Dr. John Meis:
Hey everybody, welcome to this episode of The Double Your Production Podcast. I'm Dr. John Meis here with my partner, Wendy Briggs. Hey Wendy, how's it going?
Wendy Briggs:
It's going great, Dr. John.
Dr. John Meis:
Fantastic. We also have one of our amazing hygiene coaches, Bert Triche. Hey, Bert.
Bert Triche:
Hey, Dr. John, hey, Wendy, glad to be here. Thanks for inviting me.
Dr. John Meis:
And we have some very special guests today. Bert, would you like to introduce them?
Bert Triche:
Yes, I am excited to introduce you guys to Dr. Vincent Mariano and his partner and wife, Dr. Lisa Emirzian. They work in East Long Meadow, Massachusetts. They have three practices in that area. And I've had the privilege in the last year of working with them and their hygiene department and helping them grow their hygiene department. So we're going to hear their story today, which was really quite a journey for me and I know for them as well.
And I was thrilled to be to help them grow in the way that they did. So we'll get right started. Dr. Vinny, as people call you, right, lovingly call you. What brought you to TTI? How did you find out about us? How did you get in touch with us? And what brought you to our company?
Drs. Emirzian And Mariano:
So probably about a year and a half, two years ago or so. Well, first I'm going to start by saying EMA Dental is a combination of multiple practices we've accumulated or put together over the years with three locations. Originally started with my dad's practice way back when. So we've grown it over the years. So my daughter being a prosthodontist, also living out in the Eastern part of the state, we were looking at a practice out there.
And when I looked at the numbers of that practice, it was amazing that I saw hygiene grow significantly over the past couple years. It was almost like, you know, how did this happen? It was very, I found out that The Team Training Institute was involved in that practice and I said hmm. We were impressed. We were impressed. Six months later, a few months later, we contacted, we had a very nice conversation with you Wendy and I said, Wendy I need your, I need a special person to come over here and Bert was the one. She was the best. She did a wonderful job with us, connected with us, and it was great. We had a great year discovering each other and growing the practice.
Wendy Briggs:
Awesome. Yeah. So you were originally looking to just bring that practice into the fold and you saw the opportunity that existed in your existing practices. That's exciting.
Drs. Emirzian And Mariano:
We did.
Bert Triche:
So when you first came in, Dr. Mariano, I know you were looking to improve the perio, right? So that was what you really started with. then so talk a little bit about what happened there. You went through Perio Explosion. We usually do Hygiene Explosion first, but you did perio first. And then what happened from there? I came on the scene shortly thereafter.
Drs. Emirzian And Mariano:
Okay, so I think I want to start by saying that what is very interesting about our growth and our journey has been the greatest points of our growth have been when we brought outside people, consultants into the program. We can only say so much together. couldn't do what you did. We couldn't do. As much as I'm a hands-on kind of guy in managing the 50 people we have, you can't do that.
Bringing someone from the outside. the most growth we've ever had is from different consulting companies coming in at different phases. Periodontally, I saw and I always believe that the engine of our practice is the periodontal part of the practice. That is the engine of our general practice and the specialty parts that are grown around it. If we talk of a spoke and wheel, that's the way we do it. And I've always said that hygiene is the key. That's where our relationships are built.
I wanted to elevate the role of our hygienists and I felt that the way to do that would clearly be to get the right people to come in to help do that as well as providing extra services and the other things. But the elevation of our hygienists was one of the main things I wanted to do. When we did Periodontal Explosion, that was very clear that we saw that, you know, I always tracked how much periodontal treatment was being done and I always knew it needed to be about 30 percent. We had recently bought the Westfield, a different location and that was only six percent. So I said, wow, that's a great opportunity for me to grow. And I also saw that our hygiene team, those who had the most experience and the most connections with the patients always did certainly much better. They were able to connect and be able to elevate the level of hygiene care and periodontal care...
Dr. John Meis:
Yeah.
Drs. Emirzian And Mariano:
Where our younger people weren't able to do that. What I think is... The experience and verbal skills as well. Yeah. So I think by going through this program, we've empowered many of our hygienists to be able to teach and to be able to be confident enough to propose additional treatments, whether they be periodontal or all the other. And I think by learning all together, they understood that they had our full support through the process as well. Because sometimes the hygienist can be a little cautious about conversation unless she knows she's going to get the doctor's support. And I think by all of us training together, that fear was alleviated.
And I think so much the key here is that it's training as a group and monthly calls, us being on the monthly calls and the full day programs we had, were very instrumental in making us empowered as a team to do that. So that, as you know, that walk-in of the doctor into the hygiene room, that has to be set up and has to work smoothly. And it's hard to do because you have young hygienists who don't know anything about that, and you have your more seasoned ones.
