Sep 7 / Dennis Hartlieb

The Dental Journey Toward Specialization with Dr. Jeff Rouse Part 1

Write your awesome label here.
Dr. Rouse's central research question was a simple one - why do people grind their teeth?

This led Dr. Rouse to a career of pursuing the answer to that question and what it meant for his patients and their treatment plans. Listen in to hear Dennis and Jeff discuss the significance of pursuing education and training opportunities after dental school, the struggle to pay bills while also furthering your education, the importance of taking a chance when opportunities to collaborate and to try new things come, what private practice looks like, and how to face challenges in dentistry head-on.
Dennis 00:02

Hello Dental Online Trainers. I'm Dr. Dennis Hartlieb. And I have a question for you. Have you ever wondered, why do people grind their teeth? I mean, really wondered. Well, if you're like my next guest, Dr. Jeffrey Rouse, you didn't do just wondering. See, Dr. Rouse took it to the next level. I mean, he wanted to understand, to truly understand, why people grind their teeth. And he didn't want to just take for granted the information that was taught to us in dental school. You could say, in fact, that Dr. Rouse became obsessed with understanding why do people grind their teeth? Now, this understanding of why people grind their teeth has led him down this journey into airway, or what we call sleep disordered breathing. Now, Dr. Rouse has so much information to share with us. He's been so generous in his information that we've actually broken this Sharecast into two separate Sharecasts. In the first Sharecast, we're going to listen to Dr. Rouse as he talks about his path in dentistry, and it's not linear. It's very circuitous. So for many of our young listeners, I think you'll find this super interesting about the path Dr. Rouse has taken. In our second Sharecast, Dr. Rouse is going to talk more about what it was like, and what did he have to learn, and the challenges that he had overcome, and what he knows now about sleep disordered breathing, and airway, and how it relates to us in our dental practices. So enjoy the interview with Dr. Rouse. I think you're going to love the information, and I think you'll be eager to hear the second part when he starts talking about his path into airway. Good morning, Dental Online Trainers. I'm Dr. Dennis Hartlieb, and welcome to our Sharecast. Today, I have the great pleasure of introducing a guy, actually, who probably needs no introduction, but actually, Jeff, I've got some great introductions for you today. This is my good friend, Dr. Jeffrey Rouse. Good morning, Dr. Rouse. 

Jeff 02:01

Hi, Dennis.


Dennis 02:01

How are you? There you are sporting your Bears t-shirt.

Jeff 02:05

I was actually up this morning working out and I was either going to be Royals or Bears.

Dennis 02:11

I was expecting the Royals. We're going to talk about that in just a little bit.

Jeff 02:15

No, Bears. This should be fun. Since y'all got Jay Cutler, I've been waiting for you to finally have a quarterback again. So, you might have something on the horizon.

Dennis 02:24

Well, he's a Buckeye. He's a Buckeye, so I really have some very split allegiances here. I'm rooting for the bears. But oh, that's really tough for me to root for a Buckeye. So I don't know. I'm torn. I'm really torn. I'm gonna...

Jeff 02:38

What is up with the hat? Is this little Hemingway-esque or what? Or what are we doing this for? Is it like...

Dennis 02:43

Well, you're one of your one of my fancier friends. So I thought I'd get fancy for you. So I put on my Panama hat just for you.

Jeff 02:47

I didn't know... I was wondering if that was like the signature for webinars or something. If it was like a logo or something...

Dennis 02:55

I'll have to get like a little feather or something in the side. Oh, speaking of feathers... So this is crazy story. This is off, totally off, of Sharecast information. But I have a cat. I'm not a cat person. But we have a cat. And so this morning, as I'm prepping for our little conversation this morning, my cat darts through the kitchen, flies against the wall, or against the window -- we have a big sort of a window -- and there was a bird in the house and the cat caught this bird in the air. And he was just sort of hanging on to it. He didn't he didn't kill the little lovely beast, and brought up to the bedroom upstairs, and got him to release the bird. I got a little catcher ready.

Jeff 03:16

A present!

Dennis 03:32

Got it in a little box, and freed it, and now our cat just has some feathers to play with. But speaking of feathers, there we go. I digress. All right. As many of our listeners and watchers probably know, Jeff is a prosthodontist on staff at Spear Education Center in Arizona. He is a prosthodontist. He is also a, I guess, an airway prosthodontist as, I think he refers some of his stuff to. But there's more. I did research, Jeff, and there's some things about you I did not know. So, can I tell you?

Jeff 04:05

Well, first, tell everyone I'm in private practice because everyone's gonna get the impression that I just sit out there and make crap up. Never done it in my life, so, but I am in private practice.

Dennis 04:15

We'll get to that.

Jeff 04:16

I am in private practice.

Dennis 04:16

He is. He does. He treats humans as it turns out, right? Mostly.

Jeff 04:21

Alright, so would you find out? I'm going to hold my breath.

Dennis 04:23

Here's what I learned about you. So it turns out that Jeffrey Norman Rouse is an American former competitive swimmer, a three time Olympian champion, a world record holder in three events. And so, how did you fit that into your schedule?

Jeff 04:36

I also... if you look it up... I played football for University of Arkansas.

Dennis 04:42

Oh, I did not catch that one.

