Intro: [00:00:03] Live from the Business RadioX Studio in Atlanta, it’s time for Dental Business Radio. Brought to you by Practice Quotient. Practice Quotient bridges the gap between the provider and payer communities. Now, here’s your host, Patrick O’Rourke.

Patrick O’Rourke: [00:00:18] Hi there, friends of the Dental Business Community. This is your host, Patrick O’Rourke. Thank you so much for joining us today on Dental Business Radio. Sponsored by Practice Quotient, PPO analysis and negotiation. If you’re a top tier doc and you’re not being compensated as such, you might want to give them a call. Another thing to think about sometimes is, who has signing authority in your practice for a $100,000 or more? Because if you’re getting counsel on that, you should be careful. So, consult the professionals at Practice Quotient, PPO analysis and negotiation, www.practicequotient.com or you can call their offices at 470-592-1680.

Patrick O’Rourke: [00:01:07] Now, onto the show. I am here with Dr. Ryan Vaughn of Gainesville, Georgia. How are you today, Ryan?

Ryan Vaughn: [00:01:14] I’m doing well, Patrick. And yourself?

Patrick O’Rourke: [00:01:16] I’m doing terrific. I am COVID-free and ambulatory at the time.

Ryan Vaughn: [00:01:21] Keep it that way.

Patrick O’Rourke: [00:01:22] Yeah. So, I got that going for me. It’s a streak. And I’d like to keep the streak alive for as long as possible, for sure. So, I appreciate you joining us today. Now, Ryan is a pediatric specialist from Gainesville, Georgia. And the name of his practice is Kid’s Dentistry of North Georgia. Ryan is also involved very intimately with the professional community here in Georgia, the Georgia Dental Association. Can you tell us a little bit – do you want to start with your practice or do you want to start with kind of your endeavors and your efforts in the professional circles?

Ryan Vaughn: [00:01:59] Well, I’ll start with the GDA stuff first, because that’s more high level. I’ve been pretty involved with the GDA now for about ten years. I started out doing special events like Give Kids a Smile and Children’s Dental Health Month, which is actually this month. Since 2010, the Give Kids a Smile – unfortunately, this year – it usually happens this coming Friday, so it’s the first Friday of every year in February. But this year it’s obviously been held off pretty much throughout the entire country because of COVID.

Ryan Vaughn: [00:02:40] But Children’s Dental Health Month is still continuing. That’s the month of February. A lot of times we go into schools and just teach kids and other people about dental hygiene and all that fun stuff. But even that’s been put a little bit of a damper on. So, we’re having to do it mostly through Zoom and stuff now –

Patrick O’Rourke: [00:02:58] That’s unfortunate.

Ryan Vaughn: [00:02:59] … because we usually just go into the schools and do assemblies and stuff like that, hand out supplies and stuff. But it is what it is. We just got to find different ways to get the message out there about making sure that people keep their hygiene up because it’s the entryway to the body for a lot of stuff.

Patrick O’Rourke: [00:03:17] Sure. I’ll tell you another thing about kids, so I think it’s really important – so I have two small children and daddy’s been telling them to brush their teeth every single day for their entire life. And then, all of a sudden, somebody comes into the school and hands them a little toothbrush and toothpaste – not that I didn’t give that to them before – and they’re like, “Daddy, brushing your teeth is important.” And I’m like, “Aha.”

Ryan Vaughn: [00:03:43] Well, children don’t listen to their parents. I mean, that’s par for the course. I have five of them, so I know full well on that.

Patrick O’Rourke: [00:03:50] You’re like the God of fertility.

Ryan Vaughn: [00:03:52] No, no, no.

Patrick O’Rourke: [00:03:52] Don’t stand too close.

Ryan Vaughn: [00:03:58] Oh, man. Sorry. There you go right there.

Patrick O’Rourke: [00:04:05] Yeah. So, do you get to your older kids and you say – do the older kids kind of then teach the younger kids there if you have – like, what’s the age distance between the oldest to the youngest in your household?

Ryan Vaughn: [00:04:17] Oh. Well, my oldest is about to be 13 and my youngest is one-and-a-half.

Patrick O’Rourke: [00:04:23] God bless you.

Ryan Vaughn: [00:04:23] We had four right in a row. We were 13, 11, 10, and almost eight. And then, we thought we were done and then we had a surprise, number five. I would tell you that it’s just kind of random in all families. I mean, from all my patient base that I can tell as well, children, they start off doing a fairly decent job brushing their teeth. And I think it goes with hygiene in general. Then, they get to be about tween years and then early teenage years, especially with boys, they don’t like to do it. Now, my son is the exact opposite. He’s way, way more hygienic than his sisters by far.

Patrick O’Rourke: [00:05:06] Really?

Ryan Vaughn: [00:05:06] Yeah. Which is kind of odd. And he’s number two. But, yeah, you see it a lot in practice that that’s when hygiene really falls off and you have to be really, really up on it. Because the parents, they’re like, “Well, they’re old enough now. They should be able to do it on their own.” And like, “Yeah. But you still need to encourage them and make sure that they do it.” And then, they start taking interest in other people and how their appearance is to other people. And then, that’s when things start to progress and start to get a lot better. So, usually about 15 or 16, then they start having a lot better hygiene and all around, especially toothbrushing as well.

Patrick O’Rourke: [00:05:44] Yeah. That makes sense. That makes total sense. I mean, my son is ten and, you know, certainly we have to explain, “You played soccer and basketball for the past few hours and you stink. Don’t go to bed like that.”

Ryan Vaughn: [00:06:00] Yeah. Oh, yeah. They can wash their sheets and maybe he’ll do that a little bit better.

Patrick O’Rourke: [00:06:05] This is one of the things I’ve been telling my wife, actually. I’m like, “Listen, they’re capable kids, you know, have them help you with the laundry.”

Ryan Vaughn: [00:06:15] Absolutely.

Patrick O’Rourke: [00:06:15] That will teach them not to leave everything, you know, inside out and not to put mud on it. I’m going to start making my son pay for his own shoes. He’s like, “I love these shoes. These shoes are great.” When I was growing up, I didn’t get Adidas. I didn’t get Nike, you know. And he’s like, “Look at these shoes. They’re so great.” And then, he runs in the mud, like, right straight into the mud. And I’m like, “Do you know how much those shoes cost, son?” “No.”

