Welcome back to another episode of the SPG podcast. I'm your host, Alex Sharp. Today, we have another episode in the SPG Doctor Spotlight series. I couldn't record this one in person. I guess if we were to plan better, we could have recorded this one in person. But we didn't. We're 25 miles apart, so we'll call it close enough. But with me today is Dr. Kyle Hargis of Little Rock Dintries and Implants. I've known Kyle for a long time.
And Kyle, to start the conversation off, first of all, welcome. And second of all, why dentistry? Man, that's kind of a long story. To start, originally, I thought that I was going into medicine. I knew as early as I can remember, I thought I'm going to be a doctor. In fact, in kindergarten, when I was like, you write down the little time capsule for your career, I put that I wanted to be a brain surgeon. And I missed the mark about a couple inches, but close enough. Just a bit outside.
Just a bit outside. But in college, I was pre-med. Applied to medical school was waitlisted the first time. And while I was waitlisted and reapplying, I had a buddy who was in dental school. He was like, man, have you thought about dentistry? I was like, nah, I don't want to clean people's teeth all day. I don't want to do that. It's like, that's not what dentists do. So he's like, just shadow this dentist that I know here in Little Rock and see what you think.
So I shadowed it, I shadowed him and really enjoyed it. And I was like, maybe I'll go that way, wasn't sure. And ended up getting into med school and not only complicated the issues. So then I was like, do I take this acceptance medical school or do I do something else? And my wife was applying to PA school at the time. So we kind of asked for a sign and she applied to UAB.
And we're like, if you get into UAB, then I'm going to turn down this acceptance and we're going to go to dental school instead. So she got into UAB. And we moved to Alabama and I took another year off school and applied to dental school and got in. That's how I know that they're my brother. He's also a physician. So I saw him go through med school at the same time. And the match process where you could end up in a specialty that you don't really want to end up with.
And I didn't want to go through that. So that was another contributing factor as well. Though those, those people that graduate med school and they do the matching, see my thought, my understanding of it from friends that had done it years ago was you declare the specialty that you want and then you match at different locations. So you're saying that it's also common for you to declare the specialty with the desired locations, but then they may even just say, nah, that's not happening.
You're actually going to do this specialty over here instead. So if you're applying to a residency, like that's super competitive, like, you know, ology or the pediatric surgery, something like that, most people will tend to apply to some other residency as a backup because it's ultra competitive and you don't want to not match. And you may end up as your in your backup plan. So something that you're not as happy with. So that speaks to because the whole notion of self care being a commodity.
I think that underpins a lot of what you're talking about there to where you have people that have dedicated their lives to health care. And then all of a sudden they're being jerked around at the 11th hour to say like, hey, the thing that you actually got into this to do, you're no longer able to do. And so I think that speaks to how commoditized not only the service of medicine has become, but also the treatment of the people doing the medical procedures and providing the services become.
And that's something at SPG that I honestly tried to weave into our founding is that within dentistry within our chosen field, certain parts of it have just flat out become commoditized cleanings, fillings, those things that people quote unquote feel entitled to because their insurance coupons cover them. It's it's tough to operate in that setting. And I think that would be a good transition to, you know, I was talking to cousin Mike on the last episode about how GP dentistry is one thing.
Dinters and implants is a completely different thing. And I think the people that resonate the most with dentures and implants are the ones that have experienced the other side and gotten their feet wet enough over there to realize that, ooh, that's not all it's cracked up to be. I'm going to choose my miss over here on dentures and implants. So what's your perspective on that commoditization of health care and specifically like GP dentistry?
Like how did it feel working in that environment where you were sort of an interchangeable part in the scheme of things? If they don't like Kyle, they can go down the road and get more or less the same type of service. I mean, to some degree, it was it had its benefits. You had that crazy patient that you don't want to deal with. Well, hey, you can go somewhere else. So that was the only nice aspect of it, I think.
But for the most part, you get really demanding patients who are like, well, this is what I want. It's like, well, that's not what you need. You know, you don't need just a cleaning. You need fork wads of SRP. You need all of these fillings. We're not going to do whitening on your teeth. We've got all of these other things that we have to take care of first. So there's a lot of education realizing like you're not what you need. It's not what you're here for.
