How a NYC Prosthodontist Built a High-Trust, High-Value Practice

Say that your fee is $2,000. That's about the going rate for a crown these days. Just let's take it on the higher end. And they're going to pay 80%. I can see accepting that. But once they go below 60% of what you're charging for something, you either have to have the patient pay for it or not accept that insurance. Once it goes below that 60%, no matter how many patients you're seeing, you're not making any profit at all. So you're working for free. Welcome to Austin, Texas, and welcome to the Phil Klein Dental Podcast. Today we'll be talking about what it takes to build a really successful practice. We're talking with Dr. Graziano Giglio, a highly respected prosthodontist in New York City, one of roughly 250 prosthodontists competing in the same market. Dr. Giglio leads a thriving practice with 13 operatories, three dentists, and a team of 20, giving him a unique perspective on what it really takes to stand out. We'll explore how he's been able to differentiate himself in such a crowded landscape, define and communicate a compelling value proposition, build trust with the patient, and attract the kind of patients who align with the dentistry he wants to provide. Before we bring in our guest, I do want to say that if you're enjoying these episodes and want to support the show, please follow us on Apple Podcasts or Spotify. You'll be the first to know about our new releases, and our entire production team will really appreciate it. Dr. Giglio, thanks for taking the time to join us. Thank you very much. It's a pleasure to be here. We're going to be talking this episode about practice management, and I want to begin by talking about how to differentiate yourself in a crowded market. And as a prosthodontist in New York City, you're one of roughly 250 prosthodontic specialists serving the same market. So how do you rise above the crowd and truly differentiate yourself from everyone else? Well, you need some kind of hook. That's the important part. You need something that is different and special than other people in the area. And so you can begin with, you know, personality is one thing, but you have to be good at your craft. You have to be able to deliver and you have to be able to be a good listener and address the patient's chief complaint. That is what most of the younger folks forget sometimes. is that the patient comes in for something very simple i'm in pain or i have a chipped tooth but they're addressing a bunch of other issues the patient only wants to focus on that particular issue which is called the chief complaint and try to adjust address that particular problem and that will solve half of your problems for you right now when you started as a prosthodontist you were aware that there were like i mentioned 250 or more prosthodontic specialists in the area. Now I know New York has a ton of people and you're in Manhattan, but did that in any way come into your mind saying, you know, because you were young, you started your own practice. Did you think about how are you going to compete with the other guys? Yes. So initially you're not that busy. So you have time. And so use that time and take advantage of it. by being kind to the patient, being compassionate, spending more time with every patient, as opposed to rushing them out. What I find with a lot of people is that, and I mentor a lot of young folks, and what happens is they have a lot of time, but they're on the computer. They're doing other things that is not related to the practice. So basically, maybe they're on social media. I see a lot of my younger... mentees, where they're on the phone, they're on Instagram. That's okay, yes, but not during practice time, where you should devote that to the patient. So if you do get a patient, spend the extra time, be compassionate, and give them what they deserve. And if you do that, then the patients will be cloned. Those refer patients like refers like. And that experience has to happen early on, right? I mean, you got to do that. right off the bat when the patient first comes into practice. So how can a dentist identify and communicate their unique value proposition in a way that resonates with the kind of patients that they want to attract? So you need to spend some time training your staff, training the team. That's important because if you spend some time with the patients and then also training your staff, then it's a reflection of your practice, of you and how you treat patients. So if... staff is on the same page with you. Then it becomes a concerted effort. It becomes a concert as opposed to just individually playing a role. And then you're helping out the patient. You're also enlightening the staff on how to treat patients. And that compassion will transpire to the patient. And then the patient says, hey. This is a unique place. So you have to make yourself special. So the way you do it is by treating the patient correctly, being compassionate to the patient, and also training your staff so everybody's on the same page. Now that includes the front desk people, right? Oh, key, key. The front desk is