The Group Dentistry Now Show: The Voice Of The DSO Industry – Episode 74

Dr. Roshan Parikh, Chief Strategy Officer of DSO Strategy and Group Dentistry Now editorial board member, interviews Glidewell Dental’s founder, Jim Glidewell. A dental industry legend, Jim shares a wealth of information with the audience.  Stephenie Goddard, who has recently been named Jim’s successor as CEO, joins the audio-only podcast as well. The group discuss: 

✔️Glidewell’s volume metrics as the largest dental lab in the world
✔️Role of AI and technology in the QA/QC process at scale
✔️Value proposition of using a large lab versus a small local lab
✔️How the pandemic has affected the industry
✔️ What 2022 looks like and more…

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Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry. The Group Dentistry Now Show: The Voice of the DSO Industry has listeners across North & South America, Australia, Europe, and Asia. If you like our show, tell a friend or a colleague.

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Full Transcript:

Dr. Roshan Parikh:

Hey, I’m Dr. Ro. Maybe you’d call me a Group Dentistry Now correspondent, or maybe a stand-in for the illustrious Bill Neumann. I serve on Group Dentistry Now editorial board as well. Regardless, I’m here with two dentists, two of dentistry’s finest. Stephanie Goddard CEO, and the man, the myth, the legend, Jim Glidewell, both of Glidewell Labs. We’re coming to you from the beautiful Glidewell Campus in Orange County, California.

Stephenie Goddard:

Thank you.

Jim Glidewell:

Thank you so much.

Dr. Roshan Parikh:

Glidewell is the largest dental lab in the world. I think that we live in a very metrics driven society. So to be able to relatively size up the sheer volume of Glidewell, can you give us, can you share with us some volume metrics so that the listeners can just get an idea for the size of Glidewell?

Jim Glidewell:

Why certainly, certainly. Glidewell occupy… Our main offices are here in California, Irvine, California. And our total square footage countrywide is about 1 million square feet. At this campus we have about 700,000 square feet of space here. And we have over 5000 employees. We work for approximately 70,000 dentists annually, and we do over a hundred thousand units of lab work every week.

Dr. Roshan Parikh:

Sizes up the relative business for everybody. So there’s 100,000. I think that a lot of the listeners know that Glidewell is premier in terms of dental restorations. But Glidewell also does so many other things that aren’t just restorations. So, outside of the 100,000 restorations that you guys do a week, what else makes up the Glidewell portfolio?

Jim Glidewell:

Well we do manufacture of course zirconia for not only our usage, but other laboratories too. It’s called BruxZir. We started that research in about 2005, and about 2007 we actually launched the product, came up with 16 different shades. And of course we’re able to lower the cost of crowns by not having to put porcelain on top gold. So it really helped worldwide now. People are using zirconia. We do not have a patent on that product. We had some issues during the patenting process. People always ask me that. But my patent attorney lost his license right in the middle of filing. So that kind of sums it up. But I’m so happy about that. Because we were able to take a material that’s very low cost, and not have to pass on high cost of manufacturing in the cost of the crown. So here you’ve got zirconia today. You can buy them for… our costs are like $100. But mostly, anywhere in the country, prices have probably dropped 25 to 30% over the last 10, 15 years. And we take great pride in that.

Dr. Roshan Parikh:

Do you guys end up, because of the volume and the size being able to white label any zirconia for other other labs?

Jim Glidewell:

Well, we sell them under the BruxZir brand. We don’t do any private labeling per se. We buy zirconia like most people do from Tosoh in Japan. There’s two or three other fine manufacturers too that we using some of our products. But by and large, we do all of our research right here. We have probably six or eight PhDs who just specialize in ceramic research and it’s an ongoing process. And I’ll tell you what, it’s getting better every, every day. And along with that, we also have the Glidewell io chairside milling system, which I wanted to bring out a few years ago because of what I thought was the high cost of chairside milling. And it was backed by venture capital type people that were adding on the cost of their investments. And as we all understand how that works, the dentist just wants a product that works chairside and he doesn’t need to enrich everybody on wall street. So we built those right here. And up till this time we’ve installed over 1000 units. And we’re very, very happy with that.

Dr. Roshan Parikh:

I hear that the mill not having to have the porcelain baked in the oven, and having it come straight out and be ready to be able to polish and then go inside the patient’s mouth. There’s an efficiency aspect to that too.

Jim Glidewell:

Well, the efficiency is that, even though it takes about 36 minutes to mill the crown, it comes out with a very, very small sprue attachment. And it’s actually quite shiny from the last passes of the burs that are so smooth, they almost look like a glaze. You cut off the very, very small sprue, and you can put it directly into the mouth. So it’s not like you have to mill something and then put it through an oven process, which takes quite a bit longer. The difficulty is, it’s extremely hard. Because this is fully centered zirconia. And we have to send out a diamond coated bur that goes with every crown. Once you mill the crown, you finish it, the diamond bur is disposable. You can’t use it again. I mean, the material is that hard. So you’re always also consuming one bur, but we supply that with every block.

Dr. Roshan Parikh:

Makes sense. And I think, you know, something during the last almost two years of pandemic and COVID, I think the money, the time aspect of, money value of time I think is probably at like the highest value that it’s ever been. So in terms of chairside efficiency and operatory efficiency, I think more and more patients are looking at same day dentistry as something that they need. And as far as the providers go, because of the high cost of having to turn over rooms, all of the PPE that they have to don and doff, and all those things, I feel like they more and more look to have longer appointments to do more quadrant dentistry than ever. And so something like a chairside mill I think makes even more sense today than it might have two years ago.

Jim Glidewell:

I agree with you totally. And also the concept, everybody knows this, that we put temporaries in with temporary cement. Sometimes it lasts to the parking lot. And here comes the patient back in looking to re-cement their crown. And that’s always a problem. But here you can go to a permanent cement. The patient goes out, and also tells all their friends that they had a crown done in literally an hour. And that drives more business to the office.

