got o listen to her podcast and t’s really great. I really like er voice actually. So we had a ery light hearted discussion bout the differences, the ultural differences in USA ersus UK as a dentist, what are he earnings like? What are the iggest barriers like? One hocking thing for me was the evel of debt that US graduates an land themselves in. But also he understandably was quite hocked to learn about how the ational Health System works ere in the UK. So it makes a ery interesting sort of fly on he wall sort of listening istenership you guys, let’s oll to the main interview, and I’d catch you in the outro.

Main Interview:

[Bette]
Well, I’m here on the Dentistry Rising Podcast today with Jaz Gulati, who’s a dentist in England. And Jaz and I met on an online study club on how to do online classes. And I was just absolutely thrilled that in the small little study group that another dentist joined. So what part of England are you from Jaz?

[Jaz]
Hey, Bette, thanks so much for being on. I’m enjoying doing this sort of joint thing with you. And like you said, you mentioned, what are the odds of two dentists in this very small, little micro niche, finding each other. So that’s been fun in the last, I guess, three or four months connecting with you on that I’m based in London and Reading. So it’s a place called Reading, but I guess most of your listeners will obviously know, London in England. And that’s where I practice as an associate. I also have my own podcast, the Protrusive Dental Podcast, obviously this is going on both of our podcasts. So both listeners will hear a little bit of an interesting story between us and also how things are in the US and how things on the UK in terms of dentistry, because I think there’s very contrasting working patterns, I think.

[Bette]
Well, thank you so much for doing this. Because yeah, I think it’s gonna be really interesting. I don’t know a whole lot about how dentists practice in England. So I’m really excited to hear what you have to say. So can we start with, I think, in England, that you go right from high school and to dental school, basically, where you do your basic sciences, where we do them in college and you go right in dentistry. So how do you become a dentist in England?

[Jaz]
You know, what do you need to think about where to start? And I think you’re so right, let’s start there. Because there is already a big difference there. Because, as far as I know, in US, it’s like dentistry is a post graduate degree, right? Like you already saying, or you have like, they’ve done one thing already. So here is like, you’re 18. And then you’re pretty much in dental school. And then at 23, you qualify, which for you guys probably sounds like that is way too young. Right?

[Bette]
Well, not really, if you’re focusing on, you know, because like my Dental School was three and a half years. So you’ve got five whole years to get your basic sciences and which I did in college. Before I did go to the graduate school, which is dental school.

[Jaz]
Okay, that makes sense. I see. I didn’t know that.

[Bette]
Still a little young for us. Let’s see. So you graduate from college? 22 here in general, and then 25-26 out of dental school.

[Jaz]
Yeah. So we’re about four on average, three to four years younger when we qualify. So I guess that’s the first big difference

[Bette]
And what does qualify mean?

[Jaz]
Qualify means you get your bachelor in dental surgery or BDS, you guys call it DDS or DMD, that kind of stuff. Right? So that right essentially, I mean,

[Bette]
Interesting. And then from there you go, mostly intent dependent practice, or mostly into groups or what your career path from there.

[Bette]
Most people or 99% of the dentist will do a training so it’s called like, Dental Foundation year. So it’s like a year which bridges the gap from being a student into being an independent practitioner, and it’s pretty much publicly funded. So we have the NHS a which is a National Health System, and we can go into that but I don’t want to go too into that because quite a controversial area. Of course, I also want to learn about you guys and the insurance system because we have some perceptions of the insurance system being maybe quite similar to what we have with the National Health System. So basically, we have the National Health System here. And we do this one training year treating patients under this sort of public health dentistry. And just to give you the most shocking example of one of the issues with dentistry in the UK and the National Health System is like. The NHS is great for like the other week I dislocated my shoulder right half an hour I turned out the hostile accent emergencies we call we call it a&e you guys call it er, fixed up my shoulder I was never presented a bill there was no insurance to contact like there’s we don’t pay for health care, right so it’s just taxes pay for that. So everyone can get free access to health care. So that’s that’s the medical side. But on the NHS dental side, you pay a little bit but a complete fraction compared to private dental care. But here’s the downside Betty, right? If you if I’m a patient, okay, if you’re a patient, Betty, and you come to me, and I’m performing NHS dentistry, and if you need one restoration, or you need 10 restorations, you pay the same fee, and the dentist gets the same fee. So sometimes that and that fee is pretty much let’s say 40 I’m making us dollars 42 US dollars. Okay, so whether you I do one restoration, or I do three root canals, five restorations, I get 42 US dollars. So sometimes my hourly rate is is like I might as well just work in McDonald’s.

[Bette]
Yeah, it sounds like you have no incentive to diagnose then

[Jaz]
that’s the thing. So the way we’re going out so used to be fee per item, right? And to make money, dentists would be on the other side of that. So be like over diagnosing maybe right, the trends. And now everyone’s like, Well, I think you know, it will remineralize and it’s okay. So but but the perception I have Betty of insurance based system you have is kind of similar. Like apparently, insurances are a very particular and they peanuts. Is that is that the way it is?

