Overcoming Difficulties Starting a Dental Practice

In 1976, Dr. Feffer started his own practice from the ground up knowing he wanted to head in his own direction. Although he had all the knowledge in dentistry, he was unsure how to market or run a business. Not wanting to compromise  quality and consistency, Dr. Feffer, used Keating Dental Lab from the beginning. He soon learned that he needed to be proactive about growing his business and came up with his own marketing strategies that have made his practice successful.

Full Transcript

Shaun Keating: Hey everybody. I want to welcome you to this week’s Dental Up podcast. Thank you for tuning in. This week, we have Dr. Howard Pheffer from La Mesa, California. Dr. Pheffer, it’s great to see you man. That’s awesome, dude. We been … How many years we been together now?

Dr. Feffer: We started in the early ’80s.

Shaun Keating: Like 30 years and I just … God, I remember you. Back in the day, I worked at another lab, but we don’t want it to say now. I worked at this lab and used to call in and it’s just … You really got us, you know, back in the day, we started doing big cases together and kind of cut our chops together. But thank you so much for coming down. I really appreciate this, and thank you so much.

I’d like to start off talking a little bit about sports. I’m a big sports guy, but we’ve got this March Madness. We have a pool that we’re doing here at Keating Dental Lab and I’m actually in like 11th place. I’m not doing too bad for not knowing what the heck I picked.

Dr. Feffer: It’s a lot of luck involved.

Shaun Keating: It’s a lot of luck. We actually … did you even know we were doing a tournament? I could’ve probably …

Dr. Feffer: Oh yeah. No, I’m a big sports fan, too. Huge.

Shaun Keating: We have $100,000 thing we were going to do if you get a perfect bracket. You know how hard that is. So the first day that was kind of off, but you get like … we have different prizes, like $3,000 for first, $2,000 for second. So, still a lot of dentists are in the running. Like last night with Arizona losing that just kind of … that hurt so many brackets. My bracket especially. I’ve still got UCLA winning it all and tonight they’re playing. So come on Bruins. We’ve got to get the Bruins to win it, man. I tell you, I could care less who else wins out. It’s been … ’95 since they won one. I think they have the most championships in the college at like eleven. It’s been 45 years. We’ve won one in 45 years. So you think UCLA is so dominant, but they got a really great team this year. A high scoring offense, Alonzo Ball and this Leaf kid, couple other key players. Bruce Alford’s kid’s playing there and I heard he’s going to be going to Indiana maybe or something, because that’s his alma mater. But, go Bruins tonight! We want them to win, win it all.

So, we met way back in the day and we’ve been together ever since. And you’ve just got an awesome practice out there in San Diego. It’s up in a little town called La Mesa. Have you been there forever, from the start, or what year did you start off there?

Dr. Feffer: Yeah, La Mesa is a town that’s basically San Diego. So, I opined the practice there in 1976. Little practice, three chairs basically … opened it from scratch. And I had ideas about what I wanted to do. That’s why I did it from scratch, because I didn’t want to buy everybody else’s ideas and problems. So, I opened it from scratch and I knew I wanted to … I knew from dental school that I wanted to go in the direction of crown and bridge.

As I started and I would get involved in some of these large cases, I really … I’m not the kind of guy that likes to be a pioneer. I don’t like to go where I don’t know where I’m going, either in a car or in a case. But I would cut these cases, the crown and bridge, and quality was always something that wasn’t going to be compromised with me. So, that was my challenge.

And I would cut these cases, sometimes I would get an eight, nine unit case and I would cut them. And it would be done and I would be sending it and I knew I had connected with you a little bit. I knew there was a guy, a manager at a bar’s lab named Shaun, and I would call and ask to speak to Shaun. And I would tell you that I’ve got a case coming, eight or nine units, and I’m worried about it. I don’t know if it’s going to draw well. I don’t know if it’s going to … if the bites going to be right. And you invariably just said to me, “you just send it in, Pheff. It’ll work perfect.” And you know what? It always did. And I never forgot that.