key. Tell me about how you make sure that that front desk is communicating the way you would do it if you were doing it personally between you and the patient. First off is phone skills. Because the first contact with the patient is, through the phone and so for example instead of saying you know may i ask who's calling they say who's this you know that's kind of rude and so the the patient gets a feeling of this is not a warm place so you want someone who's friendly and warm right on the phone and accommodating if they haven't filled out their forms maybe help them fill out their forms online get on the phone with them Get on TeamViewer with them. Help them out in some way. Some of the older folks don't know how to use a computer. So say, don't worry about it. When you come in here, we'll help you fill out the form by hand or on an iPad. So that's the first contact is phone. Second contact is when the patient makes an entrance, comes in. So if the front desk people are on the cell phone or they're on the phone, someone needs to make eye contact. They have to be warm and inviting, engaging to the patient. So there's got to be several people at the front desk so someone can give that patient that walks in that individual attention that they deserve. Yeah, and the sad thing is, you know, you do all these great things, but it only takes one incident to actually turn a patient off. Even though you work so hard to build that culture, somebody in the front desk... may not be having a great day. They may have personal problems. They may not have slept that night and they're a little grumpy and that can happen when they come to, I mean, is that part of your training to literally instill this and say, listen, folks, we all have good and bad days, but every day here has to be a positive day because the patient will pick it up. Yes. So we have four front desk people. Now, when you first start out, you can't afford to have four front desk people. So what we do is if someone is having a bad day, and that happens to all of us, then someone else needs to be the receptionist, be the person greeting. So they can all alternate depending on who's having lunch and who's taking a phone call. So we find that three to four people at the front desk in any practice is necessary because the phones are ringing off the hook on a Monday morning. Then someone has to be available to greet the patient. And that's so important. And addressing the patient by their name, not by their first name, by their surname. By saying, Mr. Jones, Mrs. Jones, some individual attention to that patient and a warm, inviting person. For example, when I talk about finding a front desk person, bank tellers are very good. People who work in hotels, concierge. These are the types of employees you want to attract. Is someone in the service? business, in the customer service business. That's who you want. I spoke to some key opinion leaders on some of these shows that I do, and they actually went to Nordstrom and hired a couple of people over a 10-year period. They went there. They went to whatever they were buying on a regular basis in Nordstrom, and they found this person who had the most impeccable customer service, which is a hallmark of Nordstrom. That's their main value proposition is service. And he said, hey, I know you know nothing about the dental industry. Would you consider working in a dental practice? And here's what I would, you know, this is the kind of salary that we would be offering. And he hired two people from Nordstrom. Absolutely. Great idea. Hotels. There's different types of service environments that are conducive to that. And then what happens is that they'll learn some of the dental aspects of it later. We had someone who came here. who was in the service business and didn't know anything about dentistry. But over time, he learned how to do that. And it doesn't have to be, a lot of people think that it has to be a woman. It doesn't have to be a woman. It can be a man. So let's talk about insurance participation. I mean, insurance companies, they just, the compensation that's connected to their payment plans are absurd to some extent. Some dentists are saying that it doesn't even cover their lab bills. So you believe dental practices in large part. should avoid participating with third-party insurance plans. Tell us why that is in your mind and what impact that makes on both profitability and patient relationships. We'll be getting right back to our guest in a second, but first, for the optimal bond between zirconia and your resin cement, check out Bisco's Z Prime Plus. Rated best in class by thousands of top clinicians, Z Prime Plus, featuring MDP, creates a strong, reliable bond to zirconia, metal, and alumina substrates. And nothing could be simpler. It comes in a single bottle, and it's 100% compatible with both light-cured and dual-cured resin looting cements. It's time you get the most out of your zirconia restorations. To learn more about Z Prime Plus and the entire Bisco Adhesive product line, visit bisco.com. So if you accept insurance, that means that you're going to be accepting a lower fee for that particular