Ryan Vaughn: [00:06:42] Yeah. Yeah. I know that full well.

Patrick O’Rourke: [00:06:47] Yeah. So, are you guys doing the hand me downs? So, I’ve got a boy and a girl, so we can’t do that.

Ryan Vaughn: [00:06:51] Yeah. All the girls stuff is hand me down. The boy, obviously, it’s not – not at all. But he hands his stuff down to his cousins because he’s got some younger cousins, but he’s the oldest. So, all his stuff – and the girls kind of get a little ticked off about that, that he gets a lot of the new stuff. But I mean, it is what it is. I mean, you got three sisters because there’s four girls, it’s going to happen that way.

Patrick O’Rourke: [00:07:18] Right. I’m like, “Hey, listen. My job is to keep you alive. Are you alive?”

Ryan Vaughn: [00:07:23] That’s right.

Patrick O’Rourke: [00:07:25] Mission accomplished.

Ryan Vaughn: [00:07:27] I have this little saying in my basement, it’s from Alcatraz Prison and it says, “You’re entitled to food, clothing, and medical attention. That’s it. All the rest, you have to earn.”

Patrick O’Rourke: [00:07:39] Right. So, some of that stuff is on hold and we are trying to do some education, you know, in various ways. And so, outside of that, I did not know it’s February. So, February is Children’s Dental Health Awareness Month.

Ryan Vaughn: [00:08:00] Yeah. Yeah. Children’s Dental Health Month, CDHM.

Patrick O’Rourke: [00:08:04] Gotcha. Okay. So, hashtag. We’ll make sure to promote that. John Ray, the producer there, he’s on it. John Ray, the unofficial mayor of North Fulton County. He is with us today. So, outside of that, what are you working on with the GDA? So, you’re doing ten years, you did some volunteer work, then you started to get involved, get on the board. And that in itself is like a second job – speaking to somebody who’s spent some time on professional boards. So, just tell me about that journey, and what you’re proud of, and what you’re working on now.

Ryan Vaughn: [00:08:43] Well, I went through leadership within the northern district, and just whatever has been needed to be done, that’s what I do. I mean, if they ask me to do something, then I’ll get it done. And then, after that, I’ve been a delegate because we have our hierarchy structure that we have a House of Delegates and a Board of Trustees. And then, about three or four years ago, I became a board trustee member. And I’ve been one since then. And I’ve, also, in the past couple of years, become a delegate for the American Dental Association as a whole. So, we go out there every year to do their House of Delegates, because they only have one a year. And it’s usually in different places, obviously, around the country, because they rotate it so that many people get to them as possible.

Ryan Vaughn: [00:09:39] And I will tell you, the GDA, under the watch of the the executive director who came on in 2014, I believe, maybe 2013 – a little bit closer. Sorry – just done a tremendous 180 and the association has done more for us, especially in this past year with COVID than could have ever been expected. And I’m grateful for them and I’m glad to be part of it, to be honest with you.

Patrick O’Rourke: [00:10:10] So, who’s the director that you’re mentioning?

Ryan Vaughn: [00:10:14] The executive director is Frank Capaldo.

Patrick O’Rourke: [00:10:19] Frank. So, Frank, great job. Thank you very much. So, Ryan Vaughn wants to give you a shoutout. I met Frank as well before. Also, a scholar. Frank over there, I think, does a terrific job.

Ryan Vaughn: [00:10:31] Oh, yeah. He is our attorney – general counsel, I should say. And he does a lot of lobbying for us down at the Capitol.

Patrick O’Rourke: [00:10:41] Yeah. So, what’s been interesting to me, you know, from the insurance industry, when I talk to clients in other states and some shenanigans are going on, sometimes I ask them, I’m like, “Well, what is the -” and I don’t want to call anyone out specifically – but, “Well, what does your state dental association say about that?” And they’re like, “Well, they really haven’t said anything, you know.”

Patrick O’Rourke: [00:11:16] And one time there’s one certain company, that I’m not going to mention either, big insurance company who was doing something that was adverse to the interest of the provider community. And so, I said, “Well, what does your state dental association say about that?” And they’re like, “Well, you know, the board went to the carrier, and the carrier said did this. And so, that’s what we’re going to have to do.” And I’m like, “Why are you asking the carrier?” You know, that’s like asking the fox in the henhouse like, “Hey, are you warm? Would you like a blanket?” And would have a knife and a fork. “You know, you want some Ginsu knives, a barbecue set, what’s going on?” And I was like, “You really need to tell the board to get their head out of their hindquarters.” And one of the partners pipes up and he goes, “Pat, I’m on the board.” And I said, “Well, Bob, you need to get your head out of your hindquarters.”

Ryan Vaughn: [00:12:06] I bet that went over real well.

Patrick O’Rourke: [00:12:08] I couldn’t see his face, so I don’t know. But I mean, you’ve known me for a while, I don’t change much. And so, kind of what you see is what you get. I’m like, bye-bye. And if I feel a certain way, it’s not going to change just because that person is in the room. I think I’m polite, but I’m, you know, kind of firm in the way I feel about things. And I’m also open to folks changing my mind. And so, it’s just surprising to me that there’s – and I’ve had other clients describe their state associations as effectless, which is not a good word. Right? And as far as advocacy and protecting the interests of their members, for sure the Georgia Dental Association understands that and is proactive. They don’t just sit and wait.

Ryan Vaughn: [00:12:55] Yeah. We strive to do as much as we can for our profession and our members. Because, I mean, what else should we be doing? I mean, that’s what our charter is. And by doing that, then we protect the population of the state. And that’s what’s the most important thing is the patients. But we couldn’t do it without the profession. And so, that’s what we’re here to protect.

Patrick O’Rourke: [00:13:20] Do you think that access – just on a state basis, not in Gainesville, but do you think that there’s a struggle with access to oral health care in outstate? Is that something that you guys talk about?