Shaun Keating: Can you believe that? I remember … that was back in like ’87, ’88 and on talking with you in that and I really learned a lot through you and I remember talking all the time. Howard Pheffer, cause it’s a unique name man and I just always remembered you. It’s just something … we worked together for years here and then when I started my company in 2002 … when I left that lab after 17 years … and then I started my lab in 2002, you were like “Shaun, this is great.” And you were talking about your practice at that time, because you’re a big fix guy and you were always doing … we did a lot of big stuff. And we still do.

You were wanting to venture in to the removable aspect in house. And I remember, “Shaun, you got any removable guys?” This and that, and I gave you some guys from Orange County that … I didn’t know anyone from San Diego that could wad. And removable guys are just kind of a lost art and kind of a lot of older guys, not a lot of younger guys are taking up partials and dentures and stuff like that.

But I remember you saying, “Shaun, I’ve got this idea, this plan.” Cause you were always … even to like ’90s, I remember you used to lecture and you really pushed the envelope on … big thing with marketing and you were just a freaking well-rounded … you not only have really good hands as a dentist, but you just had a really good vision, your mind and how to grow your practice. And I was looking at our numbers. You did, it looks like $1,433,000. That’s just crazy. It’s so much for a little lab bill.

But we were talking about you in 2002, that you were going to do in house and you were going to do your own [inaudible 00:06:06]. Tell me what your thoughts and how that turned out.

Dr. Feffer: Well, that’s an interesting story and you’re going to be surprised about this too, because I have this, someone gave me this idea about, you can put a little … get a technician and you can market the idea that you’re going to do some in house. You have an in house lab and you can do some denture work. Now, I didn’t really like doing dentures, I really didn’t, but what I found, cause I tinkered in it, and what I found was that it wasn’t about the dentures. Believe it or not. We did a little marketing of that and what I was attracting was crown and bridge. I was attracting people that wanted to avoid dentures, also. And that was more important than the dentures. So I kept it going and it was working.

A couple years after the 2002 time, implants became a key feature. Okay, I had been doing implants a lot, but I was always frustrated with attachments, but then innovations came in. It became incredible. And, again, it’s a funny thing, it’s kind of marketing the denture; but also marketing over-dentures, over-partials, crown, and bridge, both regular crown and bridge and implant crown and bridge. And it’s all over the years, it’s all come together and it’s been pretty amazing.

Shaun Keating: It really is. I mean, I go into your office and it literally … you have people sitting everywhere. It reminds me of my doctor’s office or whatever, when it’s flu season and it’s just an amazing thing. Cause I go to quite a few offices and there’s no one in their offices. Not that much, but it’s just amazing. And then I hear, as we go down … me and the wife go down to San Diego and stuff and we just like to go down to Gaslamp District for a night. We’ll take the Surfliner train down and we’ll go down to Petco and watch a concert or whatever, but lo and behold we’re seeing you on TV and stuff. Dude, TV commercials and stuff. Are you sofa king guy or I’m sofa king … tell me about that. Are you doing … do you do a lot of … how’s that work?

Dr. Feffer: I think about what a dentist I’d be in sales and marketing because it always has fascinated me. So, I found a way of getting the word out using the TV medium. I pretty much dappled in all the mediums, but the TV medium has worked out really well for this.

Shaun Keating: Is that super expensive or what?

Dr. Feffer: Well, you make certain relationships and you negotiate things. That part started around 2000 and it’s been going on all the way.

Shaun Keating: That’s amazing.

Dr. Feffer: It’s been fun.

Shaun Keating: That is so cool, dude. Now what about when we get so many up and coming new dentists. A lot of my guys have been doing this 20, 30 years, but so many new guys are out there. What do you think of the digital stuff coming out now? You know, digital chair side scanners for like [inaudible 00:09:05] and stuff like that. And what do you think about any of the mediums of impression taking via sending it through the internet. We’re older guys and stuff in this and it’s kind of train a dog to do new tricks. It’s just … what do you think? Do you feel it’s got a big part? Do you think it’s going to be a small segment? Or the younger techie type dentists and stuff, I think they’re going that way a little bit. I don’t know. What do you think?

