Do More of the Dentistry You Want, Not Just What You Can

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Intro: You are now listening to another episode of the Insurance Untangled podcast, where we explore the various challenges faced by dental practices due to their reliance on insurance. Join us in this podcast as we dive deep into the issues surrounding dental insurance dependence and offer practical solutions and strategies to help you take control of your practice’s financial future.

Ben Tuinei: Welcome to another exciting episode of the Insurance Untangled podcast. My name is Ben. I am one of the co-hosts on this podcast. And as you all know, we’ve dedicated this podcast for you, to help you untangle yourselves with insurance in a way that helps you be more profitable, less stressful, and, for the most part, you know, sort of centered in a way that you want to be in terms of life enjoyment—like, well, enjoying life, that is.

So today, I have my good co-host with me, Naren, who I’m gonna interview—uh—with Naren Arulrajah. Naren, how are you today, my friend?

Naren Arulrajah: I’m doing great, Ben. Looking forward to this conversation. I think you’re gonna have some fun today. It’s a really important topic.

Ben Tuinei: Yeah. I love this topic. So let’s hit right into it—to get right into it. So, the topic for today that we selected is: Do more of the dentistry that you want, not just what you can do. Right? And I can relate to that, you know, from my perspective. You know, you get the clients that want a specific service, and it’s the service that you don’t want to do. And it’s the area that you don’t really want to focus on, right? But you tend to get high demand in that area.

So the question is, how do you get more patients with the type of treatment that you want to do? So, you know, if you’ve ever felt like you’re stuck doing the kind of dentistry that you don’t really enjoy, you just gotta—it is sort of a mindset that you’re just taking whatever comes through the doors instead of doing the work that you truly love, that you’re truly excited about.

So today, we’re gonna talk about how to break free from that, and we’ll look at so many different areas in terms of, you know, so many ways as to why dentists feel this way, and, more importantly, what you can do to change that. So I’m sitting here with my good friend, Naren, so we can talk about how you can attract the right type of patients, grow your practice in a way, and finally do more of the dentistry that you want to do—not just the dentistry that you’re in demand for, right? Or the dentistry that you know how to do but that you don’t really love.

So, let’s get into this. So, Naren, you know, of course, this is a really important topic because we hear this every single day. Doctors are like, "How do we get more of these kinds of patients that need these types of services?"

So the first question I have for you, Naren, is: Why do most dentists who become dentists in the first place—what makes them want to own a dental practice? And I think that question is sort of setting up that question about wanting to do more of what you love but not being able to do that in the moment. Let’s back up a little bit and talk about: Why do most dentists become a dentist in the first place? What are your thoughts about that, Naren?

Naren Arulrajah: Yeah, that’s a great question. I have been in dentistry now, helping dental practice owners, for 18 years. So I have friends, and I’ve seen them grow old with me, so to speak. You know, we had kids who were very young when we first met each other—15, 16, 17 years ago—and now their kids are off to university. And, you know, my kids are off to university; one finished school.

And I’ve asked this question, you know, as many times as I can remember: Why did you get into dentistry? And nine out of ten, the answer is, you know, "I was inspired by someone—maybe a friend, my dentist, someone in our neighborhood—and I wanted to be like that person."

You know, very rarely do I hear, "Well, I just fell into it." Like, they start with intention.

Naren Arulrajah: The people who are attracted to dentistry, or healthcare in general, they want to change people’s lives. They want to help people. They just want to make a difference—it speaks to them. And of course, they’re comfortable with the blood and all the other things that come with healthcare.

Of course, I’m one of those people—I don’t know if I’d do well in healthcare because I’m not a big fan of cutting and, you know, that kind of stuff. But those who are comfortable with that and those who want to make a difference in the lives of others, that’s how they get into dentistry.

And then I also ask people who end up, you know, starting their practice or buying a practice and becoming business owners: Why do you become business owners? And nine out of ten, again, the answer is, "I wanted to have a practice that I want to work in," you know, versus, "I have to work in."

In other words, it’s: I see the patients I want to see. I have the team I want to work with. I provide the services I want to provide.

