Episode Transcript
[00:05 - 00:26] Rob: Welcome back to the Evolution of Dental Podcast, brought to you by Evolution Dental Science. I'm your host, Rob Norton. Today's guest is an absolute rock star of the full arch implant world, operating out of Lakewood, Florida. He has a full arch installation plant right there for same-day smiles in his office: Doctor Jacob Berger. Welcome to the podcast! How are you today?
[00:26 - 00:34] Jacob: Hey, I appreciate it, man. Things are good out my way. It's a Monday morning here, and no patients today, so you have my undivided attention.
[00:35 - 00:40] Rob: No patients today. Can you tell me about the… What’s “The Mamba Mentality” I've been hearing about?
[00:40 - 01:44] Jacob: Oh, man. That's cool that you asked that! I feel like it was something I had heard of. You know, I think most people have heard of it in the sports world with Kobe Bryant back before he passed away. But then after he had passed away, it came up in a few different settings where I was at a speaking engagement, and I think it was the first time I brought up the Mamba Mentality, or this idea of really just trying to be the best version of yourself, like Kobe Bryant did with basketball. But I remember bringing it up as like a sports analogy in the dental world, and I remember that really wasn't- I don't know, maybe that was new. Maybe it was a fresh idea. So I feel like when doctors asked me about that, or they see me mention it either in a hashtag or Instagram post or on stage at a speaking event, it's really just this idea of being all in, man, almost obsessed with what you're doing and not viewing it as a job, not viewing it as a hobby, but maybe as an obsession, which I know some people have their opinion on. It used to be “obsessed” with your profession or not, maybe not healthy for everybody. But I feel like if a patient wants somebody to do their work, you probably want somebody who's pretty obsessed with what they do.
[01:44 - 01:52] Rob: Yeah, you want somebody who likes what they're doing. I mean, if you don't like cooking, you wouldn't be the one that they put to, hey, you know, make me a meal. Yeah, absolutely.
[01:52 - 02:15] Jacob:Yeah. And that's where it was born. And I feel like it kind of took a little. It took its own little shape as I started to bring it up more often. And then even doctors would just ask me like, hey, what does it take to do X, Y, or Z? And I usually tell them it's a certain type of mentality. I'll usually just leave it at that because I never know how somebody will respond. And hopefully those that hear me say that know what I mean is it takes a lot.
[02:17 - 02:22] Rob: So were you always focused on wanting to do full arch restorations and same-day smiles? How did that come to be?
[02:22 - 03:51] Jacob: No, actually I opened up a practice in 2016. I was right out of dental school, and I had this mindset that I wanted to be that type of dentist that did everything. I wanted to offer up whatever a patient needed. How do we decrease how many times I have to send them away? That skill of being able to do anything and everything was something I focused on and found myself having days where I was doing Invisalign, crowns, root canals, 15 hygiene checks, whatever it took before lunch and then, you know, do it all over again. I don't think it was until like four years in, that I did my first full arch case. And it wasn't even doing the surgery, it was just restoring it. And I remember the lack of knowledge I had when I spoke to the oral surgeon who was going to be placing the implants, he was like, hey man, make sure to order up some multi-unit abutments and try to get these sizes and get some 17’s, some 30’s, some straights. And I was like, what the heck is he talking about? And I didn't have ChatGPT at the time to tell me, what is this guy talking about? So that was when I did my first case. That wasn't enough to get me super excited about it. It was doing a lot of full mouth rehabilitation cases, like 28 crowns on a patient with severe wear. Those were addicting. Those were fun. And that's where 4 or 5 years in, because I was offering sedation, I had done root canals, I had done surgeries, I could handle a full mouth case under sedation. And then that slowly evolved into full arch implants, which is now probably 90% of what I do.
[03:53 - 03:56] Rob: Wow. And you've brought a lot of this work in house, right?
[03:57 - 05:10] Jacob: Yeah. All of it in house now, except maybe the design process. But that took time. You know, that took time. I think my first couple of cases, I remember it being the old school method of doing a full arch implant case, you know, with impressions. In fact, that particular case was open-tray impression copings and verification jigs. Then from there it evolved into smart conversions, where we would do the denture and pop some holes into it, and slowly it turned into the photogrammetry world. That was starting to form or get more known. So I would have somebody come in with all the photogrammetry, they would do all the scans, send me my prototypes, and I was like, how much was it to send that prototype? Can’t I just make the prototype? So that turned into getting the SprintRay 3D printer that we use. I know there's many brands out there, but that's the particular brand that I started with. And then it was nice to have somebody else do the digital scans and we print it. But I was like, how much was that scanner, you know? So then we got the photogrammetry, whether it was the iCAM. And then after that it turned into, well, if I can do the scans, if I can do the 3D print, at what point would I be able to mill my own finals? And that took a lot longer than some of the other stuff I onboarded.
[05:11 - 05:15] Rob: A little longer, but it sounds like you sort of stepped slowly, side stepped into it.
