Dr. Jesse Jakubowski, Bay Center for Oral and Implant Surgery and Dr. Frank Yeh, Coastal Virginia Oral and Maxillofacial Surgery (“Dental Business Radio, ” Episode 8)
Dr. Jesse Jakubowski and Dr. Frank Yeh are representative of a new generation in oral surgery, and they join host Patrick O’Rourke to talk about getting into the industry, how they operate their respective practices, and the challenges presented by DSOs. Patrick also provides commentary on recent dental insurance industry maneuvers (example: fee reductions) happening now as we enter the homestretch of 2020; and how the choice of approach by the individual carriers to the provider community is acutely sensitive with long-term risk/reward impact. “Dental Business Radio” is underwritten and presented by Practice Quotient: PPO Negotiations & Analysis and produced by the North Fulton studio of Business RadioX®.
Bay Center for Oral and Implant Surgery
Bay Center for Oral & Implant Surgery has been providing oral and maxillofacial surgery to Pinellas and neighboring counties for over 30 years. They pride ourselves on providing the highest standard of care to their patients in a comfortable and safe environment. They have three convenient locations, all with the latest state-of-the-art technology needed to serve you and your family.
Jesse Jakubowski, Oral Surgeon/Owner
Dr. Jesse Jakubowski is the newest member of Bay Center for Oral & Implant Surgery, joining Dr. Horner and Dr. Jones in 2013. He was born and raised in Wisconsin, attending the University of Wisconsin for his undergraduate education and is truly a “midwesterner” at heart. He then decided to follow his father’s footsteps into the career of dentistry, moving to Fort Lauderdale to complete his dental training at Nova Southeastern University.
While at dental school he served in multiple leadership positions, including Student Government President and still is involved in leadership and community service to this day. It was also during this time that he developed a passion for Oral and Maxillofacial Surgery and completed six externships throughout the country in this field.
After dental school he stayed in Fort Lauderdale and completed his Oral and Maxillofacial Surgery training at Nova Southeastern University and Broward Health Medical Center. During his final year he served as Chief Resident of his surgical service and was also voted “Resident of the Year” by his peers.
Upon graduation Dr. Jakubowski and his lovely wife Kinga, an Optometrist, moved to St. Petersburg and joined Bay Center for Oral & Implant Surgery. This allowed them to settle down closer to her hometown and family in Palm Harbor. Together they enjoy almost any outdoor activity and love to involve their two boys, Carter and Bennett, and their fun loving Labrador Chloe. They are avid sports enthusiasts and enjoy cheering on their hometown favorites from both Wisconsin and Tampa Bay.
In addition to his position at Bay Center for Oral & Implant Surgery, Dr. Jakubowski was previously Predoctoral Oral and Maxillofacial Surgery Course Director at LECOM Dental School in Bradenton. He truly enjoys being involved in academics, to both help educate the dentists of the future and also advance his own education. He has published multiple articles in a variety of journals and most recently co-authored a book on lip cancer.
Dr. Jakubowski is board certified by the American Board of Oral & Maxillofacial Surgery and practices all aspects of Oral and Maxillofacial Surgery. He is a Diplomate of the American Association of Oral and Maxillofacial Surgery and a member of the Florida Society of Oral and Maxillofacial Surgery, American Dental Association, Florida Dental Association, West Coast District Dental Association and Pinellas County Dental Association. He is also a Diplomate and Fellow of the International Congress of Oral Implantologists, a member of the Academy of Osteointegration, and is certified in Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS).
Coastal Virginia Oral and Maxillofacial Surgery
At Coastal Virginia Oral and Maxillofacial Surgery, patients come first. Their primary focus is to provide the highest level of compassionate care. From the very first phone call, they treat patients and their family like one of their own. They strive to provide exceptional oral and facial care in a comfortable and safe environment.
Their doctors constantly challenge themselves to stay abreast of the forefront of the specialty in order to provide the highest quality of treatment to every patient.
Their team is dedicated to excellence in patient care and aim to be empathetic, caring and efficient. They pledge to you, our patients, and each other our commitment to provide and inspire outstanding value: because WE CARE.