So when they work together, when we talked to our hygiene team at our last hygiene meeting, what they said was that working together as a team, it allowed the younger hygienists to see the more seasoned ones and made them feel more empowered to do a little bit more. And we're still working on that, obviously. I still scratch my head many times when I walk in and I said, okay, what? Talk to me. Talk to me. But it is improving. So I think that that's the huge advantage of working together as a team, the monthly calls and certainly having the doctors involved in those monthly calls were very..
Bert Triche:
Yeah, and Dr. Mariano was, you know, he was very, very committed to being on every call. Dr. Lisa was on many of them. Many of their doctors were on. So it was a really great exchange, I thought. It aided the whole experience of the call for me with the team because he was so involved in the conversation and 100 % behind everything we were trying to implement. It was, it was.
Drs. Emirzian And Mariano:
The doctor's support is huge.
Bert Triche:
Yes, y'all were extremely supportive. It was not always a smooth ride. There were lots of bumps along the way, right? And when you're implementing change at the level that we were implementing, we had some moments of difficulty, right? We really did. However, we continued to persist and they continued to learn. at the end, talk a little bit about the result you got, Dr. Mariano, because that was a pretty incredible increase in hygiene for a year.
Drs. Emirzian And Mariano:
You know, we owe, always remember as a young practice saying I want to have a million dollar hygiene department. And then we grew that and grew that. And for years we had been stuck, but we were, when we first started, we were at a two and a half million dollar production number or collection number. And we went to three and a half million in one year. Now part of that was growing our current hygiene team and the two offices that we were, we were doing 30 % perio.
The adjunct procedures really helped us a lot, but the one location which was new, which was only at 6%, that has grown to 25 to 30 % because of the integration. So it integrated all three locations very, very well. So a huge difference in one year to grow a million dollars out of a two and a half million was big.
Bert Triche:
Mm-hmm. Yeah, I knew in the last call I said, well, think it was because I wasn't going to take all the credit for it because it was in part we grew the team and the number of hygienists. And Sarah was quick to say, no, Bert, we've been around a year and a half. It was mostly you. She said that on the call. It made me feel really good. And it's not me. It's them, right? It's them being willing to move and do it and embrace it. And it was not an easy journey, but we got there.
Wendy Briggs:
Love that.
Bert Triche:
And they're doing so much better. And I will say one of his most experienced hygienists who's over 30 years is one of his highest producing hygienists. So for hygienists out there who think, I'm too old to be able to make those changes this late in my career, it's possible. I was an older hygienist, Kim is an older hygienist, and she did it very well, right?
Drs. Emirzian And Mariano:
So a couple of thoughts for future clients. This, if you're going to make that investment, a significant investment and make this relationship, I feel very strongly that the doctors need, you can't just say, okay, here's the money and do what you can do. That only goes so far. You need to have that continuity of the doctors involved in that care. And we do that and we did that. And sometimes it's hard in a busy practice. You're managing, you're trying to, you're on the assembly line doing what we do and then you're doing these after evening courses or programs, it's a lot. But I really think it proved our return on investment was very significant because we forced ourselves to push the extra time. And sometimes, as you know, those calls were me in the car, running back from office, coming home, or dinner and all.
Bert Triche:
In the dark. He was in the dark. Yeah. Yeah.
Dr. John Meis:
Yeah, that's so wise. It is a doctor hygiene connection piece. And if everyone doesn't go through the training, everybody doesn't have the same understanding, then the results never are as good as they could be. And the other thing is the follow-up and doctors of holding hygienists accountable and hygienists holding doctors accountable. Having that discussion, having that permission, which happens during the training is really critical in getting the best results.
Drs. Emirzian And Mariano:
I think that goal setting was huge and actually sharing everyone's goals with each other as a group was very motivational. And I think what Bert did very well that she would explain and, you know, we all feel that it's not just about the money. The metrics are performance indicators and that is how we judge how well we're doing. And I think Bert did a fabulous job with that, sharing the numbers and not making people feel intimidated by seeing their number not being as great as someone else's.
It was all about a team and working together. And the numbers were just showing the results, but it was developing that value for what we were doing and making sure that each patient can choose their own value or their own level of care. And if they wanted to do these additional procedures, they could, that value orientation, and as we all know, that's a balance, know, are we going doing this just for the money or are doing this for the patient's health and we're doing it for both. We want to create value for that patient-doctor relationship and Kimberly said something very important to me. The seasoned hygienist, they were able to leverage their relationship with the patients to allow her to do more procedures. The younger hygienists don't have that advantage because they don't, they haven't developed that heavy-duty patient relationship yet.