service. So what I would say to a young person is, yes, you can accept some of this to fill up your seats or to fill up the chairs. Now, if the insurance company will only cover benefits up to $2,000, then only provide a certain amount of treatment per year. And you can do that. You can give them cleanings, you can take care of a couple fillings, and that's fine. Now, the next level, that's the first level, is only accepting insurance for what the insurance company pays for 80% of the service, and then you don't get the copay. But now, say you want to increase that a little bit, you can now go to saying to the patient, well, you have to put your copay down first. That now allows the patient to make a commitment. Now they have a little bit of skin in the game. They're putting down a down payment before the insurance comes in. And that way the patient probably won't cancel on you because they've made a commitment of some sort. They will show up for the next visit. Now the patient is spending, instead of $2,000, maybe they're spending $3,000 and they have to put some money in. That's the next level. Now there's some insurance plans that go up to $5,000, $6,000, $7,000. There's an insurance company that I accept the payment for. That's the only one. They have a $7,000 limit. Now you can do a good amount of work for that. Even though we don't accept insurance, this one we do, and it's been for 30 years. They send me a lot of patients, and then I have them pay the copay right up front. That there's a commitment there on their part. If you don't have them make the copay, then it becomes a problem. But how do you know what the copay is? You have to file something with the insurance company to know what they pay? Yes, the key here is the predetermination. And how long does that take? Because if a patient comes in, you can't do anything until you get that predetermination back. Right. So we give the patient a treatment plan and say, you can take care of it with your insurance company. They get on the phone or they submit something and they tell them usually right away. If we really want that patient, then we take care of it and we say, how much are you going to pay for this? Get something in writing that says, I'm going to pay $2,000 for this crown. And the rest is the patient's responsibility. That way, the patient knows up front. So the way that we look at anything in this office is when you explain something to the patient right up front, you tell them up front, it's an explanation. When you tell them later, when something happens, it's an excuse. And that's the difference. Then you're only working against yourself when you're trying to explain what happened later, as opposed to telling him up front and having it in writing. Now, when you started your practice in Manhattan, right off the bat, as a young prosthodontist, you didn't accept insurance or you weren't on really any plans. No, I did not. There were actually two plans. One was unlimited, paid 80% of anything. And that was from the UN, which is very close here. They had unlimited funds. meaning they would pay 80%. So I had the patient pay 20% upfront. And then I had another insurance that paid about 5,000. So those are the only two insurances that I accepted and everyone else had to pay fee for service. So those patients from the UN not only were able to park for free and never got a parking ticket. Right. But also got incredible dental insurance. So we know where the taxpayer money is going for that one. And they usually have chefs and they have, you know, drivers and everything else. So they're the ones that really don't need that benefit. But they had this unbelievable plan and I could do a full mouth rehab for $80,000. This is when I first started out. You do the full mouth and they would pay. a portion of that. So the UN employees basically kept their practice going for the first couple of years. Yeah, they were from other countries, though. So the government's from the other countries. And they loved it here because the benefits were unbelievable. Oh, for sure. The dentistry that you were doing was unbelievable compared, in many cases, to what they would probably get in their country. Not all countries, but many countries do not have the same kind of dentistry that we have here. So what do you say to a young dentist who says, well, listen, I'm starting my own practice and I have bills to pay. For me not to accept insurance in the beginning would be very difficult in my area. It's a double-edged sword because they need to get it going, but then it's hard to get off of it once you're dependent on a lot of those insurance plans. And then you also have the kind of patients that may not value or be able to afford. you know, the kind of services that you want to deliver. So how do you, what's your response to that young dentist who's in that conundrum? So you have to see what the company will pay for, what the insurance company will pay for. So for example, say that your fee is $2,000. That's about the going rate for a crown these days. Just let's take it on the higher end. Let's not just do a filling or cleaning $200. That's