I can't just give you what you want because this is health care. We can't just make decisions based on like what your desires are. I mean, ultimately, we can when we get to like the aesthetics of things, but that's always last. We've got to make it healthy first. We've got to set up a good foundation. Some people were really upset to hear that. I mean, telling people what they need to hear versus what they want to hear is sometimes hard.
And then yeah, I just think that there's that mindset that people approach things with that they view as being commodities. And I think primary care physicians, general dentists, unless you're really carving out a specific niche within that broader offering, it's tough to not fall into the commoditization.
I think the more I read about how to distinguish yourself in the marketplace, how to stand alone or stand above other people that are doing similar things, it comes down to leaning into that oddness, that strangeness, controversial book that I love is 48 Laws of Power. And one of the things in 48 Laws of Power is how you need to embrace marching to the beat of your own drum.
And I think at SPG, that's one thing that we try to double down on is the things that make us different are oftentimes the things that make us most appealing to one another, to people that want to join us and also to patients that seek us out. And that's one of my favorite things about this model is that even though it's harder to get a big number of new patients every month, because we're going direct to the patients by and large, we got some referrals, but mostly it's direct to consumer.
We're getting people that see the value of what we do. Yeah, there's going to be people that are confused and maybe don't understand exactly what we do or if they're candidates for what we do. But by and large, we get people that self-identify and they self-select.
So what in your experience, Kyle, what's the difference between working with people that have some knowledge of like, hey, there's some stuff jacked up with my teeth, I'm considering getting more taken out versus, yeah, in the GP model, they think they need option A and you're like, oh, actually, you need option E over here. Yeah. Think of a recent patient he came in, he was a dinchless, already in a denture and he was just like, I hope I'm a candidate for implants.
Just basically coming in, begging me to tell them, you're a good candidate and thankfully he was. And like, just eyes light up, just so excited. And then we're like, he was like, I want to get this done as soon as possible. So we really rushed some things and we made it, got him in about two weeks and just, I mean, the transformation in that guy just so quick. Because he just, he hated his dentures so much and a lot of people do, but he hated it so much.
He'd only had it for six months and his previous dentist had told him, like, you've got to wear your denture for at least a year before we can even consider implants. And he just came in wanting a second opinion, wanting to hear that he was a candidate. So he knew kind of what he wanted. But he just didn't know if he was going to be that, that candidate. It's like you've said before that, you know, creating that scarcity where, you know, some people actually aren't candidates.
And he was scared that he wasn't going to be a candidate. And when he heard that he was, I mean, just totally different person. Wasn't that Larry? Oh, yeah. Yeah, it was. Okay. So last week I met with Kyle and his team at LRDI and we did the SPG focus day. And what I found super helpful for the team, because the team has to rally around what we do just as much as the doctor does.
And if the doctor is the only one that sees the intrinsic value of what we provide to our patients and gets excited about it, it's really tough to move that boulder up the mountain all by him or herself. And so I like the idea of the teams having kind of a mascot or kind of a figurehead for the transformations that we do. And for LRDI, that's Larry.
That's the person who'd been chewed up and spit out by dentistry, who'd lost hope, who was frustrated, who had gone through the negative stairway of, I got my teeth, my teeth got restored, I got perio, or I got recurrent decay everywhere. And now I got a terminal dentition. Now I'm going with a denture because that's what everyone does, lack of education. And so here we are with our arms wide open, welcoming people like Larry to say, hey, there is another way, there's a better way.
And sometimes we find those people that already have that itch, that already have that compulsion that already have the motivation to move forward with all on force. But then other times people come in and they're dipping their toe in the water. They don't have the fire in their belly that Larry did. So what's what's a way Kyle from your perspective, having really thought about what you were able to do for Larry and his wife and like that amazing raving fan experience that you gave them?
What's a way to parlay that passion into someone who comes in that knows they need something but maybe doesn't have the full picture yet of what the opportunities are and what they stand to gain by embarking on that same journey that Larry did? Yeah, I think about this a lot when I have patients, sometimes you get a patient who comes in that got like first premolar, first premolar one on the top. And they're like, I just want some back teeth to chew with.
And they've got really pneumatized sinuses and you're like, well, we can do bilateral sinus grafting. We can put some implants in there, but your teeth aren't that you have on the top. They're not in the best shape. Like you're still going to have to take care of them. We're still going to potentially have issues that arise with them. And that's one thing I always educate them on. I'm like, we can go that route.