Jeff 04:44

And I'm a prosthodontist in New York City who does bronze sculptures. All of us have the same name, who I get... who I, when he was in practice in Indiana, kept getting his bills from Novell Bio.

Dennis
04:57

Well, that worked out great!

Jeff 04:58

For him!

Dennis 05:01

You're such a giving person. That's so nice of you. Can I send my Nobel Bio bills to you?

Jeff 05:06

If you change your name legally!

Dennis 05:10

There's another Jeff Rouse, that I was unaware of, that I think that you are going to be pretty impressed with here. Can you see my screen?

Jeff 05:16

Oh, I did hear about him. Yeah.

Dennis 05:18

All right, not this dude. Because I think that sort of... you could pull off that hair, I think. And that this big dude in the middle. Hang on, you're coming up. There you go. See the good looking guy right there with the tats? Yeah, this is more your style. I heard about...Yeah, I did hear about him. Doing a little Guns and Roses cover. Yeah, you're all over the Guns and Roses, right?

Jeff 05:35

I... oh yeah? No, I'm good.

Dennis 05:39

Well, this is me and I brought this up because I think about you all the time, Jeff, so... Alright, enough of the Guns and Roses

Jeff 05:47

Yeah, I heard about him as well. You know, you occasionally... It's been years but like at the beginning of all your lecture careers and stuff, you'll occasionally go in and Google like your name just to see what is going on. You ever do that? Of course you do! Everyone does!

Dennis 06:01

Admittedly, I've done that once or twice.

Jeff 06:03

And yeah, I would get those, and then I'd spend an evening going through YouTube videos of him watching... it was good.

Dennis 06:10

Yeah, he's pretty good. Yeah, I enjoyed my morning, listening a little Guns and Roses and covers. So, alright, so neither of those are you. The Olympian and the musician, and the prosthodontist in New York -- you're none of the above,

Jeff 06:23

None of the above. Nor the running back for Arkansas. I'm not him, either.

Dennis 06:26

So Jeff, let me give a little bio on you, and you can fill in the gaps here. So this is going to be a two part interview with Jeff because in this first part, I want to talk about your your background, you know. I actually remember being a young dentist, and I would see these veteran dentists who were on the circuit, they were lecturing, they were teaching, they were a great influence. And it was hard to imagine what they were like, as young dentists, you know? As they were, like, mere mortals. You know what I mean? I mean, I remember, like, I would go to the Drake hotel for the Restorative Academy. And I would go down to the bar. This was before I was ever a member, and I was this young dentist, and I would just go and I would just hang out and Le Coq D'Or, the Golden Rooster, the bar down at the bottom. And I'd wait for Spear to come down and for Dawson to come down and all these these, you know, epic, signatory dentists, and you just can't imagine that they were they were just regular people. They always were just... I put them on such a high pedestal. So, I think it's kind of nice for for our listeners, especially our young listeners who aspire to do some great dentistry and stuff, to sort of hear some about your past.

Jeff
06:27

Well let me let me throw a line in. There was a... Tom Colquitt when he accepted the presidency at the Restorative Academy, his dad had been president. And his dad took him the first time, and he was looking around at all the famous people at the time. And his dad said, just remember, essentially... I'm going to screw the lineup, but it's something like, "the more famous they are, the nicer they are."

Dennis 08:08

Oh, interesting.

Jeff
08:09

And it's true. I mean, for the... I mean, there's always jerks. Yeah, there's me. But it's true, though, if you think about all those people, when they finally met you, and you talk to them, they're like the nicest... They're not only the nicest people; they're always... they typically are funny, most of them have a really good sense of humor. But, all of them want the young dentists to be them. They all want that. And so as a young dentist, I remember doing exactly the same thing. In fact, the first time I went, Penn Jackson was showing like... saying hi to people as they came into the back door at the Drake as they were going in. And he kept introducing me. And I was like, "Oh, my God, I use that guy's instrument! And I do this, and I met him, and I read his textbook and blah, blah, blah, right?" But all those people want you to be them. And they work. They'll do whatever it takes. And that's the part I was missing. Because I felt like I was going to interrupt them, but they really want that. So now when you're sitting at the bar, and they're going, that old guy over there looks a lot like Dennis, Dennis Hartlieb's picture on Google...

Dennis 08:12

There's you! Yeah, I get it.

Jeff 09:30

No, wouldn't bug you at all to have them come up. I mean, if they're really driven, you can feel it, and if they're driven enough to come talk, holy crap! I'm all in. I love that! Yeah, I do, too. Anyway, tell people more about me now!

Dennis 09:47

It's funny, because I want to talk a little bit later about Frank Spear's presentation, talk about influencers and stuff at the Academy of Aesthetic meeting in San Diego a few years ago, but we'll come back to that. So let me just get into this. So, I want to talk about your history, but right now, currently, you're on staff... you're a -- what are they calling it?

Jeff
10:08

Resident faculty.

Dennis 10:09

You're a resident faculty at the Seattle Education Center...

Jeff 10:13

Spear Education.

Dennis 10:14

At Spear. Spear Education Center. Sorry, I'm getting nervous talking to you, Jeff. You have this effect on me. You are in private practice in San Antonio, correct? And in Seattle? I've lost track.