Dr. Feffer: Well, I’ll tell you what I think, I think that I’ve always approached technology with … like I said, I don’t like to be a pioneer and this is part of what I’m talking about. These new things come on and I’m afraid almost to step in too soon. I don’t want to compromise myself.

So, I’ll give you an example, things like digital x-rays. When they first came out, now I happened to be building the new office around 2000, 2002, I could work without digital x-rays. It’s doing endo and doing implants, it’s like it gives me a view of exactly where I’m going instantaneously so it’s … I can tell you with endo and things have been amazing. But right from the beginning the cerec machines, they got excited, people got excited about them. I kind of questioned whether it was just a marketing thing. I didn’t need their marketing.

I’m always interested in quality and I just have to tell you that with all due respect to the other people, I see a lot of people that come to my office for problems from the outside. Okay, they need help. I have never been impressed with cerec crowns and I never will be. I’ve taken so many off because of open margins, to me there’s nothing like taking a good impression and sending it to a guy like you. Seriously.

Shaun Keating: Wow. I really appreciate that. That’s awesome to say that. And I think some of the cerec guys that are good at it … you could always find something when there’s a product out there that … you’re getting the cream of the crop when you’re seeing the guys out there that are advertising. Kind of like when you see dogs and stuff, it’s 100,000 bucks to get one to look like that, or whatever. But the cerec it’s a lot tougher than it seems, and it takes quite a bit of knowledge and experience and trial and error.

Dr. Feffer: Can you do multiple units with cerec?

Shaun Keating: You can do multiple units, single units, this and that. I think you can do some bridge work here and there, shorter spans now. But it’s just something, back what you’re seeing probably, was some of the first generation or so of the porcelain, the pucks. The zirconia that’s being used is not very aesthetic at all. Even to all the modelithics from the early days was just nasty looking stuff. You have to stain it and it’s just a pure white material that we’re trying to infiltrate and stain and glaze and it’s really not a real aesthetic materiel, but it’s improved a lot with the aesthetics now.

Ivaclaire’s came in with some pucks and ingots and some stuff like that for them to use. But it’s come a long way there, but I just see it’s almost like a whole lab in there and you’ve got this system and it’s a lot of time and stuff. It’s a couple hours for each patient. But, they can come in and go out. I can see a smaller practice that’s not doing a lot of dentistry, I can see it working, but I just see other people that have a couple of associates and they do it old school with an impression and it works. But some of the guys that are cerec, cause it’s under such high magnification and the computers won’t let you go to the next step unless … it’s accurate and you can see it clearly. So it makes guys practice a little bit better now. I think back in the days they probably weren’t as accurate. Probably trying to stay in the margins and stuff. But there’s some great guys with it. It does work well for certain people, but I’m kind of an old school guy. So, I like it the old way.

Dr. Feffer: I am, too.

Shaun Keating: So, what do you think when you … have you ever recommended our lab to other guys? Or do you talk to many other dentists? Stuff like that.

Dr. Feffer: Well, I have to tell you, Shaun, since the day I came in when I was younger I couldn’t wait to … on Friday’s, I always took some Friday time off and that would be coaching time for my kids. They were athletic and I loved it. I never really got involved on a level with dentists. I gave seminars. I love, again, coaching and I help if I can help. But I don’t like mixing …

Shaun Keating: You like hanging out [inaudible 00:13:41]

Dr. Feffer: No, I don’t and so when people ask me about dentists, you’re asking the wrong guy.

Shaun Keating: And that’s so cool. What about, what did you coach? Cause I coach my … I have two boys and I met your daughter. She’s a smart cookie. She’s like … she’s doing you’re market …

Dr. Feffer: Yeah, she works … one of my daughters works for me. So, she’s doing great. I coached soccer. I didn’t know anything about soccer, but I’m athletic. I played a lot of sports myself and I loved coaching. I read all the John Warden books talking about basketball and Vince Lombardi books. So, coaching is amazing. And I’ve got news for you, that’s part of the reason why I loved … in the ’90s when I was doing seminars and helping dentists, I consider that like coaching and teaching also. I wish San Diego had a dental school because I would love to do some teaching.