Ryan Vaughn: [00:13:33] Yeah. We talk about it quite often. In the rural parts of the state, especially the very rural parts like northeast part of the state in the mountains and definitely in the southwest and the southeast, far south of Savannah, it can be a challenge. You know, we ran a study several years back and there were counties in this state that didn’t even have a dentist. Now, we’ve done our best to try and mitigate that as much as we can. But, even still with that study, we found that pretty much the entire population of the state within a 30 to 45-minute drive could get to a dentist.

Ryan Vaughn: [00:14:20] And so, a lot of the access issue, there is a – I guess the best way to describe it is, it falls on both ends. Because you’ve got the patients who just are unwilling to go to the dentist because of whether it’s fear, monetary, and other issues, they just won’t go. And then, you have some, where you’ve got dentists there, but they just can’t handle the caseload because it’s so overwhelming with the number of people that are there and the few dentists that are there. And so, it’s a balancing act.

Ryan Vaughn: [00:15:07] I don’t want to sound like people – I guess the best way to say it is, there’s a real big push within certain circles that say that access is just completely – the access problem is a huge, huge issue. Like, it’s the paramount number one issue. And I don’t think it’s as much of a provider issue as they make it out to be. There is a component to that. But I think there’s a lot of other factors in there as well.

Patrick O’Rourke: [00:15:45] I would completely agree with you. If you take a step back, you know, I like to push the argument sometimes to the complete and exaggerated other side. Was there more access 50 years ago?

Ryan Vaughn: [00:16:02] Well, I mean, there are more members of the GDA now, so I would imagine that there were fewer dentists. But the population was also less at the same time.

Patrick O’Rourke: [00:16:10] Fair point.

Ryan Vaughn: [00:16:10] So, it’s kind of hard to say one way or the other. But I would tell you that the number of single dentist offices has declined, but the number of dental offices as a whole has gone up.

Ryan Vaughn: [00:16:28] Because you’re counting the difference between single independent practices versus corporate.

Patrick O’Rourke: [00:16:32] Correct. Corporate dentistry, in my mind – I got to watch this stuff all the time in just full disclosure. We have, you know, corporate clients as well as independent. It just depends on the client, what their needs are. And so, corporate industry definitely does some good things. There’s no but, so corporate dentistry does do some good things. And just like any segment of any type of population, there’s some good ones and there’s some not so good ones. And you could say the same thing to be fair about independent practitioners.

Ryan Vaughn: [00:17:11] Absolutely.

Patrick O’Rourke: [00:17:12] But right now, I feel like there’s a crescendo of consolidation. I’ve been watching it ebb and flow for the past ten years. And right now, it is just like I’ve never seen anything like it. And so, what does that mean to organized industry, if anything?

Ryan Vaughn: [00:17:34] Well, you know, DSOs or the Dental Service Organizations, that are mostly a lot of the corporate practices, they tend to do their own advocacy. And they do participate within the ADA and its tripartite organization. But they do, do a lot of their own stuff as well. And so, you can look at it two ways. You can see that when they’re working in concert, it makes it even more imperative upon legislation and stuff within government circles. But there are some times where things run counter to the ADA or the GDA. And in those cases, we try to work together as much as we can to make sure that we find some type of common goal. Because the corporate model is here and it’s not going to go away. It’s just only going to get more and more involved in the profession itself. So, it’s one of those things where there’s no sense in trying to fight it. We should try to work together to just make our profession better and to help the patients in this country.

Patrick O’Rourke: [00:18:53] Yeah. I totally agree. And it’s something that I’ve talked about, you know, during my lectures. And so, I think it’s changed quite a bit. But there used to be sort of a theater like, “Oh, corporate dentistry.” Like, it’s some bogeyman. And I’m like, “Listen, here’s the deal -” And I would tell my clients, “- you’re a business owner. Handle your business. You can’t control what happens outside of your business. So, you do what you do and be the best that you can be, and all the chips will fall into place. But worrying about the bogeyman, that’s like worrying about whether Vladimir Putin is listening to my conversation right now.” So, Vlad. How are you doing, bud?

Ryan Vaughn: [00:19:35] Well, at least he’s not Vlad the Impaler.

Patrick O’Rourke: [00:19:40] That we know of.

Ryan Vaughn: [00:19:41] Sorry. I didn’t mean to –

Patrick O’Rourke: [00:19:47] That’s the problem with victims, they’re ashamed to speak out.

Ryan Vaughn: [00:19:52] Yeah. I will tell you, I do have an associate. But owning my own practice, the dentistry stuff, man, I love it. I absolutely love it. And it’s why I do what I do every day. But running a business, I was not built to do that. And that’s a very difficult struggle. And so, that’s what attracts a lot of the people to corporate models is that, you get to go in there, you get to practice your dentistry. You don’t have to worry about that other stuff. And so, that coupled with the increasing student debt that kids are coming out of school with, it’s very, very, very attractive to go into that type of practice coming out of school.

Patrick O’Rourke: [00:20:40] I’ve heard that. And I’ve seen some of them do a very good job, you know, on a track. And so, it’s difficult to own a business. Like, one of the reasons why I started the show, like, being an entrepreneur is not for the faint of heart. I was reading a book the other day – and I’ll give a shoutout in the show notes to the author – and in the first chapter, he’s like, “Well, so owning a business is the biggest challenge you’ve ever had.” It’s not like your marriage is hard. It is hard. Graduating from school is hard. Winning a fight, winning a championship, anything is hard. But owning a business, and running a business, and doing it successfully is the biggest challenge you’ll ever face in your life. You are now the chief everything officer. And I thought that that was awesome. And check out the show notes and I’m going to put a link to the book on that just for the audience, because I found that to be pretty powerful and I told him that.

Patrick O’Rourke: [00:21:47] So, you’re absolutely right. But, certainly, I feel like there’s two different types. I don’t want to say old school and new school, but that’s kind of how I formed it in my head. Is that, you have like an old school where you have the docs that are like you just hang your shingle out there and you’re like, “Hey, I’m the dentist in town,” and, you know, people come in, and that’s that. And then, you have the new school and maybe they’re going to go to corporate. I think that there’s certainly some people that are attracted to that or maybe they’ve tried it out and they realized, “Wow, I didn’t know any of this stuff. And so, I need to kind of learn about it first.” But then, there’s some that are definitely entrepreneurial mindset.

