The Millionaire Dentist Podcast

Episode 33: The Growing Practice Revenue Series Part 2: CEREC with Dr. Amy Marckese

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On today’s episode of The Millionaire Dentist Podcast - is adding CEREC a strategic revenue stream for your practice? Amy & Casey cover the pros and cons of spending significant resources to add CEREC to a practice. The hidden questions and concerns are discussed using an honest lens so practice owners don’t end up with an expensive coat rack.

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Podcast Transcription:

Announcer:

Hello, everyone. Welcome to the Millionaire Dentist Podcast, brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue and may not be safe for work.

Casey Hiers:
Hello and welcome. This is Casey Heirs and we have brought back Dr. Amy Marckese to discuss growing revenue streams in your practice, part two. Dr. Marckese is the proud owner of a massively successful dental spa in Indianapolis. Today, we wanted to ask Amy about CEREC, chairside economic restoration of aesthetic ceramics. It can be a nice option for practice owners and we just wanted to dive into this topic for our listeners a little more given the expense of it and how it doesn't go great for some people. Dr. Marckese, welcome. How are you doing today?

Dr. Marckese:
I'm great. Call me Amy.

Casey Hiers:
Absolutely.

Dr. Marckese:
Is that Really what CEREC stands for? I didn't know that.

Casey Hiers:
It is. That is the technical acronym

Dr. Marckese:
The acronym.

Casey Hiers:
The technical definition of that acronym. Yeah, chairside economic restoration of esthetic ceramics. Well, let's just dive into this topic. You have a real interesting history around this technology. Would you tell us parts one and two of your experience with this?

Dr. Marckese:
Sure. So I first got a CEREC, about a year into business. So it would have been about 14 years ago or so. It's already a huge financial commitment, but obviously then with where I was in the practice, it was even more so. And it was a disaster.

Casey Hiers:
Really?

Dr. Marckese:
It was the day of you had to powder the tooth to take the image, so it was pretty much like throwing a bunch of flour in somebody's mouth and then trying to get it to not wash away with saliva while jamming a camera the size of your arm in their mouth. Then it didn't work when I went to mill it. It was an absolute disaster. I went to multiple things of training. They sent people out. The company I bought it from did everything they could to try to rectify it and it was so bad that I literally told the manager of the company I bought it from to come pick it up in one piece, who I had known for a long time so he knew I wasn't kidding, in one piece in my office in the next 24 hours or he could pick it up in a million pieces in 48 hours because I was going to throw it over the balcony.

Casey Hiers:
Did that get his attention?

Dr. Marckese:
He picked it up in one piece. My rep now for, I think I told you three years, but it's been more than that. What more when the scanners started coming out, so three to five years, I don't know off the top of my head, tried to get me when the ED4 was coming out and so forth to get it. I told him, this is probably a horrible analogy, but I said, it's like talking a beaten wife into getting remarried again. Why would I want to put myself through that? It was that horrible. It was just a hard no.

Casey Hiers:
Now let's back up. What was your primary motivation to get it this first time? It sounds like it was a swing and a miss, but as a practice owner, we're talking about growing revenue streams, what was the catalyst for you to go all in with this technology early?

Dr. Marckese:
So I wasn't. I wasn't going to do this and I haven't told you this part of it. So I went out to Sirona World in October, 2019 and I went, excuse me, I went to Serrano world to get, I wanted a scanner. I wanted the Prime Scan. I had done a few demos of the various scanners and I fell in love with that Prime Scan. So I told myself I would go out there. I wanted to take some classes. I was going to get the Prime Scan. I told my rep 1,000 times don't even think about it. I am not getting that CEREC. He was like, "Well, let me get you a proof for the financing before you go." I was like, "You're wasting your time. I'm not doing it."

Dr. Marckese:
And I came back from Vegas with a CEREC, which I guess you could come back from Vegas with worse, but I came back with the CEREC. Basically what happened is when I went out there, I realized how dramatically different it was. It's two totally different things. It's to me comparing a 10 speed bike and a motorcycle. It's that different. Now, a lot of it does have to do with the imaging and I will get to there's just no way I would do anything but that Prime Scan. That is key. But anyway, that's kind of the big story.

Casey Hiers:
Yeah. So night and day difference for the first time versus ...

Dr. Marckese:
Night and day difference.

Casey Hiers:
... the second time around.

Dr. Marckese:
Night and day difference.

Casey Hiers:
And the powder and some of the ways that it was working-

Dr. Marckese:
Nothing's really the same.

Casey Hiers:
Yeah, everything's changed.

Dr. Marckese:
Everything's changed. Now, with that being said, as I said to you before we started, am I allowed to be honest.

Casey Hiers:
Please.

Dr. Marckese:
There is a huge learning curve. Again, much like I mentioned when we talked about the Botox, if you don't start using it the second it arrives in your office, you're not going to use it.

Casey Hiers:
It's an expensive coat hanger.