Jeff 10:26

Greg and I worked together for two and a half years...something in that range. And, yeah, it was just a long commute. A long commute. It was like my north side and South Side practice was a long four and a half hour flight.

Dennis 10:42

I'm going to be late for that two o'clock patient, I think!

Jeff
10:47

We did... I mean, if we were talking about dentistry, during this,

Dennis 10:51

We might

Jeff 10:51

Actually, the thought process evolved during that time. So, it was absolutely worth that effort.

Dennis 11:00

Yeah, I want to get to that in a little bit. Are you still on staff at UT San Antonio?

Jeff 11:05

No.

Dennis 11:05

Okay, so you, you were previously an adjunct professor there. You've written a bunch.

Jeff 11:10

I'd like to, interestingly, you know, it's funny that dental schools are... It's strange, because I would mind going out there still and being involved. They seem like they're getting, like, more difficult to work with over time. I don't know what you found at Marquette. But they weren't open to ideas coming from the outside.

Dennis 11:31

Yeah, I think that's challenging for a lot of the schools. Yeah, I don't know. I can't answer that. Yes, I would agree to that. And why? I don't know. There certainly is a lot of pressures for all the material they have to present to students. And I when I talk to students, I say when I was in dental school, back in the 80s, we had to learn an inch of material a mile deep. Today's students have to learn a mile of information an inch deep, because there's so much more for them to learn. So I do know these dental schools are very challenged to get in everything from analog to digital to, you know, pross and implants and everything that you know, in the cinema.

Jeff 12:07

And my demand is that if I'm going to come work with them that I need time, so I at least need a half a day of their time, if not a full day. So that's probably the reason.

Dennis 12:16

It's tough. You, back in the day, and we'll get to this a little bit... You taught and wrote a book with Dr. Bill Robbins. He was a wonderful dentist, and you guys taught and you wrote on global diagnosis. I think you're sort of ripped us off from Frank Spears' Facially Generated Treatment Planning, just saying... no, just kidding.

Jeff 12:35

In the intro, we give him credit.

Dennis 12:37

I know. And you do. And I think you guys have sort of taken that facially generated treatment plan and sort of put it on steroids you guys about a lot of quality stuff that I never thought about when I... after going through Frank's facially generated treatment plan. Jeff is a member of the American Academy of Restorative Dentistry of which I am also a member, one of the awesome organizations out there. Jeff, fill in what I missed. What other details do they need to know about you?

Jeff 12:59

Cliffsnotes is I left dental school. I went to dental school without a clue and left dental school with barely a clue as to... I honest to God didn't know what a dentist did when I went to dental school. I was going to be a physician and a buddy of mine said, "Do you want to take the DAT?" Because I obviously wasn't smart enough to be a physician, and I took the DAT and got into dental school, and the guy said, "Make Cs, and you'll get out of here." And I was like, "I can do that." So, I met Bill the last year. Well, he was teaching our, like, gifted and talented dentists, whatever they were called.

Dennis 13:31

You stuck in the back door?

Jeff 13:33

And no, no I... yeah, he just let me go to their lit reviews, just as a thing. And because of that, then I realized I needed more training. So I went to a two-year GPR in Connecticut.

Dennis 13:45

Now I wanna ask you about your dental school experience just sort of briefly before we go on. So, I think it's so interesting. There's so many people who end up in dentistry where it's sort of maybe circuitous or just sort of happenstance and end up getting into dentistry, right? You hear it all the time. So when you're in dental school and stuff... Can you can you sort of think back to that time because we have a lot of young listeners, and I think there's a lot of people who, like you said, were in dental school and sort of just didn't have a clue because that's sort of how I was, too. I couldn't put the pieces together when I was in dental school.

Jeff
14:16

My mom hated dentists. I went to dental offices, maybe four or five times my entire life. I did not go to a dental office and shadow them before I decided to go to dentistry. I went to physicians' offices and shadowed them and hated every minute of it. So I knew I didn't want

Dennis 14:32

What did you hate about it?

Jeff 14:33

I hated the fact that they only spent a few minutes... and this is back in the 80s.

Dennis 14:39

Right?

Jeff
14:39

So today it's worse,

Dennis 14:41

Worse for sure.

Jeff 14:42

But they only spent a few minutes with people, didn't really know anything, and were treating the thing of the day. I just couldn't see... and I went to different ones, and they all had kind of the same pattern. Hey, how you doing? What's the matter? Okay, here's a pill. Yeah, what are you doing? What's going on? You know, and it was... I just was like, God, that'd be boring. I want to spend some time with people. But I didn't even think about dentistry. I remember I was gonna go, I was thinking three years medical school, my fourth year would get the, you know, medical school would be credited towards my degree. So I'd get my degree and go to medical school and be done. Then going into that summer, I went and did all this shadowing; I went I don't want to do this. And honest to God, my grades were horrid. So there would... I probably could not have gotten in. Let's just go with I couldn't have gotten in.

Dennis 15:32

We'll play that card. You maybe...

Jeff 15:34

So I was walking around campus and I looked down below a building where there was a lab and the guy was in the lab with test tubes and beakers and crap and I went, well, that would be boring. I don't want to do that. And then I went, Well, how about a high school biology teacher? I thought, well, geez, that'd be really awful. And then like I said, my buddy said, you know, I'm taking the DAT this weekend, you want to come down? On the way he gave me the booklet to study. I studied it on the way down, took the test, apparently did well enough to get into school, because I got into the two schools I applied to and showed up at dental school and the guy said, C equals DDS and I said, I got that. So that's all I shot for. Just be the middle.