That's definitely a route that we can go, but you're going to have to take really good care of things. And they're already deteriorating. You're 50, 60 years old and you want something that's going to get you to the finish line. Or we can remove all of the tea. We can do an all on four. It's going to be about the same price, honestly. And you don't have to worry about taking care of the top teeth anymore. You don't have to worry about cavities or recurrent decay.
As long as you keep your implants clean, this could get you to the finish line. So that's one thing I think about. And I've had a couple of patients like that where they really came in looking for a couple of single implants to replace some missing teeth. And it was just more straightforward for them to, hey, let's start over. Let's get a clean slate. Let's get you something that you're really happy with as opposed to just some back teeth that you with.
And once they realize like, oh, I can fix the way everything looks and get back teeth that you with, they're usually like, oh, that's the way I want to go. That's so powerful because they're coming in with the level of education that they have or more accurately the level of education that their prior provider had because the prior provider probably had that worldview of where you're going to do patchwork. We're going to maintain what you have, even if it's imperfect.
And they don't have the confidence or the experience to be able to say, have you considered starting with a blank canvas, beginning with the end in mind and saying, hey, rather than limping along your imperfect 55 year old teeth, why don't we start fresh and have one apparatus that we're keeping clean that we're maintaining and that we don't have to worry about provided that we do the main things right to keep things in function and to keep things clean. And I think it's just, it's just a shift.
It's a paradigm shift because when you when you come from general dentistry, you're in the model of I'm seeing a ton of patients every day. I'm doing hygiene checks all day every day. I don't have the time or the bandwidth to have this involved with a conversation with the patient to talk to them about this other way of looking at their oral health. And we're just trying to limp things along.
And so you super impose that mindset over yourself and you say, this is what we can do in the confines of what we have. I'm going to make these assumptions that may or may not be true about what the patient wants because I'm assuming that I'm optimizing for time, expense, and things that I think we're optimizing for when in fact the patient might be inwardly thinking, what are my other options? Could we consider something more comprehensive or more exhaustive?
And that's one thing that I talked with the team in Springfield about earlier this week, I was talking to Dr. Garrett and we were discussing the power that we have with our patients to be able to say, look, there's a whole litany of options. There's lots of different doors that we can walk through together. But sometimes the door that is the most involved in one sense all on four creates the most opportunities for the patient to get the biggest outcome in another sense.
And it's just a level of comfort. And I love what you said, Kyle, about people coming in with the patchwork dentition that are wanting like an implant here and implant bridge there. And then when you add it all up cost wise, you're getting a much better result for just a little bit more money. And it's about projecting confidence and that being the right plan that helps people get across the finish line.
Yeah. I mean, I had one patient that wanted bilateral sinus grafting and two implant bridges. And I think it was more than the whole four. He's like, why would I go that route? I'm like, I don't know, but it's an option. Like you asked for your options. Yeah. Yeah. So my favorite line, I'm like a waiter at a restaurant. I'm here to tell you what the different options are. I'm going to educate you, but at the end of the day, I'm going to tell you what's good.
And in your situation, what's good is the thing that's the intersection point between makes the most financial sense, makes the most logical dental sense. And if we're beginning with first principles, what do we want that's going to last a long time, allow you to function well, give you confidence to smile. All on four is that for a large subsection of people. And that's the thing too that I've learned over the years, because you know me, I attacked this from a GP first mindset.
And there's that GP mindset of preserve, preserve, preserve. And that serves us until it doesn't. And then you get enough of those patients where you're like, why didn't I know that things were as dire as they were? Why didn't I know that my periodontal condition was slipping? Why weren't we as proactive as we could have been to prevent, you know, number eight from falling out of my head because it got so perio involved?
So you get patients like that that have been nursed along maybe by the country dentist for the last 50 years. And then they come to you and you're like, whoa, I have a new perspective and you're educating them from a different angle than what they were educated with in the past. And I love what you said about, you know, I can tell you all your options. All the options might not make sense, which means that we would let down to this option here that definitely makes the most sense for you.
Yeah. I have a few brief gears because we talked a little bit about the commoditization of GP, but I want to hear a little bit down and dirty, nitty gritty of your experience in the denturing implant model relative to your experience in the GP realm because I often say that in the denturing implant model, we have higher highs and lower lows.
