← Becker’s Healthcare Podcast
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- [00:01]
A
Hello, this is Ariana Portolattan with the Becker's Dental and DSL Review podcast. I'm thrilled to be joined today by Dr. Robert Trager, a dentist in JFK Airport in New York City. Dr. Traeger, thank you so much for being here today. It's great to have you on our podcast.
- [00:15]
B
My pleasure.
- [00:17]
A
To start us off, can you introduce yourself for our listeners and tell us a little bit about your background?
- [00:23]
B
My name is Robert Traeger, and I am a dentist. I've been here in JFK for about 40 years. Before me, there was always a dental department here, and it's been basically about 60 years. I'm originally from the Boston area and did my residency at Lenox Hill Hospital in New York. Stayed here and always is figuring if they're going to make it anywhere, it has to be in New York. So that's where I still am, but I still root for my New England sports teams. But in the meantime, being in the airport is a fascinating situation. I'm physically, as I say, in the airport. I used to be in the terminals, and then they tore it down. And I've been in the Port Authority administrative building now for about 25 years. And it's just a fascinating type of dental practice in the location that no one else in the country has. And it's just something that's really enlightens what you do because you see people from all over the world. These are the patients who work in the airport because you got 30,000 people work here, and then you get people from LY in. So in my case, it's wonderful for me to learn different languages. Not fluently, obviously, but enough to make the patients happy and to respect you, and it makes it for a much easier transition.
- [01:42]
A
All right, thank you for that. First question for you here, what are some of the biggest issues that you're following in the dental industry this year?
- [01:51]
B
Well, I read Becca's every day. I read what goes on, and there's just so much problems out there. And I am a solo practitioner. There's a big difference. When I came to Chicago for the panels, I was the only solo practitioner. They're basically up against the DSOs. So my particular case, whether it's me or a DSO, the biggest problem today facing us is the advent of AI. Is AI for all of us? In my case, I don't think so, only because of the fact that I've been reading X rays and practicing as a solo for a number of years. I have a good business background, so I'm able to handle all these problems. As far as the DSO goes, yes, this is an excellent situation for them to use for themselves. And your other big problems today basically are dealing with insurance companies. So what's really interesting is California Governor Newsom just passed a law telling these insurance companies that they can't force dentists to accept their payments on a credit card machine. They can't force you into existing and working with other insurance companies who go ahead and merge or buy out another company and forcing you, because you're on the panel to take them and their fees. So these are the things basically that I really see it's bothering. Of course, there's always a problem with the shortage of good health as far as that goes. That these problems of running and maintaining an office with the bottom line being positive is the most important thing that I can see today. As far as that goes, the fees and costs and overhead is going up constantly. And these are situations that affect everyone in dentistry and all the health fields.
- [03:45]
A
Yeah, just a follow up question for you there. Where have you seen the biggest increase as far as costs for running your practice?
- [03:54]
B
Basically, I'd say laboratory fees. Don't forget the price of gold hit 4,000. So all these precious metals are costing more, supplies are costing more. Basically they're going to use the excuse, it's tariffs. But I'm sure there are other factors in raising the cost of just living today. A lot of companies are unionized, so the cost to produce products obviously are expensive. Transportation, everything unfortunately is going up. Cost of living. So that you do find a lot of problems in maintaining and running a practice. But a lot of the biggest problems is poor management. That's the problem. The younger dentists today don't want to go into private practice. They have no business background and they can't handle it. So what do they do? They go into a dso. Wonderful. They get that paycheck each week. They have no problems. Problem is they're going to stay there forever. No, but they're not learning business acumen. So when they get out on their own, this is what's going to have a problem with. And don't you think that DSOs are having business problems? It's very difficult for them to run a business like that because these speculators out there with money managers and putting up money, the biotis practices, they all think they're going to do wonderful. But if you don't have a business background and you can't manage and you don't know how to manage health, you don't know where to buy your supplies or get the best deals, how to money market and manage your money, they're going to fail. Look at recently just what happened Friday. One of the biggest drugstore change pharmacies in the country, 5,000 stores were just closed and went into chapter 11. I mean it's amazing and this is sometimes happening with some of these DSOs. It's wonderful they have the people put up the money for this. And yet what happens is you don't have a good manager. And no matter how many offices and clinics you have and the amount of money that you can say that you take in, what good does it do if you're going to end up losing without having good management and well trained individuals? And this is what I see happening today.
- [06:06]
A
Okay, thank you for sharing more about that. Next question for you here. What are you most excited about when it comes to dentistry right now and what makes you nervous?