Frank Yeh, President, Oral Surgeon
While Dr. Yeh is from Lancaster, Pennsylvania, he headed to the University of Pittsburgh for his undergraduate studies, where he majored in Exercise Science. He decided to stay in Pittsburgh to complete his dental training, and it was while he was a student at dental school that he discovered his true passion for all things related to oral and maxillofacial surgery. This motivation allowed him to study under some of the most renowned oral surgeon experts in the field.
After graduating from dental school, Dr. Yeh headed to Newark to complete a one-year surgical internship at Rutgers University.
Show Transcript
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. Welcome to Dental Business Radio friends of the dental industry. This is your host, Patrick O’Rourke. And we appreciate you listening to the show. It’s brought to you by Practice Quotient. Practice Quotient, PPO negotiations and analysis. You could do it yourself. You could have an office manager do it. You can also do your own taxes and represent yourself in a court of law. It doesn’t mean it’s a good idea. So, if there’s a lot of money on the table, you should go and give Practice Quotient a call.
Patrick O’Rourke: [00:00:51] So, with that, I want to welcome our guest, Dr. Jesse Jakubowski of Bay Center Jaw Surgery.
Jesse Jakubowski : [00:00:58] Hello. Thank you very much for having me, Patrick.
Patrick O’Rourke: [00:01:01] It’s a pleasure to see you again, Jesse. And Dr. Frank Yeh of Coastal Virginia OMS. How are you, Frank?
Frank Yeh: [00:01:09] I’m doing great, Pat. Thanks for having us.
Patrick O’Rourke: [00:01:11] It’s my pleasure. So, you know, as I was kind of talking to you guys prior to the show, you guys have a relationship with each other. I’m not sure which one of you I met first, actually. And you have some other compadres in your circle. And so, I talked to a lot of oral surgery practices and I’ve spoken to many, many of them across the country, and I consider you guys to be kind of the young guns of growing OMS practices. So, you’ve already done it. You’ve established yourself. And, you know, I’m sure you’ve learned quite a bit along the way. And so, that’s really what the theme of the show is. How did you guys meet?
Jesse Jakubowski : [00:01:56] So, Frank and I were co-residents in residency at Nova Southeastern University, Broward General. So, we met – oh, jeez – we would have started residency in ’09, so we probably met at interviews in ’08. And we spent four years side-by-side in Fort Lauderdale. And so, we became pretty good buddies at that point. Then, I would say to this day, we probably talk, at least by text, almost on a daily basis about work, and patients, and things of that nature.
Patrick O’Rourke: [00:02:31] Gotcha. I think that that’s terrific. We all need others around us, they’re going through the same things. You know, as a business owner/entrepreneur, you guys have it a little bit tougher, even. Because it’s like, well, hey, you’re a partner, you’re an owner, so you need to understand all the aspects of the business. You know, you’re the butcher, the baker, the candlestick maker, the website guy, the H.R. guy. You know, you need to understand the building. But, also, you need to put patients to sleep and make sure that you’re delivering quality care all at one time, you know, so that can be somewhat challenging. Could that be a correct assumption?
Frank Yeh: [00:03:12] Yeah. I mean, absolutely. You know, you learn all the stuff to be an oral surgeon in residency, you learn how to take wisdom teeth out and put implants in. But no one ever teaches you the business side of running a practice, no one teaches you the H.R. stuff, staff management. So, for me, it was kind of learn on the go.
Patrick O’Rourke: [00:03:35] You know what cracks me up? When I did the chat on your website, I was like, “Hello, does this work?” And then, Frank answered and he was like, “Is this Patrick?” And I was like, “Is this Frank? Are you answering your own chat?” He’s like, “Yeah. I just want to make sure everything works fine.” That’s me. I kind of do the same thing too. I think that’s awesome. So, what are some of the challenges that you’ve overcame? Either one of you, feel free.
Jesse Jakubowski : [00:04:09] Well, I think in general, like Frank said, they teach you how to do the surgery and how to take care of patients, but they don’t teach you how to run a business. So, I don’t know that it’s overcoming a challenge, but it’s definitely learning a lot more than just the basics of going to work, seeing patients, and going home. You know, you spend, at least, as much time on the business end and trying to figure out how to run a business, how to manage staff, the insurance end – which, obviously, you came in and helped us out on that side tremendously – just learning all of those things. And we’re a little bit over seven years out of residency, and I would say it took five years, probably, to figure out what you’re doing from a business standpoint before you could say, “All right. I can comfortably do this on my own.” And that’s just something that would be nice to have some sort of education on that prior and to leaving residency. But it’s not really operating, you know, dentistry, medicine. Nobody gets that training until you’re out on your own.