[05:16 - 05:55] Jacob: Yeah. And I think it was a little bit with the first question about the mentality. I mean, it was like going all in. And when you focus on one thing, not only does it bring in the type of, I guess you could say revenue that it brings in, it allows me to buy the things I need to buy. Whereas if I was only doing one case a month or two arches a month or maybe one a quarter, there's no way I would be able to have justified some of those investments. But it was the mindset. It was that I'm going to go all in on this and give away all my patients. No more hygiene checks, no more Invisalign. It takes up too much of your brain space. So it was a side step, but also had a lot of work along that way. But it was worth it.
[05:56 - 06:11] Rob: Sounds like it was. So, was there anything you would do differently along that way as you kind of made your way closer and closer to doing stuff in house? What would you say to somebody else who is looking to bring that into their practice?
[06:13 - 07:45] Jacob: Man, I think the only thing I might do differently, looking back- I wouldn't have changed any of what I've done because it made me into the clinician I am now. But I might have said no to a few of the times where I kind of decided to go back to the general dentistry. You know, a patient comes in and says, but I really want him to do it. I really wanted my old dentist to do it. And I would say, fine, I'll do it. And that just turns into adding some crowns and fillings and maybe a root canal back onto your schedule, which is fine. I wanted to take care of the human, but then on the next day where I'm trying to deliver a full mouth case, or I have a full arch surgery to do, I have a crown delivery in the middle of that, and it's kind of hard to go all in on something with those popping into your schedule, so I wish I would have just done that a little bit better. But what I would say to somebody else is, if you know that this is going to be your passion, which is a tough thing to say, like, how do you know unless you do them? But if you do enough of them and say, I think I just want to do this, then you really have to just do that because I just, I could be wrong. I just feel like there's not enough brain space or time in the day or capacity to do full arch implants while trying to run a general dentistry type practice. That doesn't mean your practice can't be general dentistry, but you, as the person holding the drill, like to still fit in all your normal dentistry and go all in on all-on-x, all-on-four implant type dentistry. It's a little tough. So that's what I would say to somebody who said, hey, should I do this? I've done 5 or 10 or 12 and I'm loving this stuff. If you love it, then get rid of all the other stuff and just do that.
[07:46 - 07:56] Rob: Sounds like a big takeaway is there to protect your flow, protect your head space, getting into these things so you can focus on making the main thing, the main thing.
[07:57 - 08:55] Jacob: Yeah. Big time. I would say even on surgery days, my team still tells me, hey doc, that one went really well. And I think they're trying to, like, set me up like a softball pitch. And I'm like, how come? And they're like, because you didn't add anything else to the day. You know, it's when I try to add a quick console in the middle of surgery and I can step away in certain surgeries because I have an anesthesiologist for some cases. And so I'll add a couple consults because I have the anesthesiologist, or I'll do a bite adjustment because I have the anesthesiologist there, but it still goes over like an hour because it messes with your flow. And it's the days where whether I'm doing the sedation on my own or my anesthesiologist is doing it, when I can just focus on that one patient. I never have to step out of the room, except maybe for a quick bathroom break, or they're like, hey, doc, we'll do the photogrammetry. And I'll run and grab a quick trail mix or stretch my legs a little bit. Those cases go by quicker, smoother, less of, “Hey, where are we at in the process?” you know, because you were all in on that one patient.
[08:56 - 09:03] Rob: Gotcha. I mean that makes a lot of sense. You just keep your focus, don't break your rhythm. You mentor for Heartland as well. Is that right?
[09:04 - 10:34] Jacob: Yeah. Because I started in a Heartland practice and I went through their onboarding process, their leadership courses, their clinical courses. At a certain point, they had asked me to kind of jump in and volunteer some time. So I did some workshops where it was like an oral surgery workshop or root canal workshop. And that led into, hey, do you want to help out at this class? So I helped out at a class. That turned into a new passion I didn't know I had, which was helping other dentists through that setting, and eventually just kind of officially became a mentor for them. And now the class that I helped with became the class that I spoke at, which became the class that I run. All doctors come through this course at Heartland. It's an onboarding course for all new doctors. New doctors at Heartland, and new to dentistry like they just graduated. And so I teach classes for Heartland and often set up like in-office mentoring sessions, which is a little tough because sometimes, like a first year grad will come out and say, hey, I want to shadow you. I'll let them know, like, hey, I'm doing all-on-x, which is probably not going to be relevant to what you're doing in your new office as a doctor who graduated six months ago, but they still want to see it. So I'm like, hey, you can come, take away whatever you can take away from this, but I'm just letting you know. What you're about to see is from thousands of extractions, thousands of implants and lots of things that I had to set the foundation for. But it's fun. I enjoy mentoring other doctors, but I like doing it with Heartland because they have systems in place that make it easy.
[10:34 - 10:45] Rob: That's great. So you are sitting there like, hey, you might be looking at this, but this is not necessarily what you're going to be doing tomorrow at your own practice. How do you manage to balance that though?