Dr. Roshan Parikh:

When you guys look at the thousand units that are installed, what’s the average time it takes for a provider to do a restoration from start finish. Is it around an hour?

Jim Glidewell:

Stephanie knows more about that than I do.

Stephenie Goddard:

So, most of our doctors are scheduling a 90 minute appointment, that’s from beginning to end. So from prep all the way to mill and seat. So it’s actually pretty quick. But if you look at the design time itself, it’s two to six minutes max.

Dr. Roshan Parikh:

That’s great.

Stephenie Goddard:

Yeah. So it’s two to six minutes. We have support here on site. So the really nice thing is, especially for newer doctors when they onboard, they might be a little bit nervous, or maybe they’ve used another system and they aren’t quite familiar yet with our system. We go out and train on site. But after that they have an 800 number. It goes straight to what we call our CTS group, our customer technical support group. And they can just remote in and do the design for the doctor, or teach them how to do it, and then send the product to mill. But we have a great support team that does all of that, but it’s very quick.

Stephenie Goddard:

The intent is we, I believe, and I think most of our doctors that buy the system see our AI generated crown is so spectacular. I mean, it’s really pretty spot on. And there are just some minor adjustments that a doctor will make to contacts or occlusion pretty minor. But our software team, that’s one thing that Jim hasn’t had a chance to talk about. He talked about us manufacturing mills and manufacturing materials, but we also have an entire software development team that wrote all of that software that we use in our lab. And we basically took a light version of that software and put it in the doctor’s office.

Dr. Roshan Parikh:

So it’s a good transition to kind of AI and computer vision, which seems to be in healthcare. But in dentistry specifically, more and more today. How does technology and AI specifically play a role in the QA/QC process here at Glidewell?

Jim Glidewell:

Well, I’m not I’m not an expert on AI, but the one thing I know is that it requires a tremendous amount of data. Because artificial intelligence requires you to look at past things that have happened so that you can design something that’s going to happen in the future. So, when you’re doing 100,000 cases every week, you’re creating a tremendous amount of data. And that’s allowed us to go up in the cloud and look at data. Using the CAD system, we go up into the cloud, we find crown we’ve done before that is very, very, very close. And when you’ve done millions, and millions, and millions of crowns, all of a sudden, we’re able to find crowns that are extremely close to the crown being proposed. So kind of within about seven or eight seconds, you’re going to have a proposal in front of you using our CAD system that is 80 to 85% acceptable.

Jim Glidewell:

That’s been our own experience here at our company. And so when you don’t have to learn to be a technician to learn a whole bunch of different key strokes. Because I’ve heard other companies talk about, “Oh, we’re down to 10 keystrokes,” or something. Well, that absolutely inaccurate. We look at the same system and it’s 110, 120 keystrokes. And so they’re asking somebody to be a technician. And with our system, our AI is so accurate that you may want to fatten up a contact or pull the occlusion up a little bit more. But really, these are very, very few keystrokes. And for 80 some percent, no keystrokes at all.

Dr. Roshan Parikh:

That’s great.

Jim Glidewell:

Then you just send it over to the machine. The only job you’ve got is to monitor the io system, is to put the right shade block into the machine, and you have to do that yourself.

Dr. Roshan Parikh:

Okay. Well that sounds like something that-

Jim Glidewell:

Very, very simple.

Dr. Roshan Parikh:

… I’d be able to do. Yeah. And dentists are 80, 85% of time, if it’s accurate with zero keystrokes, you know… I mean dentists are just tinkerers, and sometimes feel better if they just touch a few buttons. And so I think that the efficiency side, and just being able to see the results yourself, maybe doing your own kind of A to B comparison of, “If I fiddle with it or if I don’t,” and knowing that the result is exactly the same and the insertion time, it just drops in.

Jim Glidewell:

You bring up an important thing though. I find that most dentists tend to be engineering type people. They really do like to fiddle a little bit. And this does allow you to do that. What’s amazed me is how many people, once they start using our system, get such a kick out of it, that they can’t wait to use it. I mean, it’s like, what a new thing. And they don’t have to deal with the lab anymore, which makes us feel unwanted. But at the same time, we bring about 60 to 70 operators out here probably once a month to learn more advanced techniques with the system. And as I talk to them, they’re always very, very excited about that. I’ll look down at there… We have badges that tell them, you know, this guy’s done 250 units. Some people have done 1000 units, and I’m thinking, “Oh my gosh, this has worked out so well.” And we know that compared to the other systems, our people are using like 50% more than they’ve ever used anything else.

Dr. Roshan Parikh:

That’s great.

Jim Glidewell:

I’m very, very happy with the outcome of this. Even though we’re losing a little bit of crowns that we could be doing here, it’s better for people, better for patients, better for doctors, better for dental offices. Labs are a necessity, but now when you come out of dental school, you have to use a lab anymore. Because they don’t really teach lab work that much in dental schools. But today you have the opportunity to do your own lab work without having to be a dental technician. It’s really exciting.

Dr. Roshan Parikh:

Yeah. That is exciting. And yeah, the technology aspect of what chairside milling can do. I think in out of the 64 dental schools that there are, if it’s not, it should be, I think it’s 100% of all schools teach digital dentistry. Whereas like when I was in school, it was this. You can read the CT scan. We’ll kind of teach you a a little bit, but take a digital scan here. This is our one… I think we had the… maybe a 3M machine or something. Here’s one machine take a good look at it. That’s it.

Dr. Roshan Parikh:

So it’s really… yeah. It’s really continued to evolve.

Jim Glidewell:

Well I think most of the machines today, you know, the scanners, have gotten much, much better. Whether it’s whether it’s iTero, or Trios, or Medit, Carestream. Funny, one of our researcher indicates that… Which is the one that requires powder?

Stephenie Goddard:

3M.

Jim Glidewell:

It was the 3M unit?

Stephenie Goddard:

Mm-hmm (affirmative).