Patrick O’Rourke: [00:05:16] Okay. Frank, thoughts?
Frank Yeh: [00:05:18] I completely agree. I mean, I think the biggest stress as an oral surgeon, as a business owner, is not so much the oral surgery side, not so much the putting the patients to sleep, and doing the surgeries, and taking care of the patients. It’s more of all the other business stuff, keeping staff happy, keeping the practice afloat. Especially during this COVID time – holy cow – we were shut down for two months, you know, trying to navigate through that. What a struggle that was. That was the most stressful part of our job. I think we all just come on and do what we are trained to do and take care of patients would be a lot easier. But, like Jesse said, I mean, we learn on the go. And it took us four or five years to finally get comfortable in where we’re at. The beauty of Jesse and I’s friendship is we’re always talking with one another, text messaging with one another, and bouncing ideas off each other. So, that’s the beauty of our friendship. But, yeah, I mean, I feel the same about Jesse.
Patrick O’Rourke: [00:06:18] You know, when I started this business – you know, I came from corporate America and they were like, “Well, five years as an entrepreneur. It takes you five years.” And I was like, “Whatever. I’ll get this done in two years.” Five years goes by and you’re like, “Whoa. All right.” Now, I know what they’re talking about. There’s just a lot. You don’t know what you don’t know. And, you know, you get in there and there’s a lot of things that kind of suck your time, distract you. What do you think is an important part of being an oral surgeon that you aren’t taught? Is this aspect the most important thing that you wish was there? Or is there some other stuff that you feel, like, is critical from an education perspective?
Jesse Jakubowski : [00:07:11] I’m sorry. Could you repeat the question? I kind of —
Patrick O’Rourke: [00:07:14] What do you think is the most important part of being an oral surgeon that you aren’t taught in school?
Jesse Jakubowski : [00:07:22] You know, kind of like we talked about, I think a lot of it is how you treat people and how you deal with people. Now, you learn some of that in residency. But it’s more than just the patients. You know, you come out and you just have to treat people right. You have to treat your staff right. You have to treat your referrals right. You definitely have to treat your patients right. And, really, do what’s best for them and kind of go from there. And, really, it’s about people, a lot more than you would ever think. It’s about relationships and developing those relationships. And if you have strong relationships with your staff, and your patients, and your referrals and care about people, then, I think, you’ll be well, regardless.
Patrick O’Rourke: [00:08:09] Fair. The golden rule. I like that.
Frank Yeh: [00:08:13] I completely agree with Jesse. I think it’s all about relationships. It’s not just relationships with patients and staff and referrals, but, you know, we’ve spent a few minutes here talking about the business side of our practice and how to be successful. You know, if someone taught you, “Hey, develop relationships with other professionals that are either insurance minded, accountants, attorneys.” If you get a successful network, have a successful relationship with all those people. You’ll be successful in practice.
Patrick O’Rourke: [00:08:51] Gotcha. And so, as you’re five years past now – so oral surgeons, it takes a little bit longer to get through school, then you have to do residency – now, you have a business. And so, now, you turn a corner. And, now, do you feel like you’re hitting the gas? Well, Frank – and I kind of know the answer to this – it’s like you had one practice. You’re an associate and you become a partner. And, now, you’re like, “How am I going to grow?” Right? And so, do you feel like it turned the corner? Are you mashing the gas pedal or are you just trying to get a speed limit?
Frank Yeh: [00:09:28] Me, I’m always trying to mash the gas pedal as fast as I can, you know. That’s just the type of guy I am. But I think I’m still learning in every single day. You know, there’s always a new challenge that I’m met with every day. I mean, just recently, you know, we’re having problems with our practice management software system. And it’s a jump from that software system to another. It’s just whole different. It’s something you learn something every day. But I feel like I’m comfortable enough to know, what business ventures I want to start getting into. Like, you kind of mentioned I started off as just one practice, one office, gotten to two. I was 50 percent owner. Now, I’m 100 percent owner. And then, we went from two offices to three offices. So, I feel like I’m kind of getting the comfort level of the business aspect of it, where, now, I’m ready to just kind of take off.