Dr. Marckese:
It's an expensive coat hanger, and anybody who tells you you're going to start milling 50 crowns a month with this thing right off the bat is full of it. It is a huge learning curve. It's a learning curve of the scanner. It's a learning curve of the design. Now, it's a much smaller, much smaller learning curve than it was before, but it's a learning curve. It's a learning curve on how long to have the patient in the chair, what to tell the patient, how to communicate with the patient, how to schedule. Your front office can't just shorten appointments. You're working on a clock of how long something takes to mill, how long something is in the oven, et cetera. So it's a huge learning curve, but the other thing is that the investment is not just in the scanner, in the milling unit, you have to invest in the classes and you have to go immediately, and those aren't cheap.

Dr. Marckese:
The classes themselves aren't cheap, especially if it's you and you're taking a couple assistants, which I highly recommend. It's the flights to go out there. The only place you can take assistants with the CEREC training is to Phoenix. You can't do those around here. You can do level one but you can't do any of the others without going to Phoenix. So it's a $5,000 weekend.

Casey Hiers:
So time and money.

Dr. Marckese:
Time and money.

Casey Hiers:
It takes a lot of time and money to get going with CERAC. Let's talk about once you've made the choice, made the commitment, got the training and you use it. Let's talk about how it helps your practice, how it helps your patients and general idea from a percentage of production, how has it helped your practice that way?

Dr. Marckese:
So again, it got delivered to me at the end of November, which I was again, real skittish on how this was going to go when it first landed in my office because there's a big difference between watching people do it in these classes and so forth in Vegas and doing it yourself. As we all know in the dental world, I knew this thing was going to end up getting delivered and the clock was going to start ticking on my six months before I was going to start paying for this thing right in the height of us being busy in December. It wasn't going to be a great time to learn something new, but we did slowly but surely. And sadly, we really started just rocking it in January and February and we were supposed to go out in March.

Dr. Marckese:
So we did one training in January, one in February. We were supposed to go out again in March for what was going to really kind of take us to a big leap that obviously got canceled and now we don't go till July. But in three months we went from it taking three hours to do a crown and cement it to about 90 minutes for one. Now we can do them side-by-side. Now we can do two opposing. That we're pretty comfortable with. Now, to learn that really in two to three months, I had that machine for eight months and I still couldn't get one to crank out right.

Casey Hiers:
And is it just repetition is the reason why it's gotten-

Dr. Marckese:
It's absolutely repetition and at the end of the day, you're really learning how to use the computer and how to use the Prime Scan software. That's the big thing. You will definitely notice, so I have some assistants who are in their low thirties and I have an assistant who's in her late fifties and it's a big difference on their comfort level. A lot of it's just flat out technology. The 30-year-olds can't wait to hop on there and design and do stuff and the 50-year-old is way more skittish at it. And I'm kind of that 40-something middle of the road one who's trying to be the balance of it. But that's again, you have to use it and there are days you will want to throw it over the balcony.

Casey Hiers:
Well, I've had a lot of conversations with dentists who have it and they don't really use it. You alluded to it, when you get it, start using it.

Dr. Marckese:
Immediately.

Casey Hiers:
Get that muscle memory going. It's going to take repetitions. You will get more comfortable. We always talk about dentists being high achievers. I could see some getting it, being frustrated that it's not as efficient as they thought and they don't put in the reps to get better.

Dr. Marckese:
Absolutely, and you have to pick and choose. So those crowns that need to be done on your staff, those are what you do first. That patient who really needs a crown and you know really can't afford a crown right now. And you want to do a favor to, and you're going to do a free crown because at the end of the day, I had a six month deferral. Those blocks cost about 20 bucks. So yeah, I'm going to do it through lunch or we're going to block a day or two to do these. So you're cranking out some free crowns, but it's worth it. Do it to people who go talk about it. That makes a difference. I have to say, they love the same day crown.

Casey Hiers:
Let me ask you a bit of an unfair question. What a setup, right? Compared to how it improves the patient experience versus revenue to the practice, which would you say is more compelling or more significant? And here's the deal, let's say it's great for the patient, but it has really improved your revenue. That doesn't mean you're not patient-centric, but I wanted to get your feeling for the balance of revenue versus patient experience.

Dr. Marckese:
For where I am with it now, it's probably very 50/50. For where I think I'll be in six months, it's probably going to be way more revenue-driven. The only thing I'm sending to labs as of now, or as of March I should say, is our anterior crowns. I haven't done the level of classes where I feel comfortable that I can give my patient the aesthetic crown that I know my lab guy can do. I don't know. They show you cases that you're like, you can't believe the CEREC did that, but I don't know if I'll ever get to that because I think my lab guy's a badass. And that's okay. I don't have to do every crown with it, but every posterior crown, I cannot wait to learn how. I do we have a ton of patients who have implants. I haven't done a bridge in forever.

Dr. Marckese:
So I can't wait to learn to restore implants with it. That's going to be huge. That's what I'm bummed out that I'm set behind a class in time because I was supposed to be doing that class in July instead of the one I'm going to be doing in March.

Casey Hiers:
So map out the class schedule for us. So you had the initial training.