Shaun Keating: No kidding.

Dr. Feffer: But they don’t, so.

Shaun Keating: Well, we’ve got Loma Linda University over here. We do a lot of their work over there. We could get you … you should because what you have you could replicate it. And I just think you’re such a nice guy and you run a … you’re a worker bee. There’s a lot of guys that they want to work a couple days a week and just live the life and you’re in there grinding. You work Monday-Thursday, every day. And you … when I come in your office sometimes you’re like, “I can’t see you, Shaun.” And you’re entranced. I see you overlooking … cause you can see right through and you can see you sitting there and you’ve got your microscopes and loops and just, you’re going to town.

It’s an amazing practice. For you to be doing it all these years, you’re kind of winding down a little bit, I would think, and you’ve got a gold mine of a practice, but at the end of the day there’s more to it than just working your ass off. We’re all getting older, but to give back a little bit I think you should do something down the line. We do a lot of educational things here. We do a lot of over the shoulder programs in this chair and we can do some [inaudible 00:15:43] with those. But with you, man you’ve got to do something with helping out, maybe do some courses.

Dr. Feffer: Well, you have to realize that I’m older than … people tell me I’m older than I look, but it’s time. And as we sit here, I’m in the final stages of moving on. And when I’m finished in the practice I’m not going to go to the mall every day with my wife, I’m going to stay busy. And what I want to do is, I want to consult. And so, I’m going to consult with younger guys or dentists in the San Diego area and also reach out. I’ve done it before. I’ve sold tapes. I have information for people and like I say I love coaching and teaching, so I’m going to do that. That’s what I’m going to be doing.

Shaun Keating: That is so great to hear. No, that is awesome, because you’re the real deal. A lot of guys, they like to go out there and talk, they’ve really never been in the trenches that much. And it’s like, a lot of guys, I love hearing them, but it’s like dude … they can’t shake a stick at what you’ve got. I’ve got numbers here. I can’t believe all the implants we’ve done and you’re big semi-precious PFM guy, too. And I always told … semi-precious probably your best bond to PFMs.

Dr. Feffer: That’s what I want [inaudible 00:17:05]

Shaun Keating: It’s the strongest. It’s the best marginal integrity. As you get to those high novels, whites and high novel yellows, they get softer. That whole flexing in semis is just awesome. You do a lot of our ulchers. I think you really [inaudible 00:17:20]. Not just your zirconia substructure, that we layer with the [inaudible 00:17:24] and CZR. Just across the bar too, so many attachments, so many implants, and it’s just so smooth. And it’s such a pleasure to work with you, with your attitude and your staff. How many staff do you have there?

Dr. Feffer: I have thirteen.

Shaun Keating: Thirteen! All girls?

Dr. Feffer: No, I have Dr. Riffkin, who works with me, and then I also have two lab techs, denture techs. One’s a manager and so they work … the other two men. So, we have four guys. Nine girls

Shaun Keating: No kidding. That’s amazing. What about on your ops? How many ops are you working out of?

Dr. Feffer: We have six. Six full ops.

Shaun Keating: And you just kind of bounce from op to op, or is that one your main one there, or you have ones that you do an endo in, ones that you’re doing surgery, is there one …

Dr. Feffer: Well, I have one that I’m in the chair that’s where I’m doing either the crown and bridge, endo, implants, whatever. And then there’s’ another one that we get a lot of the consultations in or exams. Then I have a couple hygienists and so part of the art of what I do is what I do in that consultation room. I’ve had … we get the biggest problems in San Diego and people come in and I take a look at that pinup. I’ve got it down. I know what works, what won’t work. I know what’s going to help the patient. So it’s kind of like, people tell me it’s kind of like watching a chef in a busy restaurant. But I’m enjoying it, don’t get me wrong, cause I’m enjoying it. Cause I have good people.

Shaun Keating: That’s what it’s about really.