Some of those high highs like the patient Larry that we discussed, you're not going to get that level of service and that level of fulfillment doing a quadrant of fillings on a very weird or but then you also have the low points, the doldrums, the troughs of experience and the denturing implant model. And if you're comfortable talking about it, there was a recent low point that you that you have dusted yourself off from and in our like, you know what, that was an experience.
We got that out of the way. We're never going to have to repeat that again because that was a one of one. And even though it was a one of one, it gave us a lot of lessons moving forward. I learned a lot from it. You learned a lot from it. It shows us what to avoid, what to talk about, how to handle things that don't go perfectly to plan. But what did what have you learned recently from that patient experience that finally came to a close? Oh, that's a tough one.
I mean, that was just earlier this week. Fresh. Yeah, it is fresh. And that was sometimes you just can't make people happy, unfortunately. And I think that's what it boils down to. Some people don't want to be happy and you will never make them happy. It doesn't matter how good of a job you do. So this fellow in question, we did surgery on him. He was double all on four and his bottom arch failed. He did everything wrong. He was eating pizza a week after surgery. He was smoking.
He wasn't wearing his night guard was grinding the crap out of it. And just did everything wrong. Unfortunately, this bottom arch failed. The plan was that we opened him up, we go back, we put more implants in. And when we opened him up to remit those implants at like six weeks post-op, I mean, it was just it was like a taco shell for a job on just cortical borders, nothing on the inside. So no, no bone left to place implants in. So we removed all the implants and we grafted them up.
Then he had to wear bottom denture for four months. He didn't actually wear the bottom picture, which was good because of those grafts failed better than he decided that, you know, we'd go to a snap down instead of all on four did a financial concerns. So we did the snap in, we placed our implants with let him feel. And, you know, patient was originally a smoker, but he told us to stop smoking and we place our four implants. Everything was great. Got good torque on him.
Dave surgery suited him up real well. And, you know, like, all right, we'll see in three months to uncover on uncover a day when the implants had failed. And I just got, you know, a three implant snap in on the bottom, which isn't, isn't a bad option, but he's like, you know, I'm done with surgery. And yeah, just never wanted to be happy, even though he had a good result and blamed everything on us, even though at his final appointment, he had to stop and take a smoke break.
And it's just like, oh, we really didn't do anything wrong for this guy. And, you know, I kicked myself a lot for this. This guy, because I was like, what is going wrong and really questioned myself there for a while. But now I know it's like, he wasn't taking care of it. He was doing everything wrong. Just bad luck. He was rude to the staff. And I've realized that it's just not, you know, not all money is good money.
And sometimes it's just better to say no to the patient on the front end, which I think would probably have been the only way to avoid that situation with him. But then it's a cat's point. 22, it's a chicken or egg where would you have known or had the fortitude to be able to say no on the front end when you have like a teed up opportunity like that. Like you almost have to go through that. Yeah, to be able to say, okay, this is another this guy.
Yeah. It took like two years from now you might have another one. And then you're just like, okay, the red flags are the same. The level of demand and erratic behavior and all the things that accompany that type of a person, you're a bit, you're a better able to sniff out. But again, you don't know it until you get through it. That's the exception, not the rule, luckily. And so I like what you said about some people just don't want to be happy. That's human nature.
And as service providers, we I made the illusion earlier to being a waiter at the restaurant being a dentist is much the same as that where we're offering people services, people are coming in to be served and we're in the people business. And so we've become really adept people, readers, connectors with people sniffing out what their fears are, what their objections are, what their goals are too.
But we gather a lot of information by listening to them, by getting a sense of what they're truly looking for. Because a lot of times there's things that are going beneath the surface that you have to be in tune with them to pick up on. That's why I love what Derek teaches about first before we do anything else. We got to listen, like truly, truly, truly, truly listen. And only then can we weave what we've learned through listening into our pitch about what we recommend for people.
And I think it's in the listening that we get a sense of, is this person reasonable and rational? Is this person seeming a bit irrational, but really they're just scared. And then once we get over that fear factor, they're going to be fine. Or is this someone that's just the horse of a different color like this guy was where there's no rhyme or reason, their brains been addled by any number of chemical substances over the years. And we just got to move on.
