Welcome to the Healthcare CEO podcast. Join us as Daniel Fernandez, healthcare leader and patient experience advocate leads dynamic one-on-one discussions with healthcare executives, consultants, and other industry experts. Listen in as they share actionable insights and unique perspectives into the day in the life of a healthcare CEO.
*The following has been adapted from our full-length interview, which can be found here.
Meet Dr. Bill Layman
Dr. Layman was raised in a small Virginia farm town, served as a paratrooper with the Army’s 82nd Airborne, and is an Iron Man athlete. With almost 20 years in the orthodontic field, he also has an MBA from the Wharton School of Business. He creates life-changing smiles and empowers fellow practitioners to start and own their own practices.
Getting Started in Dentistry
Daniel Fernandez (DF): Now, before we get started, I’ve got the most obvious question here. Why dentistry? Why did you choose dentistry to begin with?
Bill Layman (BL): Well, dentistry, I love the biology of things. I had some family members that were in dentistry and I saw that they were able to innovate, to help, to create, to use their scientific mind, but also their artistic mind. And there was a lot of autonomy. 20 years ago when I started looking at schools that I saw in dentistry, that was one of the many things that really attracted me to this profession.
DF: You’ve been in practice for over 20 years? Correct?
BL: I’ve been in practice since 2004, so 16 or 17 years.
DF: What are some of the favorite lessons learned over the last 16 years or so? I’m sure there are quite a few, but any of that kind of stand out?
BL: The biggest things that stand out are probably two things. One, when somebody says they trust you, that should hit you like a ton of bricks. If it doesn’t, you know, definitely check your motives at the door. Second thing is when you feel really confident or if you have a lot of passion about the treatment or route that you’re recommending, stick with it. That’s something I’ve done in the past, as I when I was younger, would try to superman my way out of what I felt was the right solution, even though the person I was recommending it to may have been scared, may have been not really willing to do that. And I tried to adjust. And, everything turned out well at the end.
It was just more headaches and more uncomfortable conversations that you have to have with yourself and with the patient, so the biggest thing I’ve learned the first five, six years in practice was make your plan, study your plan and be confident in your plan. And that applies to really anything you do.
DF: I imagine over the years you’ve changed a lot of people’s lives, specifically their smiles. Any favorite stories that you have that stand out?
BL: There’s a common story that stands out where children — and even adults — come in and they are reserved, they are hunched over, they are maybe less confident than they could be. And through a 12 month, 24 month process, you get to see that person bloom. And that is the number one joy in this job. Yeah, that would be it. There are so many individual stories like that, it’s hard to get into the details. But that thread is what I’m striving for. It’s the ability to help that person with at least their smile and their confidence that comes from that projection of their inner feelings with a smile showing through. That’s pretty fabulous.
DF: That’s got to make you feel good. Makes me feel good just hearing it. Let’s talk a little bit about that evolutionary story. I mean, you started in 2005 and built a practice up. Was it multi-location?
BL: It wasn’t at first. We started with one little gas station that we renovated — an old 1940s Phillips 66, and from there, just tried to get our feet under us. We started from scratch, we just started knocking on doors. I did work one or two days a week at an office about 45 minutes away to pay the bills. And we took a lot of insurances. It was interesting, because this was back in 2004, 2005, when it kind of felt then like it does now. Everybody was making money in stocks. Everybody was buying houses and selling them for 20 percent more. There was a lot of ambition out there and I just decided to hunker down and really work this part and, you know, we started out as a Medicaid provider, which I think, unfortunately, in dentistry can be a fallback position for a lot of people. And sometimes it needs to be.
But being able to see so many complex cases and be able to see so many people at the beginning of my career, really laid a foundation similar to what Gladwell talks about in Outliers. I got ten thousand hours in on so many different complex cases, that now we have a lot more time now to spend with the emotions of it, with the systems of it, with how we can improve the patient experience. But having that clinical foundation at the beginning really helped us innovate in other parts of the practice that we may not have had time to.
DF: Did you eventually keep that practice or did you sell it?