Dennis
16:13

You were at A&M for your undergrad? Yeah. So it's so funny. And I... it's unfortunate how the challenges to become a dentist today are so so much greater than when we're in school, right? Well, you know, it's funny you talk about just sort of showing up at the DAT. I remember when I took the SAT in high school, I had just went out on a bender the night before, woke up in the morning, grabbed two number two pencils, and just went and took an SAT. And in today's world, you know, there's years of preparation for the SAT. And in today's world, there's, you know, at least a year preparation for the dental admissions test.

Jeff 16:15

Yeah, they got to do all kind of... I got a kid that came through the office and had to do a whole bunch of hours in my office. And I mean, it's... No, I wouldn't, I couldn't have gotten into dental school today.

Dennis 16:58

And I feel the same way. I mean, I started

Jeff 17:00

And world would have missed me.

Dennis 17:01

Yeah, I know, right? Exactly. Well, no, that's a truth. And that's the crime of it all is, right, is that in in our efforts to get higher grade point average students -- and nothing against them, they're awesome -- but there are people who maybe could offer a different feist to the dental world that are going to be super challenge getting in and with the curriculum as they are today. And, you know, the challenge of getting into schools. But yeah, no, that's really interesting.

Jeff
17:26

And I talk to my kids about it all the time. I've been incredibly lucky at running into the right people at the right time. So Bill happened to come into my life, my senior year of dental school where I didn't... I honestly didn't have a clue what I was going to do next. I didn't know what running a practice was. I didn't know anything... I was like, I would have gone to graduation and then gone. Hmmm... What am I gonna do now? With my DDS!
So Bill came into my life, and I realized I needed to know more. The difference is, I have never been afraid to just do something. Like, okay, let's go to residency. One year? No, let's do two years. And you know, just like going up and practicing with Greg and Frank up in Seattle. It's like... Greg said, one day I was sitting in the back of a car, and he goes, "I've got so many patients, I need somebody in the office." And I was like, "I can do that." Actually I texted him about an hour later, and I was like, "you know, I can do that because it'd be really cool to have, you know, to kind of work through this material with you.How about I come up?"
I mean, and I just left. I would go back and forth every other week.

Dennis 18:39

Quite the commute!

Jeff
18:40

I've never, I've never been afraid to just do some... Well, and then the next part of my history is I went to the residency, I practiced for 12 years. And then I realized if I was going to really have an impact, I needed the specialty certificate. Not that I could do necessarily better dentistry or anything else, but it gives me an automatic credibility when I speak.

Dennis 19:03

Yeah.

Jeff 19:04

So when I stand up, when you say you're a prosthodontist, you know, Jeff's a prosthodontist, blah, blah, blah... I don't have to prove to the people that I know what I'm talking about. It's given. Now it doesn't mean that it's right.

Dennis 19:14

Nope, it just what it is.

Jeff 19:16

It's just the reality of me standing up with that certificate. And so Bill and I had been together and writing textbooks, and I'm in the restorative Academy already. So I'm doing pretty darn good without a Prosth certificate. And yet, from 2000 to 2004, half day, I would go to Prosth half day, I would run my practice, and then I go and work in the lab all night long. So I put in four years that were really, really hard in order to get that certificate. So I've never... I've always... when I've gotten a lucky break. Bill is in my life. Bill wants to come practice with me. Bob Cronin allows me to come back to a residency. Greg Kinzer says, "Come practice in Seattle." I've always said, okay. I've never been afraid of it. And I think that's the difference. And it's seeing you walk into the bar at the Restorative Academy, the person that isn't afraid to come up and talk to you and take advantage of that. There are advantages to that.

Dennis 20:19

Yeah, there's no doubt. I think, you know, it's interesting. I, I toyed with the idea of going back for my Prosth degree at Marquette, and ultimately decided not to, but for a lot of the same reasons that you talked about, some of it was with teaching, some of it was with patients, you have this immediate credibility. In our community, we did.

Jeff 20:40

Oh, you did? Okay.

Dennis 20:40

Yeah, we had a number of prosthodontists that were in the community where I was practicing. And so for some of these... And so it would put you on there. Yeah, because they'd come in and say, well, what's the difference between you and Dr. prosthodontics? And then I'd have to say, "Well, my training is after school, theirs is during school," you know, stuff like that. I don't know that it changed the trajectory so much of what I'm doing, but what would you... What advice would you give to people who are thinking about going back after they've been practicing? Because that had to be a big decision. I mean, I know it's a big decision to go back.

Jeff 21:10

I cut it... I got... Once again, I got lucky, though. I didn't have to sell my practice because I couldn't have done that.

Dennis 21:15

You had to make money. You had to make money so you could do your residency.

