After-Hours Dental Care: Fixing Access and Staffing

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0:00 People would get a toothache at night. They'd go to the emergency room. Dentists are schedule out and they sure as heck don't want to come in at 8:00 at night, leave a message, we'll come back to you. Kind of a really professional real dental office, not just kind of one of these things where you feel like you're going into, you know, a little sketchy area to get a tooth pulled out. We're not going to steal your patients. We're going to treat them and send them back to you.

There's two game changers in my mind that you're you're giving to the marketplace. One is the whole concept around you know urgent dental care and after hours concept. If we're talking about business, there's a little side thing that we've done too on the business side is we've set up insurance captive. You have a good product and nobody knows about it. In medtech, the difference between a good quarter and a great one isn't always the product. It's the friction standing in the way. Broken sales cycles, misaligned teams, deals that stall at the finish line. Every leader feels it and the best ones know how to remove it. Welcome to Zero Friction, the podcast where we go inside the minds of MedTech's top commercial leaders to uncover the real barriers they face, the decisions they make, and the systems they build to keep the revenue moving.

I'm your host, Terry Coutsolioutsos. Let's remove some friction. Welcome, Zero Friction Nation. Terry Coutsolioutsos here with another podcast. I have a great guest today who is in the process of disrupting how dental care is delivered, when, where, and how. Jeff Ludlow, DDS is with us today and he has a dental practice, but he also has a brand new concept he's bringing to market around urgent dental care. So, welcome Jeff to the podcast. Love to learn more about you, your personal journey, and where you're heading with this new concept of urgent dental care.

Well, thanks for having me. I'm excited to be here and yeah, we'll see where where this new model takes us. So give us a little background on like you know stepping into the dental arena like you you have a practice today that you're operating but you know where did the concept come up with well first let's just start with your personal journey where where did it all start you know wanting to be a dentist and becoming a dentist well wanting to become a dentist is actually a funny story I originally thought I was going to be a teacher and a basketball quote co coach love playing basketball growing up but you know I'm 5 foot n so we knew I was never going to make the NBA and but I love teaching I thought I was going to be math teacher and I sat down with a girl I was dating at the time and she was like, "Hey, are you sure you want to raise a family on a

On a teacher salary?" And a lot of people do that and there's nothing wrong with that, but it kind of hit me a little bit. So, I started thinking and a kid I grew up, his dad grew up with, his dad was a dentist and he had a boat and I'm like, "Oh, well maybe I should be a dentist so I could get that boat." So I I didn't go into it with the love of teeth, but actually once I got into dental school, man, I found out I had a really passion for it. I loved learning.

2:48 And then I love dentistry because it's this blend of you can you can have this blend of uh blend of being a business owner and a healthc care provider. So it really scratched a couple itches for me. I've always kind of wanted to be a little bit of an entrepreneur a little bit control my own destiny. But then I also loved working with people and helping you know change their life. So it ended up being a really really good fit even though I didn't start out as I just I love teeth. So anyway about 20 years ago longer than that now but 22 years ago I graduated from dental school worked as an associate for about a year and a half and then branched out and started my own practice. It was in a small town in North Texas. Was the only provider there. We're just trying to figure out how to make it happen. Didn't even really do the demographic search like you're supposed to. Just jumped in

And got lucky. It was a great area, lots of growth. We worked really hard to make people happy. And so that practice really started to grow. I said, "Okay, I can do this." So then I started five other practices in small towns and tried to be the first dentist there. try to kind of grow one of these DSOs like they talk about now. This was, you know, 15 years ago before they became common knowledge, right? Didn't love that. I figured I could actually do better if I grew one big practice instead of five others because then you have less staff to manage. You got less things to do. Ended up selling those five and just sat and worked on my practice, my main practice now where we have five providers, seven hygienists.