[Bette]
Well, not not really, I think you’re kind of comparing it to like an HMO plan, a health maintenance organization plan, where it’s kind of the same thing. There’s no incentive to diagnose but the dentist gets a certain amount per month per head, plan, whether or not the patient comes in. So it’s really not necessarily in the dentist’s best interest to have a patient come in and utilize their resources. So that would be comparable, I think, to an HMO, what you’re describing, but not comparable to preferred provider organizations, PPO and private practice where you definitely get paid for what you do,

[Jaz]
what percentage of practices are fully private?

[Bette]
Well, I’m not an insurance expert, but I would guess and fully private I’m going to call PPO and cash because the fully private just cash probably less than 5%. I mean, very small, but PPO, I guess, 60 to 70%, are ppl. So they are getting paid for what they do. And then we have, as you say, the other incentive was to diagnose too much. And to do too much work, as compared to the HMO which has, you know, a disincentive for doing too much work like what you’re describing. So but that’s not that’s not the norm is, you know, HMO is not the norm, even though it’s certainly growing

[Jaz]
without it without a doubt. Well, in the UK, believe it or not, a lot of practices are fully private, because it’s either your NHS, and then you do some private on the side. And the way you decide what you offer, the patient is, if it’s something they need, you give it on the National Health System, if it’s something they want, then you can do privately. But here’s where the lines get little bit blurred, right? Is whereby, like crowns, right? Like you say to the patient, oh, I can only do a metal crown. And they’re like, oh, but I want a white one. Or you want a white one. Oh, in which case you have to pay privately. So we call this mixed practice. So this is not how we are taught to be dentists. Right? We don’t this is the conversations we don’t want to have as dentists. So this is the biggest downfall as a nation we have, and because the prices are so low, like you know, I’m talking like I said, rock bottom low for National Health System dentistry. This is acts as an anchor for the private sector, and brings everything down. So you know, it’s difficult to justify true high fees, because everyone’s you know, the Joe public thinks, oh, but I can get five fillings for, you know, 80 bucks, and you’re saying one link privately is, you know, $700 or whatever. So it’s just a massive contrast.

[Bette]
And we get into that a little bit with dental collar dental care, as it’s called in other states where it’s, it’s funded based on income. So if you have a low income, you would qualify for dental or medical or, and we get into that kind of thing. What do you want with Danica, you get a silver crown, if you want to pay 500 700, whatever extra you can have a white crown. So we get into that as well with denti Cal as well as with HMOs. So what would you What do you think the average crown fee is in England? What do you what would you say? Okay, that’s

[Jaz]
a great question. And I would say so, if you’re doing a crown for a patient who’s getting National Health Service dentistry, so Just practice the patient would pay around about an hour I’ll commit to the US dollars the patient would pay around about 400 US dollars now really no extra extra get good, good. So extremely low.

[Bette]
Whereas more in the terms of our medical or dental

[Jaz]
Yeah, but but that’s like you know, you know, you could be earning very well in the UK and you can see NHS dentist and they will charge you $4. But what makes it worse Betty is remember, like, that includes everything that includes the crown that includes the core that includes a root canal, believe it or not, okay. And if they need three more restorations, technically, if you can do it like properly and play ball, you have to do it under that fee that $400 covers everything, which is the problem now I’m private dentist. So my crown fee is 950 pounds, which is around about 1600 1700 maybe less 1500 US dollars. That’s is that more comparable to?

[Bette]
For sure. Yes, I think most dentists here are probably a definitely over 1000. And that really, really good ones would be even over 2000 or 20 503,000. I mean, but I think most people in the 15 $100 range is Yeah, really comparable. So this NHS is that required is that like an internship, you have to do this one year out of school,

[Jaz]
you kind of do like you could go private, but who’s gonna hire you, right? Like, you know, who’s gonna take a risk on, you know, a brand new grad. So that’s why I said the 1% it might happen, but 9% you do it, but you know what, that’s the good thing is that this is like your training ground, right? You know, you actually get so much experience because like, he Now navigate to my appointment times because the average checkup time for NHS dentists or dentist forums or NHS contract will be like 10 minutes, or 15 minutes. Whereas I’m privately in our new patient, I would see 14 minutes to an hour, I just can’t operate like a hamster wheel like you’re constantly just in and out in and out patients. But all we can talk about this big difference now, I guess is where whereas we are seeing one patient at a time, right? So one patient gets, you know, 15 minutes in a diary. So we see four patients an hour, let’s say for checkups. And maybe that’s how the average NHSN says sometimes it seemed like kids 5555 minutes and just, you know, just burning through the mall. So in a day dentist might see like 6070 patients, which I think is crazy. And that’s why I couldn’t do it. I left the National Health Service. I’m fully private. So but we you guys from from my understanding, as most of you guys are just hopping from surgery surgery kind of doing the same thing. I mean, explain that to me.