Jeff 21:18

Yes. So the ADA allows part time residents, and they also allow you to get credit for experience. And so once our pediatric program here, a pediatric dentistry residency program, would take in like three and a half residents a year, and I met one of the half [people]. And that's how I knew about it; I knew that it was allowed. So I went and talked, for a year, I talked to Bob Cronin at San Antonio, about that opportunity. And after a year, he said, "Well, apparently you're serious, because you keep talking to me about this. Alright, let's do it." The other part that had to occur is that I had -- because Prosth is three years -- and I had to get that last one forgiven that last, which would be two years, right? Because I'm not doing six years. I'll do four, but I won't do six. So at the end of four years, here's the scary part, you then have to apply for it. You don't know going into it that it's going to be forgiven. So anyway, he had to... He did it. Once again, just the right person giving you a lucky break. But you saying, "Okay, I'm there. I'm doing it." I think that's important. That's an important [part.]

Dennis 22:34

What would you advise people? Someone who's like, yeah, that was the question. I was talking more about me! I know, I know. But let's help out the others!

Jeff
22:43

Well, I guess the first thing is I think you have to realize that dental school just teaches function and biology. So you were talking about facially generated treatment planning, so aesthetics, function, structure, and biology. Dental school is just about structure and biology. And so you will always be a tooth dentist, if all you do is leave it at that level.
And so you really have, what you said, a couple of choices. The choices are do I learn this through school? Or do I learn it in a continuing education environment? I find at the very beginning of careers, learning it in school makes more sense, because financially, it makes more sense. And once you get out, you're going to have to start repaying bills, and you're going to have financial constraints that are going to limit your ability to really evolve quickly. So the advantage of going to residency isn't necessarily the... it's about speed. I mean, you can get it, get there either way. I just think it puts you on a faster track. And you get, in a couple years, what would probably take you 10 to do through a continuing education route.
Dennis 23:59

Yep.

Jeff 23:59

Now down the road, you're both going to come to the same knowledge base. I mean, a rehab done in your office and in my office are going to look exactly the same. We're going to do the same thing. But you know, you said the doctor prosthodontist down the street just got there quicker. Because they did in school, and you had to evolve through it. And then you had to find the cases to do it. And you had to talk the people into doing it, right? As opposed to the school where they're coming to you to do it.

Dennis 24:25

Exactly.

Jeff 24:26

So you have opportunities for cases, you have people to mentor you along the way. It's just a better environment to learn and you don't have the stress of paying bills, you know, and the family and all the other stuff that you're dealing with. So I love residency programs, if it is feasible for you to get there. The problem, once again, today is I probably wouldn't have gotten into the residency program. I mean, they're really hard. Now I let me... I'll put a caveat in there. I think the best prosthodontists in the world were general dentists for a while. I, in watching myself in comparison to the people that went through with me, I got more out of it because I didn't have to learn to prep and impress and...

Dennis 25:12

Yeah, right.

Jeff 25:13

I had that part. I got to focus on the things I was weak at doing -- removeable in particular I wasn't good at -- so I got to focus on those things. And I got to focus on the more intellectual part of it rather than the mechanical part of it. So the military -- and it's not true today, but it used to be -- the Air Force, especially, you had to go three to five years in their General Dentistry before you could apply to go back into Prosth.

Dennis 25:42

Oh, interesting.

Jeff 25:42

And that's why those guys that came out in the day, they were so freaking good. Because they had already done it a while and now they're really focused. So I think that's good. Now it doesn't necessarily apply to other residencys, though. It's not like you're going go out and do a ton of Ortho, right? I mean, although I love working with specialists that have been restorative dentists, like they understand me better Yep.

Dennis 26:09

I think that's absolutely true. It's people that I get to work with that had a GP background, they get that GP experience. And I think also during the residency later you are -- you should be -- most likely more mature. Right? And I think then it gives you a much different set of eyes.

Jeff 26:23

You should be! You and I?

Dennis 26:26

You should be more mature! You did a GPR at Connecticut, right? You were up in Connecticut for your GPR? First of all, why did they let a Texan into Connecticut? And did they give you police escort on the way out when they finally got you out of there?

Jeff 26:41

It was a good program. It was really good. It was actually Harold Lowe's Cariology Program for years. Okay. And then it had to evolve because you couldn't get... I mean, as the ADA had all these requirements, cariology isn't going to going to qualify, so they evolved it to a GPR. And then the coolest thing happened. Once again, I just kept getting these really lucky breaks. In 1984, implants, endosseous implants, from Branimark are introduced in Toronto at the Toronto conference, right? So now, in 84/85, they start spreading through the US in schools. San Antonio happened to be one of the surgical sites; Connecticut happened to be one. In order to do implants at that point in time, only oral surgeons can place them and only prosthodontist could restore them. Well, Connecticut got the ability to do the surgery. But they didn't have a Prosth program. So they had to your GPR, though, and they brought a prosthedontist in to run it. That was their workaround. And so I went and did a two year GPR that was a Prosth program. And so, we didn't have all... we had very little lit review. We were just cranking out the dentistry. And, you know, occasionally I did general anesthesia and I had to do some hospital stuff, but it was pretty much a Prosth program. So when I came out, I spent a year and a half working for a periodontist here just doing implant rehabs day in and day out.

Dennis
26:49

Oh, interesting. Oh, wow. So that's a great start. So I was going to ask you about that. One of the big challenges in today's world, especially, though it was certainly when I got out, is getting into practice and stuff. Obviously, there's different pressures today, you know, DSOs, and different types of practices, insurance type built practices. Those are all, you know, pressures on young dentists coming out. So when you came back from Connecticut, and you went back, you went back to San Antonio, correct?