what they pay. And they're going to pay 80%. I can see accepting that. But once they go below 60% of what you're charging for something, you either have to have the patient pay for it or not accept that insurance. Because your overhead is about 60%. Most overhead in dentistry is about 60%. That's the cutoff point. Now, if you just want to keep the chairs filled and pay your bills, 60% should be the minimum you accept. But once it goes below that 60%, no matter how many patients you're seeing, you're losing money because your supplies and rent and utilities. cost you a certain amount of money, and then you're not making any profit at all. So you're working for free. That's where you cut it off at 60%. And that's not, yeah, working for free is not sustainable to a business. Let's talk about provisionals for a second. You know, some dentists look at provisionals as temporaries, and they don't spend a lot of time on provisionals. They don't think it's worth the resources. In a lot of ways, they underestimate the importance of provisionals. Why do you believe, and of course, I'm asking a prosthodontist, so we kind of know what you're going to say, but why do you believe making really beautiful provisionals is such a critical part of building a successful aesthetic practice? To me, a provisional is advertisement to the dentist and to patients. So if a patient comes in and has a beautiful provisional on the anterior teeth, they're going to go to work and say, look at this is only a temporary. So who made it? Now they get referrals. Now you send this off to the endodontist, right? Or you send it off to an oral surgeon or periodontist. They see the provisional. Wow, this is, he's a good dentist. I couldn't even get it off. It was so tight. That's the second. And then the third aspect of it is that you will not have emergencies if you make good provisionals. I see some dentists having constant emergencies with provisionals. So if they keep coming off, for example, we put them in here with Duralon on everyone. If we're seeing them next week or next month or next year. So that provisional is not coming off with Duralon cement. Whereas if they keep coming off, the patient is upset, they're missing work. And now it's taking up your chair time. So it's a loss loss. There's no win there for anybody. How do you fabricate your provisionals? So what we do is we have a scan on every patient we treat. And if we need to make a provisional, we already have a shell made out of a hard acrylic that's milled. So we have that shell ready to go, and it's very cost effective. Say it costs us $30 to make that provisional. Think about how much time you save at the chair. You're saving hours rather than having to make a provisional from scratch. What material do you mill it from? Well, we use something called iVotion, which is a hard material, which is about 130 megapascals. It's made out of the material that you use for dentures. It's as strong as a denture. And now you're just relining it with some auto-polymerizing acrylic inside. But the shell is really hard. It's as hard as a denture. So the shell stays. It's not like a matrix. It stays. It stays. Right. But you still have to fill it with an acrylic to give it some body. But the outside is 130 megapascals, which is strong. And to mill that takes what, 10 minutes? 10 minutes to 30 minutes, depending on, for one, it's only 10 or 15 minutes. That's very quick. And it just saves you so much time. And say it costs you less than $30 to fabricate that. So say a patient comes in or calls up and says, I broke this tooth. We say specifically, which tooth did you break? they said oh i broke my front right tooth can you send us a picture they send us a picture or email or text to the to the front desk the front desk now sends it to the lab the lab mills it before the patient comes in so that they broke a tooth now we have a provisional a beautiful looking provisional not only that say you don't have a lab and the dentist could has a milling machine or a chair side milling machine you mill it and then you can stain and glaze it yourself by putting it in one of these curing ovens. It's not a hot oven. It's just light cured. We'll be right back with our guest. But first, I want to tell you about VOCO's newest composite, Grandioso 4U. Top clinicians are calling it the most tooth-like universal composite ever made. Unlike traditional composites that force you to choose between either an anterior aesthetic composite, a stronger layering posterior composite, or a fast but aesthetic -compromising bulk fill, Grandioso 4U does it all, simplifying your workflow while delivering superior results in a single material. It cures 4mm in just 10 seconds, looks stunning with 5 cluster shades covering all 16 Vita shades, and handles like a dream with 50 % less resin. It's a 91% filled nano hybrid, giving you tooth-like strength, ultra-low shrinkage, exceptional wear resistance, and an amalgam-like high radio opacity. So as they say, seeing is believing. So grab your free sample of Grandioso for you today at voco .dental. So the other day I had an emergency on Saturday. We have a major