[Bette]
No, not really, I think the high you know, the higher end dentist do see one patient at a time, the higher fee, the one you know, operate just the way you’re operating. I wouldn’t say that’s the norm I do I have people do jump from operatory to operatory. But usually only two operatories where they’re getting somebody numb and then they’re going back and maybe finishing a prop, that kind of thing. And then coming in and watch, you know working with the next patient. But at the lower levels, the HMO in the den a cow that kind of level. Absolutely. And like you say burning through the kids, where you have a whole line of them. And since we can delegate so much of it to you know, accelerate, so yeah, burning through the kids and even the adults at the very lower end, same thing, the better. You see, it

[Jaz]
seems so strange to me, the thought of the patients just sat there, you know, with the prep done, and they’re waiting for the next agent. I guess they’re all used to it. I’m guessing you’re used to this way of practice because, you know, how do you feel that awkward sort of silence awkward pause awkward gap, I just can’t understand it?

[Bette]
Well, I think at the lowest level, they expect it, they’re paying nothing and they know that’s what they’re going to get. And they’re going to sit there and be on their phone or that kind of thing. But at the higher level where you are jumping a little bit most doctors leave and assistant in the room with the person to chit chat the whole time or do impressions or you know, kind of waste time and a lot of ways. But you know a lot of people a lot of patients come self entertained with their phones now. And there’s the TV and all kinds of other entertainment options. But I would say the norm is to work with to ops. On most practices a dentist is working in two operatories all the time sometimes three.

[Jaz]
Okay. Well, most of us is 90 I’m saying we’re just working in one operatory and that’s it. One One question I have thought of his average income levels because here in the UK, we think like we all want to go to the US and practice because we feel like you guys earn a huge much bigger earning power. And I sometimes think the reason why our BDS our dental qualification is not valid in the US is because the US like dental boards kind of know that if you open the doors to UK dentists will all go there in a heartbeat. So that’s my sort of rationale.

[Bette]
Interesting. So how much do you guys make a year on average, okay, on average now

[Jaz]
this is according to Yeah, accountant figures. So I’ve actually looked at the National dental accountants figures and the latest figures suggest 68,000 pounds a year, okay. Now obviously these averages are based on a means and not medians and It probably involves lots of part time dentist, maybe mother of two who works two or three days a week. So the figures are a little bit skewed. But let’s go with it. So it’s 68,000 pounds. I think that’s around about, you know, 100,000 US dollars, I’d say. But that’s obviously gross before tax. And what’s that comparable to other jobs? Pretty good. Like the average income in the UK is 27,000 pounds. So 27,000 pounds, the average full time income, and then the dentist will get 68. So tell me, what’s it like in the USA,

[Bette]
I’m not really involved in organized dentistry to say so much. So I don’t know if I can give you exact figures. But I think it’s about 140 to 150,000 average for a general dentist specialist, probably double that on most specialties that are, you know, over 300,000. And certainly a lot of private dentists doing 300 400 Plus, you know, that really have it dialed in and, you know, high fees and art sitting with the patient and selling treatment and that kind of thing. So your lower, you know, but I don’t know how that’s comparable to cost of living. I mean, obviously, there’s a lot of other factors in there. But it sounds like we’re quite a bit higher.

[Jaz]
Yes. Which is why I think you guys have closed the door to us, you see, because we don’t want to leave this sort of contractual system that we have with public funds, dentry, and Republic all want to go to America. Now. I know some people who have left the UK for the US and done the additional, you know, three or four years or whatever, and, you know, spend a significant amount of investment to retrain and practice there. And they’ve all been pretty happy from it. You know, they’re happy happily practicing us now. And it’s a big jump to make, you know, five years in dental school UK, then you go to us and do it all over again. It’s a big, it’s a big step. Yeah. It’s

[Bette]
a huge jump. I don’t know if it’s worth that. But who knows? Maybe it is. But yeah, sounds like we’re making more money per se. What’s the ratio of women to men?

[Jaz]
Okay, so traditionally, it was very much a male oriented. So when I look at the photos from my dental school, like, you know, 6070s kind of thing. Male, but nowadays, let’s talk about today. It’s about 60 62%. intake females, and then about, you know, 38 40% male.

[Bette]
Oh, wow, we have very similar we have probably 5050 going into Donald school right now. But I think nationwide, it’s probably 20% or even less female still, you know, when you when you factor in all the 67 year old dentist and all that, you know, it’s still overwhelmingly male, which is gonna change. And here in a few years. Yeah. So very interesting. Well, I’d like to talk a little bit about I don’t you know, you and how you and I met I mean, we know how we met, but and then your course because you’ve just been so impressive in the group.

[Jaz]
Well, you know, you’ve done the the beach testing for me as well. And I was glad for that. But yeah, the course idea and the reason I joined the community that we’re part of now is sort of like podcasting, and then wanting to share knowledge. So I’ve been podcasting like yourself, I mean, how many years we’ve been podcasting at

[Bette]
about two, two and a half. But I’m been slacking lately for sure. No question.

[Jaz]
Well, yeah, same, same. Same here two years.