[10:45 - 12:07] Jacob: Yeah, they both have their little mark that they leave in a day. Like when a doctor visits, I move a little slower and my team knows it. Like when I mentioned, hey guys, we have a guest tomorrow. Doctor so-and-so from Georgia is coming down to visit. They don't really make a big audible sigh, but it's kind of like, uh-oh, because they know that means I'm going to talk more. I might take an extra 20 minutes, I might back up and let the doctor take a look, and maybe I go to the office afterwards to walk through what I did, why I did it. So I do know that it messes with the flow a little bit, but I think it keeps me on my A game because I have this certain accountability to this doctor. This doctor knows a certain amount. It doesn't matter what fraction they know compared to what I know. I could care less about that, but they're going to be. Did he do the flap right? Is there a sterile environment? How does he talk to his team? How did he numb? Does he keep track of how much anesthetic he gave his patient? And if at any point I look like I'm being reckless, or I look like I've lost a little bit of the standard of care, that would be a bad look. And I'm not saying that that happens. I'm sure no dentist does that. But knowing you have a doctor watching you and that your reputation will leave that office with whatever vision they saw, whatever they saw that day, their POV is going to be what gets out to their world, to their small groups.
[12:07 - 12:08] Rob: Mmhmm.
[12:08 - 12:55] Jacob: But it's worth it because it makes me better. I also have found that maybe like 20% of those doctors send me a patient in the near future, so it almost became like a revenue stream because they say, hey doc, I love the way you did everything. If my aunt needs this surgery or my dental assistant needs it, or I meet a patient. And even though we're in Georgia. Can I send her to you? As far as the classes go, though, they just mess with the schedule a little bit. You know, I have to- Maybe I can't do a surgery on a Thursday because we would normally deliver the temporaries on Friday. That's just the flow I have. But if I have a flight to catch, it might affect that. I might do the surgery Wednesday/Thursday instead of doing the surgery on a Thursday and delivering on a Friday. So it messes with the flow. Less time in the office means less reps, less opportunities for patients. But you got to give a little, take a little. It happens.
[12:55 - 12:58] Rob: Speaking of the flow, can you talk us through your workflow? What does your workflow look like?
[12:59 - 13:08] Jacob: Yeah. So I'll walk you through maybe from start to finish when we meet a patient. So I know that's really early on in the flow, but the way we meet these patients-
[13:08 - 13:09] Rob: That’s part of it!
[13:09 - 14:58] Jacob: Yeah it is, I mean you got to find them and social media, ad spend, Google spend, whatever place that you can show your work, which leads into when we meet them. We do take great photos before and after because eventually that will become one of the ads. Eventually, even though I changed their life, I did some dentistry. That becomes the ad that I'll use six months down the road. So we give them a call, we get them in the office. I usually call them all the night before, introduce myself. Hey, I'm the guy that's going to be meeting you tomorrow. I'm sure you're nervous, but we'll be answering all your questions, trying to break the ice, and I'm sharing some of my secrets. So I hope doctors use this because it will make a difference. They come in feeling like they already got to know me. Even if it was a 30 second call. We do the consult, which usually involves a CBCT and a conversation, and then we get them signed up. You know, hey, this is what we're going to be doing. Here's how much it costs. Put together a treatment plan: consent forms, photos, more consent forms, more photos. Now I incorporate getting some pre-op videos just to see how their lips move. Then they get scheduled. So surgery day I'm usually walking into surgery day already knowing what implants I'm going to be placing. I've already looked at their CBCT, and mapped the whole thing out. I don't order a surgical guide. I know there's doctors, they use surgical guides, there's some that don't. So I've already mapped it out, my “surgical guide” is here. And it works out for me. That's how I find success. My team will place the IV, or I'll place the IV and the patient goes night night. And then this is where the clinical workflow comes in. This is where we place an arch tracer or some other type of fiduciary marker, and numb the patient. They get scanned. That's our pre-op scan to send to the lab. Right.
[14:58 - 14:58] Rob: Right.
[14:58 - 15:11] Jacob: You have your usual pre-op and then you have your marker pre-op. And then we take out all the teeth, start dropping implants. I will usually throw on, while the site is still open. We like to throw on our photogrammetry, get it out of the way.
[15:11 - 15:11] Rob: Right.