emergency. Guy flew in from Boston to have, he smashed his front teeth. He fell at a football game. Landed in the stands, broke his front teeth. He was at a high school football game. You know, you hear about Friday night lights. Well, while videotaping his son, who was the quarterback, flew in on Friday night, Saturday morning, we saw him. His dentist sent us a scan of his mouth. Our technician on Saturday morning copied those, milled them in 20 minutes, his front four teeth. We had a shell of his front four teeth ready to go. Yeah, that's amazing. That's amazing. That's a service that the patient's willing to pay for. Yeah, yeah, that is amazing. Now, what about the dentist who doesn't have the milling chair side? They print up the scan, take an alginate of that, and now you have a matrix. Right. Just take an alginate the old -fashioned way of the cast. Let's talk about the exceptional customer experience. Every business, it doesn't matter what it is, it doesn't have to be dentistry, and we talked about Nordstrom, that's been around a long time, has developed its reputation, its credibility. And it has driven success to the business through exceptional customer experience. And that includes customer support. That includes returns if you're in the retail business. When it comes to your practice, what are some specific ways that delivering high-quality aesthetic outcomes translates into stronger patient trust, more referrals? And this is all obviously based on the customer, the patient, feeling that they're being treated in an exceptional way. A lot of dentists do is they focus on themselves rather than the team effort. It has to be a concert. It cannot be an individual just playing one instrument. It starts when the patient walks in the door, as we talked about. And so you're only able to provide a certain amount of service. You're spending a certain amount of time with that patient, but the patient is spending probably 40% of the time with the rest of the staff. You walk out of the room. or the hygienist, or someone at the front desk. So it's important that you treat everyone well during that time. But the way you treat your employees is also how you treat your patient. You see, you put them in the same category. And so if you're treating your employees and your team well, then they will in turn treat the patients well. So everyone has to be trained. In our office, employees do not get... to spend time with the patient unless they're trained. It's just like a hotel. They have to go to a training program. Tell us about the training program. What does that mean when they first get hired? Or is this an ongoing daily huddle, weekly meeting? Or is this something they go outside of the office to get trained? We do it in the office. So say we're hiring a new front desk person. We have three or four people. Now, we're increasing the size of our office, so we're going to hire one more front desk person. Okay? So the team leader, we have a team leader at the front desk. She's the treatment manager. She's the one who takes care of the front desk. You have to have a point person, a lead. That leader will orient the employee and then put them on the computer system and show them how to enter. or a patient, so on and so forth. Is that the office manager or the treatment? Is that two different things? Do you have a separate office manager? We have an office manager, but the treatment manager is the one who's in charge of the whole office, meaning the front desk. She's the lead. Even though we have an office manager, the way we do it is it's a younger person who's much more computer savvy than the office manager who does a lot of the back office work. So the back office work means human resources, some payroll, things that are done. Collection. Not collection. Oh, that's so important. Yeah. The collection is. But I don't want to take you off track because you were doing really well. I was just curious to know if it was the office manager and the treatment manager was the same role. No, it's two different people. Yeah. So that person makes sure that that person who's hired is up to speed on. The things you mentioned, getting on the computer, talking to the patients as far as how to get them into the practice, what they need to fill out and all that stuff. So how much training is involved there? Hours, hours and hours. So for example, they're not allowed to really greet me or answer the phone until they're trained. And so they're in the background. They try to absorb it. They're taking notes the whole time. So it takes a few weeks. Do you do a kind of a mock? kind of simulate someone calling the office and you'd kind of tell us about that. So what we do is we treat all our friends and relatives. So they get to practice on friends and relatives rather than doing it as a mock. So they don't know that the next patient walking in could be my cousin. That's interesting. They don't know that it's someone in the office. They don't know. We actually, friends and family, you know, really close friends. And there are a few. They get 50% Curtis. So they're a little bit more understanding to someone, right? We use