I just want to jump out of bed and go to work. So that’s what creates this desire to (a) become a dentist—helping people and making a difference—and then (b) being able to do the dentistry and create a life that you want. That’s what leads to practice ownership.

But that’s kind of where everything starts, and then things go sideways. And I’m really glad to kind of explore, you know, perhaps why it goes sideways and how to kind of, you know, perhaps regain control and, you know, have a meaningful conversation today, Ben.

Ben Tuinei: Yeah. You know, I love that, Naren, ’cause I could think about my days—like when I was early in my career, I did not want to do a specific service. But naturally, people—other professionals—that didn’t want to do it, most people came to me and said, “Nobody wants to do this for me, so can you help?”

So I naturally ended up doing the things that I didn’t want to do in my career, right? But you do that in your early stages just so that you get the business and the trust.

And I hear this theme so many times, Naren—that so many dentists feel stuck, that they’re doing treatment that they don’t really enjoy doing. It’s not what they like. You have a lot of dentists that go to implant courses and they want to do more implants, but they get stuck with their days full of composite fillings—not implant treatment.

So, how do doctors get in—like, how do people in general—I shouldn’t just point out the doctors, but why do so many people sort of get stuck in this way, where they feel like they need to do the work that they’re in demand for, but it’s not the work that they really enjoy?

How do we get into that position?

Naren Arulrajah: Yeah, I think that’s a great question. I mean, if you look at most people who, um, you know, who have nine-to-five jobs, I would say if you were to interview people, a large number of them—I wouldn’t say all of them—but a large number would say they’re not really happy with their jobs. And that’s because they’re going to work because they have to, not because they want to.

And what I mean is, they perhaps have a lot of payments to make—you know, the car, the house, the kids—so they have to go to work in order to continue making those payments. So almost like—even though you’re supposed to be living in a free country and you have freedom—you really don’t have freedom. You have to do this just to, you know, get through one more day.

Naren Arulrajah: And it becomes like—right—imagine going to the salt mine and working in the salt mine. Or, you know, I know many of us can’t even imagine that because we don’t know what it looks like or what it feels like. But it’s just like—it becomes a tragedy, right? And dentistry also can turn into that if you’re not careful.

And of course, there is a way to get out of it. Usually, what happens is dentists think, "I’m in practice, I need patients," right? And what is the best or the easiest way to get patients? Sign up for a PPO plan. You know, here is the deal of your lifetime—you’ll get as many patients as you want. Sign on this hundred-page dotted line.

And usually, what that means is yes, you will get patients, but there’s a big catch. And the catch is:

One, you only get paid part of what you, you know, for the work you do. So if you do a thousand dollars’ worth of dentistry, you might get paid $550. And that’s not just a one-time fee for the very first time the patient shows up—that’s a lifetime, you know, handcuffs, if you may.

That’s one catch.

The second is, many people—or almost the majority or vast majority of people—who come through this thing called insurance or PPO plans, their very first question always is, “Is it covered?” Because they think if it’s not covered, it’s not important.

Even though the same person might book a vacation for $5,000 or $10,000 or drive this beautiful electric car or, you know, sports car—in their mind, "Well, if it’s not covered, it’s not important."

So it comes with this baggage.

And imagine now running a business where you’re making 55 cents on the dollar. So you have, you know, a hundred dollars’ worth of expenses—because you can’t pay your team half the PPO fee just because your insurance company only pays you half.

You can’t tell your landlord to charge you half because the insurance company pays you only half. You have to pay everybody full fees.

And as you know, expenses, on the other hand, have gone up—especially with COVID and, you know, all the other stuff that’s going around. Everything is more expensive—rent is more expensive, salaries are more expensive—but insurance companies really haven’t kept up.

And so you’re getting paid less and less while your costs are going higher and higher.

So imagine getting up in the morning and going to work in a place like that.

Naren Arulrajah: The only way you can make ends meet is you work harder. You see maybe more patients to make the same money you made last year. You kind of lose the relationship—like, why did you get into dentistry? To change the lives of people. You don’t have time to even say hello because you have so much to do just to kind of keep the lights on.