[15:11 - 17:24] Jacob: Already have those files getting sent to my designer so they can start plugging it in, and then I'll close it all up. Interrupted sutures, for the doctors that are going to hear this, I'll usually place like PGA sutures. The Chromic Gut sutures, they kept dissolving too fast. I think TFE was expensive, and when you tie it really tight, it cuts through the gums. And then we throw on whatever we're going to use for digital scans. Some doctors use the photogrammetry bodies, some use the iCam cylinders. But then we scan the tissue and then my dental assistants, right then they swap. Now whoever helped me with the top arch isn’t going to help me with the bottom arch. They need a break. I probably need one too, but I don't get one, hehe. And then we go through the same process on the bottom. But I will add like during this process. So if somebody could envision what that room looks like. I might have an anesthesiologist to my left. I have a dental assistant to my right that's handing me my implant drill. They're passing me the implants. The other one is on my left side, actually chairside. Suction, retraction, lifting the chin up, whatever we got to do to get through the case. And that's why I usually work with two assistants and an anesthesiologist. I would just add a third assistant if I was doing the anesthesia myself. Or if I only have two assistants that day, one will be my monitor, one is my assistant, and now I'm the one grabbing the implants. And I'm the one, you know, saving the stickers and logging in what size I put. We close it all up and we send the patient home. And my designer sends me a file. We 3D print that, and the patient comes back at around 10 or 11 a.m. the next day, and we take off the caps, put on the teeth, adjust it, hand them a mirror, and then sometimes even pull the phone out and film. This is an awesome moment! In fact, on Friday I had a lady that I didn't think looked amazing. Her teeth did, but like her lips were swollen. There was blood on her lip. Her face was a little swollen, but we handed her that mirror and the tears that came and like the crackle in her voice from the emotion of like, my teeth are done, like, you did it. It was cool. I gave that patient probably one of the longest hugs I've given a patient-
[17:24 - 17:24 ] Rob: Aww!
[17:24 - 17:43] Jacob: But the day before she kicked my butt. She was bleeding a lot. She kept moving in her sleep, but it was just cool to have that moment. And that's when, that's the workflow to give them their temps. I know there's a whole new workflow after that. How many prototypes do you give them? When do you give them their finals? But that's a lot.
[17:44 - 17:50] Rob: It's all part of it. So you had another one, another patient reaction that went pretty viral didn't you?
[17:51 - 17:54] Jacob: Oh yeah. Man, are you thinking of the one that you guys helped me out with not too long ago?
[17:55 - 17:57] Rob: I think so, can you tell us about that one?
[17:57 - 20:05] Jacob: Yeah. That was fun! So with that smile makeover, one of the things that happens with smile makeovers, like the one that we posted not too long ago, is when you offer sedation and you offer smile makeovers. Patients that reach out, they don't know what they saw on social media was a hybrid, right? They might just reach out and say, I want a smile makeover. My teeth are bad. And so some patients sit in my chair and they don't need all-on-x, they don't need all their teeth out. They just needed three implants and eight crowns and 15 veneers, whatever it may be. Right. And so my old football coach reached out to me and he was one of those. He's like, I need what I keep seeing. You keep posting these like weekly and I'm seeing smile makeovers. So yeah, we did it. With a case like his, again, if you're going to do full arch dentistry, I do know even though it messes with your flow, you're going to do some full mouth smile makeovers. And in his case, I think it ended up being that I had no way to justify taking all his teeth out. There were eight good ones in the front, eight good ones on the bottom. It was just the back that was… crap. It was mad. And he gave me permission to say all this, he knows. But that required taking out teeth, dropping in implants, kind of chipping away at it in quadrants while putting crowns in the front. And your team at Olivia, I know they partnered with Evolve and they’re all part of the same family there, but Olivia, they did an amazing job giving me some amazing products. I mean, I think it ended up being 16 crowns and another two, two, two and two. Another eight implant crowns and happy patient, happy patient. But when you see those cases, you have less of a canvas because you're working with their teeth, their anatomy, their nuances. You don't get to just take it all out and start from scratch. But there was something about his smile that was so genuine. And even some of like the arch type, that was like, I could have fixed that if I did all-on-x, but it didn't matter. It made him happy and that's probably what made it most viral. That, and then we did it as a way to help somebody in the community that couldn't afford that type of dental work, and he got it. And the team at Olivia helped me a lot, and so did my team at the office.
[20:05 - 20:24] Rob: That's absolutely beautiful. What are some of the tools that you use? I know you mentioned the SprintRay printers before. Is there a specific kind of, umm, is there a specific model or kind of techniques you use with that? Is there one particular milling machine that you gravitated toward? What made you choose those?