Yeah. Yeah, it's a tough situation, but I think, you know, you don't, you don't know until you do it. And now that we've done it, we know not to do it again. And I want to connect this back to something that Voreholt said in the doctor chat a while back. He made this really key point about at any given time, chances are there's at least one patient that's hanging over your head like a specter that you're just thinking about when you're not doing anything, hops into your brain.
How are they doing? What's going to be the next shoe to fall? What am I going to have to worry about with this person? And, you know, now that this guy's out of your hair, what does that feel like? I mean, it's huge relief, at least, you know, from that perspective, but now it's like, okay, what's next? Because there's going to be something. I mean, I'm sure it won't be as bad. It would take a lot to be as bad as him. But, you know, patients have failures and that's just part of the game.
In fact, yesterday, I had a patient come in. We did a four snap over denture for the bottom. She's got cane out of cane on on the top and one of her anterior implants had failed. No big deal. We just took it out. We grafted it. She's got three healthy implants right now. So we like, okay, like we're just going to let you heal up. And then in a couple of months, once your graft is healed, we'll place another implant there. No big deal. We'll, uh, we'll get you taken care of.
But then I let that color and I sent this in our pod chat. So the southern pod chat that sometimes you let that experience color, everything else that you see. So the next patient that came in, it was a three week post-op for an all on four. We took off his prosthetics to, you know, evaluate to evaluate the tissue. We decided we were going to adjust the bite in the lab. So we put some tissue caps on while the spikes get adjusted.
And we took off the tissue caps when the straight multi units came out. No big deal. We'll just torque it back down. And then I was like, I probably should check the torque on all the other straight multi units. Just make sure everything's down good and tight. So that's what I do. And two of the other three go fine. No issue. Everything torques and then the same implant site as the one that had just failed on that girl. Uh, when I go to store it down, it's hurting a little bit.
Like, oh, no, like two failures in one day. What are the odds? So I, you know, internally, I'm freaking out a little bit, but eventually I just decided, okay, let's just numb him up. It's probably just tissue and Benjamin. And like we, we should cut a torque. We got to make sure that it torques at this point. We can't just let him go. And then in a couple months, it's failed and we're in a lot worse spot than we are now. Took an X-ray. Everything looked fine on the X-ray.
So I'm like, OK, everything looks good. We're just going to numb him up. We're going to get this done. So numb him up and torque it down. Then it's fine. But because I had that previous failure, you know, just two hours before, I was like looking through these failure glasses and it's like, OK, everything, everything's falling apart. And I'm still fairly new to this. I've been in my office for a year. So sometimes it's just hard to just let it roll off.
You know, and that's one thing I'm still working on is that it happens. Even if it had been a failure, it wouldn't be the end of the world. We would put new implant in form. But you just can't let previous mistakes color your future success. It's the same as playing basketball. Yeah. And then you airball a shot and we're like, I can't let that airball influence my next shot. Like you have to almost irrationally believe that the next one's going to go in. Or else it will never leave your hands.
You'll be you'll be too chicken shit to take the shot really is what it comes down to. Yeah. I don't know if you're Ted Lasso fan, but where he's like, dig old fish, you know, had a short memory. Just forget about it. Short-term memory. Yeah. That's that's again, easier said than done. And I love the spot where you're at right now because a week ago, we could have had this conversation and I could have told you, hey, remember the goldfish thing? Short-term memory loss. Don't let shit bother you.
But it's easier said than done. Like now it's easier for you to say, hey, it's done dismissal letters been written. We're good and you're you're better able to actually internalize that. But you had to have gone through it and then the door had to be closed for you to fully see OK, this is what it felt like when I was worried about it. This is what it feels like now that it's behind me.
And then the next time there's a patient issue like that, although I bet there's not going to be one just like that. But the next time there's a patient challenge, you're going to be able to think back and say, OK, goldfish. Let's attack this one. Chances are this one's going to turn out great. I can't let any kind of negative self-tawlker doubt encroach upon my ability to make this my next larry. It's how I would think about it.
And it's and it's the same with your team because like I met with your team. You have one of the best teams in the whole company. Like your team is incredible from top to bottom. And I think the more that you help them to have that goldfish mindset to because it wasn't just you that got wigged out by that dude. It was the whole team that wigged out by that guy. Yeah. So helping them to normalize the fact that that doors closed.
Everybody else that comes through our front door is going to be much more agreeable and appreciative and moldable. That's the key is that we have the power to set the boundary conditions for how these experiences go. We own the stage. They're coming into our dojo. So we set the guardrails. We set the parameters and generally we don't have people trying to run into the gutter.