[Bette]
Yeah, I’ve had a little bit of issue with direction, I want to go. But what I, where I’m going now is to follow people’s journey, who just bought or sold a practice, I was focusing, we talked about this a little bit before, I think we turn on the recorder is like I was focused a little bit more on money, which I still think is really, really important to hop it. But I was getting hit up and having speaker having people record that we’re just what should I say? charlatans, you know, just trying to have data, most of whom were financial planners, and just do anything to talk to groups of professional, and I didn’t, I ended up not liking that direction. So I went back into, you know, what I do for a living, which is sell practices and try to follow people’s journeys and help other people that way? What were the pitfalls and that kind of thing. So yeah, I veered a little more into money, because that is a passion of mine. But I’ve kind of gone back to the practice self kind

[Jaz]
of thing, good for you. And well done for sort of, you know, taking that step and moving away from what you weren’t enjoying, and going into more of, you know, what you like and what you produce and what your listeners will value more, I guess

[Bette]
I just didn’t feel good about having talking to people and putting them on my podcast that I was not comfortable with them philosophically at all. And some of the podcasts that came across when I would question them on, you know, oh, yeah, borrow money off your from your house and put it in your retirement plan. So you make more money, you know, the financial planner, I was, I was just not on the same page with a lot of people. And that did come across. So that’s not the direction I want to go, to use my platform to do that kind of thing. But you on the other hand, did an online class for dentist. So tell me a little bit about that journey, how you got interested in, you know, the splint topic and what you did?

[Jaz]
Sure. So I mean, like I said, two years ago, I started the podcast almost by accident because So what I was doing at that point was, I’d moved back from Singapore, which I where I was practicing and really loving life. Singapore is a beautiful place. Have you ever been better now, just like Asia, like just the most beautiful weather all around great food, great culture. And we had a great time we my wife, but my wife got homesick. So we came back to England. And now word got out. Because morale in the UK dentistry scene is not very high. Okay, it’s low. So word got out there. Hey, there’s this dentist who went to Singapore. And he came back, and maybe we should start moving on to Singapore. So like, every day on my commute home, I was on the phone to a brand new dentists now they will ask me questions. Oh, what’s it like in Singapore? How much do you earn? Do I need to do any additional degrees? Are there any exams, the whole notion, the whole spiel, and everyday I was speaking to a new dentist. So eventually I was okay. Let me record an episode on a pod. Let me start on the podcast. And then the first episode was about you know, being a dentist in Singapore. And my experience is just so that I could free up more time for I want to help everyone. But I wanted to free up my time, because I was doing one to one I just couldn’t handle it. Right. So I didn’t want too many. And that was my first foray into podcasting. And then I started to come out my shell, because I’m quite a geeky dentist, I do. really shy, you’re so shy. Exactly. So that allow me to pray to practice my excess energy and, and place my excess energy somewhere. The podcast became my channel for my energy. And I started to bring on like, for selfish reasons, I start to bring on guests who I want to learn for. And at the same time, I was learning but then people were learning as grown and grown and grown, like, you know, recently about 150,000 listeners plus, and something that you know, 120 countries in the world, and it’s just amazing. But one thing I found around the middle of podcasting was, I was just doing some solo episodes about one topic I’m very passionate about, which is occlusal, appliances, and splints. And that absolutely blew up like there was one episode called Michigan splints are overrated. And people really, really took an interest in that. And then I just started to share like people, dentists, were now calling me up and asked me for advice about which occlusal clients to make for their patient. And this is something that I’ve been attending courses like for so long, to learn from different people and to develop and fine tune my own occlusal philosophy. And then I thought, Okay, that’s it, I have to share this content, I have to share this knowledge. So put together like 11 plus our modular learning. And by the way, along the years, I’ve done like, you know, a certificate in dental education because I love sharing what I know, and trying to become the best educator I can be. So that was the birth of that and part of learning about how to become a better online educator. That’s how I met you, because it was part of that community that we that we joined. And that’s how I guess it it led to this moment. Now we’ll be discussing all these interesting things and to podcasters have connected.

[Bette]
Yeah, very cool. So what what made you interested in splints? Where did it Where did that come from?

[Jaz]
confusion, like, I find like I’m such a geeky dentist that if something confuses me, like the two things that confused me the most at dental school was orthodontics. Like what the hell’s going on? Right? Like, what how is this working? This is voodoo magic. And then the other one was, I mean, occlusion, always right. Like most Auntie’s come out, thinking, you know what the hell occlusion is very complex field. There’s too many schools of thoughts. So fast forward now eight years and the two things which I ended up doing extra qualifications and extra learning on is lots of occlusion courses like I mean, a lot flying all over the world. And orthodontics I’ve got a deployment orthodontic, so I probably my personality couldn’t stand being confused. So I ended up just pursuing more and more than that, and and so that really piqued my interest, learning from different educators, Michael milkers, Barry Glassman, I did the Dawson Academy. My principal is panky trained. So all these different schools of thoughts and just trying to figure out why and how, and what are these different schools of thought, so that’s what I really got into and I also, I have a massive bruxism myself. So helping my own self and making my muscles relaxed, also, sort of sparked me on to help other patients and then dentists.