Dr. Marckese:
Yes. Which by the way, real important with that, those trainings get full fast. Now, granted, I was buying this probably at the time more dentists than ever we're buying it in the year coming off of Sirona world, but I actually had that class scheduled for us before it was even delivered. And there were some people in our class who hadn't even gotten their unit yet, but it was key because we had ours for about two weeks. We knew questions to ask. We knew mistakes. We knew things that they were talking about like, "Who's gotten this glitch or who's gotten this?" We could actually say, "Yeah, yeah. Yeah. That's happened to us." So you have to do that first level one training. Literally within weeks of getting that you don't have to, I would highly recommend it. Then I would do that level two training within that next two to three months.

Dr. Marckese:
That level one training is really how to use a scanner, how to better understand the software, the difference in blocks and materials, and, oh my God, that's a whole other story. How to stain and glaze, that's all in your level one. Your level two does more of the staining and glazing. That's more inlays, onlays, how to do crowns side-by-side, how to do crowns opposing. Then level three and four get more into the cosmetics and/or the implants and so forth.

Casey Hiers:
So if somebody is not committed to the training-

Dr. Marckese:
Don't get it.

Casey Hiers:
Don't get it.

Dr. Marckese:
Nope.

Casey Hiers:
And that was what I wanted to know, who should get it, who shouldn't get it? It sounds like the profile would be if someone's easily frustrated if they're not perfect and if they don't have the time maybe in this season of their life to devote to it, don't do it.

Dr. Marckese:
Absolutely. It is a huge learning curve. You have to have the right mindset for it. You have to have your staff buy in so to speak. You have to have your staff want to learn. They're ultimately helping you with the scans. I'm addicted to this scanner. We use this scanner for everything. We now do Sure smile cases with it also of the Prime Scan. There's another huge revenue stream. I can't believe how much that took off. Within a week of us doing Sure Smile we had 10 cases.

Casey Hiers:
Nice.

Dr. Marckese:
That's taken off, but part of it is the staff loves, loves being able to use it. My girls, two of my three in particular are killing it with it and it gives them pride. It's one more thin. We all know they don't want to suck spit all day. They, just as proud as they are to come and tell you, "Look at these anterior resins I did," they want to come tell you, "Look at this crown I just designed before I send it to the mill."

Casey Hiers:
Variety's the spice of life and you're giving that to your ...

Dr. Marckese:
Staff.

Casey Hiers:
... employees and your team. That's good. What's one piece of advice you would give a dentist considering adding CEREC to their practice?

Dr. Marckese:
Have a true talk with yourself and with your staff about if it's the right time. Again, ideally I probably wouldn't have wanted this thing to be delivered in December when we're all slammed and I didn't have time to learn a new thing, but the way the financing was the six month of the fact that I had just come off of learning about all this and seeing it was that happened to be, for me it would have been more ideal to maybe have added it at a different time. But you have to understand you have a year long commitment of learning.

Casey Hiers:
Looking back, does the return outweighed the cost or do you see that-

Dr. Marckese:
Right now I'd say I'm even. I'd say what I'm spending on what my CEREC bill will be, which has been deferred so I haven't paid a CEREC bill yet to be quite honest, but I was supposed to in April, would be about equivalent of what my lab bill was that I'm no longer paying for those crowns. Or I shouldn't say that. My lab bill is now really just my anterior crowns. So there's definitely a trade-off there. I think that will spike as I do more.

Casey Hiers:
Let me ask you this, in a normal, let's say a normal time of scheduling and busy-ness, what would you anticipate being that line to where it becomes profitable?

Dr. Marckese:
I think we're going to turn that corner right here when we ...

Casey Hiers:
Shortly.

Dr. Marckese:
... get to get back to business. Especially after again, we're lagging behind in this new class in July, but if we would have taken that in March and especially as I take off on this implant stuff, I'd say probably ultimately in the normal world, which we certainly aren't in right now, six months.

Casey Hiers:
Okay. Well, I think that's helpful. Amy, I appreciate this. If there's ever a time when growing revenue streams in your practice is of interest to our listeners, it's now, and the big takeaway I got was in your heart of hearts, if you're not going to dedicate yourself to the training ...

Dr. Marckese:
And your team.

Casey Hiers:
... and the team and the time it takes to get everybody up, it's going to collect dust and it's going to be expensive. If you're all in, you're ready mentally, it can boost your practice tremendously and your staff has fun doing it too.

Dr. Marckese:
Yep.

Casey Hiers:
Very good. Well, Amy, thank you.

Dr. Marckese:
My pleasure.

Casey Hiers:
To our listeners, Dr. Amy Marckese, owner of a very successful dental spa in Indianapolis is a great resource around this. And we appreciate your time. Thank you.

Dr. Marckese:
My pleasure.

Speaker 1:
That's all the time we have today. Thank you to our guests for their insight and for sharing some really great information, and thank you to you, the listener, for tuning in. The Millionaire Dentist Podcast is brought to you by Four Quadrants Advisory. To see if they might be a good fit for you and your practice, go on over to fourquadrantsadvisory.com and see why year after year they retain over 95% of their clients. Thank you again for joining us and we'll see you next time.