Ryan Vaughn: [00:22:26] Absolutely.

Patrick O’Rourke: [00:22:27] Like, they want to build their own game, then their own empire. And, you know, they’re working on it. They work on their craft. They have their mastermind alliance. And so, hats off to all of them. Like, I get a kick out of them, their energy and their enthusiasm.

Ryan Vaughn: [00:22:42] I mean, to be able to do both, my mind is not wired that way. But a lot of people are. And, I mean, they do a really, really good job with it.

Patrick O’Rourke: [00:22:51] And managing people would be easy if it wasn’t for the people.

Ryan Vaughn: [00:22:58] That’s true. Isn’t that the truth?

Patrick O’Rourke: [00:23:01] Yeah. That’s what I was told. And so, how much business talk or business subject matter is there in your insanely expensive dental school?

Ryan Vaughn: [00:23:15] We had, I think, one class. It was split up over two semesters. During that class, we had to learn how to set up a dental office, and write a business plan, present it, and try and get funding, and learn how to design an office for what you want to do, number of patients, and stuff like that. But at the end of the day, you’re in the middle of doing all of your other coursework and seeing patients for doing crowns and bridges and stuff like that to get stuff accomplished to graduate. And so, it’s almost like playing Monopoly. Like, you learn a little bit about real estate, but you really don’t know about real estate play Monopoly.

Ryan Vaughn: [00:24:03] And so, like I said, I had to present a business plan because I had to start my own practice and all that. And I didn’t have to design my own practice because I went and restarted an old dental office for pediatrics, which took that part away. But it was a stepping stone, like it was a start. But, in my opinion, it wasn’t enough for going out there. Because once you’re out there and you’re, like, sitting there waiting for the phone to ring and your only employee is your wife, you sit, and sit, and sit. And then, finally, once that ball started rolling, it went just fine. But that initial shock, it’s something else that you’re not prepared for. And I don’t even think that even if you had, like, a full-fledged class throughout all four years of dental school that it would still prepare you enough for that.

Patrick O’Rourke: [00:25:04] Yeah. Yeah. I wasn’t prepared. And, you know, I would [inaudible] for corporate America. And I had a lot of good mentors and still do. But, you know, everybody is like, “Pat takes five years.” I mean, “Five years? Let me show you something. I’m ready for that. Five years. That’s too long.” Five years goes by in a blink of an eye. And then, I’m like, “Oh. I see what they’re talking about.” Now, you’ve kind of finally found your groove. And sometimes I get calls, usually around July. I get calls from kids and they’re like, “Hey, I heard you’re real good. And so, I just closed on a practice or were about to open our doors -” and it’s like a Friday, you know, “- on Monday. And so, I need really high fee schedules and I want to be credentialed on Monday. All right. Make that happen. I only got ten minutes before my next patient.” And I’m like, “That’s not going to happen.

Patrick O’Rourke: [00:26:00] And so, “Nobody explained what credentialing is to you and, you know, how much leverage do you have, and how much access do you want to have to these various pools of discount insurance patients. Have you thought about any of that?” And he’s, “What are you talking about?” And so, I feel like part of what I like to do is educate. And, unfortunately, when I went to schools, I get in there and I spend a lot of time, you know. And I’m like, “So, nobody told you about any of this stuff?” I got my white board going. And they’re like, “No.” It makes me feel good because I feel like I’m educating them. But at the same time, I feel like I’m throwing a stone in the ocean.

Ryan Vaughn: [00:26:39] Yeah. Exactly.

Patrick O’Rourke: [00:26:40] And it’s like somebody has to tell you about all of this other stuff because the bullets are live. The meter is running. And it’s your money, baby, you know. Yeah. It’s a great business, because your market is people with teeth within three miles of you. That’s pretty awesome. But you have to be able to not just be confident and effective in your clinical skills. You need to be able to articulate that value out to the people with teeth that want to keep them. Right?

Ryan Vaughn: [00:27:11] Sure.

Patrick O’Rourke: [00:27:12] Tell me kind of how you’ve built the prestigious reputation that you have and enjoy in Gainesville.

Ryan Vaughn: [00:27:21] Okay. When we get a break, I want to come back to the insurance because I was going to say something to that effect. Because that was one of the more difficult things to deal with when starting a business is insurance. When I built my practice, I built it similar to the way I practice in residency. When I did residency, I had a very unique experience. We had a a clinical and didactic side with some really, really awesome professors. But then, it was also split half way with Children’s Healthcare of Atlanta. And so, we did a lot of hospital style dentistry with a lot of special needs patients and stuff like that. And so, I learned how to be both in a practice setting and also in a hospital setting. And so, I translated that to my own practice. And so, I try to treat children to the best that I can.

Ryan Vaughn: [00:28:22] And I have different levels of, obviously, treating children, whether or not we just do it with them just sitting in the chair, if they’re cooperative enough to do it that way. Or we do oral sedations in the office. And then, in some cases, we actually take kids to the hospital and treat them at the hospital with them completely under anesthesia. Usually, reserved for very, very young kids or kids with special needs. And we try to treat most of our patients in the office that we can. I try to spend as much time as I can with my patients. I don’t try to run it to see as many patients as I possibly can in any given time frame, because not only is it just not conducive for the patients, because, I mean, kids, they need as much attention as they can get. But it also wears me out. If I have to sit there and just see a patient and not make a personal connection with them, then I feel like I’m just going through the day and just knocking over dominoes and not getting anything out of it. And so, that’s how we’ve focused our practice.

Ryan Vaughn: [00:29:33] I would tell you in terms of treatment, we’re pretty conservative about how we do things. I don’t know if you guys are aware – this was, like, five or six years ago – there was a product that came out that’s called Silver Diamine Fluoride. We use that pretty religiously in our office. We’ve been using it since it came out. It’s helped tremendously with kids who had just tiny, tiny little spots in their teeth. Because it used to be before, if you had young kids that had tiny little spots in their teeth, I mean, you’d have to do fillings in them. Especially in the molars, they don’t usually fall out on boys or girls until they’re 10 or 11 years old. And if you got a three-year-old, that’s eight years, that cavity is going to bomb out and become something really bad very quickly.