Dr. Feffer: And that’s the key. I’ve learned that. I have assistants that are just amazing. All of my people are good people. And they’ve been there. I don’t have turnover.

Shaun Keating: Yeah, see that’s where we come together and I think a lot of successful companies and businesses, it’s when you do take care of your people. And they stay with you.

Dr. Feffer: Exactly.

Shaun Keating: And there’s no turnover. So, there’s not retraining this new person every three months, and I think it’s the same thing in football teams I talk about or basketball teams. When you can have a core unit that’s together, that wins together, fights together, lives together kind of. It’s a neat thing. You really do take care of your people. And the staff, when you go in there and when you talk to them they’re all upbeat, they’re all just … they’re all there to help and there’s’ no separation, it’s kind of all cohesive unit. It’s a neat thing and I think that’s in life, you can be a plumber, a painter, whatever business, lawyers, just got to take your staff and treat them good. And find the best staff and take care of them. Pay them wage. Try not to get stingy and chincy here and there. When you look at the big picture that they’re going to be with you ten, fifteen, twenty, thirty years, and it makes your job easier. And it just all works, when you’re all working together, firing on all cylinders.

Dr. Feffer: Absolutely.

Shaun Keating: And that’s just such a neat thing. And when you say that it makes me feel really good. Now, what do you think, for a few tips you can give dentists, what do you think they can do to help out, say with their marketing? You’re the master at it. I know you do a lot of things, but for new guys coming out, what do you think? Do the yellow page ad, do some mailers …

Dr. Feffer: Well, I tell you, it’s a great question, and let me try to answer it this way, I really … I might not mix with dentists, but I have a lot of respect for dentists, a lot of respect, especially the young guys. I really believe this, I would debate anybody, I don’t think there’s a tougher profession in the world than dentistry. Because what we have to do is so difficult, it takes … that’s what you’re trained to do and then you come out and you have to do that and besides that you have to know how to run a business, we’ve had no business training. How to run people, staff, you’re not a psychologist. Market, you know nothing about marketing. You have to do all of these things to be successful and it’s devastating.

I think it’s why people always say dentists lead all professions in heart attacks, suicide, and divorce. Well, there’s a lot of stress in dentistry. I think that you’ve got … to get help somewhere is so critical and I have to tell you, and this is what I learned myself, I don’t think the help is out there. I think we’re inundated everyday on these things online and it used to be in the mail, courses, this, that, and I’ll get you a hundred patients a month and you take them and it doesn’t work.

Because of what I told you before about being all about marketing and sales, that was my thing, I developed my own. I learned … I have this drive and I learned how to do it myself. And then that’s what you said the work and when I met with a marketing guy once, I was trying to learn how to market veneers. Okay, and he saw my practice and he said, “Howard, is what you do, is it duplicatable?” I said, yeah. And that’s when we put together our seminar and I gave about six seminars in the ’90s and they were unbelievable. And they helped dentists incredibly. I don’t even want to tell you how incredibly, cause it would sound silly.

Shaun Keating: Yeah.

Dr. Feffer: Okay, but it was really effective. And then there’s reasons that we stopped had to do with the other fellow that got a little greedy. So, anyway and then I went on to sell the tapes. So, my advice would be that you have to … probably the one main thing, as far as marketing is concerned, that’s something that varies according to your practice and according to what’s available. Now we have the internet.

There’s different ways … you have to do something because that’s what I learned. I learned in the beginning, I’m not going to sit back and wait for people to find me, it’s not going to happen. I have to, remember I started from scratch, I have to find a way to bring some people to me. But once you bring them, and that’s … you work that out, you figure that out, once you bring them …

and I have to tell you, I think the biggest factor of all is you can have everything, you can have everything you want, you can have all your equipment, you can have your staff, you can have everything, you can even bring the patients in but … I used to have, probably the most popular aspect of my seminar, probably the number one and the tape afterwards that sold a lot, was what I call selling dentistry and that to me is the number one thing that a dentist has to learn. You have to make people desire and value what you have and that’s the key.