Jim Glidewell:

Unfortunately, it hasn’t got much traction, okay. But, it was the most accurate. When we look at remakes by scanner type, the powdered machine has the least amount of remakes of all.

Dr. Roshan Parikh:

That’s interesting.

Jim Glidewell:

But nobody wants to use powder. You know, it’s the death mill for the scanning industry, but it’s very, very accurate. Easily the most accurate scanner that we use. They’re all very adequate now. If somebody’s not good enough, they fall out of business right away. So the remainders today are the survivors of a very difficult competitive marketplace.

Dr. Roshan Parikh:

That’s right.

Stephenie Goddard:

I should have said, it’s actually a True Def, 3M sold it to Midmark-

Jim Glidewell:

Oh, you’re right, you’re right.

Stephenie Goddard:

… so it’s now the mid.

Dr. Roshan Parikh:

Midmark, yeah.

Jim Glidewell:

Yeah, 3M didn’t didn’t want to hear that anymore. We understand. And they poured millions into it. And the concept was a very good concept actually.

Stephenie Goddard:

I mean, look at where we are today with digital dentistry. What is it? 40% of our single unit crown and bridge cases come in digitally today.

Jim Glidewell:

Yeah.

Stephenie Goddard:

To Glidewell. So we’ve become a massive digital lab.

Dr. Roshan Parikh:

Wow.

Jim Glidewell:

But on top of that, I think it’s important to point out that a lot of cases where you cannot use an intraoral scanner because a tissue is hiding the margins. Now, if we can come up with some kind of other machine that will read that great. But until then PVS impression materials are going to be here for a long, long time. Unless you want to do a lot of electrosurg.

Dr. Roshan Parikh:

That’s right. That’s right. Oh yeah. I had an electrosurgeon, when you had to put the ground on the patient’s back, and you’re like, “It’ll be okay.” And then they’re like, “What’s that smell?” I’m like, “It’s your gums.”

Jim Glidewell:

It’s your mouth.

Stephenie Goddard:

I think though that Jim raises something interesting, and I would love for you to talk a little bit about the technology, Jim. Because we do still get a lot of PVS impressions. And so new technology that our teams have worked on, both our manufacturing engineers and our software engineers, is a desktop CT scanner. So that we can digitize those physical impressions that we get, and still create a digital workflow for the doctor.

Jim Glidewell:

Yes. That’s called a micro CT scanner. It’s desktop, probably about 20 inches long, 15 inches high, and about 15 inches deep probably. And it’s a x-ray emitter, and we’re able to digitize and and scan every PVS impression that comes in here very accurately. And we’re using that right now. We’ve built about 80 scanners, but we’re using it on probably 40% of all cases coming through the door.

Dr. Roshan Parikh:

Oh, wow. So then-

Jim Glidewell:

You don’t pour a plaster model. And some of those, if you take… engineers will tell you, there’s a thing called error stack up. Which means, if you go from the impression which is going to have some error in it, and pour plaster into it, you’re going to create more error. And on down the road, you know, by the time you’re done, it is really amazing that a crown fits in the mouth. So we’ve been accepting those outcomes for a long, long time. And as far as inaccuracies, it takes a little longer to put them in the mouth, you know, a little… And so with CT scanning, we take the impression and we just scan it right there and digitize it without going through all the model and die steps that create problems for most dental labs.

Dr. Roshan Parikh:

So it reduces that error stack.

Jim Glidewell:

Yeah. It reduces stack up errors quite a bit.

Dr. Roshan Parikh:

Yeah. Because maybe I owe you guys an apology. Because I’ve definitely over the years used a lab as the reason why the crown didn’t fit. When I had to take a new impression and and then send it back-

Jim Glidewell:

We didn’t bring up your name, did we?

Dr. Roshan Parikh:

Yeah. No, no, no, no. But I never said your lab by name. But I think dentists, labs take a lot of that blame when you’re in the chair. And then if something didn’t get paid, it’s the insurance company’s fault. So it’s never our fault, but it’s always one of those two.

Jim Glidewell:

I see the time in the future when micro CT units will be in almost every dental office. It’ll be a coming time for that. And instead of sending it to the lab, you’re just simply going to scan the impression in your office. You’re going to have a scanned impression because you need to PVS, because you’ve got tissue all over the crown. Especially when you get older crowns, you have to pull them out for one reason or another. You cut them off and you’re always going to have a lot of excess tissue there. So you’re going to have micro CT scanners in dental offices in the future. And you’re going to only send the scan to the laboratory, if you don’t have your own io system sitting there. But if you do have a CT scanner, it’s a good chance you’re going to have a .io machine, you’re just going to go right to your own machine. And we laboratories will never know what happened. We’re just going to slowly go out of business. Heck what happened here?

Dr. Roshan Parikh:

You know, when you think about the future of scanners and what it can produce, and how many more dental implants are being placed, how would the technology be able to look an edentulous space and kind of preplan so that a patient could maybe leave with a temporary?

Jim Glidewell:

Do you want to comment on that at all?

Stephenie Goddard:

You can comment on that one. That was a little technological.

Jim Glidewell:

He was looking at you when he asked the question.

Dr. Roshan Parikh:

Just looking in the general vicinity.

Jim Glidewell:

Well, I don’t know quite how to answer that one truthfully. I do think it’s coming. I mean, software development is so fast. We utilize probably in the neighborhood of 80 software writers today, full-time basis, 80 people writing software. So, one of the reasons we’re not what we’re called Glidewell anymore, we’re not called Glidewell Laboratories is because the word laboratories indicated we’re just a dental lab, you know? And truthfully, as you’ve been around our campus, this is a huge engineering operation with machine shops, wood shops, everything under the sun. We write software, we hardly just make crowns anymore. And of the 5000 employees we have, probably 400 are not involved in making teeth somewhere like that.