Ryan Vaughn: [00:30:17] But with this, a lot of times we don’t have to do that anymore. We can try and put this stuff on there. And it’s just a little paint brush, really easy for the kids. Other than the taste, it tastes kind of funny. But we just do that a couple of times and then we just monitor it. And a lot of times, as long as we can get some hygiene change as well, we’ll stop the decay from getting any worse and then we just kind of leave it and watch it until it falls out, which is fantastic.

Patrick O’Rourke: [00:30:46] So, is this like a sealant?

Ryan Vaughn: [00:30:49] No. The best way to describe the consistency of it, it’s kind of like Orajel. It’s very, very thin. And so, you take it and you put it on a little brush and then you just kind of put it in between the teeth. Because most times – not always, but most times with kids – when they’re going to get cavities, they get them in between their teeth. Whereas adults, they’ll get them on the tops of their teeth and other areas. They usually get them in between teeth. And so, we use that to just kind of flow in between there – not the word, best word is staunch but it kind of is like doing that. If you’re trying to just arrest all of the bacteria that’s in that spot, that way it forms like a barrier from other bacteria getting in there and restarting the cavity, basically.

Patrick O’Rourke: [00:31:34] Gotcha. Yeah. That’s what I was going to say. I was going to say arrest. And I was going to be smart, I was going to say, arrest the corrosion.

Ryan Vaughn: [00:31:42] That’s a good way of putting it.

Patrick O’Rourke: [00:31:43] Yeah. Okay. Well, not to take the words out of your mouth, you know. Well, I said corrosion, not bacteria.

Ryan Vaughn: [00:31:48] It’s like Rust-Oleum for teeth.

Patrick O’Rourke: [00:31:50] There you go. I know what that is because of Toy Story – no. Not Toy Story. Cars.

Ryan Vaughn: [00:31:56] Rust-eze Medicated Bumper Ointment. We watch a lot of kids movies and TV shows in our office.

Patrick O’Rourke: [00:32:01] I love kids. They’re awesome. I really do. I watch a lot of that.

Ryan Vaughn: [00:32:01] I hope Disney doesn’t come down on me for that.

Patrick O’Rourke: [00:32:01] I don’t think so. Disney, listen. If you guys want to sponsor the show, you want to get the word out. You need to take Ryan and Patrick, and all of our families, to a wonderful Disney vacation. And we’ll give you the proper credit. I will say I love Disney World. You know, you go there. I don’t want to know how much it costs. At the end of it, they’re like, “All right. Here’s your bill.” I was like, “Don’t even show me. I had a nice time. I had a nice week. Don’t ruin it by telling me how much it costs.” But the level of service that they have and the whole experience there, wonderful. So, we’re looking at getting back to them.

Patrick O’Rourke: [00:32:46] I also a Disney planner. As a matter of fact, did you know that for Disney – this is totally sidetracked – they have Disney planners that work for free. Like, Disney pays them and they love Disney. And they’ll plan out your whole thing. So, Holly Ramey is ours, and she’s one of our neighbors, and she is terrific about it. So, big shoutout to Holly Ramey and her husband, Mark, too. Thanks for listening to the show, guys. So, Disney, listen. All ears. Please feel free to contact me if you want to be a sponsor. All right.

Patrick O’Rourke: [00:33:23] So, going back to that, so you’re kind of known in the community. And so, when was the practice originally established?

Ryan Vaughn: [00:33:33] It was opened August 1st, 2009.

Patrick O’Rourke: [00:33:37] 2009.

Ryan Vaughn: [00:33:37] It’s going to be 12 years at the end of July.

Patrick O’Rourke: [00:33:40] All right. And then, now, you have an office not just in Gainesville, but also in Flowery Branch.

Ryan Vaughn: [00:33:45] Correct.

Patrick O’Rourke: [00:33:45] All right. So, what was behind the decision behind expansion?

Ryan Vaughn: [00:33:49] A friend of mine, he’s an orthodontist up there. He had built a building because he was going to put his orthodontic practice in it, and he did so. And he had asked if I wanted to open a second office. Well, at the time, in the Gainesville office, where we were at, was really, really full. And I was like, “Well, why not try and start a second office?” And my wife was really, really instrumental in that decision. And then, they came to realize that running two offices is very, very difficult, so that took some time. And, also, I knew I wanted to get an associate because, like I was saying, the other office was very, very full. And that also took some time, too, was finding the right person that I really thought could practice dentistry the same way that I do. Because you don’t want to just pick somebody off the street and take them as a dentist because you want them to have the same mindset, the same compassion that you do. That way, there’s very, very little discrepancies between how the patients are treated in the office.

Patrick O’Rourke: [00:35:07] Sure. That makes total sense. And that’s really probably the second biggest, you know, concern I hear from clients is finding quality associates and keeping associates. And I think even in pediatric, it’s totally different, especially in the south. Not that it’s not like that everywhere, but it’s still Ryan Vaughn. And Ryan Vaughn, they know you. They know Kid’s Dentistry of North Georgia. But, you know, one of the things I love about Georgia is that, well, you know, they know who you are. And people do business with people that they want to be able to look in the eyeball and shake your hand and make sure you know what you’re talking about.

Patrick O’Rourke: [00:35:48] And so, when you have that going on, then it’s your reputation. So, they’re a representative of you and doing so with kids, too, in a clinical manner. I totally get that. So, how is Flowery Branch doing then? So, you start there from scratch then what?

Ryan Vaughn: [00:36:12] You know, I could only devote so much time to the office at first because I had the other office to attend to. And so, we’ve grown it slowly over time. But it’s doing really well. I mean, I can’t complain, especially with my associate. We’re running both offices pretty much full on for at least four days a week. And then, we also are in the hospital a day a week, one of us is. Because we also get a lot of patients coming from the health departments throughout the northeast part of the state. And the reason for that is that, the state Medicaid system, there’s very few pediatric dentists in the northeast part of the state who take Medicaid insurance.

Patrick O’Rourke: [00:37:01] So, like Blue Ridge, Toccoa?