BL: I kept that practice. I started from scratch. I’m still in that same practice. We expanded out to three other locations and ended up selling those locations because I actually ended up wanting to contribute to a bigger part of dentistry. And I felt like having an MBA would help me be in a position in the future to help dentistry and healthcare as a whole because of the complexities of healthcare. I wanted a little more education behind me to make that impact that I was looking for. And so I went back to school and got my MBA. And at that time, I had thought about really scaling up practices. And once I worked on the math of it and looked at it and realized some of the challenges of it, I sold the practices and moved to a different phase in my career.
Opportunities in a Challenging Year
DF: You talked a little bit about complexities. There’s no greater complexity than the last year. I know it was challenging for us all. What were some of the greatest challenges?
BL: I actually think last year was about as simple as it gets. March of last year, we were shut down because of COVID measures. For me, the joke I used to always be that that it’s really tough to make changes in the practice because it’s like trying to change a tire on a car going 100 miles an hour. Well, all the cars stopped and that gave all of us an opportunity that we never would have had. I mean, I was on a slow march to 65, 70 years old, never taking a breath. And that shutdown made everybody take a cosmic breath. And that was really fantastic for us. And I had a lot of great wayshowers talk about this is your time to innovate. This is your time. This is not chaos. This is not craziness. This is an absolute gift from the universe. Now, not negating the people that passed away with COVID. That’s not the energy of this. But from my particular situation, to have that moment to pause and evaluate was fantastic. And just getting into a place where as a team, we just looked around and said, you know, what do you want to do? Coming out of this, we can do whatever we want. And that was really nice to have that opportunity.
DF: It sounds like you’re echoing some of the things that we’ve heard from other guests as well. It was really a chance to fundamentally think about how you’re practicing and how you were evolving the practice and the direction you potentially were headed. And we’ve heard a lot of people sort of shifting ideas and strategies because of the downtime that they’ve had.
BL: Yeah, we were able to innovate. There were some things that we wanted to do on the patient experience side that we just couldn’t quite get our hands around. And that was the implementation of telehealth and orthodontics. Being able to change the patient experience from 13 to 18 in-office visits to, in some cases, three to four in-office visits and the rest of it being at their desk, at their home, anywhere we can connect with them and capture images to give them feedback so we’re just starting to see the extreme benefits of that. Our small office, about 1400 square feet, we would see about 80-85 patients a day. Now we’re down to 45-50. That’s including some of the telehealth. So it really gave us an opportunity for all of the technology that’s been given to us over the past 10 or 15 years to take a moment and realize how to really implement that, to make the patient experience better.
DF: Now, what aspects of it? Because when I think of dentistry, I automatically think you will be sitting in a chair. And that’s that’s pretty much everything. How have you been able to incorporate telehealth and how you’re practicing?
BL: With orthodontics it’s different. With general dentistry and other parts of dentistry, you still need to have that in-office experience. In dermatology, if my son goes in or has some acne problems and the dermatologist says, I’d like you to apply this cream two times a day for six months, does he really need to go back into the office to check the skin? Maybe, maybe not. For a great majority of cases, we can do a call like this. We can look at it. We can see how it’s responding. We can check if you’re using it or not, and we can adjust. And let’s say 20 percent of those cases, there’s something strange happening? Well, then come into the office. But we’ve still knocked out eight out of ten people, and they’ve had a much better patient experience because of technology.
And so with orthodontics, it’s the same way. You put certain types of brackets on. You can monitor a case until they’re ready to change a wire or make a change. And then they come in for that. With Invisalign, the clear tray technology, if people are wearing it and doing what they’re supposed to do, eighty percent of our cases, we can see them just like this. They’ll send us some photos. We work with them on that when we see them. And we can make it very easy for them.
Preparing for Future Trends in Dentistry
DF: So according to the US Bureau of Labor Statistics, the demand for dental services is expected to increase as the population ages. And on average, there are ten thousand Boomers retiring every single day. So the demand for more complicated procedures will, of course, increase. You feel like adding in some of these efficiencies like you’re talking about, like how telehealth will allow you to potentially see more patients, or you think some of these efficiencies will help to serve a larger population?