[20:24 - 22:39] Jacob: Yeah. So I would say the SprintRay brand, right, has so many things you can buy from different resins, different technologies as they upgrade. So we do have their Pro2. When it came out, we still printed some stuff on the old Pro because you gotta do what you got to do. But it feels like going from like back in the day when a new PlayStation would come out, like everybody would move to PS3, but I might still play a PlayStation2 game. You know, sometimes you do that and the resins that we've learned to adapt to the situation. If you find yourself dealing with broken prototypes while you're waiting for them to heal, we ended up going with their Tough2 because their model or their resin, it's a little stronger. But I'll even share some of the other stuff that we use. The iTero scanner, I'm willing to talk about that. I know there's so many scanners out there, there's so many that have their own different pros and cons. It's just that's the particular one that we use and we have a great deal on it through Heartland Dental, creating a great deal through Align. But I know there's the Medit, Straumann has one. I think I've gotten so many different brands, I won't go into them all because it'll sound like I'm a fan of one or the other, and I'm really not. It’s whichever one gets the job done and also is cost efficient. But then more into what we did with finals, I had to look at it like, do I get the most expensive mill on the market? And I don't know if we even have the workflow for this. Like, yeah, I might average, let's say eight/nine arches a month. To me, if the doctor asked me when I should buy a mill? Probably when you're averaging eight arches a month. It makes financial sense to get one, but it doesn't mean your first ever mill purchase should be the most expensive. That was the way I looked at it. So I got one that was good. It was through a company called Roland. I know there's so many out there. There's probably ten that are better than Roland. There's probably ten that are worse than Roland, I don't know, I don't get that into it. And I don't go to, like, the lab trade shows to see all the cool stuff. I probably shouldn't, because then I'll try to buy everything that has a robot, hehe. But then you have to decide which zirconia do I use? And you have to get into, where do you buy your drills? Who's going to do all this? Do you hire somebody who's a lab tech at a lab?
[22:39 - 22:46] Rob: Yeah. That was actually my next question: who did you pick and how did you select somebody to run your little operation inside?
[22:46 - 25:28] Jacob: Man, I'm not going to lie. That's hard because I have somebody and I walk through the way it works at our office. But in a world where dentists [are] probably, not always with an extra assistant. Like you don't have extra assistants on a regular basis. So I've always worked with three assistants and then it went to two because somebody leaves or somebody gets a new opportunity. So I had this one assistant at our practice that was just really good. When I got the SprintRay. And I said, hey, I'm going to give you this role, this responsibility. You're going to make all the temporaries for a little while. They had already shown that they were good with the smart conversions and denture adjustments. And so I said, look, I'm going to invest in you a lot because you're going to go to labs and watch, you're going to have to read up on onboarding processes with how the SprintRay works. So they learned about all of that. Sprint Ray comes in and does the training, but they have to learn how to paint, how to glaze, where to get the paint, where to get the glaze, how many times to cure it. And then you have to figure out if they only work from 8 to 5 or sometimes in our office we only work from 7 to 3:30 with no lunch. How are they going to get all that done while also being a dental assistant? And it's not easy. So we had to figure out a way like are they always going to go into overtime? Do you pay them per product, per item? It becomes tough. So once I realized we had the right person for it, then that turned into you're going to make the finals as well, because now I would have to find another person, teach them how to paint and glaze, or I'm going to spend a lot of money on somebody who's really good at it. But what if I don't have enough arches for them? I might give a salary to somebody and have a bad month. What if I only have four arches that month? But they're going to get their monthly salary. So I found a flow that works for me. The same person does our temps. They also do our finals. She prints them, she mills them, and then when I need her as a dental assistant, I have to know. If you're going to pull that person, they can't finish the cases now, so you might have a delay on your cases, but you need an assistant. Whereas if you were to just hire a lab person, they probably would not have that ability to jump in the room, take X-rays, or do a digital scan. So that would be probably my advice to a doctor watching this is to find somebody on your team that you already trust. You already want to invest in them and have them take on that new skill set, but just know they have to have the mentality. Maybe you could call it the Mamba Mentality, but they're taking on a whole new craft. It's going to take them away from what they signed up for. They never signed up to be painting and glazing in a corner, quiet without patient interactions. So you may go through or have turnover with that role. But that's how we do it at our practice. It's what's working for us. And I like that flow.
[25:29 - 25:41] Rob: That sounds like a pretty conscientious approach, you know, making sure that they have adequate time to do whatever you're calling on them to do. You know, whether it be an assistant that day or be the lab runner, a lab manager the next day?
[25:42 - 25:56] Jacob: Yeah, I probably sound more like I'm good at it and I'm conscientious of it now. I'm sure in the building I'm like, why is it not ready yet? When's it going to be ready? Like, you can't make it in one hour? I hope I say it right, but only my team would know, hehe.
[25:57 - 26:05] Rob: Hehehe! Fair enough! So it sounds like a track to grow tremendously. How has that influenced the growth of your practice?
[26:06 - 26:21] Jacob: You know it could, if the mindset and the goal was to do more. I had a moment where I said, I want to do better, not necessarily more or at least right now. Like, right. We all go through these seasons in dental-
[26:21 - 26:24] Rob: That’s a good differentiator though, like better and more are not always the same thing.