Dr. Roshan Parikh:

Wow. That’s a big number. Yeah. A mentor of mine told me one time that like, to be simple is unbelievably complex on the back end. And so, I think that the simplicity that patients and doctors experience through being able to send a case to your lab, and how seamless it feels, is kind of in the the background. There’s so much complexity to be able to build that system. And I think that… I’d love to get your thoughts on, as more and more efficiency comes to dental care in the retail healthcare space, I see there’s a marrying of patient experience and the consumer experience that we know from Amazon as being able to click one button. and just be able to have your package. I mean, sometimes these cords that I ordered come in three hours and then you don’t… And then New York, they’re looking at delivery that’s not fast, but now they’re looking at ultra fast delivery. That could be 10 or 15 minutes. And there’s a lot of VC money being thrown around hyper-efficiency. But as the patient experience kind of marries to the consumer experience, how do you guys see that in the future?

Jim Glidewell:

We have been working on fast delivery systems for a long time, I’m going to say at at least 20 years. And today and today we don’t have hardly any crowns that will leave here in less than… had been more than three days. We work 24 hours a day. If you’ll notice the offices next door, we do not have locks on our doors because we’re open 24/7. There’s no reason to lock your doors when you’re open 24/7. So most laboratories in our industry, they work eight hour shifts, and they require two weeks to get a case back. I think one of the reasons we’ve grown so darn large is that we get cases back in three to four days. Now, in the future, we’ll be trying to improve that all the time. Every day we work on making things faster. We’re always experimenting with, “Could we do this, could do that? What time can we negotiate with FedEx to pick a case up?

Jim Glidewell:

We even make some cases even right today at the FedEx property in Memphis, Tennessee, so that we can deliver cases to outgoing at midnight. So that we got another five hours to get cases out that day. And still we’re working 24/7. But I think if somebody was to send us a scan by 10:00 in the morning here, which would be 1:00 Eastern Standard time, we’re Pacific Standard time out here, we got it by 10:00, we probably could literally get a case out the same day. You can get it back by tomorrow morning at 10:00 through FedEx. So that’s kind of a very, very… and we talked about temporaries before. They’re falling out constantly at their job. You don’t have to take them out, they fell out.

Jim Glidewell:

So, we know everybody needs their crowns back as fast as possible. So we’re trying to accommodate that. We’re not trying to accommodate our workforce by saying, “You’re only going to work a 40 hour shift, 8:00 to 5:00.” Because if you go into a 7-11 or some kind of a small shop, stop and rob shop they call them out there, people are working 24 hours a day. There’s a lot of people out there that are willing to take those jobs. So not everybody wants them, but I’ve found many people that want to work night times. Especially today when childcare is so expensive. Sometimes today our we’ll have employees here who work in the day shift, and then their wife or their husband will work the night shift. That way they have full-time childcare coverage all day long.

Jim Glidewell:

So we’re trying to accommodate everybody. As soon as we said we’ll run run night shifts, we were inundated with people who wanted to work nights, because they needed to do the childcare issue. Out here in California it’s like $1200 a month to put your child in daycare. And what do you do? And with wages being what they are, it’s hard to pay 1200 for that and pay $1 million for a house at the same time. Very difficult. Southern California especially is very challenging.

Dr. Roshan Parikh:

Ties in really well to something I’ve been thinking about, is just a lot of the Group Dentistry Now audience, they’re DSOs and emerging groups. You probably touched on a lot of these points. What’s the value proposition to use a lab like Glidewell versus their kind of traditional local lab as they look to grow and scale?

Jim Glidewell:

Well, we have Glidewell is standard pricing, fairly low, not the lowest. Because at $100 we find that some of the people who go to DSOs, especially if they’re making their work in either Vietnam or China… Which is fairly efficient, I’m always surprised how fast those people get cases back all the way from China, you know? And the quality is not that bad, truthfully. One time I used six labs in China just to test them, they were very good. I went downstairs and slapped a few of my people around, I said, “Look at this, look at this.” I was expecting to see really bad work, you know. So, the DSOs are buying it. A lot of them are negotiating with people that are here, who have offices in the United States, and they’re sitting overseas, and that’s not so bad. But with Glidewell, we’re still fairly low priced compared to most all dental labs. I mean, the average laboratory crown in the United States is $150. You know, we’re at $99 for one of our crowns. And if we go to a scanned operation where we don’t have to make a model and die, we actually drop our prices almost 20… Is it about $20?

Stephenie Goddard:

20.

Jim Glidewell:

So we’re like 79 or $80 per a case without model work. And usually the model work goes in a trash can when it gives to the office anyway. It also costs us more to ship a box than it does to ship an envelope with a crown in it. So we actually really like doing that. But Glidewell, we try to accommodate everybody, all their needs. But there are times when we just have to have a standardized approach to making crowns and selling them. And we hope that their business model meets up with our business model and it’s acceptable to both parties. And that’s why we work for as many as 70… this year we will work for 70,000 dentist total. Now that’s not every week, but we work for 24,000 dentists every week. 24,000 dentists send us work every week. And then during the week, and whether it’s sleep appliances, or maybe removables that they don’t do all the time, it comes to us. So at the end of the year, we’ll have 70,000 individual dentists sending work to our company.

Dr. Roshan Parikh:

Wow. That’s remarkable.

Jim Glidewell:

Yeah. Which is close to half.

Dr. Roshan Parikh:

Yeah. Yeah. I think that-

Jim Glidewell:

I’m not sure. What do you think the crown is? Maybe 150,000, or 155,000?

Dr. Roshan Parikh:

Yeah. 150, 155, 157, something like that.

Jim Glidewell:

That’s kind of what we think it is. 155,000 active dentists.

Dr. Roshan Parikh:

Yeah, that’s right.

Stephenie Goddard:

I was just going to add on, Ro, if you don’t mind.

Dr. Roshan Parikh:

Yeah.