Jeff 28:37

I was going to buy a practice in Houston. I had already made arrangements to go visit with the people on Monday morning. And I talked to the guy here in town that was a... he was a periodontist, a famous periodontist. And he had done a set up a practice where he decided I don't want to... these implants are so new, and the people working with them, my restorative dentists, are ending up messing things up for me. And so I'm going to just control everything. So he brought a restorative guy in, and that guy was leaving, and he needed somebody else. So the weekend before I bought the practice, he offered me an opportunity to do that. So, yeah, so I did blade implants. I did designs for blade implant companies, in fact, for some of the Prosths. We did subperiosteals, we did ramus frames, we did... I mean, we did all kinds of... and then we did endosseous, and I designed a few implant company prosth stuff as well. So it was cool.

Dennis 29:32

Then you got off, and you started your own practice?

Jeff 29:34

I bought a practice, yeah. I bought an existing practice. Yeah, but once again, I keep catching these breaks. This guy was very into... And this was in the day when the the interest rate was 10%. And so the dentist would fund a chunk of it like 80% of it or 50%? I can't remember; it was a big chunk, though. And so you would pay them 20% down and 80%, whatever. So they had a desire to make sure the practice ran well, right? So for three months, he came in full time every day and sat with me and went through stuff. He did ortho. So he showed me how to do that. Did you work with someone at that time? When you bought practice? No, I didn't. So he walked out and you walked in?

Dennis 29:45

Cool.

Jeff 29:53

And then, for three months, he would come in once a week and go over things with me. And the nice part is he directed me where, you know, you need to go here for continuing education on case presentations, you know. You need to go here for the ortho, you need to do this, you need to do that. And he had his office set up the way that Bob Barkley had talked about. I don't know if you remember

Dennis 30:43

For those who are not familiar with Bob Barkley, he was an out of the box thinker in dentistry in the in the 80s, right? I think that's when Bob was... 70s and 80s?

Jeff 30:55

70s and 80s, yeah. So it was about co-development, co-discovery... A lot on, you know, involving your patient in evolving their dental health. He also had a bunch of hygiene kind of things as well. His big deal with coat when you ever hear co-something discovery in particular, that was Bob.

Dennis 31:18

He sort of changed dentistry from the dogmatic the dentist says you need, you know, you need two crowns, and you need, you know, whatever. Bob Barkley was about how to bring the patient into the, into the discovery of their needs, and help them sort of almost sort of design their treatment, right? Because it's based on their, their needs, desires, wants, stuff like that.

Jeff 31:39

So he had a practice set up on that philosophy, and there was a lot of the hygiene component to it where he had, actually, a little room set up for hygiene. It was a really cool system. But he also had the whole office wired for video and sound, so that he could listen to how his staff talked to patients later. And they could review it at staff meetings. Now, this would be a better way to say that. And it was really good. But he would listen to my case presentations and do the same thing. And I was open enough that I saw that as a huge opportunity rather than what you know, being critical. Yeah, it was really, I mean, I just, I keep catching these breaks, but being able to be open to it, I think is the key.

Dennis 32:22
When I was a young dentist, I would have my staff sit outside my operatory, on the sort of against a wall, and they'd have a little clipboard, and I had my assistant in my front desk person. And every time I said like a dental term, like the papilla, they would make a like a little check, right? And anytime I would like talk over the patient, I'd interrupt them, then they'd make a comment and stuff. And I would have to pay them. So I'd have to give them money, for like $1, every time that I said, like, you know, like gengiva or papilla or occlusion, I'd have to pay them. And so it was my way to sort of train myself to, first of all, learn to listen to the patient, but also talk in a non-dental vocabulary with the patient and bring them into the conversation. So I didn't have the advantage that you had, but we can certainly make that work in our practices, if we bring in our very skilled listeners who very often are not the dentist, but everyone else in the practice, you know? That's a great opportunity.
What challenges did you have then? You got into your practice... And I love asking this question, Jeff, because there's so many young dentists who are buying practices, or taking over practices, and they I think, very often feel like they're unique in some of the challenges that they're going through. What what do you remember as being some of the tougher times, the challenges you had?

Jeff 33:36

Managing staff. Firing somebody for the first time. I mean, my associateship wasn't fun, because I had a wife, his wife, the other guy's wife involved in the process, and they kept changing the the contract and stuff. So I've dealt with the bad business challenges. On your own, though, the nice part about being on your own is they're your challenges and your solution. I love that about dentistry. So I had at one time thought it'd be neat to go back and run a Prosth program. And then I realized that somebody else would be telling you what I can do and what I can't do and how I can do it. And I thought, "Well, that isn't going to work." And so, I don't know, you know, challenge... challenge would imply that, I mean, it's kind of out of my control in many ways. And I think in dentistry, we've got a lot of difficulties that we have to work past, but if you're running your own practice, right? So that's been my perspective, the whole time is yes, I've had to fire people. I've had to deal with shitty patients. I've had to deal with an office that leaked and had black mold in it. I've moved to a new location, I've had to deal with horrible landlords, but they're always mind challenges. They're always things that are still... that I can deal with, and I can move on. I had to deal with sitting out eight weeks to the Coronavirus, I mean. But I mean, at the end, we had a great year last year. We had a better year than we needed the year before because it's my challenge, it's my thing, it's my opportunity to do something different or see something different. That's what I love. I love that I can make that choice. So if I was to say, what's the biggest challenge in dentistry, it's to somehow get yourself in a position to control your own destiny. That's the biggest one!