[26:24 - 29:24] Jacob: Yeah. And doctors have asked me like, hey, how do you go from 2 to 4 arches or 4 arches to 8 arches a month? And then I know doctors who do 20. Man, I'm like, good for you. I don't know that I want to do 20. I don't think my body can take it. I don't know if my ADHD can take it, you know, like I have to- It's a lot for me to do in one case. I have to find time to plan the implants. I have to have time to set up the sedation meds. You have to deal with the nuances of that patient and how picky they are or how demanding they are. Right? And so if someone was like, hey, you just had, or I think we had one of our best months recently in March, we did, I think, 13 arches. That was exhausting. I don't want to do 12 in a row of that. I want to do better on my next 8 arches than I did on my last 13. And I want to just keep making the flow better, more efficient. But yes, in theory, we are set up to do more because of what we put in place, right? I could add another couple hours to a day like we did a three arch day where two team members came in early. We did one arch, we switched, you know, flipped the room. We started the next two arches late, but now I didn't finish until 6 p.m. I don't want that to be my norm. And so could we? Yes, we do have what it takes to grow and to add more. But right now, I think I'm at that place where if I could just make whatever eight arches I do that month, the best placed implants, the best suturing that I could do, the best tissue closure, the best temporary, the best bite adjustment. I want to make sure that the patient has a beautiful bite. We gave them the color, the shape, the characteristics they wanted, the patient experience they wanted. I don't want to have to go into the next room, and the patient- I can tell when they're like begging for your time or your attention. And so I'm at that spot right now where I'm like, you know what? If I have to up my charge, maybe $1,000 to be able to give them more of my time or to use a better material, then I'd rather do that than go cheaper and add more arches. And so this is the flow I like right now. And that could change. You could do this podcast with me in 12 months and I might be like, so we're doing 14 arches a month! And that would be a blessing! Don't get me wrong, that would be a blessing. I think I joked the other day with my implant rep. I said something like, man, you know, these months where they hit you, where you only have 7 or 6 and I'm like, all right, what do we need to do next? Where do we need to pivot? And he's like, yeah, I shouldn't have done that six-seven to a bunch of kids. But it was funny because at that moment he's like, dude, I know dentists that would love to have 5 or 6 arches on their schedule. And you're over there, a little bummed that you had six. And I'm like, yeah, I don't really want to have six. It doesn't keep the lights on at the same level. So I think that probably answers that and more, but I feel like that's the important thing I would want even patients to know, my team to know, hey guys, I'm not here to just add more. I'm here to get better and give them the value that they've paid for.
[29:24 - 29:35] Rob: That’s a valuable perspective. So on those days where you do have, say, three arches in a day or, you know, a dozen in a week like that, what do you do to unwind? What do you like to do outside of the dental world?
[29:36 - 30:52] Jacob: It used to be basketball, but my lower back, every time I play basketball, I find a way to throw my back out lately. So, I would say, you know, I would encourage anybody that has a busy week like that to have your thing. I need to find my thing again. It's been a while, and that's one of the things that can get exhausting. I wouldn't say that it puts me on the cusp of burnout. When you're obsessed with something like, you're having so much fun doing it. So for me, it's probably just finding time to lift some weights, jump in the sauna. When I go teach a course, that flight there and back is usually my thing, you know, it's like, as much as I know I could work on that plane and I have to battle the workaholic demons that are like, check emails, look into your patient files, look at your presentation for tomorrow. Sometimes I'm like, you know what? I did enough. I think I can take two hours and watch this Netflix movie, and I'll just sit there and, you know I'll still get a coffee or a Diet Coke instead of an alcoholic drink, just so I don't land with a headache or a little bit tipsy. That's my way to get away. But at one point it was basketball. And maybe another season it might be, who knows? Books or chess or swimming. Who knows?
[30:53 - 30:57] Rob: Some way to step away for a couple hours and just clear your head space then.
[30:57 - 31:10] Jacob: Yeah, it’s needed. I think we all know what's needed, but I think that's where I have room for improvement. And I've admitted that to doctors that say, hey, how do I do what you're doing? I said, be willing to sacrifice a lot.
[31:10 - 31:12] Rob: What's something that stands out that you did have to sacrifice?
[31:13 - 31:14] Jacob: Sleep.
[31:14 - 31:15] Rob: Sleep?
[31:15 - 32:10] Jacob: Yeah. If you want to try to stay healthy, have relationships, be a dad, run a practice, be there for your patients, go to church, watch the basketball game, like you have to pick which thing is going to go down. You know? And right now it's sleep. I still monitor everything with my little WHOOP, you know, and try to, try to monitor and say, okay, can I function off of this many hours of sleep. And you know, I still have to make sacrifices and say, okay, time to cut it, time to turn the lights off. Maybe tomorrow morning I won't get up at five, maybe I'll get up at six. But the thing that for me went down was sleep. And as of now, I'm functioning great. In my mind, I can do what I've always done, which is 5 or 6 hours of sleep. I've been doing that since I was in high school, so a bad night for me is four and a half to five. A good night for me is six, and if I get 7 or 8, man, I'm yawning and I'm feeling all lazy and lethargic. So that's that's what-
[32:10 - 32:13] Rob: There’s a point of diminishing returns then, hehe!
[32:13 - 32:32] Jacob: Yeah, exactly. But I've had doctors say like really what would you have to sacrifice? And some people really like to travel a lot. Do you want to get a phone call when you're traveling every weekend saying, my prototype broke or I'm having pain like this type of dentistry. Sometimes patients need you on a Saturday. I don't love that. But that's what I signed up for.