Stephenie Goddard:

One of the other things that I think that Glidewell does is, I really commend Jim on his philosophy which is, he wants to provide high quality crowns at an affordable price for all dentists, irrespective of whatever group you belong with. And so that’s been his mantra, is to lower the cost of dentistry for everybody so that it becomes affordable. So, we try to keep our costs as low as we can. But then we also do a lot of things. So, one of the reasons why we make our own materials, why we have an R&D department, is so that we can continue to lower the prices, right? So, we make our own implant parts so that we can lower the costs to the dentists, instead of buying from somebody else and then passing on those elevated costs.

Stephenie Goddard:

And then we also do things like education. So, we have a phenomenal VP of clinical, which is Dr. Park. I think you may have met him. But he’s built a phenomenal team of educators. And you know, Jim’s big philosophy is to give out a lot of free education and really help, not just dentists in the US, but dentists globally. We have a huge following in India and in Latin America of our dental education, online education, and we make it available free to people all around the world. So that is a big focus of Glidewell. So, it’s not just that we’re your local dental lab. But we provide a lot more services. And that’s really where I think Jim’s philosophy of giving back to the community in ways that not everybody can do or thinks about doing.

Dr. Roshan Parikh:

Yeah, that’s great. And I think like, in today’s day and age, emerging groups and DSOs, if they’re in the business of being able to commoditize dental care to make it more accessible and convenient to the public at large, by being open six days, seven days a week versus four days a week. I think that they’re really looking for groups or manufacturers, vendor relationships that are more of a partnership. And those value-added services of education, clinical education, CE, being able to have… I think that you guys have a lot of robust data that you can share with the enterprise level clinicians, or some of their senior leadership.

Dr. Roshan Parikh:

So that they can look to see which one of their clinicians probably needs a little bit more handholding, because their crown remakes are a little bit higher. And I think that to the earlier point around money value of time, if that seat time goes from 10 minutes to 20 minutes, I mean, that’s a lot of productivity that’s lost. I mean, plus it being a subpar patient experience. And I think that you guys being able to emphasize the quality and efficiency and help partner to make the clinicians better I think really resonates too.

Jim Glidewell:

I’m not a proponent of socialized dentistry, but we’re in a country where only 50% of our population has ever visited a dentist. So, our free enterprise system is always promoting profit at every turn. At what point do we feel as a profession, are we letting down the public, that they feel that they’re priced out of good dental care? So, I think the DSOs today are looking for ways to put more people in the field, have it more accessible. And we’re looking for ways to lower the cost constantly. The other day, Dr. Christensen made a remark about our company’s thing, that, “How have you been able to go the last 15 years without a price increase?”

Jim Glidewell:

And that’s because every year we become more efficient, and why should we raise our prices to increase our margins, just because we can? Sure, we could raise our price at 3 to 4% a year. And after 15 years you’re up 45%. And there we are at $150 a unit, you know? And yet we’ve stayed at $99. And that’s because we are able to make our own materials. I’ve always thought implants are an incredibly good part of dentistry. I mean, that’s good dentistry. Do I think three-unit bridges are are good dentistry? No, not necessarily. Because typically you’ve lost a tooth, and that means a tooth on either side that are also medically compromised. So, what are we doing? We’re hanging the occlusal forces of three teeth on top of two compromised teeth when we make a bridge.

Jim Glidewell:

I would much rather see us put an implant in that place, and that’s good dentistry. Dr. Christensen always pointed out that when the cost of an implant can get below the cost of a three-unit bridge, we’ll start doing more and more implants. But when I look to it, the company that were running 80%, 86% margins, and I won’t mention any names. But 80% margins on their products. I said, “Implants are just too expensive. What’s it really cost to do that.” So, we teamed up with Dr. Jack Han at one point, who had helped invent the replace implant for Nobel. And we said, “Would you like…”

Jim Glidewell:

And he had left Nobel at that time, because he was… I don’t know if I should say it that way, but he wast GPs how to place implants. A lot of the oral surgeons and periodontists didn’t appreciate that. So he found himself like, “What happened to me?” So, I said, “How would you like to invent, or develop another implant?” So, Dr. Han came on staff, and we started building implants again. And today we’re becoming a force in the implant area, under 200. I don’t even know what the prices are, 160 or something, or…

Stephenie Goddard:

I’m going to say the wrong price, so don’t let me quote it.

Jim Glidewell:

I can’t remember what the… But I mean, I mean, everybody else there’s are 450 plus, plus, plus. And we’re basically 150, 170 plus a little bit. But we still have an incredibly dumb 50% margin on everything we sell. How much more money do you need? I mean, come on. And the other thing is though, since we’re not backed by VC money, we don’t have to pay anybody a very large return on our investment. We can sell implant parts and be very happy with making 50%, because we get to take that and it right back into buying more machines, and making more parts even cheaper, so that we don’t have to raise prices.

Dr. Roshan Parikh:

That’s right. Well, that sounds like something I was… I’m listening to your book, Constant Change on Audible. And you were talking about in that, if you take out 10 cents, or if you take out a dollar out of it, you have to pay 50% tax. You’re better off putting the money back into the company, so that you can have the ROI over time, and it’ll make much more money for you. But being able to reinvest in your people, and the technology to be able to have more and more efficiency to not have to raise prices of crown units or anything for the last 15 years, that’s remarkable.

Jim Glidewell:

Yeah. We get more efficient and we still, we all make a living. And the thing about Glidewell Laboratories is, we reinvest all excess cash flow back into the company in a form of research and development. I personally don’t take money out of the company, and I’m the only stockholder, because I own about 700,000 square foot of real estate.

Dr. Roshan Parikh:

In Southern California.

Jim Glidewell:

Right here, you know? I try to pay our real estate, it never exceeds about 3% of our gross sales of a company. I advise anybody who’s going to enterprise never pay more than about 3% of your payments in rental. So unfortunately, that 2 or 3% comes to me, and I do not need to take any money out of our company at all. I don’t take any money on. Everything goes back into research and development.