So, it's a it's a big it's a big dental practice. Then I got the other itch of and I got to I got to do something different. And that's where this we call it after hours dentistry idea came. I realized that that pain was a motivator for people. I realized that people would get a toothache at night. They'd go to the emergency room. Emergency room wouldn't do anything other than, hey, here's some antibiotics. Let's charge you 600 bucks and send you home. And then the patient would have to find a dentist, have to figure out where to get the actual treatment done. And I looked at that and I was like, "Dude, if you're gonna pay me 500 bucks, I can get you out of pain. I can get you on the right step. Like, let's stop wasting the time in the in the health care system that especially in the emergency health care system, that's broken in a lot of ways in my my personal opinion."

Sure. And so we tried to meet that that niche there is to help people that don't normally go to the dentist or that work all day and that don't have time to go to the dentist. And so we started this concept and we're open from 6:00 to midnight Monday through Friday and then 10 to 10 on the weekends. and and it's turned into we do urgent care and we do a lot of comprehensive care from crowns to cleanings to whatever because I think there's a little bit of a need there for you know dentistry. You know it's really interesting because certainly over the past 10 years we've all seen on the the health care side of things not the dental care but the health care side of things the explosion the explosive market in urgent care. I mean, you can't can't drive by a, you know, a grocery store plaza or, you know, without seeing some sort of urgent care facility, you know, in a metro

6:01 Market anymore. And it makes perfectly good sense why you would not want to have an urgent dental care practice, whether it is something that actually happens urgent accident, you know, athletics, weekend, soccer, you know, somebody's head hitting somebody's mouth. I mean all those kinds of things or people that are busy professionals that don't have time to go to the dentist during the day and you know the only times that they can go is the weekend or they can go in the evening and you know what a what a great way to make it easy for the patient. So you talk about like you know the podcast is zero friction and the concept of this urgent dental care concept is really removing the friction of you know urgent care around the dental arena because even if you do get a hold of your dentist they might tell you to wait three or four days and who wants to wait three or four days if they're in pain right absolutely you know dentists are

Scheduled out and they sure as heck don't want to come in at 8:00 at night especially if you're a new patient right if you're just some guy they don't have a relationship with then they're like ah leave a message we'll come back to you. In fact, most people's messages say, "Hey, if you're a patient of record, call this number. If you're not, leave a message and we'll call you back in the morning." So, you're right. There's a ton of obstacles that that patients have to go through in healthcare and especially in dentistry. A lot of dentists, and myself included, you know, we start to think that we're so good that we only need to work three days a week and we schedule our patients from 9 to 4 throughout the day. And that's great for the provider, but on the other side from the patient or the consumer, well, that's start starting to really limit the access. Uh, and I also think the access to like good providers

Because oftent times those that are on the weekends are kind of working because they have to and they haven't built something. And so maybe there's a reason why they haven't built it yet. Either it could be timing or it could be they don't have the skill set yet. And so with with our after hours concept, what we've really strived to do is to make it kind of a really professional real dental office, not just kind of one of these things where you feel like you're going into, you know, a little sketchy area to get a tooth pulled out.

It's, hey, let's bring quality of care. Let's bring great providers and give the access to the people that are desiring it. You know, that's a great concept, too. And so I'm guessing as you're trying to create an easy button and removing the friction for the patient, what kind of friction has it caused in terms of running an operation and building a practice around after hours and weekends? I'm sure that's not easy for you as an owner operator. You know, what are some of the challenges that that you face in making it easy for the customer, but it's hard to run from a business perspective? Well, yeah, it's interesting. We've learned a ton doing this. One of the things that I was actually surprised about is to the public. We've had to kind of change the paradigm for them because most consumers or patients aren't used to being able to see a dentist at night. So, sometimes they're not looking for one at night. They're not looking to actually schedule uh

9:03 Their dental appointments around their schedule instead of the doctor's schedule. So, we've actually had to do a little bit of public marketing directly to the consumer as well to say, "Hey, this is a viable option." So, that was surprising is that we had to change the the public's perception of what it means to go to the dentist. And that was harder than I thought it was going to be. Yeah. And then and then of course, what was hard about it? What was Let's dig into that. What was hard about it?