them as guinea pigs in a way. It's just the way we operate. So for example, we get a new assistant. So if it's someone, another relative of ours that's sitting in the chair, say, hey, listen, we're training somebody. Do you mind if we put that person in the chair to, you know, the assistant's chair to train? And so now I can talk to them and the person behind them, the assistant trying to train them. is also talking to them. So we use our friends and family as the guinea pigs for the new trainees. Yeah, I just went to a restaurant opening in Austin, Texas, and the guy that owns the restaurant invited us over, and they fed us like kings and queens for free. But they wanted to know our feedback on the service, how the drinks were. We didn't drink much, but we had one margarita each. And how was the food? And it was quite a question. an answer period after the dinner. But that was their way of figuring out whether the things were running smoothly. It was their first dress rehearsal before they actually opened the restaurant to the public. So what about turnover for you? You train your staff diligently. You make sure they're all up to speed. You have to instill a culture, make sure they're in alignment with you on the culture of the practice, right? Because that's really important. Yeah. What about turnover? Have you had a lot of that or you keep employees for a long time? We have people here that have been working on us for over 30 years. Some at 26, 27, 29. We have some in the teens, meaning 13 to 19 years, right? There's different. But we've had troubles with getting good dental assistants. Now you can get front desk, you can get good hygienists. In New York, we've had trouble and my friends are all in the same boat. Partly because of COVID? After COVID, yes. People have dropped out. They don't want to do it anymore. So they make an appointment to have an interview and they don't show up most of the time. And this is rampant all over the place. My friends in Seattle can't find hygienists. They pay hygienists more than that cleaning just to have them. They pay them more than what they're getting for the cleaning just to have a hygienist. And we tried paying them more. It doesn't help. How do we fix this problem? I like people have extended function. They're called extended function assistants. So they can do more than a regular assistant. That helps us because we cut down on the chair time and also cut down on the operator time being in the room. Is there a shortage of EFTAs out there? Yes. So you have the same problem then? Right. And so now what we've done is we'd rather take someone out of school and train them for 90 days, six months, than to hire someone with bad habits. Here's what happens. In the dental office, a lot of dentists feel that all they need to do is have someone who makes the patient feel comfortable, sets up a room, and can also clean up a room. Those are not the only functions that an assistant should provide for the patient. They need to be able to hand instruments so you can be efficient. deliberately handing instruments, not passively. And so what happens is that we find that many of them are just cleaning up rooms, setting up rooms, and gabbing with the patient, just talking to the patient. That is unfair to the patient because it's going to take 15 to 20 minutes longer per hour to get that patient out of the chair. Slows down the procedure. They're not handing instruments correctly underneath the patient's chin. They're not making the right transfer. And so now we have to train them. Now, we will take anyone with a good attitude. And as long as they're teachable, we will hire them. And we will train them and say, look, you're going to be in the background for the next 90 days. You can greet patients. You can sit them down. You can clean up rooms. You can set up rooms. But we will not have you treat the patient. on your own, especially with anything that's complicated for 90 days. Yeah. Talk about the challenges of being a dentist and owning your own practice. I mean, like you don't have enough things to worry about than a shortage of assistance. Now, are the assistants in New York City doing intraoral scanning? Yeah. Oh, absolutely. They saved me so much time. Okay. So they have to be trained for that. That's a whole nother. Yeah. Yes. But that's easy to train. They love it. The younger folks love it because it's computer driven. It's all in the computer. They love it. They have an affinity for it because they're so used to working on their phones and on the computers. They're trained from when they're children. Any millennial is great with that. Right. So every new patient, you scan them fully and have that record in your file so that whatever happens, you've got a whole mouth scan, which is a great thing to have. You've said that 70% of growth, and we've talked about this and it's well known, comes from word of mouth. So how do you capitalize on that 70% and get... to be advocates for the practice. So we talked a lot about this, you know, the compassion and the trust that needs to be developed. If the patient trusts you, they will listen to anything you