You know, and then your team gets burnt out because they also have to work harder to make the same money they made last year. And they’re like, “Oh, I’ll go get some other job.” So they’re going to, you know, a fee-for-service practice or, you know, these niche practices that are attracting people who pay full fees. Or they’re going to different industries—I mean, they don’t have to just go into another dental practice, they can work in another industry.

So you create this negative cycle: you’re working harder for less, you’re losing the good people, and then it becomes this handcuff. And the only reason they’re doing it is, “Well, if I don’t, I don’t know how I’ll support my daughter or how I’ll pay for my mortgage.”

So kind of the same story that we see in, you know, nine-to-five jobs where people are not happy starts happening to these people. And that all started because they lost control. They lost control of the whole equation.

Because if you lose control of who your patients are, you lose control of everything. If you lose control of how much fees you can charge—because the insurance company sets the fees and only pays you partial—you lose control of everything, right?

So that’s where everything starts. So even though this young dentist with a wonderful dream of making a difference and a wonderful dream of creating the practice of their dreams ends up going in the opposite direction.

Ben Tuinei: Yeah. That’s kind of sad when you really think about it. You know, it’s like we all want to kind of live the lives and do the treatment professionally—or at least work the professional lives—that we’ve envisioned. But I imagine that most people don’t get there.

So I looked at some statistics from the Department of Labor. So this is the annual vacation spending per household. National average of spending in the United States of America is between $2,500 and $4,500 per household.

But the numbers change depending on your income. So if you’re making $100,000 or more every year as a family, you’re spending between $6,000 and $10,000 annually in travel. Middle-income families, between $50,000 and $100,000, they spend $2,000 to $4,000 annually.

Low income, which is under $50,000 a year—there’s no statistics there because it’s inconsistent. Most people don’t actually go on vacations in those income categories.

But it’s just—it’s kind of interesting to see among the category of people that you want to see as patients, that they prioritize vacations more than they do other areas of life, such as dentistry.

So, if you’re kind of stuck in this mix, Naren, of getting requested to do treatment that you don’t really want to do, what should you do to fix that as a dentist? What are your thoughts there, Naren?

Naren Arulrajah: Yeah. I think, go back to the root cause, right? Why are you in this mess? You didn’t—attract the patients you wanted to see. You took any patient, especially those who want free dentistry, right? In other words, the only reason they’re coming to you is not because of your training, not because of your expertise. It’s because the PPO plan said, "You don’t pay anything, just go see this—Dr. Smith." Yes. You know, you can only get, you know, half a tooth—uh, one tooth—done every year because we only pay 1100 bucks. I’m talking about, let’s say, crowns and caps and whatnot. I mean, it doesn’t even cover a single tooth in many cases. But it’s free. So they’re coming to you because they think it’s free. The same person, like you said, who’s willing to spend—or who is spending—six to ten thousand on a vacation is, you know, nickel and diming you and not wanting to pay a cent.

Naren Arulrajah: Um, so you, you kind of—and the funny thing is, only half of America has, you know, an insurance plan. So the other half of the people are paying cash anyways. But we are so busy fishing in this overcrowded pond, where you don’t get the healthy fish, but, you know, this, you know, thousand-dollar, you know, like the capped fish, where there’s only, like—and they will only do dentistry that’s covered by insurance, right? Yeah. So I really think that’s what you need to start fixing. So the first step is to start attracting patients who are not coming to you because of the PPO plan. So how do people find anything today? How do they book their vacations today? How do they book—you know—find somebody to renovate their house today? How, where, how do they go and find a car to buy today?

Naren Arulrajah: They go to Google and they start researching. Are you showing up? You know, um, are you the one that keeps showing up again and again for anything and everything they’re typing in as they go around choosing the dentist? Remember, people choose everything else. And outside of this, people who are on PPO plans, they’re also choosing healthcare, right? I mean, like, I have friends who spend tens of thousands of dollars on healthcare—you know, all kinds of tests and all kinds of, you know, corner service and whatnot. So they are out there. People, especially when they get older—like, let’s say after the kids, you know, adults—they’re spending money on themselves, on their own health. Health, by the way, is actually going up in spending, especially discretionary health spending. It’s just that you’re not even trying to, you know, fish in that pond. You’re not even trying to attract those patients. And it’s nobody’s fault because you are the one who just—it’s, it’s kind of like, I have two pools. One is really crowded and dirty, and the other one is pristine and beautiful and big. But I’m just so busy, you know, fishing in the wrong—uh, wrong pool or, or swimming in the wrong pool.