Patrick O’Rourke: [00:10:24] Gotcha. So, you have, like, a mogul clause too. You have to get special clause in order to be a mogul.
Frank Yeh: [00:10:31] Oh, yeah.
Patrick O’Rourke: [00:10:33] So, you’ve been reading Mogul Magazine, I hope.
Frank Yeh: [00:10:35] That would be great.
Patrick O’Rourke: [00:10:37] Very good. So, Jesse, in your situation, you walked into three successful practices in Pinellas County. Pinellas County, Florida, part of the Tampa Bay region. Go Bucs.
Jesse Jakubowski : [00:10:52] Go Bucs.
Patrick O’Rourke: [00:10:52] That’s right. And we’ll give a little shout out to all of our friends and family back home in Tampa in a little bit. For those of you who don’t know, your host, Patrick O’Rourke, is a Tampanion. I’m born and raised in the City of Tampa. That’s correct. Proud of it.
Patrick O’Rourke: [00:11:07] So, Jesse, when I met you guys, you already kind of had a nice machine going, right? And so, now, it’s even nicer. So, as your pivoting, and you turn this corner, and you see some open ground – COVID has been a little speed bump, that’s for all of us. But, you know, I think that’s just temporary and a test of our gumption, if you will. So, I don’t want to get too deep into COVID, but I know it’s challenging. We all have a rut. But yours, still, the future is bright. So, what do you see as you pivot?
Jesse Jakubowski : [00:11:47] Yeah. So, I had a little different situation than Frank did. I joined a group practice seven years ago. It was two practices. Pretty much right after I joined, we bought a third practice. I became a partner within about a year from that point. And, yes, I am less than very happy and lucky to get the partners that I got that treated me fairly and equally from day one. And I walked into a relatively well-oiled machine – not that it’s a machine, but you get the point. I worked in a very nice practice, a very well-respected practice that I’m very happy with. And so, we continue to be partners to the day. There’s three of us. This past summer, we did bring on an associate as well, so, now, there’s four of us with the three locations.
Jesse Jakubowski : [00:12:41] And we’ll always be a group practice. You know, as soon as you guys are ready, you can join us as partner and we’ll keep doing what we’re doing. And the practice is doing well. Whether or not we’ll grow or we’ll expand, you know, I think that’s obviously a conversation I would have with my partners as opportunities arise. But at this point, I don’t think there are any plans for that. Just to continue working hard and, you know, the future is unpredictable. And so, you know, I’m always kind of the same way as Frank, and I like to keep my foot on the gas and just be prepared for anything that might get thrown at us. I’m very happy with what’s been handed to me as far as this location and my partners.
Patrick O’Rourke: [00:13:33] Absolutely. I mean, you guys already have three and a very good footprint with an established reputation. You know, you don’t want to grow just for growth sakes. In my humble opinion, you know, we’re not growth oriented. We’re a bit of a boutique. I hate that word, but it’s kind of true. We’re not volume based. And it makes it to where you’re able to pick and choose and take only projects that you are sure that you’re going to be successful with, and work with people that you want to work with, and not run around with your hair on fire. So, that’s one part, for me, that I’ve learned over the years is that, there’s a little bit of a balance. You know, I’ve got two small kids. I know you guys have kids, too. And, you know, professional fulfillment is important. But, you know, one of the reasons – I assume is true for you guys, too – that we all work is to provide for our families and be good fathers, right?
Jesse Jakubowski : [00:14:32] Absolutely.
Frank Yeh: [00:14:33] Yes.
Patrick O’Rourke: [00:14:34] And so, kudo’s to both of you, though, too, because you’re both still very involved in your professional community. Frank, are you the president now of the Virginia Society Oral and Maxillofacial Surgeons?
Frank Yeh: [00:14:48] Currently, I’m the vice-president of the Virginia Society of Oral and Maxillofacial Surgeons. Next year, it’ll be president.
Patrick O’Rourke: [00:14:56] Gotcha. Very good. So, I’ve sat on some boards before. I mean, it’s a commitment multiple years, because you’ve got to go by secretary, treasurer, vice-president, president, which is like a whole second job, by the way.