If you think of it like a bowling alley where the ball is banging up against the gutter, like most times you don't have to use the gutters. If you know what you're doing, but occasionally they're there for a reason and it's for crazy patients like that. So how do you feel like your team with that saga having been closed now? How do you feel like they've bounced back? How has their confidence and engagement been trending since that's been over?
I mean, it's been a breath of fresh air for everybody. Just because you don't realize like how much of a storm cloud some people are. Until like you no longer have to be around them and just being able to like let the staff out like, hey, you know, he was threatening and abusive towards us. His treatment is done. Like we have dismissed him and everybody's just like.
And one of the things that we were worried about was 30 days of emergency care and like do we have to see him if he needs something? And we talked to the SVG lawyer and he was like, if you don't feel comfortable, you don't have to see him. I was like, nobody feels comfortable seeing this fellow. So we're not going to see him. So, you know, we sent the dismissal letter and I could just see on all the girls faces. It's just like a sigh of relief.
Like, you know, it's just like we just took that burden and just dropped it off of them, you know. So it's been a big change, obviously, since just two seconds. When we sent the dismissal letter. And it takes a long time to build new habits because like it or not, because of the presence of that storm cloud, habits have been formed. Grooves have been carved in that record. And so now what we're doing is we're regroving LRDI's record as a way to think of it.
And that happens in huddles like we talked about on in our focus day and like celebrating the winds, looking forward to the opportunities and giving each opportunity that little extra bit of gravitas because we know that chances are we're not going to have one of those again. And the next one's going to be better. The next one's going to be more way more likely to be a Larry than that guy.
So I think that's a helpful framing for your team because the more the more vocal you are about that being your operating system internally that you believe that the next one's going to be way better. The more that it influences your team's perspective because then on the days where you're truly down in the dumps, for whatever reason, you've put in all that legwork for your team to be the ones pushing you up the hill rather than the reverse.
Yeah. And I think also one of the things like you said, he's one of one we've all we've all talked about that. And we know that this is by no means the norm. And this isn't something that we really have to worry about again. And it's something that we can easily now that we know what to look for. And there were signs probably at the beginning, you know, he got very frustrated when he was in the office and he wasn't initially approved for financing. Like he got very angry and agitated.
You know, those should have been signs that we should have watched out for. So then like any time anything didn't go exactly like he wanted. He got very angry and agitated. And so then he started having these implant values because he's not taking care of himself. He's smoking. Like we told him not to like he's told us that he's not and but never took ownership for anything that he did. It was just outward anger, just volatile and seeing that volatility like we know, but to look for now.
In addition to obviously some of the hard surgical skills that you've picked up, crafted, honed over the past year. And also in addition to say those those. Conflict management conflict resolution type skills that you've picked up with patients like that. What are some of the other big elements where you've improved over the course of the last calendar year? Because it has been right out of year or a little over, right? Almost started at my practice November 14th.
So we're like to remember those October and November. OK. Yeah. Congratulations in advance. But what are some of those things that you've picked up on? And we're like, man, I'm way better in November of almost November of 2024 than I was in November of 23. I mean, every aspect. Well, probably a lot worse at feelings and crowns now.
But when which yeah, when I came on, I I had very little implant experience, had a lot of implant knowledge because it done a lot of self study and knew that that's where I wanted to what I wanted to do at some point. Didn't realize I'd be lucky enough to get the only do implants. But I guess we can kind of go to my background to work at your GP office for a period of time. And things were were slow. There wasn't enough space for me.
So I came to you and was like, hey, I need to do something because I was fresh, grad. You ended up getting me connected with a different office that ended up being a Medicaid meal. And that was honestly like a great spot for me because that's where I found out. Like I love doing extractions and dentures and it got to the point. That's the only thing that I was looking forward to was my extractions and dentures. And so you weren't looking forward to the op caps and the GMO DBL WTF fillings.
Yeah, no, no, not at all. I would like literally like look in through my schedule and it's like, oh, I've got I've got a full mouth extraction coming up or like, oh, I've got some emergency patients on the schedule. Like those, it's weird to think this, but in a Medicaid put in a Medicaid facility. Like sometimes an emergency patient comes in and it's a full mouth extraction. So I was like, like all the emergency, my schedule was just like emergency extractions.