Ryan Vaughn: [00:37:02] Correct. Blue Ridge, Toccoa, Habersham, White County, Franklin County, Union County, all of them. We get a lot of the patients that they see at the health departments there who when they need treatment, they come down to see us. And a lot of times it’s some really severe cases. And so, we actually see them in the hospital setting to get them taken care of. Like, two or three-year-olds that have 12 cavities, 15.

Patrick O’Rourke: [00:37:28] It’s awful.

Ryan Vaughn: [00:37:29] Yeah. But I see it more as this is what I’m doing for my community type of thing, because these patients need to be seen. And so, we pick up as much slack as we possibly can.

Patrick O’Rourke: [00:37:45] That’s one of the things about pedias, I think that all doctors really have this to some degree or another. But it’s more so to a higher degree, what I’m about to say. The pediatric specialists do the work because they love the work. And a lot of time, Medicaid is frequently part of that because they want to help the community.

Ryan Vaughn: [00:38:12] Sure.

Patrick O’Rourke: [00:38:12] And from an insurance, I’m going to circle back to that first from this standpoint, most of our pediatric specialist clients take Medicaid and then you’re looking at the commercial PPO contracts. And the theory or the school of thought – which is not totally wrong, I have to say, and sometimes I’ll subscribe to it – but what will happen is that, the commercial carriers will say, “Yeah. Your client is on Medicaid.” So, they’re taking $20 for an evaluation. We’re paying them 25. What’s the problem? And so, especially in a case like yours, it’s really just a time roadblock where we then have to articulate, “Ryan is not doing it because Ryan needs patients.” They’re like, “Oh, they must need patients.” Ryan is doing it because he wants to treat the kids in his community and that’s why he’s doing it. So, he’s losing money there. But we’re not going to lose money over here with you guys. You’re not going to be able to get to ride the, you know, 30 cents on the dollar train because you’re not poor. I’m you’re not singling out any carriers. Not today anyway.

Ryan Vaughn: [00:39:27] Yeah. No. I’m going to plug them as well. But when we started working with Practice Quotient about eight years ago, they were a godsend because they were able to help us do things that we were unable to do. Because we would contact the carriers and they’d be like, “Yeah. No. You’ve got what you got.” I mean, to be honest with you, it’s the same thing I say to my kids, you get what you get and you don’t pitch a fit. But when inflation hits and you’re still making the same thing, then it makes it a little bit more difficult because dental supply costs don’t go down. They only go up. So, it does make it difficult.

Patrick O’Rourke: [00:40:13] Yeah. It does. So, your experience with Practice Quotient, that was positive.

Ryan Vaughn: [00:40:20] Absolutely. We’ve used them twice now.

Patrick O’Rourke: [00:40:22] Yeah. Terrific. Terrific. Glad to hear that. I appreciate the kind words about the work. It’s one of the reasons why I do it too. It’s certainly not on the cover of fortune wearing mogul clothes. Not yet.

Ryan Vaughn: [00:40:36] Are you sure you’re not wearing them now, though?

Patrick O’Rourke: [00:40:38] I borrowed this jacket.

Ryan Vaughn: [00:40:39] Okay.

Patrick O’Rourke: [00:40:45] But that’s a drawback sometimes with Medicaid. So, now, you’re drawing from all over. So, now, the health departments know where to send their patients. You know, this is Business Radio and I’m really familiar with how it all works, right? So, That’s not a profit center. That’s not going to keep running five kids fed.

Ryan Vaughn: [00:41:06] Absolutely not.

Patrick O’Rourke: [00:41:07] And so, now, we’re also having to build the reputation as the kind of place to go. And you’ve done a terrific job doing that over, you know – 11 years, 12 years? -12 years now – so a dozen years. Now, you have an associate. Does having the associate allow Ryan Vaughn to take more vacations?

Ryan Vaughn: [00:41:27] You would think so.

Patrick O’Rourke: [00:41:29] I would think so.

Ryan Vaughn: [00:41:30] And I would tell you that I do take more time away from the practice. But most of that time is either spent with doing stuff for the GDA and helping them out. It also gives me some time to do some of the administrative stuff around the office that needs to get done without having to worry about patients and doing it after hours. So, that way I can spend more time with my family, which is the major key.

Patrick O’Rourke: [00:41:53] Right. Yeah. You know, I coach basketball now.

Ryan Vaughn: [00:41:57] Oh, yeah?

Patrick O’Rourke: [00:41:57] Yeah. You know, I’ve been doing it actually for – this is my fourth year. And probably one of the most satisfying things I’ve done in the past ten years. And I built my own business and I’ve done a lot of stuff that I’m pleased with. Like, that’s been cool. Like, I’m pretty excited we got a game this Saturday.

Ryan Vaughn: [00:42:16] Oh, so there is a season?

Patrick O’Rourke: [00:42:18] Yeah. We’ve had two games and we have two more games. We’re not going to do any makeup games. And so, you have to finish above 500 in order to make the playoffs. And so, my kids are fairly adept at math. Cherokee County Public School, thank you. I said, “So, if we have one loss and one win and two games left, how many games do we need to win in order to have a winning record?” And they’re like, “All of them, Coach.” I’m like, “That’s right.”

Ryan Vaughn: [00:42:52] Winning is everything.

Patrick O’Rourke: [00:42:53] Yes. Well, they don’t like to lose. I’ll tell you these kids, they don’t like to lose less than me. And I don’t really approach anything to come out not victorious, let’s just say that. I didn’t know anything about basketball four years ago. I didn’t play basketball.

Ryan Vaughn: [00:43:09] Oh, really?

Patrick O’Rourke: [00:43:10] Yeah. My wife is just like, “You need to get out of the house and stop working so much, blah, blah, blah.”

Ryan Vaughn: [00:43:16] Working with kids is satisfying, for sure.

Patrick O’Rourke: [00:43:18] It is. Yeah. I’ve learned a lot, too, about myself and also about patience. But it’s been very gratifying. So, you know, I can see how that work would be a lot better than just crunching numbers all day, you know, like some people do. And arguing with other grown adults about things that should be just put right. So, stop wasting my time, insurance companies. Thank you.