And so when I was starting, back in our day, and I was starting to do these bigger cases, I realized something very important. I realized that my competition wasn’t the dentist around the corner, or even across the hall, that wasn’t my competition. I realized that my competition was the jeweler, the card dealer, the travel agent, I had to make people value what I had so that I could compete with them. And I just want to tell you, I want to go on and on, but I just want to tell you what I’ve developed over the years, and I use this every day because now I’m dealing with cases really big involving implants and it’s the same principles. And what I have, I have no problem expressing it and showing you that it’s actually more valuable. I have an advantage over the card dealer. I don’t think they can compete with us, with me. So, it’s about learning how to do this and I think if you put it all together then you can have a very successful career.

Shaun Keating: That is so … that is just great advice there and we’re going to have to get those tapes out of the old …

Dr. Feffer: Oh, well the tapes have been modified and improved for twenty years so now … and I’m going to do this.

Shaun Keating: Oh, you’re going to do it?

Dr. Feffer: Yeah, I’m going to …

Shaun Keating: Well, you let me know because I like to send it out to all our clients to see if they would be interested in it. Like I said, we do have a lot of younger dentists starting out with us. And even my vet guys, they might be interested in some aspects. Because it’s not like the old days where …

Dr. Feffer: Absolutely.

Shaun Keating: Patients are walking in the door easily nowadays. It’s pretty tough and fierce. Especially out here in the LA area, Orange County. There’s a doctor on every corner it seems like and they’re all chasing it to the bottom dollar and that’s not going to get it. There’s got to be more to it than patients, they kind of got with this 50% off and all this coupon strategy, with the malls and stuff like that with sales and that’s not a real good thing.

Dr. Feffer: Well, I’m definitely going to be doing it. My daughter’s pushing me. Stacy wants me to do it and I’m going to do it, because that’s what I’m going to be doing. So if your people get in touch with you, let me know and …

Shaun Keating: Yeah, absolutely.

Dr. Feffer: I’ll be developing how I’m going to do it.

Shaun Keating: That’ll be awesome. We can replicate Pheffer practice and it is really … you run a real smooth practice. It’s very predictable and it’s very consistent. Gosh, it’s an awesome thing. Well hey, I want to thank you so much for this. Short and sweet today. We got Friday night, we got Bruins today, baby. Got me a little lunch time coming up here, too, looks like, don’t they? But, Dr. Pheffer, thank you so much for coming and visiting today. I want to thank you. If there’s anything ever you need from us, you know that with me, man. If you need anything. You need those cases done in a couple of days, too. Certain patients, you know we’ll do that. I just can’t thank you enough for all the years and all … you’ve supported us here and our techs and they were so happy to see you out there today on the floor. And seeing Bob, Brandon, and Jim [inaudible 00:27:48], you were just talking about how important those guys for all these years. They’re just glowing seeing you and stuff. I can’t thank you enough.

Dr. Feffer: You know what? I can’t thank you enough, either. I appreciate everything you’ve done for me.

Shaun Keating: That’s awesome, man. Well, everybody hey, thank you for tuning in this week’s Dental Up podcast here at Keating Dental Lab. Make sure you subscribe to us on iTunes and leave a review. We also have an Instagram account. It’s pretty cool. It’s @keatingdental, I think. And then if you ever want to go on YouTube, we have a bunch of videos, a lot of education videos. And I don’t know if you know, but all of these podcasts are put on YouTube, also. You don’t have to watch it, but just listen to it. I want to thank you all again for listening this week and go Bruins.

Dr. Feffer: Thank you.

Shaun Keating: Hey, I want to thank everybody for joining us on the Dental Up podcast show this week. Be sure to follow us on Facebook, Instagram, and Twitter. Or search Dental Up podcast on iTunes and get our weekly feed. Don’t forget to visit keatingdentallab.com/promo for exclusive offers. Keating Dental Lab is a full service dental laboratory and we’re nationwide. We would love for you to send us a case, so we could show you the Keating difference. If you dig what you’ve heard, please leave us a review on iTunes and we’ll be back next week.

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