Ben Tuinei: Right? Right. I understand that now. That’s actually a really amazing explanation of it. You know, it is—it, when I think about professionals in general, it’s so interesting that most professionals, in my observation, they don’t really, they don’t really spend most of their time doing the area of their profession that they are really good at or that they really love. You know, and that could be a function of, well, maybe most people that need the service that you know how to do very well are not finding you. So, so when you look at dentists—like, how does getting the right patient in the right treatment category that you shine at—how does that help a practice grow in a big way?

Naren Arulrajah: Yeah. I think, um, success creates success. Suffering creates suffering. You know, um, I know, uh, one of the famous quotes that made a big difference in my life is this quote, uh, from, uh, Stephen Covey. He said, "It’s not what happens to you that determines your future, it’s your reaction to what happens to you that determines your future." You know? And he, he talks about this, uh, idea, and I think he got it from Viktor Frankl, who’s a famous psychologist, you know, concentration camp survivor. You know, there is this small duration of time between stimulus and your response to that stimulus—that’s called free will. But 99% of us don’t exercise that free will. We react. I slap you, you slap me back. I take a knife and I stab you, and you take a gun and shoot me. You know what I mean?

Ben Tuinei: Right? Like—

Naren Arulrajah: It takes 10 seconds to say, "Oh, well, Naren slapped me, but is slapping him back the right response? You know, I see he has a knife in his hand, so maybe I should, like, take a second to, like, not do that." You know? I mean, so, like, we don’t do that. I mean, I—I mean, I’m giving you a simple example to make a point, but we—this happens day in and day out, where you get stuck in this rut and you continue to kind of go deeper and deeper into this rut. So imagine, you know, you had 30% PPO patients, and then eventually it gets to 70%. So eventually your team doesn’t know how to answer the question, you know, "Is it covered by insurance?" They say no. And then you don’t present an ideal treatment. You don’t go to the courses. You don’t have money to invest in technology.

Naren Arulrajah: So really, like, I think start fixing that problem and start, you know, um, you know, start attracting patients from some other source. So I would recommend, you know, for example, looking at SEO, because SEO, compared to all of the marketing techniques, it’s a fraction of the cost. So the first question is: if I’m typing in, you know, different things in your city—like, you know, dentist near me, dentist [city name], Invisalign—like, all the things you are interested in, are you showing up on Google search for free? Uh, and not just for one or two or three, but for hundreds of these searches. If you are not, that means you have an opportunity. Now, again, you can define it as a problem or an opportunity to dominate and get patients at a fraction of the cost. I know an SEO patient could cost like $60 versus a PPO patient could cost $500 a year, because every year you are doing double the dentistry to get paid half, right?

Naren Arulrajah: So— and then you multiply it by 10 years. So why spend, you know, $500 times five years, assuming the patient stays with you for five years, when you can spend $60? Like, start finding the root cause, the root problem, and then fixing it and get good at it. Get reviews from people, right? Because reviews are becoming more and more important when people choose you. And once you start changing that, once you start creating that success where the patients who want high quality, who want your training, who want your expertise are starting to come to you and pay you full fees—they’re paying you $10,000, $20,000 for a, you know, a big case—now you can, you know, invest some of that money back into your team, attract more people, invest it into technology, invest into, you know, um, you know, um, training, uh, so you can continue to up your game.

Naren Arulrajah: So it’s almost like you create this positive momentum where every year you’re making more money, taking home more money, doing more dentistry you love, increasing the number of people in your team you love working with—versus the other side. Every year the fees are getting cut, and you would do—you know, you have to make do with, you know, less money per new patient, and just the quality goes down. You don’t have a relationship, you don’t have time for classes, you don’t have money for classes—you know, education. So it just creates a negative cycle and it becomes like a, like, like, like a nightmare. I mean, we know that suicide is highest—or one of the highest—uh, places in inside healthcare is in dentistry, just because, like, you go down this wrong road and it, it kind of creates this, you know, like feeling of, uh, you know, overwhelm, where they feel like they’re stuck and they can’t do anything.