Ryan Vaughn: [00:43:48] I feel the same way. Like, I can relate to children maybe because I have the mentality of a child – I don’t know. But when discussions with adults tend to go sideways sometimes. Kids, they don’t normally do that. That’s why I like just kids.

Patrick O’Rourke: [00:44:02] Kids are typically easier. You know, they don’t always understand what I’m saying. And that’s why if I start losing an argument with the kid, I just start using really big words that they don’t know. And then, I’m like, “Yeah. How about that? You didn’t know about that, did you?” I use my – I can’t even say it. And if that doesn’t work, if they actually do know the words then I just start speaking a different language.

Ryan Vaughn: [00:44:30] Which one do you usually default to?

Patrick O’Rourke: [00:44:33] Portuguese or Spanish.

Ryan Vaughn: [00:44:34] But don’t a lot of kids know Spanish?

Patrick O’Rourke: [00:44:36] They do. So, I have Portuguese as back up.

Ryan Vaughn: [00:44:38] Gotcha.

Patrick O’Rourke: [00:44:39] Because I’m like, “[Foreign language]. What do you know about that? Well, if you don’t know about that, then you don’t have a leg to stand on, do you kid?”

Ryan Vaughn: [00:44:54] That’s right.

Patrick O’Rourke: [00:44:54] So, I have a question for you.

Ryan Vaughn: [00:44:58] Sure.

Patrick O’Rourke: [00:45:00] There was some recent legislation, 11, on the out of network surprise billing, which then the dentist got wrapped in on. Give me your interpretation of it.

Ryan Vaughn: [00:45:15] Well, the surprise billing is a really hot button issue, because what you have is, especially in the hospital settings, you’ll go in and the hospital – medicine itself is very, very segregated, and I don’t mean that in terms of a racial divide. I mean that in terms of, there’s a lot of different specialties. And so, you’ve got doctors who specialize in very, very small niches. And so, you go into the hospital and you have an ailment, and you don’t know what that is because you’re the patient. And then, you’ll go into the E.R. and then you’ll get shuttled somewhere else, and then somewhere else, and somewhere else. But you think that you’re fully contained within the hospital setting. So that every person who comes in there to see you for a different reason to try and figure out what’s wrong, they will fall under the umbrella policy of the hospital itself. That’s not necessarily the case.

Ryan Vaughn: [00:46:14] And so, suppose you’re in certain instances, you go in there and then you have to go under anesthesia. But the anesthesia group that is at this hospital is not under the same umbrella policy of the hospital. Then, you get a different bill from the anesthesiologist, which doesn’t fall under your in-network fees or coverage with your insurance, and so that’s what surprise billing is. And so, you get another bill that’s way outrageous because you weren’t aware of it. And at the time, I mean, you’re not mentally 100 percent there because you’re either in pain or something else is going on. And so, what the surprise billing was intended to do was to make it so that the patients are aware upfront if there’s any services that fall outside of the realm of the hospital fee structure for your insurance.

Ryan Vaughn: [00:47:10] Now, dentists got involved because there’s some nuances there because there are dentists, such as myself, who do go into the hospital setting. And so, it was one of those issues where we don’t want to – you’re kind of having to work both sides here. Because at the same time, you’re basically telling a group of people or professionals that you are not going to be allowed to do this. And they’re like, “Well, this is what the patient needs.” Because your fees or your –

Patrick O’Rourke: [00:47:55] Your plan doesn’t cover that, right?

Ryan Vaughn: [00:47:57] Correct. And so, you’re like, “Well, I can’t give the patient what they want because you’re telling me I can’t use my fees to do that with.” And so, there’s a fine line that you have to straddle. And, to be honest with you, I think the bill that has come out, I thought the legislature at the state capitol did a very good job with it, to be perfectly honest.

Patrick O’Rourke: [00:48:18] I thought it was fair. I mean, it’s fairly clear. And it is an issue, particularly in hospital settings.

Ryan Vaughn: [00:48:26] Absolutely.

Patrick O’Rourke: [00:48:29] On one hand, I’m like, you know, what does that have to do with the private practice? General dentists? You’re not talking about surprise bills, right? You’re out of network. At the same time, the docs that are fee for service only, there’s still plenty of them in the state and, really, all over the country, they don’t participate with any networks. But they already tell people they’re like, “I’m not in your network.”

Ryan Vaughn: [00:48:57] Yes. They tell them upfront. Correct.

Patrick O’Rourke: [00:49:00] And in the Great State of Georgia, in and out of network benefits have to be the same for all fully insured business, which not a lot of people know – which they really can thank the GDA. I hated that rule while I was still on the insurance company side, by the way. I embrace it now. So, good job GDA. And there’s only two states in the union that have it actually, so it’s Georgia and Texas. And so, I feel like it’s not that really big of a deal because I feel like the docs are doing it anyway. That was my take on it. And there’s also federal legislation, so when it mattered, what Georgia State did anyway, because very similar stuff was in the Federal COVID bill.

Ryan Vaughn: [00:49:44] Correct. And with that said, I’m very interested to see what becomes the repeal of the McCarran-Ferguson Act. I would like to see a lot more competition in the insurance industry. But I know insurance always tries to find a loophole.

Patrick O’Rourke: [00:50:01] Yeah. I mean, I’ll just give you my take on that for dental anyway. So, for dental insurance, you know, I feel like that there was a sort of school of thought that everybody in the insurance industry are all friends and we’re all getting together and, you know, smoking cigars, playing poker, and plotting out the world domination. That’s not the case. So, your competitor is your competitor. It wasn’t as open as I think that it was perceived. So, the impact of that, I don’t see it having anything profound. Now, I think it doesn’t hurt the provider community at all. Don’t get me wrong, it definitely does not. And it could have been used. It could definitely could have been used. That exception could have been used as a shield and maybe some things happened that I didn’t know about.

Patrick O’Rourke: [00:51:11] But I can tell you that, you know, intellectual capital is guarded very, very closely within each organization. And it’s not shared with those that wish to eat your lunch, which is your competitors, unless there is a very compelling reason to do so. Well, now, they can’t. So, dental insurance isn’t as complicated though. You know what I mean?