Dr. Roshan Parikh:

That’s great. Well, it sounds like… In the book, I think they referred to you as an entrepreneur with a Kentucky heart. And it sounds like that’s what you are. What inspired you to write the book Constant Change?

Jim Glidewell:

I wrote the book… as I get older, I’m 76 years old now, and you don’t live forever. So when you write a book about something you accomplished, it seems to be of good note anyway, that your children and your employees, and everybody will have a historical record of what happened. So it was really just a historical… We’re not trying to make money on a book. We’re trying to, “What happened? How did it happen?” And to let other people look at how you build a business from zero to over 5000 employees in that period of time, in an industry that’s not known for growth. I mean, I’m not in high tech industry. We’re not making computer chips here, anything like that. You know, we don’t have breakthrough technology. But we developed some breakthrough technology here. But we just keep going, you know? I don’t look at retirement. I think you read my book. I do have a exit strategy, it’s called death. When I die, I’ll quit coming to work.

Dr. Roshan Parikh:

Well by your demeanor and, and just your spirit, it seems like live forever.

Jim Glidewell:

Yeah. Well, you know, I have more fun at work than I do staying at home. I’m not saying my wife asks me to do things, but I’m just saying I have more fun at work.

Dr. Roshan Parikh:

Yeah. I can’t see you as somebody who’s watering the plants in the morning and trying to collect the bell peppers from the vine. I don’t see you as that guy.

Jim Glidewell:

I don’t read the newspaper to find out what happened yesterday. I’m trying to figure out what history we’re going to make tomorrow.

Dr. Roshan Parikh:

That’s neat. That’s really neat. Well, Stephanie recently being promoted from chief experience officer to chief executive office, some big shoes to fill. But getting Jim’s approval must be empowering. Great. First off, congratulations. And what metrics, when you look at the success of this business… When I walked into the office, I saw the scoreboards that were there of what restorations and what states, which is amazing. But what metrics do you look at for success on a daily, weekly basis?

Stephenie Goddard:

Jim has… we have a lot of reports that we look at. I mean, we’re looking at backlog, remakes, we’re looking at… I mean for us, you talked about consumerism, right? Customer experience is really important to us. So, Jim talked about speed. Speed of a crown delivery really is a product in and of itself, right? So how do you create that customer experience for our doctors? And then they can create that experience for their customers. So, when you look… I was listening to a podcast recently, and they talked about dentistry as this sort of weird mix of a patient and a consumer at the same time. So how do you help a dentist straddle those two arenas of, “They’re my patient first, but they’re also a consumer of products from me as a dentist.” And so, I respect that, and I understand that.

Stephenie Goddard:

So, we look at a ton of metrics within our own business to help our customers to be successful. So Jim talked about lowering the price of dentistry. So, we’re constantly looking at what new products can we add? One of the things I like to think about, that I always commend Jim on is, he comes up with these ideas of… I’ll just use the BruxZir product as an example. The first one that we ever made was the ugliest thing I’d ever seen. And you know, you sit there, and you think, “Well, what’s wrong with what they’ve got today? Their dentists are doing fine.” And he did not give up. And I remember they passed around that crown. It looked like an Opal, almost. It was shiny and had all these colors in it. And everyone was sitting there thinking, “What is he thinking? This is so ugly.” But he did not let go.

Stephenie Goddard:

And that’s the kind of spirit that I’m so looking forward to learning from him is, what makes his mind tick, and why does he never give up?” Because when you look at where Jim started at his kitchen table, to a million square feet today, how does one man’s mind get you from there to here, to where we are today, to where we’re going to be in the future? And so, we’re constantly looking at how to improve the product, how to make it faster, how to make it a better product for the patient. So, there’s a lot to constantly look at and we have. Jim’s got an amazing team of people, Dzevad Ceranic, who’s our EVP of lab operations. He started off at the bench at Glidewell. How long ago, Jim, 25 years ago?

Jim Glidewell:

25, yeah.

Stephenie Goddard:

25 years ago, as a dental technician. And now he’s running the entire lab function. And he sits right here in the office with Jim and I every day. If there’s an issue, they talk about it. It’s really amazing to see what Dzevad and his team have done with that lab. And they’ve hired a new team of what we call, continuous quality improvement, but a Six Sigma team who’s constantly looking to reduce the waste in the way we manufacture product and improve the quality of the product that we send out on the backend.

Dr. Roshan Parikh:

That’s great. Yeah. I think the efficiency of what the… I loved what you said about the patient experience and the consumer experience. And for the dentist, they’re both. I think that you guys seem to not only think about the dentist as your customer, but you also think about the patient as your own, as your customer. And so being able to think about both of those constituencies as being equally important, even though only one of them pays it directly, the bill back to you guys is great. You’ve mentored many young leaders over the course of your career. I’d assume that you’ll continue to play a big role in leadership, and also be being able to bring more women into leadership roles like yourself.

Stephenie Goddard:

I hope to. I mean, women in leadership is a big passion of mine. It has been for a long time. I think you know; I created the… Jim let me create this program that we call Guiding Leaders. It was a 12-month leadership development program for female dentists. And we’re actually going to launch a second version of that next year. So, I’m really excited to get that started again, because we had 14 phenomenal women in that program. And I was so grateful we had that right before the pandemic hit. Because this group of ladies was so connected. They got together for weekly happy hours when we were all in lockdown. And their businesses were shut down. And there was a lot of fear and angst.

Stephenie Goddard:

And they showed up to help each other and give each other advice on, “Hey, here’s how I’m applying for my loans,” or “Here’s what you can do,” or “Here’s some things that I’m doing.” They talked a lot about tele-dentistry. So that, women coming together and supporting one another was really amazing. The thing about the pandemic that discourages me a bit in dentistry in particular is, we had such a great trajectory of female dentists coming into the profession. And I think 51, 52% of all students now are female. But only about 35% are actually female practicing dentists in the total population today and growing.