I really think that’s not the case anymore. Like, I mean, we—we have the Reducing Insurance Dependence Academy. We have more than, like, 1,500 doctors and practice owners who are on this journey of changing their lives. I’m not saying you have to get out of all PPO plans, but get rid of the worst ones. Drop the worst one, the next worst one, and then create options for you. Right? Do you want a life that you control, or do you want a life where somebody else is dictating everything to you?

Ben Tuinei: Hmm. Yeah. I, I, I like that, Naren. I think you hit the nail on the head there with your last comment there—having the life that you want. And sometimes it requires a lot of patience to get there, you know, but patience combined with the right process—you’ll get there much faster than most people, right? Which leads me to my next final question. This is all about marketing. It’s all about reaching out and finding the people that need the service that you’re really good at, that you want to do. You know, you might be good at other things, but you don’t necessarily enjoy doing them. And that’s the key in life—is spending your day working on something that feels like a hobby, you know?

So how do dentists know, in terms of this whole idea of marketing to get the right people that want treatment that you want to do, right? How do you do that? Like, how do you get your marketing to work in that way, Naren?

Naren Arulrajah: Yeah, absolutely. I think the way to, um, get your marketing to work is, you know, start analyzing your marketing, right? So one of the places I would start is I would start tracking: how many new patients are you getting from your marketing? If you’re doing ads and SEO, then how many are you getting from each method? And how much are you spending? So you start figuring out the cost of a new patient. Then compare that to PPO patients. We know an average PPO patient will cost you $2,500 because as long as they’re there with you, you’re paying half of what you make to the PPO plan in the form of a write-off.So of course, you don’t want to spend $2,500 a new patient—you want to spend as little as possible. SEO might cost you a hundred dollars a new patient or $60, versus Google Ads might cost you $400.

Naren Arulrajah: So start getting your metrics, figure out the cost of a new patient, set up call tracking, get Google reviews, and at the very least, you know, have somebody do—help you figure out where you stand. How are you doing versus your competition? And then come up with a plan. And we offer something complimentary. It’s called the Marketing Strategy Meeting, and the link is ekwa.com/msm.  So in that Marketing Strategy Meeting, we, um, you know, review you and your competition and give you kind of a, you know, strengths and weaknesses update. Plus, we’ll give you a roadmap for success. So book that meeting—insuranceuntangled.com/msm —and find out where you stand. And it’s complimentary, so you have nothing to lose except a lot to gain, because now at least you know where you stand, and you know, if you want to change your future, what you need to do—what are the steps you need to take.

Ben Tuinei: Yeah, I love that, Naren. I mean, I think about my day to day—when I was young in my career, I didn’t want to do certain things, and I spent the time to market myself so that people knew me for something else. Something else that I wanted to help people with, you know? And, uh, you know, what you just mentioned there about the marketing component is—it’s true. Like, a lot of dentists these days—and I can count thousands of them—that want to do a certain thing, and they position themselves on the internet: SEO, Google, you name it, advertisements. But they position themselves in a way where that’s all other doctors know them for, and that’s all what the community knows them for, right? So then naturally, they end up building a massive following of people and a referral network that feeds the kind of treatment that they want to do. That’s a very profitable area for the practice.

Ben Tuinei: So Naren, thank you for educating us on how to do that. I think that’s a very, um, important part of dentistry these days—marketing the right way. So, so thank you, Naren, for that. And thank you for all your insights. And I just want to take a minute as we wrap up this episode to thank our listeners for joining us on another amazing episode of the Amazing Insurance Untangled podcast.

If you liked today’s episode, don’t forget to share this with your friends and family on social media. We also appreciate reviews, ’cause that’ll help other doctors and team members find our content. So check out insuranceuntangled.com,  request the Marketing Strategy Meeting—just do insuranceuntangled.com/msm.  Naren and his team will most certainly get back to you to schedule those particular, uh, invitations to do that complimentary Marketing Strategy Meeting.

Folks, until we meet next time, we want to wish all of you best of success. Thanks for joining us today. We will see you next time. Take care.