- [06:17]
B
Excitement is for most people the AI which obviously if used correctly can help. But I because I'm a solo practitioner and at my age I'm still working five days a week and people don't believe it. But I wouldn't know what to do if I didn't. So what I love now is my implant restoratives. Now I use a three eye zimmer and I use the encoder. I just have to take picture and scan of a implant. I take an impression, you have to clean off the top and see the code numbers. All you have to do is take an impression, send it to the lab and there's not that many here in the New York area that do it and they scan it, send it right to the laboratory in Florida and you get back the completed implant restorative crown. That's all you have to do is go in if you use a customer but cemented and go ahead or just screw in the implant itself. So to me, in my particular case, this is what I'm very excited about as far as that goes. I'm excited about the fact that I can manage a dental practice. I've had the background for over 40 years. So this way here I can navigate through all the problems that a lot of other people have. But dentistry is changing. There are more, more technologies being invented and used as far as that goes. But the biggest things today for most people is how to navigate with these insurance companies. They're the ones that are hurting. In fact, today on your podcast or on your daily 25% of dentists now are not accepting insurance or leaving it because of the problems that they have, and it's just terrible because they don't know how to deal with these insurance companies. I know how to deal with it because I've been doing it for years. And you try to outsmart us. Trouble is, I've been around long enough to outsmart them. So as much as they try to mess around with me, I go ahead and beat them at their own game because I know what to do. And what I try to do is tell these individuals, companies, whoever has to deal with them, they offshore everything to the Philippines or to Canada or basically, if it's not the Philippines, it's India or Costa Rica. Always ask for a US Supervisor. Don't let them try to help you because they don't know what they're doing and they're poorly trained and they'll admit it. So always ask them to say, basically, no offense against you, but what I have to have done has to be certified and agreed upon by somebody administration. So please transfer me to a US Supervisor. And believe me, you'll get things done much faster. But let them know the game that they're playing, that you're aware of it. And when they go ahead and try to force you to take a credit card where they take off two and a half percent or more, or they down code the fees and you just tell them like I do, I'm in the airport, there's 30,000 people there. And a number of these airlines and companies use your insurance. I will speak to the HR people and tell them this particular company is not doing a good service for their employees and they're going to hopefully so switch somebody else. They don't want to lose subscribers. All right? They want that money, but you got to let them know that they can't fool you play games, because they know most dentists don't have a business background. So you got to go ahead and preempt everything and show them that you're smart enough than.
- [09:49]
A
All right, and last question for you. What will the most effective healthcare leaders need to be successful in the next two to three years?
- [09:58]
B
Well, the healthcare leaders cannot go ahead and buy up everything that they see that's available. When you get too big too fast and you can't manage it, it becomes a tremendous burden. That's what happened to Rite Aid, as far as that goes. And there are other DSOs. Sometimes I have money problems as far as that goes. And these are the things that they could be be aware of. And of course, you have to have the right help, the right type of individuals who are loyal to you and want to stay there and learn. And when you interview them, you should ask, what do you plan to do in the next 10 years? What do you look forward to? What is your anticipations as far as that goes? Because if you're running a big DSO and you're having all these patients come in, some have lousy plans, some have Medicaid and so forth, you have to know how to navigate through the them in order to meet the bottom line. If you're going to DO fillings for $25 and another company or contract will pay a hundred, like with me, it's just amazing. That's why I make sure that I see the type of patients that I want that have good plans and I try to find out from HR the type of plans they have and to know just what the bottom line is. You just can't take everyone that shows in the door. So you can go brag and say that you're taking 800,000, a million dollars. No, you want to take in what you feel is the correct fees. And even with the insurance companies, don't be afraid to negotiate with them as far as that goes. Let them know that you're a business person, you get your paycheck every two weeks, or I like to get mine the same way. And at the same time, what they have to learn is how to make sure that they don't delay payments. See, the game that they play now is just like today, we call up the insurance company and they're telling us we use dental exchange. A lot of times we file electronically. One of them, one of the Deltas, goes ahead and has the nerve. And this is the manager. And he tells my office manager, well, we don't accept electronic claims, only ADA forms. Are you sure now? She says, yes, well, I want to prove you wrong. And he said, what do you mean? Because I have other claims that you sent me electronically that you paid on. So I'm proving you wrong. He got so upset, he just hung up on it. This is. They don't like for you to know more than they do within. Main goal is to keep the float. They have all this money in reserve, collecting interest, anything they can do to delay payments to all these big DSOs or any solo dentists. That's the game that they play. And when you send in, they'll tell you they never got the X rays, they never got the paperwork as far as that goes. So this is the scenario that they use to go ahead and discredit the work that you do not Pay you on time and go ahead and make it frustrating. In fact, I think they've caused, because I read on the line there's a lot of these places causing fraud. In other words, I'm sure not completely their fault, but I see a lot of these individuals and companies now. The dentists are being sued in the companies because of fraud. But then again, the honest, small individual wants to be honest. You're forcing them to find ways, possibly commit fraud or do things they shouldn't do because of the way they're disrespecting the profession of dentistry and down coding and doing everything they can not to have to lay out money. Now, the loss ratio, a lot of states are now trying to get loss ratios instituted between 83 and 85%, which is excellent. But you need the cooperation of politicians and you need everybody working together. And that's why the ada, unfortunately, is losing membership and all of the dental societies because they're not getting the support that they really need. People can open up an office and be in dentistry and don't need the support. And with bad management, this is what happens. In fact, the ADA, unfortunately, has lost a lot of money because of bad management in certain cases. And this happens. Professional organizations and people have to be aware that these things are happening. And no matter how big an operation you have or how small it is, you have to navigate the system, be aware what's really happening out there. And that's why, unfortunately, these younger dentists who are mostly going into these type of situations, have no idea of background once they leave, or if they try to open up or even have a couple of friends open up an office. And they're going to fail, unfortunately, or they're not going to have the ability to go ahead and run it as a business, which it is. And this is my problem. Looking forward to a lot of these individuals out there. They do not have the background.
- [14:43]
A
Well, that is all I have for you today. Dr. Traeger, thank you so much for joining us on our podcast. Been great speaking with you, learning more from you about your experiences in the industry, and I'm looking forward to connecting with you. Good in the future as well.
- [14:56]
B
All right, thank you and have a good day, Adriana. Pleasure. And anytime you need any import, I'm more than happy to give you my input as far as that goes, because as I said, I've been around long enough to at least have some decent ideas. At least I hope so, to help people. Thank you and have a good day.
- [15:13]
A
You too. Thank you. Bye.