Ryan Vaughn: [00:51:35] Yeah. But there’s another side to that, at least in my opinion, that dental insurance has not changed much in the past 50 years. It’s a very archaic system. I mean, medicine, the insurance industry has evolved tremendously in that 50 years. Whereas, dental stayed pretty much the same. I mean, you have a thousand dollars maximum for most insurance policies. But, you know, as time goes by, 50 years of three percent inflation, that’s not going to get you as much as it used to.

Patrick O’Rourke: [00:52:07] Right. You’re absolutely right.

Ryan Vaughn: [00:52:08] I would like to see changes but, I mean, there’s only so much I can do.

Patrick O’Rourke: [00:52:16] There’s a lot of chatter going on – and it’s more than chatter. That’s not the appropriate word. There’s a lot of effort initiatives and mental and financial energy being put into medical dental integration. And so, I just did an interview with Marc Cooper – Dr. Marc Cooper out of Portland, and he’s doing a conference. In fact, that show will post right before your show. And so, I’m listening to it kind of see what happens. You know, have there been any medical and dental integration efforts that you’ve seen that have directly impacted your care and/or financing of the health care at your practice?

Ryan Vaughn: [00:53:01] Not yet. I know that the ADA is making a strong push to try and get dental more integrated in the medical side because, like I previously just mentioned in a fly by, there’s a lot that goes on with oral health that it continues on to the systemic health as well. And so, the ADA is really trying to push to have a lot stronger collaboration with our medical colleagues. And, you know, I got a lot of that. And I didn’t really think that was as much of an issue when I was in residency, because, I mean, I worked with the physicians down at Joe all the time. And I was like, “Okay. We’ll do this.” A kid got just diagnosed with cancer. We got to make sure that their oral health is completely fine before they undergo a bone marrow transplant or anything. Because if they don’t, anything that’s in their mouth – if they have a small cavity – it’s going to become an abscess in the cellulitis like that because they have no immune system.

Ryan Vaughn: [00:54:04] I mean, that’s just one example of the collaborations we did all the time down there. And I think that’s very, very important especially now with adults, especially older populations and all the systemic health problems that they have, that a lot of them don’t see dental care. And a lot of times, a lot of things can be caught if they go see their dentist along with their physician as well, and they talk and they collaborate together.

Patrick O’Rourke: [00:54:35] Sure. Absolutely. Coordination of care. Continuity of care. Well, I’d like to thank you. We’re going to have to wrap up today. One last question, though, who is your favorite Teenage Mutant Ninja Turtle?

Ryan Vaughn: [00:54:50] Oh, man. Really? That’s an easy one. That’s Donatello.

Patrick O’Rourke: [00:54:54] Donatello.

Ryan Vaughn: [00:54:54] I grew up a Donatello fan. I mean, absolutely. Because you had Leo and he led the group. And Rafael, he was a livewire. And Mikee, he didn’t really care about anything.

Patrick O’Rourke: [00:55:07] Kind of an airhead.

Ryan Vaughn: [00:55:07] Yeah. But Donny would always figure things out. That’s me, I’m just trying to figure things out. I thought you were going to ask me about the Super Bowl being as you’re a Bucs fan.

Patrick O’Rourke: [00:55:17] Unless you’re going to root for Tampa or say nice things about Tampa, then we’re not going to talk about that.

Ryan Vaughn: [00:55:21] Okay. All right. I’ll keep my mouth shut then.

Patrick O’Rourke: [00:55:27] Tampa Bay Buccaneers. I’ve been rooting for that team for as long as I’ve been alive.

Ryan Vaughn: [00:55:33] I don’t blame you. I’m the same way.

Patrick O’Rourke: [00:55:35] So, it’s tough because I live here in Atlanta. So, it’s not like people are walking like we’re in the same division. They’re not happy for me or anything, you know.

Ryan Vaughn: [00:55:43] But I think they appreciate that versus you being a Saints fan, because Atlanta really does not like New Orleans.

Patrick O’Rourke: [00:55:48] I learned that the hard way by going to New Orleans. And I went to a NOLA Atlanta game with somebody [inaudible] so we had a box and I wore Falcons – I bought a Falcons shirt and let’s just say that that environment was not hospitable. I had no idea. That was pretty much a brawl all day.

Patrick O’Rourke: [00:56:13] Well, with that, let me thank you, Dr. Ryan Vaughn. When people are trying to find you, if they want to find you, they want to talk about the northern district of the GDA and/or they have kids and they want quality of care in the Gainesville or Flowery Branch area of Georgia, how do they find Dr. Ryan Vaughn?

Ryan Vaughn: [00:56:29] You can just go on and search Kid’s Dentistry of North Georgia. The telephone number is 678-450-7011. And we have a website, it’s kidsdentistrynoga.com. And if you have any questions for me about the GDA or anything like that, you can reach me at the office or you can call the GDA direct and their number is listed on the website. I think it’s 404-636-7553, if I remember it correctly.

Patrick O’Rourke: [00:56:59] That’s pretty good memory.

Ryan Vaughn: [00:57:01] Well, I call them or they call me quite often because we talk a lot. But, yeah, if you’re ever in need of anything, I’ll be here.

Patrick O’Rourke: [00:57:11] All right. Very good. Well, I appreciate you coming by to chat with me and I’m sure our listeners appreciate you. I also appreciate John Ray, our producer for doing a terrific job, as always.

Ryan Vaughn: [00:57:20] Absolutely. Trying to keep my phone silent for whatever reason. I don’t know why it’s going off like that.

Patrick O’Rourke: [00:57:27] And I’d also like to thank our sponsor, Practice Quotient. Practice Quotient, PPO negotiations and analysis. They’re a national firm. They got clients from Anchorage, L.A. to Miami, to New York. We are headquartered right here in Atlanta, Georgia. Representing top tier providers, we’re a bridge between the provider and the payer community.

Ryan Vaughn: [00:57:48] They do an awesome job.

Patrick O’Rourke: [00:57:49] Thank you, Ryan. I appreciate that. I did not pay him either. All right. So, with that, until next time.

Ryan Vaughn: [00:57:55] All right. Thanks.