[Bette]
So what’s your philosophy was splints? Where did you I watch party your class? Obviously, I can’t, I could, but I’m not so interested in watching all those hours of dental anymore, but I watched I mean, the class was fabulous. You were dynamic. It was fabulous. But what what would you say your philosophy is? Is it more like Dawson? Is it more like spear or is it more like

[Jaz]
That’s it? That’s a great question, Betsy. I think my philosophy is an amalgamation of all those. But but very much it is diagnosis LED, and this I mean, there’s a whole app, there’s another episode of my podcast, which is like the which is the best splint and the whole episode I was leading my listeners on I was like, yeah, there’s something called the G splint, the Pilates plan, right. And this is like the best plan ever. And I was just like, building it up, building up building up, but really, the moral the story was, Every patient’s g splint is different, right? Because it’s like depends on how bad orthodontics before. Are they having pain or are they just is it just protection? What’s the goal? So the philosophy is very much getting a good History, getting a good diagnosis and also looking at the patient’s like features, what are they likely to comply with? What are they likely not comply with? Because Betty one, one thing we can’t rely on when it comes to occlusal appliances and splints is the evidence base, like the literature is absolutely poor and unreliable. So therefore, we have to use the other two arms of evidence based dentistry which is the patient’s values and condition experience. So I’ve been taught by such, you know, great people in occlusion, and I’ve adapted it and sort of taken a leaf from panky taken big leaf from Dawson, the whole beast splint stuff, learn a lot from the nti. Guys, Barry Glassman, and I’ve made my own school where which is very much lead by diagnosis, but that no one’s right or no one’s wrong. But what what does this come say? What can we learn from that? What does this come say? And sometimes it’s arts and crafts, right? No, every patient is different. Every patient is unique. And you have to find that magic potion that will work with your patient.

[Bette]
I think that’s a really good philosophy, because there are so many different camps. And I agree with you when I was practicing. I did not I did panky and spear and kois. And I was just confused. I mean, totally, completely confused, like, what’s the right way to go? And I never put it together, I just quit. So

[Jaz]
why did you always go? I never got to ask you want Why? What made you make that big life decision and leave Coco dentistry?

[Bette]
Oh, that’s a long story. And it’s multifaceted. I mean, I think that one of the main reasons is, well, let’s see. First of all, I got divorced, and I have two little kids. And I thought, I don’t like anything about my life. So I’m going to redo everything. And also, I think I wasn’t truly a dentist, where you are, you’re excited about it all that I love talking to people. I love diagnosing I love doing the treatment plan and selling a treatment plan that’s like, Oh, my God, I have to do the work now. So I I didn’t like being chained down, where I can say, okay, February 2022. This is what I’m doing on who and then the Rancho Cucamonga belta courthouse right behind my office. And I started getting a lot of attorneys and judges had lots of attorneys and judges as patients. And I just thought they had a lot more fun in

[Jaz]
life than I did. Wow, the grass is always greener on the other side is

[Bette]
always greener on the other side. But I just really feel like I wasn’t a dentist at heart. And I think I was a mediocre dentist. And I was doing all these great classes. But I thought I don’t think I can really perform. And you know, do it at the level that is needed. I wonder how many hundreds of dentists based on this last two minutes of this episode will now reconsider their careers. Probably none. But they shed I was in I don’t know if you’ve heard of, I’ll shoot what’s new. It’s called readers group. And that went on for many, many years. 40 years in Newport Beach, Newport and ultimate I’m kind of steady club. And they probably had it had several 100 members and I was a member. And you know, everyone knew I was doing this. I had 50 people pull me aside and say I wish I could do what you’re doing. And then I had probably another 50 say you’re making the biggest mistake of your life. And one person I said if I have to flip hamburgers at McDonald’s, I’m going to be happier than what I’m doing now. So I’m doing it regard and I didn’t have a lot of things tying me down like, you know, a spouse and debt and this kind of thing. So you know, it was the risk was all mine. And how do you feel now? And

[Jaz]
how’d you feel? Man? Like are you glad so glad I get it? Yeah, good for you.

[Bette]
I just wasn’t you know, I went into dentistry I was on the cattle train with all my friends going into medicine, dentistry, etc. But I really never made the choice that that’s like what I wanted to. And now that I sell practices, I would say 80% of the dentists are kind of mentally in my camp. Whereas 20% are like you they’re like love dentistry. Every little bit of it. But a lot of people do not. I mean, it’s it’s not unusual, even when even if they’re good dentists, they don’t like it.

[Jaz]
I agree and I think that 8020 I agree with it disfigure I agree with I think 20% are overly passionate. And then 80% I was just like, you know what, it pays the bills, it’s okay, I can tolerate it. And then some of those 80% are like, you know what, I’m living my life is fake. Like, I’m hating this. And you you made that decision that you know what this is not for me. And and kudos to you for for doing that. That takes that takes a lot of guts. So So while then look what Look, look what you made of it. You know, I love what you’re doing and what you’ve done and help so many people in a different way.