Frank Yeh: [00:15:09] Oh, my gosh. Absolutely.
Patrick O’Rourke: [00:15:10] And then, you’re the previous past president, which still has its obligations. It’s like after you work out, you have to have a routine afterwards, and the president is doing okay. So, that’s a lot to take on in addition to being a father, being a husband, and a business owner, and a mogul. So, what’s been the most satisfying thing about that type of time and effort spent for you?
Frank Yeh: [00:15:42] With the VSOMS?
Patrick O’Rourke: [00:15:44] Yes, sir.
Frank Yeh: [00:15:46] I’ll tell you what, no one ever tells you when you first commit to VSOMS to an officer position that, “Hey, this is a four year or five year commitment.” And I committed when I just had two kids and everything was going smooth. And, now, I got a third kid and I’m running around with my head cut off. But, you know, I really love this organization. It really helps, especially here in Virginia, keep our specialty in the forefront. It basically fights for our specialty, whether it’s in a [inaudible] rights, insurance rights, licensors. That’s really kind of the gratifying part about being an officer is, as you get inside scoop of what’s really going on with my profession. And I feel like what I’m really trying to do is try and protect my profession, try to protect my specialty here in Virginia. That’s always gratifying.
Patrick O’Rourke: [00:16:41] Yeah. It’s key. It’s key. And, you know, you do some education and some professional development yourself, Jesse. Why don’t you to tell us about that?
Jesse Jakubowski : [00:16:51] Yeah. Sure. I’m involved in a couple of things. I, actually, just became executive board on our County Dental Association, and so that’s a five year track to president. So, in five years, I’ll be president of that. So, that’s relatively new.
Patrick O’Rourke: [00:17:08] Congratulations.
Jesse Jakubowski : [00:17:09] I’m looking forward to that commitment. And I’m sure I’ll be struggling with the time commitment once it gets down in a few years from now. But, now, I’m happy with the decision, so that’ll be good. In addition to that, as far as other things like we talked about, we do some lecturing and clubs for the dentists and staff in our area. So, we do that as a practice, probably, five or six times a year. And that had been a pretty big group, 150 or so per study club. And we did start that back up this fall. But we’re kind of limited in space, so we’re down to about 70 attendees and we’ve had two lectures this fall. So, we do that, which is a great way to get out there and talk to dentists, and teach, and educate, and get feedback from them.
Jesse Jakubowski : [00:18:05] In addition, I lecture at a local VA. It has a general practice residency, and so I go there and lecture to their residents. It’s a year. So, I’m still active with lecturing to some of the LECOM groups. LECOM is Lake Erie College of Osteopathic Medicine, which has a branch down in Bradenton. And so, I had taught at that school for the first two years I was out of residency. I was oral surgery program director there for two years. And then, I went fulltime at private practice. But I’m still involved with them and I still have students that come up and shadow me from the school as well. So, kind of a little bit all over the place with the education. But it’s still nice to stay involved and to talk to people and teach.
Patrick O’Rourke: [00:18:57] Gotcha. It’s nice to help people, right? It’s fulfilling giving back. You know, trying to say, “Hey, look out for these potholes too.” Do you ever get involved in the business conversations?
Jesse Jakubowski : [00:19:12] Not necessarily. But the dental students are so focused on dentistry and oral surgery. You know, the funny thing is, like, I love finance, I love personal finance, I love tax law. Honestly, if I go back and teach again at LECOM, I would love to give them, like, a little mini-finance course or business course or something like that just to prepare them more than I was prepared, because that’s really key to that.
Patrick O’Rourke: [00:19:41] I think you should for sure. I think that’s a brilliant idea.
Jesse Jakubowski : [00:19:48] Yeah. Yeah. It’s on my radar for the future, so we’ll see how things unfold.
Patrick O’Rourke: [00:19:54] And this has just been my observation and this is anecdotal, but, you know, just kind of two schools – and I say the new school. But the new school of doctor/owners are more entrepreneurial in mindset and spirit. They tend to be more – they’ve done their research. They’ve done their homework. You know, they have a pretty firm grasp of, at least, where they want to go. And they thirst for that knowledge. And they’ll just kind of I’m going to do my work and I’m going to be the best at this. They understand that it’s business as well. And you guys are like the tip of the spear of that new school.