Well, I think just cuz like the only time people are looking for a dentist at night is when they're in pain. And so that was the easy market, right? Is oh, they we could get top of Google, we could pay ads, we could we could advertise all that type of stuff for urgent. I'm in pain. I need a dentist now who's open at 10:00. So, we kind of dominated that for a while. We still do, but right, but finding the patient that is like looking for a dentist throughout the day and say, "Oh, I need to go to the dentist and then having us rank with other providers and then benefit than our cost benefit is, hey, coming at night after work." Got it. So the general public, the general dentistry is taking a little bit longer for us to grow, which is okay because the the urgent the urgent care is is it's an easier sell. It's it's an easier, you know, closing for hey, you're in pain.

Let's take care of the pain and and usually that means that's a little bit higher price ticket. So that's okay. but to try to build a practice that also sees comprehensive dentistry at night. That's where a lot of direct consumer and a lot of, you know, unique selling. Yeah. Is that's a really interesting concept, too. I think there's a lot of ways to get to consumers just everybody, you know, is on Facebook or Meta is probably a good way and and you know, convenience. That's where I just speak to like we all live in this push button society. You know, you know, I'm talking to a lot of healthc care models that are becoming more teleaalth, more more push button like triage kind of concept and you know in pain convenience scheduling things making it easy to schedule those are all you know phenomenal concepts and I'm sure like you have I've seen photos of the office too. It's it's a nice looking office.

It's cornerbound. you know, you probably get a lot of traffic, you know, in those platforms that are driving by every day. So, those that's probably a really good way to to create some awareness, too. Yeah, absolutely. We're on one of the major highways there in Dallas and so a ton of traffic and and then it it it requires us once we get the patient in there, say they call for they need a tooth extraction or whatever, then we got to be good about winning them over and say, "Hey, let's schedule you back so that this doesn't happen again." like let's let's have good price points, let's have, you know, how we work with your insurance, let's have available hours so that then we can start working them and building that relationship to grow that long-term practice as well.

11:58 Like we don't really want to be just the practice that says, "Oh, we take you care of take care of you and send you down the road, which we do if they have another provider." So, we work with a lot of dentists as well to say, "Hey, we're not going to steal your patients. We're going to treat them and send them back to you." But if that patient doesn't have another dentist, we don't want to just leave them hanging so that then they they're calling us every, you know, three weeks because they got pain.

Let's work to prevent it so that maybe it saves them money in the long run and they actually get care. So we have to blend both those models because that's another challenge that we had is how do we get dentists to trust us to send them to send us their patients that they don't want to handle at midnight, right? And so we have to balance that. And we we want to do both because there's a need for dentists to be able to have urgent care that they don't need to come into the office for, but also trust us not win their patient over and and steal them and capture.

Dentists are sticky that way. You know, they're everybody's sticky that way. Nobody likes customers walking out the door, you know. Nobody wants that. So, you know, that's a really interesting concept, too. And that's probably something that you know you have to really you know balance and understand who your referers are and you know making sure that you know you're reporting back to the referring physician building that relationship so that bridge continues because that's probably a nice pathway too for you. Absolutely. And and we've actually talked with a couple providers about putting together like a little subscription plan for them so they can pay us a monthly fee. Then they can send their patients. That patient will get looked at for free or we'll put the temporary on for free or whatever. So they can kind of trust us that way. And then if they want us to do a little bit more treatment, we'll talk to the provider and say, "Hey, do you want us to take out this tooth or do you want us to send them back to you? You

Know, we're happy to manage the care." And what I found is is providers that are good, that that know what they're doing, that trust themselves, that are confident, they love what we do, right? Because they know that we're good, but we're not as good as your, you know, primary care doctor that you've had a relationship with and all of that. And so working with those type of caliber dentists makes it even better because they're high quality dentists. They know what they're doing. They they trust us, we trust them, and they know they're going to get their patients back because of what they do. And they just and they're putting their patient first, too, which is an amazing concept.

Absolutely. Yeah. Absolutely. First, it's a great marketing thing for them because to your point, exactly. They can go to their patient and say, "Look, I can't be there tonight, but we've partnered with After Hours Dentistry. I know they're going to take care of you. We want to get you taken care of." And absolutely, it builds value for their practice as well. Great point. That's awesome. And so, I guess there's probably another couple other pieces of friction. I would guess staffing after hours on weekends is is a is like a bit of a headache too as a business owner operator, you know, especially when you want to provide that high level care. You know, you're white gloving it no matter what situation it is. So, it's that's probably a challenge for you.