BL: Yes and yes, but it depends on the practitioner. For me, it’s not necessarily seeing more patients. It’s having a better relationship with them. It’s having a team that’s not running at 98 percent hot. They’re running at 88 percent. So they’re more effective, because you can run labor in the ground. I mean, yes, you can get 100 percent out of somebody. But how long is that last? It’s sprinting versus walking. They can walk with you all day. But if you start sprinting, how long can they keep up? And also so you can change your lifestyle based on those efficiencies, which I think is what all the iPhones and everything promised us. But somehow we got busier. I don’t understand that, but I think we got busier because we wanted to — we didn’t really have to, did we? I don’t have to be home waiting for a rotary phone anymore. So there’s something there.
And also it does, on a larger scale, allow the demand to be serviced effectively by the current growth of suppliers, because I also feel like there’s a huge danger in trying to mess with the probability of somebody being able to be successful in that job based on their entrance exams and their entrance criteria. So growing the supply of doctors, per se, may not be very healthy either. So having efficiencies to have our supply rise sufficiently with the demand, I think would work out really well. But technology is the key.
DF: Let’s talk about maybe some of the newer doctors that are coming out of school. According to the ADA, the average dental school debt is nearly tripled over the last two decades. It leaves a lot of dentists burdened with some of the highest debt of any profession. What advice would you give to a new practitioner?
BL: So, I’ve given some talks on this to residents in the past few months and the research is showing about $425,000 of student loan debt and as of 2018 for the average orthodontist coming out of school, and that is staggering.
So you have increased population, you have increased case fees. And there’s favorable interest rates now. And so the number by itself, four hundred twenty five thousand dollars, sounds like a nice house in a nice neighborhood in most cities. Well, the house doesn’t give you the earning power that a lot of these degrees do. I am a huge advocate and will beat the drum all day long of starting your own practice. If you’re scared of the business side of it, if you’ve ever balanced a checkbook, there are business managers who can easily handle a lot of the things that you need. And especially in orthodontics and in dentistry, going out there and doing your own thing is going to be the biggest bang for your buck that you can get. Everybody graduating dental school is extremely intelligent and can master enough the skills that they need to make that happen and to be able to service those debts.
DF: Do you have a favorite book or one that you’ve read recently that you recommend?
BL: Well, definitely Think Again, by Adam Grant, is an absolutely amazing book because it allows the reader to go on a journey through many stories that Adam tells about rethinking your biases. And nowadays it’s worse because if you always look at YouTube or something and you always just go with what’s recommended, you’re never going to grow because they’re just keep feeding you the same thing that you’ve already looked up. Another one that’s really great for anybody in this profession is The Leader’s Checklist, by Professor Michael Useem. He takes you on a journey of a few stories and how there is a checklist that he developed working with boards of directors and working with students and working with major titans of industry that show the best practices for being a leader.
DF: Favorite quote?
BL: “The only way to find out the limits of the possible is to go into the impossible.”
DF: That is one of my favorites. What has the last year taught you personally?
BL: Don’t take yourself so seriously.
DF: Any final closing thoughts for our listener? Anything that you would want to convey to them?
BL: The more you look out for others, the better you feel about yourself — and the more they look out for you. That goes along with something at the Citadel I learned, that success in a group environment is rarely dictated by what you do alone, but what you encourage others to do. I remember Alex Gorski came and spoke to us at school one time and he made it very clear that anybody who works in his C suite, he asked them to write out and help him understand three people in their career that they brought in, nurtured, and saw succeed, and that really hit home. If you’re at a certain level of business and you haven’t done that, you may be fizzling out because you, by yourself, can only go so far.
Learn More about How Dr. Layman and Other Leaders Are Shaping the Future of Healthcare
Watch the full interview with Dr. Bill Layman, and be sure to subscribe so that you don’t miss future shows where we interview other industry-leading healthcare CEOs and executives as they look to shape the future of healthcare.