And then occasionally I'd have to throw in some fillings because I needed something to fill it up with. But like it was, I was trying to put fillings on other doctors and just take all the surgery. And I felt pretty confident with my surgical skills and when I, you know, came on because I worked there at the Medicaid and all like just doing extractions for over a year. And then I get in and it's like, well, you don't, you don't know what you don't know.
And I've done some done an implant or case or two before I got started. And then you get in there and you're like, oh, man, this stuff, this stuff's different. And it's not that the surgeries are hard. I mean, they are technical. Like you do need to know what you're doing. I don't want to like tell people, like it's not hard. You can just go up and do not long for. But, you know, once you know what you're doing, like it becomes fairly routine.
But the biggest difficulty, at least for me, was like managing things when they don't go right. You know, and with most patients, that's not an issue. And most of the time they heal like they're supposed to. I think of another guy. He was one of my earlier cases that we did. He came in and he'd been smoking as well. And to have his anterior implants had like 30% bone loss. They were stable. They were well integrated, but he had actually stopped smoking.
Like his wife had caught him smoking and he was done smoking. I was like, well, you're done smoking. These implants have some bone loss. I was like, if you were a family member, I would replace these implants and we put something better in there because the long term prognosis of those is not great. Let's get it done before you go into your files or county. And super easy conversation. I hadn't heard this from four old at the time, but it was, you know, this is what I'm seeing in my experience.
And this is my best recommendation. That's what it did. And I don't know that I've handled everything like that, but that's what I tried to do. And I tell you, it's now the one yesterday where it was like, you know, this is what I'm seeing in my experience. You know, this implant is going to fail better to take it out on our own terms while you're not hurting.
And then it will on the weekend and you have an issue when you, you know, can't get in and we're trying to squeeze you in on a busy Monday. And that's the biggest thing is I think my people skills. I feel like I've always talked well with patients. In fact, that was probably my biggest problem at the Medicaid meals because I was spending too much time talking to patients instead of doing dentistry. I don't know if I'm shucking teeth.
Yeah. Yeah. Uh, but I felt like it was important to educate patients. I'm like, why we need to pull all of their teeth and why going to a denture is the best option for them given the circumstances and what Medicaid is going to cover for them. And why I didn't recommend an immediate denture. That's because Medicaid only pays for one denture in a lifetime. So you got to make sure it fits.
And it's still only going to last, you know, five, 10 years, but at least it's better than six to 12 months with like an immediate. So I thought while you were recounting boreholtz heuristic for holds formula about how this is what I'm seeing. And then, you know, this is, you know, by my best recommendation, like using that flow chart, I think that's really good, especially for people that come in that don't have a strong sense of urgency either.
Like you could use that same one, two, three flow because again, you get some people that have the sense of urgency, they have the pain, they have the wedding coming up. They have something that's causing them to seek you out. And there is a timeliness to their sense of urgency.
But other people, you get some of these people that are just testing the waters, they need something, we're concerned because they have periodical radio loosensings, we're concerned that there's stuff going on that could be even more problematic and lead to a true emergency. So I think using that flow that boreholtz introduced is also really great in consultations after we've listened. And then you can, you can lay information out that way too.
And because ultimately where I've gotten wrapped up in the past is by creating too much of a koop-oop ladder of options, whereas it's better off just to say, my best recommendation is this, and then only go back to a different option if we prove that that's not viable for whatever reason.
Yeah, I think that's one thing that I'm still working on is you get into this mindset where it's like, we got to do the, the, you know, the four, we've got to do the view, and then we've got to do the Lincoln option. And that's one thing that's taken me time. And when I have patients come in, they don't know what they want. What I do is I try to educate. I'm like, these are the things that we can do, giving your situation, like your teeth are terminal. They need to come out period.
It doesn't matter what we're doing to restore them. Like your teeth need to come out for your health because they're making you sick. They're, they're send action in there. They can cause issues. We need to get them out. And then I go through the options of this is what I do now. But when I first started, I would just go through the options and be like, what are you interested in? Um, so now it's like, we've got dentures. We've got over dentures and then we've got all four.
So now it's like my best recommendation is the all long four. If that's what, you know, it was attainable for us. That's what we should definitely do. It's as close as you can get to replacing with God gave you. And, you know, for most people, they're like, yeah, that's what I want to do. Now it's Arkansas. So a lot of people don't have the financial means to afford an all on four. Unfortunately, it's like, that's okay. We can just take one step back and look at.