Stephenie Goddard:

But we did see a bit of a pullback in female dentists practicing because of the pandemic. So many of them did have to give up at their careers or put their careers on hold because of childcare, or family issues, or parents, or, you know, whatever the issues may have been. But it seems that they took the bigger hit in their careers. And so that disappoints me quite a bit. And I’m hoping that we can get them back on the path that they were headed toward.

Dr. Roshan Parikh:

Yeah. I hope so too. And it seems just dentistry as a profession seems to have bounced back much more so than hotels or restaurants. And so, I really, I see that with leaders like you at the helm. I think that bounce back sooner rather than later.

Stephenie Goddard:

I have seen though in dentistry… I mean, Jim, you’ve seen it as well. I think that doctors have talked to you. We had a doctor here a couple weeks ago who couldn’t hire a hygienist and hasn’t been able to hire a hygienist for six months, and he is doing his own hygiene appointments. It’s the doctors that have been coming here recently have talked about their own staffing issues and how they’re struggling with finding people.

Dr. Roshan Parikh:

Yeah. I…

Jim Glidewell:

Well, we had to raise are beginning salaries here to $17 an hour to get any attention. The market’s really tight. But now you’ve down to 4.6 unemployment nationwide. California’s even a little tighter than that. So, I think there’s still people who are out of work, who were maybe not wanting to go back to work. I’m not sure, I’m not sure what’s happening. We’re not fully staffed. I say we’re fully staffed, but I hear that we’re what, 300 or 400?

Stephenie Goddard:

We have 400 open positions right now positions.

Jim Glidewell:

We have 400 open positions even here at our company. How are we getting work out the door? How does that math work? One thing I wanted to add during this little podcast too is, dental laboratories by and large, I think we tend to take shots at each other once in a while. But to become a successful dental laboratory owner, you’ve had to pass the test of fire, of making crowns that fit in the mouth. I mean, there’s some professions you can fake it. You’ve got a license and you’re licensed by the state, and you get to be in business forever. But a dental technician can’t fake it. Either we do it or we don’t. So all the laboratory guys I know nationwide for the most, part do really, really good work. I think dentistry should be proud of and happy with the fact that there’s good laboratories across the entire country.

Jim Glidewell:

When I go into other laboratories, I sometimes look at what they’re doing, and I come back and make changes here. Because I’m really… find out that maybe we’re not as good as they are occasionally, you know? I just wanted to bring it up. Because somebody asked me. The other day we had his fellow drop by and mentioned a laboratory called da Vinci down in Los Angeles. So, I went down there one day and visiting with Danny who was running this company. And he invited me to look at some of his veneers he was doing. And I sit down, and I looked at his veneers. Immediately went home and slapped my own people around a little bit. “Damn, we got to do better. Because Danny’s beating us,” you know? I’ve had it happen before. I’ve had technicians… of course, being the world’s best technician, I was a very good technician I think at one time. But I realize there’s a lot of great technicians out there. But running a business that really takes care of what dentists need overall, is more than just making a good crown.

Jim Glidewell:

And I hope that’s what we’re doing for the people we work for in the DSO community, and also just in general dentistry. That’s probably why we’ve been rewarded with the size we are. But there’s also the ability as a manager to continually expand and expand the capacity to take on more business. Whereas most laboratories get to a certain size, they get fat and happy and they quit growing. They need a bigger building; they won’t do it. They need more benches, and they won’t do it. And they found a place that makes them satisfied but will probably limit the size of their company. And we’ve always had a, as the book indicates called Constant Change, we’re always in the mode of constant change. We build our own cabinets here. We do our own electrical work, our aluminum studs, drywall, anything you’ve seen as you walk through our campus that’s being built, is built by Glidewell people.

Jim Glidewell:

I think there’s 175 people that just do construction projects throughout our company, because we’re constantly changing. Someday you… like a plaster department is being replaced by a CT scanning operation. You don’t need all those sinks and ovens anymore. You just have CT scanning. You did away with 20% of your workforce when you bring CT into a dental lab. And you have to change the benches. They’re a different kind of a bench. So, we take old benches out, put new ones in. That’s part of what constant change is. And most of us don’t like to do that. The only time we build a lab or a dental office, we build it one time, and then we hope we never have to do it, because it’s such a painful experience. We don’t want to ever do it again, you know?

Dr. Roshan Parikh:

That’s right. And I think that that goes to what Stephanie was saying earlier. Is like, in your mind, it’s like the relentless pursuit of perfection, and just wanting to be the best version of yourself every day, and not becoming complacent. Which I think that dentists sometimes have an eight operatory practices, and they could have a 12 operatory practice. Or they have a great patient experience. They could add a specialist. But they end up, some not all, but they end up running it more as a lifestyle business. And they’re like, “Well, I’m doing really well. I have a good work/life balance.” But it it’s not necessarily… It’s more thinking about the doctor’s point of view, versus what other patients they could be helping.

Jim Glidewell:

I was speaking this morning with one of my staff, and I said, “Most people do the same things every day. We repeat our experience today, what we did yesterday. We drive to work the same way; we have the same breakfast. We never want to change anything.” And what I do, the only thing I’ve done, and I get way too many accolades for being a change artist. But every day I come to work, I’m looking to change one or two things on a daily basis that will make the company better. Make somebody’s experience better. That’s what I challenge myself. And it’s somewhat uncomfortable, because you’re never really happy with who you are, and that’s who I am. Every morning I come to work, I think, “What can I do today to make some changes?” And then my own little body, I’ll feel better about myself. I’ll feel good if I can make sure I made a change that helps us, helps the company, helps dentistry, and ultimately helps the patient.

Dr. Roshan Parikh:

When you look ahead to 2022 and beyond, for 2022, what do you guys look at as a successful… when you’re sitting here 12/31/2022, what does success look like for Glidewell?