15:01 Yes, that's that that's the hardest part actually is because because we want like and you know how it is these days, everything's about reviews and Google and all that. So, we can't we got to work really hard to make people happy. And if we're just throwing providers in there that don't care because that's all we can find, that's a big that that's that's a challenge. And and I care about what people think about me. So, if my name's attached to it, like I don't want people messing with that. So, we've had to work really hard to find the right providers. Fortunately, they're they're out there. And we found two kind of providers that fit really good for us.

One, it's the it's the guys that are maybe starting their own practice where they have a little bit of ambition. They know they know want to take good care of people and but they're still growing and so they need a little extra money. They're in the hustle phase of their life and so they don't mind working at their practice throughout the day and then maybe come work a couple nights for us to pick up a little extra money. So, we love those guys because they kind of know what it's like to run a business and they're figuring it out and and they can they can help grow ours. The second one, and we stumbled upon this, right?

Like this was a growing area, right? Like you think it's just gonna all work out and and sometimes as a a business owner, you you learn on the fly a little bit. And then the other avenue that we found, there's a there's a dental school in Dallas, Texas&M dental school. And so we've been able to use dentists that are doing their residencies. So these are guys and girls that are are training to be specialists. So periodontist or orthodont endodonist you like went above another level of general dentistry then.

Correct. Right. So they're licensed dentists. They have a license and but they got to go to school throughout the day to get their training and so then they can moonlight and pick up shifts for us on the weekends or at night. And it's a great way for them to pick up some extra money and kind of starting to learn what it's like to actually do real dentistry. And so and they're they're high quality people because they're getting accepted to these I was say they're getting accepted to an accreditation program so they're not you know they're not at the bottom of their class they're at the top of their class already. So, exactly. And so, that's been a great little niche for us. And it's been fun cuz some will leave and then we'll get others that come in as the next group comes in. And that was a little fun avenue that we found that is has been working really really good. And because, you know, a lot of them are single, so they don't have family, and they just

Like, hey, I just need to get some money and get my training and learn more. And and then there's been some where we've, you know, talked about the business side of it and what it looks to to run a business and what are the finances behind this and so that when it if if they go start their own, they're they're starting to see more of the real world while they're still in school. So, it's been fun that way. Probably a good pipeline for you too for talent if you're building your practice out too. But, you know, I've always those fellowship programs on the healthc care side are always, you know, great avenues and on both sides for for those looking for work and for those seeking to find really talented people. It's always been a really good thing there.

18:03 So, we got the the the the staffing pieces figured out. You know, you're still working on trying to figure out the how to get the people in the door the right way, you know, I guess the convenience. Yeah. And it's I think Yeah, like I said, there's a paradigm shift. I mean, we spend a lot of money in Google. We get we get good flow. We do okay, but like I'm the type of person that just wants to like blow this out of the the water, right? And so, we've built this office with 10 dental chairs in there.

And so, our goal is to get all 10 of those just working all the time. And so, so we're moving there. But to to get all of those filled, it requires some different levels of of marketing, right? And so that's where changing the public a little bit and getting those in-house referrals from dentists is is our next big push, right? Kind of really grow the side of that. You mentioned something to me when we had our first sort of initial conversation around a subscription or like like more like a concierge plan that you you've you've are actually in the process of putting together and delivering. Correct. Yeah. So tell a little bit about that because that's a that's a really interesting concept too. Yeah. So, this was this was a concept based on I had a conversation with one of my my patients in my main office where I see patients there two to three days a week and they were getting frustrated because they were teachers

And the school district changed their insurance and they felt like they couldn't use their insurance at our office. And I was like, "Well, how much are they charging you?" And they said, "Our premiums are about $150 a month for dental insurance for their family." And I was like, "Wow, that sounds like a lot by the time that the dental insurance doesn't cover anything." You know, they'll cover a maximum of 1,500 bucks a year or something. And I'm like, "Okay, so you've paid them almost two. They're only going to pay you back 1,500.