[Bette]
Yeah, I mean, totally different path, but I loved it. I made the decision early on after I graduated from law school to stay in dentistry, because all my friends were dentists to everything I knew and my whole world was, you know, was related to dentistry. So I made the decision to stay in that space. So, yeah, it’s been absolutely great and I’m very happy. I don’t think I’d be happy. If If I’d stayed a dentist so, but I think you’re doing the right thing. When if you’re not happy in dentistry, I think you need to look around for things that could make you happy by doing different procedures and staying engaged and interested and figure out what parts you do like and focusing your practice on that. Because I think, you know, there, there’s a whole bunch of middle ground between doing what you’re doing and me quitting. And most people are in that middle ground.

[Jaz]
You’re so right. And I think that one of one advice I can give to anyone listening now and then never heard you say that how you how grateful you are that you made that decision to leave dentistry. And here I am on the opposite end of the spectrum, saying, Oh, my God, I love dentistry, I guess, if you’re in a if you’re stuck, if you’re unsure, then I think totally do what you’re used to. Yes, there’s that dentistry is such a flexible field, like you can literally limit your practice to a couple of procedures, you can find your niche. Well, a lot of other professions, you can’t do that. So it’s about finding your niche in a way. And sometimes it means that you have to get out of your comfort zone to experience a new course or a new philosophy. And there are many, you know, as much as people hate it, there are lots of different schools of thoughts. And sometimes you see, to hear another school of thought it’s like a religion almost. So it’s like a call, you have to almost join the call, and then they might rekindle your passion for dentistry. And that’s the reason why I love the podcast I do because obviously, your podcast NC rising is has a different angle. Mine is very much trying to attract all these dental geeks. And so I love getting messages from all over the world saying, you know, I actually lost my love for dentistry. And now from listening to your energy, I’ve regained my love for dentistry. And that’s the biggest praise about had my life. So I think that’s what it’s all about for me.

[Bette]
Yeah, that’s, that’s really, really a gift. That if you can find that. And one thing, just to talk about my money passion a little bit, one thing that holds dentists back from being able to do that is having too much debt, you know, and not continuing to have the freedom to do what they want to do is this debt from dental school, like I would say, not dental school. I mean, dental school is useful debt in most cases. But when they go out, and they have to have the new Mercedes, the new, you know, the new BMW, the multimillion dollar house, and you know, we’re payment by payment. And then you have a hiccup and, you know, you’re in trouble and you can’t make other decisions. You can’t say, Okay, I think I’m gonna just chuck it all and move to Michigan, or wherever, you know, I think you really limit your life choices when you get in so much debt. And here where I live in Orange County. I mean, it’s very prevalent where you have to keep up with the Joneses, by having the new whatever Tesla, the new whatever. And that’s a huge mistake dentists make, I think, and it really limits their life.

[Jaz]
Yeah, I mean, maybe it’s because I’m an associate, and I haven’t taken on huge debt, because I haven’t even looked at buying a practice. So maybe I’m not speaking for the rest of our profession. But in the UK, it’s not something we discuss a lot about, you know, debt. And I feel so us grads, they do talk a lot about that. And that is like, quite a significant thing there. So that’s another difference between UK and US that you guys are always or, you know, I had lots of dentist friends in Singapore, who trained from the US and they moved to Singapore. And then they were talking about Yeah, huge debt and stuff. And it’s, it’s not something that you have here. And I think maybe it’s because one of the good things, I guess is that you wouldn’t believe how much I paid for my dental degree. Right? My tuition fee at the time, at the time. I mean, now it’s a bit more but at the time was 3000 pounds, let’s call it 5000 US dollars per year. And that’s the that’s the tuition.

[Bette]
So yes, I pay for my like rent and stuff separately, but that’s nothing compared to what you guys pay. Oh, it’s it’s very common for people to come out with four to $500,000 worth of debt. Very common. So that’s why I thought you

[Jaz]
guys, you know, predominantly the debt was that but I guess, I guess you guys are just accumulating that debt more. Yeah.

[Bette]
I mean, I think, yeah, you come out with a half a million dollars worth of debt. And then lenders will give you more money. And because you’re a doctor and you pile on top of that you’re your Tesla payment, your Mercedes payment, your boat payment, your this your that. And I think that dentists feel they have so much debt that it doesn’t matter. I’ve told this story before, but it’s still made one of the biggest impressions that, you know, on a money scale that I’ve ever had, I was speaking for the CDA at some California Dental Association with some new graduate kind of thing. And right in front of me, this girl sitting have this beautiful Louis Vuitton purse, and I just looked at that purse at the mall, you know, like a few days ago, and it was like 11 $12,000, and I thought I would never pay that much for a purse. But I’m thinking in my head while I’m talking. I wonder if it’s a fake? You know, I have all this internal dialogue going about her purse, and which is ridiculous. And I’m talking, you know, on and on. And then she gets in line to talk to me afterwards. And I had asked her, I said, Is that a real Louis Vuitton? She goes, Oh, yes. I like how much student loans do you have? She goes 500,000. I’m like, What are you thinking? And she got she said keywords to me. It’s like Monopoly money. She goes, I can never pay it off. It’s not even real. I don’t know. I buy what I want. That’s it. I mean, that’s a very, very common feeling or response that you Dennis tab because they don’t, they don’t understand what it takes to pay off half a million dollars of loans. I mean, they kind of get it, but it’s like a forever jail sentence, and they’re just not going to live that way.