But what I think it has done is by having the younger people intertwined with our seasoned hygienist, it allowed them to grow quicker. And it's still a progress, they're not there yet, but it's a process. And they are growing and they are developing and becoming more seasoned with their patients.
Bert Triche:
I think that's an interesting point, Dr. Vince, but also I would comment on Max, who came in right before I came in November. He was brand new to your practice. And last month he did $54,000 of production in a hygiene chair. And he doesn't have any relationship with these patients at the moment. it's going.
Drs. Emirzian And Mariano:
Look at the superstar.
Bert Triche:
It can be done even when there isn't a relationship to leverage. Yes, do we have an advantage if we're leveraging a relationship? We do. But when you have the skill and you develop the skill for conversation and being able to educate at the level that he's doing, he is knocking it out the park and he's surpassed every hygienist in your organization in the matter of three months, which has blown me away. I mean, I can't talk about him enough. And he's male.
Drs. Emirzian And Mariano:
He has a skill. Yeah. And he challenges with certain patients saying they didn't want to see a male hygienist. And he overcame many obstacles in that regard. But everyone loves him.
Bert Triche:
He's a male hygienist, Wendy and he took over the practice of one of your seasoned hygienists, right? He took over that practice where those people weren't saying yes to her, when they're saying yes to him. So I find that very interesting that he's been able to jump that hurdle and he's quite, he was quite a find. I wish we could duplicate him and put him in a bottle cause we could sell him for a lot of money.
Drs. Emirzian And Mariano:
Right. Yeah.
Dr. John Meis:
Did you say a $54,000 month? Wow, in hygiene.
Bert Triche:
And hygiene, yes. He did like 60 something root protections, 20 curadonts, a ton of sealants. He's got the highest fluoride percentage in their practice. I mean, it's amazing.
Drs. Emirzian And Mariano:
I think what we've learned from Max is that, you know, when you sit in this room, this is the room where do a lot of our interviews for new staffing and the technical skills many times can be secondary. We want good skills, but that's secondary to that personal relationship of that connection. And that is what I've learned that when I interview, that's what I'm looking for. I'm looking for that patient skills, those soft skills that really make that patient, the patient doesn't know how the margin is or whether you got that piece of calculus. It's our job to make sure that's done. What they know is do you care and can you explain things simply and let them make them or help them understand what you're trying to do and give them an option.
Bert Triche:
Mm-hmm.
Wendy Briggs:
Yeah, a couple things stood out to me. You mentioned consistency earlier, and that's one of the things that we talked about on our very first phone call, if you recall, was the fact that really, even though our company name is The Team Training Institute and we're the host of this podcast, our goal is to establish systems that endure. And that's really what Max and Kim and some of the other providers have proven is that when you have the systems, that are built, they generate from the right place, right? Doing what's best for the patient, always putting the patient first, giving patients the opportunity to choose more care. And then we plug the right personalities into those systems, they deliver the results.
So that's what you've really done an amazing job over this first year of building those systems, establishing consistency. As you mentioned, you've had some of your seasoned providers able to mentor and help the development of your newer providers. All of those are really why you've gotten the results that you've gotten, which is really amazing to see.
Drs. Emirzian And Mariano:
Now, looking forward, the other thing that I think the program did, and Bert, as we've talked about our different staffing, I think Sarah, who joined us the year, year and a half ago in our Westfield location, we're looking for leadership now. We need to move forward with leaders within the hygiene department who can then help lead us moving forward. And I think Sarah meets that bill very, very well because she's experienced, she's seasoned, and she wants that leadership. have other CS and hygienists who are at a part in their career and say, no, no, I don't want that extra stuff. So I think the next level in this leadership and us finding that Sarah probably is the person that's going to take on the next step of leading and helping guide our program and department is really very, very important.
Bert Triche:
Mm-hmm. Yeah, you need that accountability piece. One thing I did want to touch on, Dr. Mariano, at the beginning when we talked, you were so obsessed with all of the write-offs with hygiene, and rightfully so, because it was big. Remember, every call, I listed what the write-offs were. But the interesting thing was that last call, they had done $317,000 as a group, and the write-offs actually went down because you're higher level production is going up, which I thought was really, really interesting because a lot of what we offer the patients are out of pocket expenses. There are no write-offs on sealants for adults and curadont and fluoride and that kind of thing. So the write-offs become less of an issue as they do better with the preventive services that go up, right? And that was very clear in that last set of numbers that we looked at. The write-offs had dropped down at like 21 % where they were up at 24, 25 % early in the game. So I thought that was a very interesting thing. And Dr. Mariano was, go ahead.