Well, I see who's I see who's making the money on this and it's not me and it's not the patient. So, as we know, the the dental insurancees are in it to make money." And so, so I started thinking about that and I said, "You know what? I think if you paid me 150 bucks a month, I could give you some pretty high quality dentistry. And so we built out our own little, we call it an all-inclusive membership plan. And so we charge patients now $149 a month. And whatever they need as far as their dental health care, we do. So they they get all their preventative stuff included in that plan. If a patient breaks a tooth and they need a crown, we actually do the crown for them. And there's no extra co-pay. So, we've capped their dental health care spend, whatever that is, 1,800 bucks a year. And it's great. It's great for like people that have retired.

20:46 They're on a fixed income. Fortunately, I have talented providers in my main office. So, we can do implants. We can do this stuff inhouse. We don't have to send it out. And so, we can give them full concierge comprehensive care at a base price on that. and and we built it kind of with the idea like I said, well, if the insurancees are doing this to make money, we could probably do it better than them and still make money in the process. And it's been great. So, we have about we have over a thousand people on that plan. We launched this just a couple years ago and we've we've slowly built it. And so, as a provider, it's awesome, too, because now I'm getting a little bit of subscription income that I can bank on. And it's just like any other insurance plan. the person that comes in and they need the work, they take advantage of it, but have, you know, 800 people that aren't coming in that month and they're help

Supplementing those people. So, when it's their turn and they need help, we have the the ability to fix it as well. It's a really interesting concept, you know, and it's again, you're you're just taking the middleman out of the the ball game, the insurance provider, who's really not adding any value to the conversation at all, by the way. No. And in fact to your podcast, it's just bringing in friction, right? Because now we either have to work with the insurance company. We got to wait. We got to see what they're going to pay.

Once they short pay everything, then we got to go talk to the patient. The patient's mad at us even though it's not our fault. It's the insurance's fault. But it's just it's just friction in the way. And so I go to my patients and I'm like, "Look, we we eliminated that. And now the incentives are the same. I want to keep you happy so you pay me 150 bucks a month for the rest of your life. So, I'm gonna take you give you the very best care that I can. We're gonna do all the preventative stuff. If something breaks, we're going to fix it the longest time because I only want to fix that tooth once. If I got to fix it over and over and over, then that's dumb. So, I need to fix it right on you, by the way, at that point.

Exactly. So, I got to eliminate the friction in my life on that. Right. And so, so I have to treat my patients right. I have to. And then we've eliminated the friction for them on the fee. They know they're not going to have to come to the dentist and now they need a crown and it costs $2,000. Well, that's just included. Oh, I need an implant. Well, that would have been $5,000. Well, that's just included. So, we've eliminated the money side of that and I just need them to come in and take care of themselves, get their preventative stuff done so that that we have this long-term relationship. And it's aligned the incentives. It's been awesome. And if we're talking about business, there's a little side thing that we've done too on the business side is we've set up a an insurance captive.

23:25 So, so my dental office now pays a premium to this insurance captive. So, a lot of these subscription membership goes into my office tax-free because it comes out as a premium and we based it in this insurance captive. So, there's a huge tax advantage play for the business side of this, for the dentist that kind of makes up some of the difference that sometimes you feel like you're losing because, oh man, this patient only paid me 150 bucks and I'm giving them a $1,500 crown. In my mind, I'm like, oh, that that doesn't work.

But when it's over time and you have enough people on the plan, then then of course it works because you know if we have a million five in subscription revenue, I can do a lot of dentistry on a thousand people for a million five and and still make money. So you have to have a different paradigm shift in that as well. But it's been a really fun concept that I think is is could be a gamecher for providers. I have to say there's there's two game changers in my mind that you're you're giving to the marketplace. One is the whole concept around you know urgent dental care and after hours concept. What you know number one is 24/7 you need a dentist and you're there.