[32:33 - 32:39] Rob: Sometimes that's part of it. You recently expanded your practice at Lakewood Ranch. What led to that move?
[32:40 - 35:11] Jacob: So we expanded our building that was already planted. Right. So we opened up the office. It's in Lakewood Ranch. If somebody is listening to this, and they don't know the area really well. It's also known as Bradenton. And it's like an hour south of Tampa. That's where we opened the original office that I helped open with Heartland. But it was six chairs for dentistry and six chairs for hygienists, and three doctors were sharing those six chairs. So I had two, my partner had two, and my other partner had two. Well, I literally put the SprintRay in the hallway. So you had in the hallway the SprintRay, the wash station, the cure box, and you had to have a compressor under that to spray down the stuff. And I had to put a sand blaster in like my office. Like there was, there was not enough room. It wasn't just about, where do we get more chairs? Where do we get more room? We couldn't even make a final in the building. I had nowhere to put a mill. I'll tell you how creative I was getting, because the construction was going to take a while and I was like, I'm ready to make finals, but we don't have the space. So I was about to buy an old Sprinter van and put the mill in the Sprinter van, park it in the back of the building. There's a medical office next door and they're not even that busy. I was about to knock on their door and just be like, hey, y'all are not that busy. Is there a room I can just have? Like on my own business? We could put a door. I was trying to get creative. I was like, my garage. Could I put it in my garage? Do I have to? And so sometimes you start to, like, bust at the seams. And if I run over, my partner needs a room. If my partner runs over, I need a room. So the decision was we can't build up. I don't want to find a new location. But we tried. There wasn't any good new location. So Heartland Dental and I came up with how this was going to make the revenue worth it. We decided to add 1300ft² behind the building, but it took a lot. I mean, we had to move the dumpster enclosure, which needs a permit. We wanted to move the grass, which needs a permit. We were going to have two less parking spots, and needed a permit. I mean, it was like a year worth of permits. But now I have three new operatories: a surgery suite, a smaller surgery suite, a records room that can still act like an operatory, a consult room to do all of our consults and an in-house lab, as well as our own sterilization area. Because dentists out there that do these cases, especially when there's multiple dentists, you'll have dental assistants like, what are these little dominoes? And they don't know what an iCam is. They don't know-
[35:11 - 35:11] Rob: Oh no!
[35:11 - 36:11] Jacob: So stuff could be either not placed in the right place or which drawer is this in and who used all the bone graft. So having a separate sterilization area was helpful. And then yeah. And doing all that does not make you more revenue. All it did was give my partners two chairs that I was using so they can make more revenue because they can see more emergencies, more new patients. Technically, just because I got a new spot, nothing gave me more revenue. It just hopefully created a better world class experience for our patients. And it gave us more room to work, less rushing. Sometimes we can have all the instruments sit there and be like, we'll get to it in two hours. We're exhausted. Let's take a break. Let's do our clinical note. But if we were still sharing the old space, the other teams would be like, doc, y'all got to clean your instruments. Doc, can you clear out this area? Doc, we need that room. And so that's one of the reasons it helps. So now I made it a 12. It made it a 15 practice with an in-house lab.
[36:11 - 36:15] Rob: Wow. That's a lot of work through there.
[36:15 - 36:31] Jacob: Yes. Busy, busy practice, man. And my partners are really good. I mean, it's not like we have somebody who sees two days worth of patients. They both have full schedules. They both see six hygienists worth of new patients every day, and periodics. So it's a busy, busy house practice.
[36:31 - 36:35] Rob: Yeah. Sounds like it sounds like a big improvement for your workflow to have that extra space though.
[36:35 - 36:37] Jacob: Oh man. Big time. So much.
[36:37 - 36:41] Rob: It’s a worthwhile trade for sleep, hehehe!
[36:41 - 37:17] Jacob: I'll be honest, it was. And that was a lot. The buildout was a lot. Somebody asked me like, would you ever open up your own practice on your own without a DSO like Heartland Dental? And I've thought about it like it's tempting sometimes, but I learned so much and so many valuable learning opportunities that came up through doing a build out like that, through somebody else's financial dollar, you know, like the practice is going to pay for it. But Heartland Dental fronted one point something million dollars, and I learned when to put windows. Why did I put a window there? Why didn't I put a 220 outlet right there? I learned so much during that process, and I also got less sleep during that process.
[37:18 - 37:23] Rob: What are some of the bigger things that stick out to you that you learned from that process?