Drs. Emirzian And Mariano:
That's where we came in and this end is because as those, as you know, they were looking at production and to get in there incentives of production, but the back office has to look at that, make sure that our patients are being told. And so we had a whole bunch of attempted and did their best with systems behind the scenes so that make sure that those patients knew if it wasn't insurance covered, this was going to be. So there are other issues that we all know behind the scenes have to be done that the.. I just have to be aware of, but yes.
Bert Triche:
Yeah, yeah. It's a team effort. dentistry is a team sport. Wendy says that all the time. It takes everybody. That's why we're all sitting in the room together when we coach because they all need to. Yep, yeah.
Drs. Emirzian And Mariano:
That's so great when everyone's together. It couldn't have been done without having everyone together.
Bert Triche:
I agree. Yeah.
Wendy Briggs:
I would also say too, it's interesting as we've watched your journey, I haven't sat in on any of the calls or anything, but we keep our finger on the pulse of what's happening with your growth. And you're very, very similar to so many of our long-term clients that we look back and we dig into their story and we love this part. But we always say, our relationship is a journey and the first journey is that first step and the first step for us is always hygiene.
But I love how you mentioned that you recognize it now that the first year is done, we really need to have a conversation about year two and where you're going because like you said, you grow to a certain point and then there are other systems that need focus. Like you mentioned, having leadership in hygiene, having a leadership structure as you continue to grow because I know you're probably going to continue growing. And my guess is you're gonna still be looking at other practices and following similar models that you've done.
Bert Triche:
No you're not because we're the same age and you're not old. That's not old, right? We got a lot of years left in us.
Wendy Briggs:
But that's the beautiful thing is, you know, the growth that you've had this, you know, a million dollar increase in hygiene alone. That's just the beginning, right? And there's so many other things that get exciting when we look at, okay, what are the other opportunities that exist for your practice and your team right around the corner? And certainly I can tell you that so often doctors don't even think about what's next because they don't want to add on more work or more effort or more energy. But Dr. John, you always say, I don't know the exact phrase, I'll throw it to you in a second, but something like, "Bigger is not always harder." And sometimes the bigger the organization gets, the easier it is for the owner doctor. How do you exactly say that? I know I didn't get that exactly right.
Dr. John Meis:
Yeah, people assume that if they're going to grow, they're going to grow in the way that they've grown to this point. And so they think it's going to be more work, more effort, more stress, more cost, all of that. But that's really not what happens when we build a leadership team around. And so it's bigger, should get easier if you do it right.
And you two would be great addition to our Spark group, which is our small group and DSO group. And it's working on that leadership, developing the leadership among other things, developing the leadership of that next level of people, as well as business development, as well as operational efficiency and all the other things that group practices have a different struggle. You figured out how to do one well, but as if we want to reach a practice that's self-managing and even better, self-growing, it's going to be the team around you that makes that happen. So that's what our Spark group does. You guys should be a great fit.
Bert Triche:
We've talked about that. We had a meeting with Heather and we've talked to Dr. Mariano.
Wendy Briggs:
That's the point, right? Is that as you grow the systems in your practices, you get to a point where, just like you said at the very beginning, Dr. Vince, that the biggest growth you've had is bringing someone from the outside in because you've gotten it to where you've gotten it all on your own. But there does come a point with practices for our listeners to recognize that you can say things three or four different ways and they don't hear it the same as they heard it from Bert. And there's power in that, right? So we love that part about what we do. We love being able to partner with the best providers in the world. We absolutely love working with such amazing doctors such as yourselves and consider us fortunate to be a part of your story. So thank you so much for being willing to share that with us today.
Dr. John Meis:
Yeah. Well, amazing job, doctors. Congratulations on your excellent result, your wonderful practice, the patient care that you're providing. Absolutely amazing. So that's it. Yeah, that's right, Bert.
Wendy Briggs:
Great job to Bert as well. So yeah, good job.
Bert Triche:
Thanks guys. I love what I do. You know that. Lots of passion, right?
Drs. Emirzian And Mariano:
The best energy this girl has, that's for sure. Well, I hope this was helpful and we enjoy the whole experience and hope to move forward in some other capacity. But we didn't expect this, but we hope it is helpful in your own growth.
Bert Triche:
Thank you.
Dr. John Meis:
Well, absolutely. Thank you very much. So that's it for this episode of The Double Your Production Podcast. We'll see you next time. Bye everybody.
Drs. Emirzian And Mariano:
Thank you. Bye.