The other aspect is you know finding ways for people to actually take be more proactive about their dental care. Subscribe to the dentist versus the insurance. You know work directly with you and not deal with do I get paid for this? Do I not get paid for this? Do I get reimbured for this? do I not get reimbured? Can I how much is it going to cost me to do it this way? It's all sort of built in and you really are taking this customer perspective and making creating easy buttons for them, you know, through and through. So, you know, I I love the concept. The question is how do you go to the market and really find a way where these great concepts, how do you get people to like find out about them? That's that's the one, you know, the the the interesting piece is finding that pathway for the people that can really take value of these things because it's they are very valuable whether it's whether it's saving time or money. They're those

Are two of the most hot commodities in the world today. Yeah. And it's just like anything, right? It's all it's all marketing and and awareness, right? If you if you have a good product and nobody knows about it, then that doesn't do you any good. So so much of it becomes how do we drive this to the the public and get them on board. The after hours has been too like along the way even the experience once you get them now you got to create the experience too so they keep Oh yeah. You don't want to lose them.

25:55 Absolutely right. Like if if I'm not in my subscription plan if I'm not taking care of those people then that's been a waste because I've done a lot of work for them to get them healthy and then if they drop it well that was just a waste you know on my end right. So yes, you have to develop the experience. You have to get the get it out there and then once you capture them, you got to keep them. The internal marketing is huge. The how they feel about when they come to the office is huge. And so I do I think if we're going to run good businesses, you have to do both. You have to get the product awareness out there. And then you absolutely have to take care of people, especially in healthcare nowadays. like you know you go to Walmart or whatever you just expect some things not to work out and you're like that didn't that didn't work out but in healthcare man like I still

Believe that we're taking care of people and we're not selling widgets and so we got to it we have an extra level of responsibility to to do it on both sides. Well that's awesome. Well Jeff um any other closing comments on on how you want to finish the podcast off before we before we put a wrap? I do have one more question for you. Throw it out. Yeah, bring it. No, I got I got nothing else, man. I'm just Good. So, this is this is my favorite question and I try to ask it to every guest. I'm going to ask it really slow, so I'll let your brain process it a little bit, but you know, current day Jeff goes back to 22-year-old Jeff or 18-year-old Jeff, what is the one piece of advice you would give 18-year-old Jeff today? You know, I think about that a lot and and it's a great question because I think you probably get a ton of different answers from everybody

Because if they answer it honestly, it kind of speaks to kind of some of their insecurities or what what really gets down a different level. I would actually and I don't I don't know how people normally ask this but for me I would tell myself that one to trust yourself and it's going to be all right because you know I went through had when I had all those multiple practices long story but it doesn't matter you know I had to go through some legal fights and all that right and that was super stressful right and but what I've learned 20 years later is that that if I trust myself and and I'm not afraid to work hard, which I know that cuz that's who I am. That you know what, it's going to be okay. And so I can let a lot of that anxiety go. I can enjoy the journey a little bit better because even if it works out badly, it's going to be okay. And so I wish I would have

Known that. I wish I knew how to trust myself a lot better when I was younger. And I think Yeah. So there you go. It's such a great message, by the way. And you're right, like it it like that whole question, you know, kind of comes from some of the things that I in my life as well, you know, haven't trusted myself and let fear kind of creep in its way. And and so those are what what a great way to leave the podcast. And and Jeff, thank you so much for being here. Number one, and I just want to say like really truly revolutionizing two two different aspects of dentistry. One is just the whole urgent care and the afterh hour component which is making it easier for patients to have access to dental care.

29:09 And number two is, you know, helping patients find a different way to subscribe and maybe not use insurance but subscribe to their provider where they're going to have a much higher level service long-term relationship that is all beneficial. Yeah. Thank you. That's what we're trying to do and hopefully that resonates with some people. It does. It resonates with me. Thank you, Jeff. Appreciate it. All right. Thank you. That's a wrap on Zero Friction, the show built around one simple idea. Remove the barriers and the revenue will follow. If today's conversation was valuable, please subscribe and share it with somebody who needs to hear it. That's how we will grow this community. I'm Terry Coutsolioutsos, revenue architect powered by AI. Come find me at my website, myrevrx.com, and let's talk about what friction is costing you and your organization. Until next time, keep removing the barriers and keep the revenue flowing.