You know, an over denture and an all on four or, okay, we need to take two steps back. And now we're looking at upper traditional denture versus the lower snap down. And then, you know, maybe the ball drops all the way down and we end up with the media adventures, but that's okay. They know what our best recommendation is. And most people are, I know you might talk about banking people for the future.
And that's one thing I always tell them, like, you know, we can't wait too long because we are having bone loss continually after we don't have teeth. Um, but this isn't something, you know, that if we can't make it happen right now, that doesn't mean we can't ever make it happen in the future. So you sow the seeds for those upgrades. Exactly.
That's something that we went pretty in the weeds on when I met with Jordan and the team in Sarasota about the notion of, especially if you have relatively few dentures going out, you can put them on something resembling like a denture recall where you get, you have an excuse for them to come in. You can look at how things are fitting, check for sore spots, et cetera.
But then you can also evaluate the resorption of the jawbone and see how things are shrinking, how the gaps are forming if we're losing ground. Hey, this is an opportune time while the window is still open to convert and to use that immediate denture as you're healing prosthetic for when we go to all on four.
So you could recapture some of those over time and every office may have a different perspective on that, but where if it's just the people that are like, yeah, I legitimately want to upgrade this. This is a, this is a right now thing, not a forever thing for me and just having a way to have a steel trap to, to make sure that those people stay in your crosshairs, to, to get them back in, to have another opportunity to get them to move forward.
Yeah, with our immediate denture patients, we see them like, you guess, I'm pretty early on, make some pretty early adjustments, but then it's like soft liner, two months, soft liner, four months, you know, we do a hard liner six months and every time we see them, it's like, well, you know, just so you know, like when we're tired of the denture, like we can always add implants, you know, we could just doesn't have to be what you're stuck with, especially if there's any complaints
about the denture. I don't like it covering the roof of my mouth. It's like, well, we can, we can make that, we can make that better for you. We have some solutions and letting them know like you are still a candidate, like we can still move forward and then trying to see them, you know, a year later or so as well. Well, pile as we wrap today, I want to ask you one final question. What would you say is the biggest piece about being an SPG that you're grateful for?
Definitely like the group of guys that we have or guys and ladies that we have being able to like take my issues to the doctor chat, reach out to or hold, reach out to, you know, like a mentor and Aaron and the other people that we have that like, I can't imagine doing this on my own.
You know, those, those lows at the lows, when you're at the bottom, you really do feel all alone and you call like the patient I had yesterday where, you know, the multi unit was pinching the tissue and I was worried about the implant failing. I was telling him like, hey, about that. He's like, oh, it's happened to me. He's like, you know, it's like we had a patient come in. I thought his implant was failing. He didn't play stand plants.
He's like, I am completely ready to place the implant and numb them up. He had his sedation medicine and everything and went to, you know, take out the implant and it wasn't moving. And it was like, it happened. So I'm like, well, that makes me feel a lot better like that. I'm not alone on this. Like other people have made these mistakes as well. Just the community that that y'all have built.
Like I really do feel like we've got a good group of doctors who have a wide variety of experiences, wide variety of knowledge and being able to use them as a sounding board. When things are going great or when you can't figure something out or when you're down in the dumps and need to hear that, hey, it's happened to me too.
Now doing stuff alone is brutal and feeling like you're the only person that that understands is so isolating and you just can't get any frames of reference to be able to understand. Is this normal? Am I handling this the right way? Am I crazy for having done this or brought this on, bringing this on myself? And you're absolutely right. What you said is spot on consistent with what my answer to that question would have been to.
It's just the group, the network, the teamwork, the all for one, one for all. The encouragement that we give one another and the larger doctor chat and then the smaller pod chats. And again, in the same vein, I'm grateful for the fact that you wanted to do this, Kyle, that you saw the value and what we're building and what we're doing, that you wanted to be along for the ride and contribute so mightily to it. So I just want to say thank you for being Team SPG.
Thank you for serving patients and your team so well at LRDI. And it's been fun. Yeah. Thanks. I'm glad to be a part of it. Yeah, dude. Well, thanks, Kyle, for being on the interview and hope everyone has a wonderful week signing off of the SPG pod.