[Jaz]
I can’t even imagine that level of debt. And that’s it. That’s one that another major difference between UK and US is that Yeah, maybe that’s why you guys borrow more money because you already have such a huge level of this. What’s another extra couple 100,000 here and there, right?

[Bette]
They just don’t feel it. They just don’t understand it. They don’t feel it. And they think, you know, I’m gonna be in the grave before I can pay it off. So I might as well enjoy life.

[Jaz]
Do you do know if most dentists actually do eventually pay it off?

[Bette]
Some people do. I mean, some people really focus on getting a paid off, but that’s a minority. And then you’re really trapped. I mean, you are trapped in that practice, and you better produce whatever it takes. Because then you take on a wife and kids and they all have expectations, too. So yeah, we get ourselves in a lot of many situations with dentist and dentistry here, which it sounds like you don’t have. That’s a good thing.

[Jaz]
No, we don’t. And you reminded me of something actually very interesting is another cultural difference. I mean, dental cultural difference is that we have this perception in American dentist that you guys are no offense, you guys are really aggressive, like three implants that you guys are like, you know, you got like 200 pieces of this big fat birds and rages crowns everything. Yeah, something that we think needs efficiency. And you guys like right, this crown it, you know, and I actually experienced this firsthand, like, you know, n equals one, like, there’s one dentist who qualified us who will work the same price to meet in Singapore. And we’re always doing all these come concerts and stuff being minimal. Every patient got a crown with her. So I know that this perception that we have that you guys are very aggressive treat implants.

[Bette]
I think that can be true. With a lot of people that can be true. And of course, then it comes down to an individual’s own ethics and morals and beliefs and that kind of thing. For myself. When I first got out of dental school, I had a job, it was really hard to find a job. So I finally got a job. And probably my first couple weeks or so they made me do to a pickle retro. Phil’s on six and 11. And I did it. I mean to this day, I’m embarrassed and ashamed. Except I did it. I have no idea how to do it. I’ve never done it. Yeah, I knew in theory, what should be done. And I swear to God, that person lost six and 11 because of me, you know, but it’s not. I mean, people, I people do stuff like that I did it. And so I didn’t lose my job. And so I wasn’t embarrassed that I couldn’t do it. But I’m way more embarrassed that I did do it. I’m just horrified that I did it. But it’s not you know, it’s just not uncommon. For whatever reason, you got to make the payment, you can’t lose the job, whatever people are compromising. So I think it does come down to your individual ethics, who you are as a person, how you diagnose

[Jaz]
Well said. So that’s one thing I haven’t told you about is that in one of my in every episode that I do, I have a protrusive Dental pal, it’s like one tip I give like, you know, clinical dentistry or communication or whatever. And one of them I just stole from your podcast. Okay, so I need to now credit you because you You did such a good job of reminding me of this, this is a great little poll, I’m gonna let you say cuz you’ll do a much better job. It’s basically the one about the power of a silence after you present a fee can just just give my listeners again a flavor, the only Betty can have them.

[Bette]
Well, I do think being quiet. And you know, after your present a fee being quiet is hugely important. I think it’s really important to present the fee in a confident and clear manner and not too confusing. And then be quiet and let a patient respond. It’s kind of the old philosophy of he who speaks first loses. But when you know that you’re doing whatever it is that you’re doing six anterior veneers, the fee will be $12,000. That’s it, be quiet, keep eye contact, and they’re either going to say something that lets you go the next direction. Sure, could you do it next week and time for my daughter’s wedding. Or you know, that’s nothing I can afford. But I’ll save for it. Maybe we can do it in a couple of years. Whatever it is, I think the doctor is always best positioned to handle that objection or the next comment compared to an office person. I don’t like doctors to delegate, you know, treatment presentations, at least of any magnitude to an office person because they can’t, you know, they’ll start talking about payments, they’ll start talking and payments may not be the issue. So I think the less you say when you’re presenting the treatment, the better. You don’t want to confuse people. You just want to be really clear, then be quiet and listen to what they say and go from there. So I don’t even remember what I said on that podcast.

[Jaz]
But no, you covered it well, but but it’s an important lesson. I shared it with my listeners as a poll and a redo thing that a lot of young dentists it can be a challenge right or any dentist it can be a challenge like when you’re not used to presenting fees and you’re doing more complex. Working to maintain eye contact and say confidently for the first few times, and then you have that silent and that and those three seconds seem like three minutes. And then what’s the most common thing? We’d say like, Well, why don’t you think about it? Well, once you go home, and that’s the worst thing you could say, like, get out of here. I’m uncomfortable. Yes, exactly. So I sort of highlight that,

[Bette]
I did use a lot of consultants in my dental practice, you know, and like you say, I took little bits from each of them. And even when I present listing agreements, now I do that, like, this is how much it is, this is what I’ll do won’t do whatever, you know, they do it, they don’t do it. You know, the same thing with with presenting treatment, I think you need to be eye level with the patient need a knee, I think you need to be looking at them not have not have the chart not have a lot of extraneous hand movements, just say whatever it is, you have the veneers cost. You don’t have to talk about everything else in the world, you can talk about that later. Like after they’ve accepted we’re going to need to take models we’re going to need to data die. But to present the treatment, confidence clarity and keep it short and be quiet.