[37:26 - 38:35] Jacob: You know, I would say if I gave it less of my time, I don't think we would have some of the things that I'm enjoying now. Like when I walk into the sterilization. The flow on that hallway works perfect for my dental assistants, but if I would have just gone with their default drawing, it wouldn't have worked out that way. I had to like, close my eyes and envision if I was an assistant, what order would I do this in? Or when I walked into the lab, okay, I can't put the mill next to the printer because of the dust, and if I put a window there, the light might hit the SprintRay. And if I put the compressor there for the whole office, it's loud. Are the patients going to hear it? So I would say the thing I learned was sit in every room mentally, if you're building an expansion like this or a new practice and think, what, what things would I hate? And so it worked out like one day I think the surgery suite was so freaking hot because we added two windows, but I never had, so I got the windows tinted. Then I learned I needed to change the damper on the air conditioner because it was a new air conditioning machine, so I learned a lot from it. And these are things that I never thought I would have to do or even think would happen. But they happened.
[38:35 - 38:37] Rob: But they're all factors at the end. Yeah.
[38:37 - 38:38] Jacob: It is. Exactly.
[38:38 - 38:50] Rob: Especially when you're building out something new like that. Well, what about advice for doctors that are looking to either get into or level up their full arch workflow? What's the one takeaway that you would give them if you could?
[38:52 - 40:50] Jacob: Man, that's a good question. I would say I'm going to give a quick little curveball to most that have listened to this whole thing, and they would go, oh, that was not what I was expecting. I would say, read the book Leadership and Self-Deception, and read the book Extreme Ownership. And maybe we can throw a picture of those two books up, or they can put it down below or something. You can be a good clinician, you can be obsessed. You can have the biggest space, you can have the coolest tools. But if you don't know how to lead your team and be humble when you suck at something, and when I talk to a team member in a way that viewed them as an object or an obstacle, that's in one of the books, you'll, if they read that, they'll see that you can do more when you're a better leader, a better version of say, not a tyrant, not a- Like, let's say, Michael Jordan. I mean, he won championships because of his mindset. But how many team members could have been better if he wasn't a jerk to them? And it worked for him. It works in sports, I can say get you, get your stuff together, focus, like make the shot. But in dentistry you're working with somebody who can, who can go down the road and get a job tomorrow and say, I don't want to work for this guy anymore. Like he demands too much for me. And so how you lead, how you take responsibility, how you have your team members’ backs. Recently we had a patient say, how come my finals aren't ready, blah blah blah, and my team member dropped the ball. They forgot to write the name down, the color down. And so I called the patient. And this is something I would have never done had I not read the book, but I just said, hey, I forgot to do something, Bob or Margaret, and I messed up here, and you're not going to get your case on time, but it's on me. And I didn't do it so my team could hear. But if they did hear me, they would see that I didn't throw my team under the bus. I took responsibility because it's my team, it's my practice, it's my patient flow. So if there’s any doctor listening or practice manager, just those two books, Extreme Ownership by Jocko Willink and Leadership and Self-Deception by the Arbinger Institute.
[40:51 - 41:03] Rob: I haven't read the second. I’ve read the first. It's incredibly good advice. Yeah, leadership is a powerful thing. I think it often goes underrated, especially in these kinds of circumstances. That’s amazing-
[41:03 - 41:46] Jacob: So much so, man, when I teach my onboarding class for all these new doctors. They often say, because it's half leadership, half clinical. We wanted more clinical, we wanted more clinical. And it's like, you want more clinical, but you'll get enough of that. You need more leadership. You just don't want it right now because your mind is on clinical skills. And, yeah, I think that's the one thing I wish I would have done sooner is read those books sooner. And yeah, so that's not my clinical advice. I don't tell somebody, you should spend more time on the CBCT, or you should buy this particular photogrammetry machine. You should read this freaking book. And then all the other stuff you'll find time for. But if you suck as a leader, if you suck as a communicator, you're never going to get all the cool toys and the eight arches, the 12 arches, the great team members. You're not going to get any of that.
[41:47 - 41:53] Rob: But all flows from there. Doctor Jake, amazing. Thank you so much for being here. Where can people find you online?
[41:54 - 42:43] Jacob: Yeah. You're welcome and I appreciate the opportunity to chat with you guys. I would say the best place to reach out to me is probably on social media, on Instagram or Facebook or TikTok. I'll usually put it down as @dr.jacobberger and it's B-E-R-G-E-R, but said like a cheeseburger. I’m @dr.jacobberger and I usually respond to DM's. If people have questions, we post our cases there. We try to post funny videos, but I will say of all of my videos, all of my posts are meant to grow the practice and grow the type of dentistry I'm doing. So I usually don't post a lot of gory pictures and pterygoid implants. And check out this trans nasal. And look at this little accessory canal squirting blood. No patient wants to see that, so I don't post any of that stuff. It's more so patient-focused, with a little bit of humor and a little bit of before and afters.
[42:43 - 42:46] Rob: I love it. Thank you again for being here, man. I really appreciate your time.
[42:47 - 42:48] Jacob: Hey, you're welcome, man. Take care, Rob.
[42:49 - 43:04] Rob: Thank you. And thank all of you for joining us for this episode of the Evolution of Dental Podcast. Remember to look for us on Apple Podcasts, Spotify, YouTube, and anywhere you find your favorite podcast. Remember to like, subscribe, follow, and never stop evolving.