Jim Glidewell:

Well, personal growth probably of 10 to 15%, placing another thousand io scanning and milling systems, expanding our reaches down into South America. The expansion into South America has become kind of a surprise. But what we have done is, years ago I started a video department. And Dr. Mike DiTolla, he was very instrumental in helping with that, and also zirconia. He was one of the ones who initially did not like the look’s zirconia too.

Dr. Roshan Parikh:

The opal.

Jim Glidewell:

He certainly came around to it. Because he was the guy placing them. I thought, “Get in here and put that white crown in the mouth.” He been really happy about that in the beginning. So of course, he helped co-develop that. And I always say thanks to him. But we must have produced close to 500 videos on, how can you describe dentistry in 500 different ways? I don’t know. But we have over 500 out there. Some of them are remakes of earlier videos. And Maurice, who’s doing our audio work right now, he’s the fellow who’s been in charge of almost all 500 of those videos. But especially in a place like India, where people speak English, our videos extremely well. That’s our highest country for viewing of Dr. DiTolla and all the subsequent videos we made. That’s the highest viewership. South America, very, very high. So, the Glidewell name down there for some reason has a very good attraction anyway. So, when we go down there, we always pick up a lot of customers and they know who we are.

Dr. Roshan Parikh:

Yeah. I mean, it’s a globally recognized name.

Jim Glidewell:

You know, we’re not selling… A lot of the videos we’ve done have nothing to do with Glidewell at all. They’re how to give an injection. You know, how to place an implant before we were even doing implants. We were actually placing implants and doing it on video. And Dr. DiTolla I remember did his first video on screen. And I’m not sure he followed through, or he did many more after that. But it wasn’t something he cared about doing all the time. But anyway, we’ve helped train people for free. If you can take the profit motive out of something, and just give it away for free, like the video operations, and it helps us. Sure, we got our name out there better. But I’m really proud of what we’ve done. I had no idea in India how much continuing education they were using our videos for. That’s fantastic. Do we get paid for it? We don’t care. Have no interest.

Dr. Roshan Parikh:

That’s great.

Jim Glidewell:

It’s just better for people. Yeah.

Dr. Roshan Parikh:

That’s great. Anything, anything to add for, Stephanie for success?

Stephenie Goddard:

Yeah, I just going to add, you know, when I started here 15 years ago there were 1100 employees. And back then we had our first… do you remember, Jim, our wax mills that we were using in the gold department. And so, we had just started introducing technology. And I remember people being afraid of technology, right? And Jim was pushing, “No, we’re going to implement technology.” And he is constantly changing everything. “And we’re going to implement this. And then we’re going to add scanners. And we’re going to add 3D printers, and then we’re going to…” So, it’s this constant development. But I remember being here and people being afraid of technology.

Stephenie Goddard:

Because “Oh, what will happen, the technicians are going to lose their jobs,” or “People are going to lose their jobs.” So fast forward 15 years later, 1100 employees back then, 5000 employees today with the mass amount of technology. And that’s the one thing that I would see as a growth opportunity for us, is the continued career development of our staff. So, a lot of the people that were technicians are now for instance, in our engineering department, or in our software development department. So that’s a huge goal for me, I know, and for Jim personally, is to continue to develop the careers for people who may have come in to help us as a technician, and now have a future growth plan. So that continue to grow our staff and create more careers for people.

Dr. Roshan Parikh:

That’s exciting.

Jim Glidewell:

Can I add to-

Dr. Roshan Parikh:

Of course.

Jim Glidewell:

Something I was thinking about, the concept of constant change. I’ve written this book now called Constant Change. So, this is a plug for the book. No, we don’t make money on books, that’s not our business. And I don’t think we sold more than a couple thousand books total. So, it certainly hasn’t done any… it’s a rounding error on our income statements. But we’re going to… I think anybody who wants to know how to… If they’re interested at all in what we’ve talked about today, they should get that book. Because in the book, there’s all the ideas that I’ve used to build the company over this last, you know, 50 years actually, since January 1970. And they can buy it on Amazon. I think it’s 15, $17. I’m not even sure what it is, and you’ll get it tomorrow. If you wait enough… I think we’ve ordered 70,000 books.

Stephenie Goddard:

We’ve given a lot away.

Jim Glidewell:

Yeah. We’ve ordered 50 or 70,000 copies of it, and they’re going to be going to all of our customers for free. So don’t call Amazon or order the book. You’re going to get one for free anyway.

Dr. Roshan Parikh:

Oh, that’s great. That’s great.

Jim Glidewell:

Because I really believe there’s a lot of good things in the book, ideas that I have stolen from other people, you know, claimed as my own. But boy, there’s some great ideas in there. And it really helps people even run a dental office. So, it’s coming.

Dr. Roshan Parikh:

Yeah. That’s great. I would say, mimicry is the most sincere form of flattery, right?

Jim Glidewell:

That’s right, yeah.

Dr. Roshan Parikh:

So, well, last question. From the book, I have to ask. What color is your Hummer H2, and is it in the parking lot today?

Jim Glidewell:

I refuse to drive a car to work that is better than what my employees can afford. So I’m driving a 2017 Chrysler minivan right now, and my silver Hummer is parked in the garage.

Dr. Roshan Parikh:

Okay.

Jim Glidewell:

Because you know what? It’s so fancy, it’s ostentatious. It’s got Massey chrome wheels, and chrome everything. And I realized that’s not really very quiet to park the darn thing.

Dr. Roshan Parikh:

The minivan is though. The minivan is quiet-

Jim Glidewell:

The minivan

Dr. Roshan Parikh:

… unassuming.

Jim Glidewell:

Yeah. I think I’m going to take the hub caps off, to make it look even more dull.

Dr. Roshan Parikh:

Well, thank you guys both for being on The Group Dentistry Now podcast. Much appreciated. Through the book, and through these conversations, I know that I have to try and change two things today. So I’m going to work on that myself. But thank you so much for being on.

Jim Glidewell:

Thank you so much.

Dr. Roshan Parikh:

Thank you, Ro.

 

 

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