Dennis 35:27

Don't you think, like as dentists, that's sort of how we are, right? We like controlling the outcome. Right? I mean, that's...

Jeff 35:32

You know, I would say that until I, there are until...

Dennis 35:37

Until airway!

Jeff 35:38

Yeah, until airway came along. No... until... I am spending a lot more time with... Out at Spear, a really cool thing is happening, which is that the average age of our dentist is getting really young. Amazingly young. Like just graduated young. And there are a group of newer dentists that don't see running a practice in the future. That's not their world. And that's different to me, that's something that dentists, when I came out, that was the goal. It was like, how can I figure out a way to run my own practice, or put it together a group where we run it together, but it was always this, I want control. And I can see the younger dentists' point of view. I mean, I get it, because they don't... you know, like, they can go, Well, Megan's not doing her job, and somebody else gets to deal with that stuff. They got to go home, and the paycheck arrives. And that's cool. I get it. I would hate that, though. Just my gut would hate that. Because the price you pay for that degree of security is the lack of the... my son got married in Turkey, just a couple weeks ago, and it was a last minute, kind of [thing] with a month and a half notice. Like, we decided to do this, the Corona thing is cleared up, and we can make it happen. A month and a half from now, we're going to Turkey; can you come? And I go, Yeah! Here, let's block those two weeks off.

Dennis
37:15

Don't have to ask anybody.

Jeff 37:17

We're out of here. So, I got to just shut my office down for two and a half weeks and leave. And you know what? I'm the only one that had to say it. No one else. I didn't have to run it by anybody. I didn't have to deal with that. I haven't ever worked Fridays. I don't have to ask anybody for that. I just decided it. If I want to go back and put airway protocols in, I just do it.

Dennis 37:39

You just do it!

Jeff 37:41

So I think that if I was to say what the biggest challenge is, I would urge... Oh, and the other thing is, in order to evolve your dentistry, you have to have control.

Dennis
37:51

Oh, for sure!

Jeff
37:52

I don't think or I don't think that within a corporate setting you can evolve to do the dentistry. So if you watch... I mean, if somebody is sitting in the audience watching what you do, and they want to do that, if that's really where they want their dentistry to go, they have to have control. They've got to have control, or at least partial control; it's got to be in a group of some form.

Dennis 38:13

You know, what I've seen is I've seen -- because I've been teaching for so long at Marquette -- and so I still keep in contact with a lot of the former students... that a lot of them will go into a DSL or some sort of group practice, but because of that lack of control, ultimately they slide and pivot, and they start looking for their own practice because they want to have that control. It's certainly not all of them, but I think there is that sort of experience where like, I want to do more of this type of stuff, but the practice that I'm in, it's just not designed for that. It's not going to work in this type of practice. And if they... they come to the realization that if they want to do that, they have to have control, and that's forcing them into looking at joining into a smaller practice or, you know, a smaller unit type of practice where they more control, or buying their own practice. So I've seen that.

Jeff 38:58

The hard part, the hard part is -- it's my life, which is, an opportunity is going to come up, and you've got to be brave enough to say, okay. And that's tough, especially when you got when you've got... we always talk about student loans, but Geez, you've got a car payment and a house payment. You've got, you know, [my] wife just told me she's pregnant again, or whatever. I mean... And it's even tougher on women dentists.

Dennis 39:26

Oh, without question!

Jeff 39:27

I mean, because now you've got all these other societal pressures and stuff that are crazy and that they have to deal with. So I don't... Yeah. I hope more young dentists get the message that they ought to be on their own and out of that environment because I think there's such joy that comes from control.

Dennis 39:50
Well, it's the Yin Yang, right? There's the Yin Yang is that yeah, it's great. There's all the pressures of owning a practice. There's all the stressors of owning your practice, but ultimately, it's on you. What's great about dentistry, I think, is that there's so many opportunities to figure out how to get it fixed, right? So study clubs, other dentists to talk to, consultants, you can get these things fixed. And as long as you don't get into a situation where you feel like you're alone, that you're stuck under a nutshell, and it's hard to see your way out of it, as long as you're open to talking to others, and understanding that you are not alone -- in the situations that every dentist is going through, every dentist has gone through before, or not every one, but certainly most of us have gone through!
Well, that's kind of that right? Unless you're sort of doing things that are irresponsible to yourself or to your practice, that's typically not going to happen. But for... I mean, I was certainly in that position. Also, I think this is important for people to hear is that without question, there are months where I just wasn't getting paid. When I built my new practice, I went a year without paying myself when I built my new practice because I was putting everything to pay down the debt on the new practice. And we just tightened our belts, sucked it up, and everyone in the office got paid except for except for Dr. Dennis Hartlieb. But, you know what? I had control of that. That was my decision. That's what I needed to do. It was my decision to build the practice and all that. So, I think it's wonderful, but it's not without those type of stressors. But in the end, we get to control things. And I think for people like us, who want to have control, I think that's what makes it so, so beautiful.