[Jaz]
Perfect. And I love it. I just want to highlight again in case you missed it the first time on my show. One important tip that was any other tips. So you have and I’ll put you on the spot here. But any other like one more tip you can give maybe to to the dentist listening from the producer podcast side to help become better communicators when it comes to money or tree implant presentation. Any other tips that you picked up in your when you’re getting these consult consultations?

[Bette]
Let’s see what can I say is another tip I would. There’s a lot of dentists whose practice I go into and have no idea about their overhead. And you know, of course, that’s a lot more important when you own your practice. Or it’s very important when you own your practice compared to being an associate. But I think you need to stay plugged into your practice as to what the front desk is doing, what your numbers are, how much you’re diagnosing how much sometimes people say well, I you know, there’s no crowns on my schedule. Well, that’s because you didn’t diagnose anything. One of the consultants I had first I had, right, I had like a two and a four year old, I had arrived late, you know, I’m paying this consultant through the nose. And here I come in 20 minutes late. And she just kind of totally slowed me down. She said, Do you know that the energy that you bring into the practice today has a huge effect on how you’re going to diagnose how the patients are going to feel about you? Everything, so you need to calm it down, get their hair half an hour early and have your head in the game. If you only want to work four hours, that’s fine, but you for four hours, you have your head in the game. And I think that’s a huge mistake dentists make as they come in, very scrambled, not ready to work and not ready to be totally present in their practice. While they’re there. I’d like people to cut hours and be totally present and probably do double the production,

[Jaz]
well said about presence. And to add on to that, like forget about any arguments you have with your spouse. Forget about you know what you had for dinner last night, forget about all the unread emails, you have to forget about absolutely everything and give your patient every single ounce of your energy.

[Bette]
Yeah, and and then you will diagnose what you want to do patients will like you and come back and do the rest of their treatment because they feel that you’re totally present. I mean, that’s what we all want from our relationships we have, you know, with healthcare providers, with friends with everybody, like be totally present, be with me. And then when you’re not with me Do what you want

[Jaz]
100%. And that’s when you get to be yourself and show your true self and practice with your values at display, and then you obviously in time will attract the patients who have the same value as you so it goes full circle basically,

[Bette]
right? I think it does, too. It really does. And the people that do the huge numbers. That’s what they’re doing. They have their life together, or organize it in a way that they can be calm, they can be clear. They’re confident and focused. And it comes out into all aspects of their life.

[Jaz]
How many days is average dentist clinically work in the US? For four? Okay, thank you for hanging out there. Yeah, I mean, maybe four, maybe even four and a half five? It really varies. I think they’re a practice owner, you can have to maybe work three. It varies. But there’s a whole saying that if you drop back to three and a half days clinical, I think maybe panky sort of said this, but if you drop back to three and a half days clinical, you find that your income really doesn’t drop that much, but your productivity, your energy levels remain high. So the reason why just put that in there is because we can burn out if you do too many cocoa hours and to be able to show up in the way that we described the last few minutes. You have to almost do less and go in less than work less hours so you can have the energy to be the best entity you can be.

[Bette]
Yeah, I’m totally a fan of that three days, I think. I mean dentistry is hard work in every way not only physically but mentally, emotionally. Three, three and a half days I think is really powerful. effect, and you know, do a lot of see and interact with your colleagues and you know, and enjoy a long career not trying to burn out in five days, I mean, five days will burn you out really quick.

[Jaz]
Obviously, if you’re the new grad, then there’s the whole beauty because, you know, to to balance out with accumulating your 10,000 hours, right, getting those failures in. So there’s something to be said about actually going quite quite hard initially, but not at the sake of your mental health. So there’s got there’s a fine balance we struck initially, but as you gain more experience, definitely, you know, make time for the finer things in life and, and then drop back your clinical hours so you can have more energy and vitality. I agree. Amazing or better. It’s been great to have you on for the producer it listen to and I hope this has been valuable for your guests as well.

[Bette]
I’m sure it will be and I think everybody will be really interested in hearing it and hearing what dentistry is like in England and checking out your course.

[Jaz]
Thank you so much.

[Bette]
Thank you.

Jaz’s Outro: So thank you so much for listening all the way to the end guys. That was Dr. Betty Robin from the density rising podcast, please do check it out. If you’d like Betty’s dial, she is very much like a her episodes are non clinical. So I think there’s something beautiful about that as well. And you have to respect her her journey and her sort of desire to make massive change in life and leave dentistry. So that has to be respected. And I think it’s great what she’s achieved as an attorney, and also now looking at practice acquisitions. So I’ll catch you in the next episode, same time, same place.