tell them and they will accept treatment. And trust isn't built over one or two days or a week. It's over years. So that's the important part. You have to take your time with the patient, spend the time. have a staff that is going to assist you correctly, make the patient feel at home, and then you will get the referrals. And not just from the patients, but other doctors. Like we talked about, this is kind of like a wrap-up. The provisionals are key. Keeping patients out of pain, that's important. Because if you go to the dentist, and say you do root canals, right? You're an endodontist, and you do root canals. And that patient goes back and says to the dentist, Wow, I had no pain. All of a sudden, that dentist is going to refer you more patients because, hey, last patient had pain from another dentist, another endodontist. I'd rather send them to the one that doesn't cause pain. The other thing is, should a dentist really spend time on the other 25% to 30% of the marketing side where they do external marketing? Is that something that's really worth doing? or should they just continue to work on the 70% of the growth of the practice and not even worry about the external marketing? Some people do that, but you should do some external marketing. What does that mean? Social media, making sure you have a good website. That's important. Having things like branding your practice. That's important. An association. And people don't understand what branding is sometimes. Branding, we call our practice G-Dental. We have logos. That's important as well. We have lip balm that we give to patients with our logo on it. Now, the logo doesn't have to be large, small logo, because people don't like wearing anything or showing anything that has a big logo on it. Keep it small, but it reminds them every day when they put the lip balm on, right? We don't put it on our... toothbrushes or floss or anything like that. But a lip balm is really important. People say, oh, I love this lip balm. It's pear. You're giving these things to patients that already exist in the practice. So that's not really the other 30%. You're building the 70% word of mouth to some extent because you're relying on them to advocate for you. What about the actual community when you go out and you don't know what kind of patient's going to come in? You're just looking for more patients. Should that be a priority? Yes, you should make that a priority. You should look at points of congregation. What does that mean? Places like synagogues, churches, community, the schools that your children may go to. One time we gave a bleaching for free at an auction and we ended up getting patients from that. That's external marketing. So some social media. Now, what I don't want people to do is spend a lot of time during practice hours. doing social media because you're taking away from the patients. And that's what I find a lot of my young folks doing. They get so wrapped up and it's fun to do, but they're not getting the return on investment. So you don't hire an outside marketing person or team to do your external marketing. You do that yourself. We have someone who does it internally when they have time. A dentist does it? One of your... No, no, no. We have someone here. We have a lab tech and one of the assistants who do it very well. And they do some external marketing. So they do things that are fun for patients and for referring doctors. We have a site for that. So I really think the take-home message is, in a lot of ways, everything you talked about related to practice management is providing the exceptional patient experience, right? I mean, you have to be a skillful dentist that's going to put out nice work or else that will catch up with you. You're a phenomenal... dentist, you're an aesthetic specialist, you're a prosthodontist, but people fly from all over the world and come to your office. You have all the high technology, you've got the digital workflow. But if you didn't have the exceptional patient experience, I keep saying exceptional customer experience, but it's really patient experience, the whole thing falls apart, right? Because eventually you're just working much harder to keep your business going because you're not getting that patient to be an advocate for you. And I think that kind of sums it up. Any last thoughts before we... wrap it up just there's there's all types of books you know on the speed of trust and and it's it's all about trust once a patient trusts you they will do whatever you ask of them but they have to feel safe the patient has to feel safe in your environment so you want a safe environment that's serene calms the patient down not hustle and bustle although we have many operatories here it feels like a home the waiting room is isolated from the hustle and bustle of the clinic and that's key it's also how you design an office so that the patient feels safe they're in a trustworthy environment and they're going to get exceptional treatment those are the three things all right Dr. Giglio great having you on look forward to having you on future programs have a great day thank you very much it's been a pleasure