Jeff 40:32

Yeah, maybe I'm disconnected with the world of dentistry, but I don't hear of a lot of foreclosures on dental offices. I mean, I think it's like once you get in there, yeah, you may not have a good month, and you may have difficulty... I mean, I've had to, for years... I mean, I was one rehab away from not paying bills. And if that one canceled, I'd have to go, well, I guess I'm not getting a paycheck this time, or you know, I guess Patterson Dental is going to have to suck it up because I can't pay that bill off. And I've done that a lot. I mean, I've juggled who I'm paying this month A LOT. But I still had control over everything. And I still was happy to... It was a good experience. So I haven't heard of anyone that got into situations where they were juggling this bill and juggling that bill and ended up having to go file bankruptcy. And that just doesn't come up much in dentistry unless they do something incredibly stupid. Yeah. And you get to do this stuff that's fun, too. You get to do dentistry that's so... it's challenging, and it's complex, but it's so much fun. And you don't get that opportunity otherwise. I mean, I see all these brand new dentists coming to Spear and when I hear about their stories, and they're involved in organizations that I know they're going to go home and just get frustrated because they can't use. And they're sharp; they know... I mean, they get it. They get the material, they understand what's going on. And then they go home and they're like, you know, I can't do it. And so I'm hoping that we get a little bit of a pendulum swing more towards a bunch of dentists now start coming out of those environments and seeing that there's something better that can be done. And people want that. I mean, they're in a group... I actually love the fact that there are corporate dentists near me, dentistry groups near me, because those take the patients that I don't want in my practice, you know? I don't have time for those people. I want the people wanting the next that I can educate and evolve and do the next for. So I've never been challenged by those group people. It's cool.

Dennis 43:57

I agree. I think those, the DSOs and practices like that, I think they serve a population that wouldn't fit well into my practice. And that's awesome. And I think they give young dentists an opportunity to get a job, which is absolutely critical, given the amount of debt that they have. And I think there are many DSOs that are working really hard to do things in the right way and have an education for their young doctors and stuff. So I have no no problem with DSOs at all. I think that for the individual dentists, though, you have to figure out if your end goal is going to be satisfied in a restrictive practice that I think most DSOs are going to have to be in, or do you want to push the envelope, start learning more, and be able to create more opportunity for your patients. And I think that's what general practice ownership provides for people. And I guess everyone's going to decide for themselves, which I think is ultimately what's awesome is that you have multiple pathways you can choose, and, you know, owning your own practice with its ups and downs, heart aches, and, you know, and love and fun and stuff like that, it's just part of the whole game. And so I, like you, I'm optimistic. I think that there's going to be... there's a pendulum swing. And I think it's going to swing into somewhere more in the middle, where there's going to be many dentists that are in big group practices, but there's still gonna be a bunch of us that are doing our smaller practices, more boutique practices and providing for patients that are at that level.

Jeff 45:25

I need that because I want to sell my practice at some point.

Dennis 45:28

I think they'll be there.

Jeff 45:38

I need somebody to buy it.
So your question was challenges, and, honestly, it tends to have a negative connotation, a challenge, and I loved it. I think private practice is amazing. And yes, I, you have things that are more difficult, days that are more difficult, but I just, I've always enjoyed it. I'll tell you what I hate about private practice is HR.
Dennis 45:49

I hate doing human resources. I do you know, and thank God for my partner, Chris, because he's okay with it. I don't know if he loves it, but he's okay with it. And so he'll do it for us, but I am no good at it. And I don't like it... I'm no good at because I just don't like it. I don't like worrying about that stuff.

Jeff 46:06

I just don't talk to my staff. And, you know, if you never talked to them, then you have no HR concerns.

Dennis 46:16

All right, everyone, get out your pen and paper here. You're going to need to write this down. This is from the mouth of Dr. Jeffrey Rouse.

Jeff 46:22

That was back in the day when you would go it's, you know, it's Thursday afternoon. That's our Friday, let's go have a drink together. And no, we're done with that. In fact, if we have to talk, that's problematic.

Dennis 46:37

Alright, so Jeff, here's a problem is that we haven't even started talking about sleep stuff. And we're way... I know. I'll come back. We'll do another time. So can we do this? Let's, we're gonna take a pause. And then we're going to do a part two because I think we have to talk about some airway before we let you go. So Dental Online Trainers, meet up with us with the next episode. And we're going to talk about airway. And I want to learn about the Seattle protocol. I want to learn about the stuff that you doing at Spear. And that, I think, will be a good conclusion to our conversation because I can't let you go without talking about that stuff.

So Dental Online Trainers, we'll see you at our next session when we continue this conversation with Dr. Jeff Ross. So we will see you at that next meeting. Well, thanks so much for listening or viewing our Sharecast today. If you enjoyed this information, and you want to get more information from Dental Online Training, then check us out at DOThandson.com. That's one word. DOThandson.com. Or check us out on Instagram, or Facebook @hartliebDDS. And be sure to share this with your friends and colleagues who you think might be able to get some great information from the Sharecast that we've shared with you today. Okay, until next time, I'm Dr. Dennis Hartlieb, yours for better dentistry.



Dennis Hartlieb, DDS, AAACD

DOT Founder

Join 3,000+ dentists who get monthly restorative dentistry tips

Share this page

Latest from our blog