Jesse Jakubowski : [00:20:38] You know, I think everyone carries so much more debt now that if you’re not business minded, you’ll never be able to tackle the half-a-million dollars in debt you’re in after you’re done with residency. And so, unfortunately, it’s an unfortunate/fortunate consequence that you become business minded because you need to.
Patrick O’Rourke: [00:21:01] That’s a really good point. Really good point.
Jesse Jakubowski : [00:21:07] Absolutely.
Patrick O’Rourke: [00:21:07] Frank, anything to add?
Frank Yeh: [00:21:07] Absolutely. I mean, you learn all the necessary tools that you need to be an oral surgeon when you come out of residency. You know, I think Jesse and I are just down to earth generally nice guys, so we treat our patients well. We’re always going to do the right thing. But what we’ve kind of learned over the years is that, if you look at the trend of not just oral surgery, but dentistry. Dentistry is probably more ahead of our time than oral surgeons are. But, you know, if you look at the trends of Google, outpatient marketing, public marketing, you really need to start having that kind of business mindset if you want to be successful in life or successful in business. And just like Jesse said, our debt load these days is just astronomical, that if you just sit back and just expect patients to come through your door because of just your name and the way you treat people, that’s old times now.
Jesse Jakubowski : [00:22:05] Or if you are extremely good looking like Frank Yeh.
Patrick O’Rourke: [00:22:13] Is that what you do in Norfolk and Virginia Beach, you just put on big, like, billboards of your face, Frank?
Frank Yeh: [00:22:19] Oh, man. Billboards with my face on it or I’ll just have signage on corners of some streets, newspaper ads.
Patrick O’Rourke: [00:22:29] You should do it like you and your wife, though. I think you’d get better results that way.
Jesse Jakubowski : [00:22:37] There you go.
Frank Yeh: [00:22:37] You’re more good looking than I am.
Patrick O’Rourke: [00:22:40] So, yeah, I think the days of just hanging a shingle and, you know, being fine is great. You know, “Hey, people come in to me because I’m the doc.” Like, those days are gone. And, you know, there’s been corporate or, you know, private equity money in dentistry for a while. I got into specialist fairly recently within the past few years. And I’m sure you guys are somewhat aware of it, neutral towards it. You know, but there’s one thing that I’ve observed and I tell a lot of clients and I’m like, “Look, bud. If you just go out and go shake some hands and kissing babies and make yourself available in the community, your local Chamber of Commerce. You know, maybe even if you don’t like people, like, why don’t you send somebody out there.” If you’re not a good looking guy like Frank Yeh or Jesse, you know, go hire somebody that’s very friendly and personable and have them go out and represent your practice. Because familiarity breeds trust, you know. And so, you know, your website is important. Google reviews is really important. But it’s also, you know, health care always has remained and will be inherently local, in my opinion. You know, just health care is local. That’s that. What do you think of that statement? Frank, we’ll go with you first.
Frank Yeh: [00:24:08] That health care is local? I absolutely agree. I absolutely agree. I think you make a name for yourself in your local community by treating patients right. I mean, talking about external marketing, you know, you treat these patients right. They’re going to tell their family members. Their family members will come to you. Yeah, I think for sure, health care is always going to be a local thing, if I’m understanding that question correctly.
Patrick O’Rourke: [00:24:38] Yeah. I mean, I was just kind of making a statement, so I guess not too much to comment on there. Jesse, would you like to add anything.
Jesse Jakubowski : [00:24:45] No.
Patrick O’Rourke: [00:24:45] No?
Jesse Jakubowski : [00:24:45] I agree.
Patrick O’Rourke: [00:24:46] Fair enough. Is there anything special that you guys do besides – you know, hey, were all surgery practice, but is there a niche that your practice does differently and/or better than most people or most other oral surgery practices, you know, with all due respect? What do you think sets you apart? And we’ll go with Jesse first on this one.
Jesse Jakubowski : [00:25:13] Sure. You know, it’s funny, when I joined the practice, the practice name was Bay Center for Jaw Surgery, because before I had joined and well before I joined, they weren’t even doing orthognathic surgery anymore when I joined. But one of the big niches of the practice was orthognathic jaw surgery. And over the years, we did less and less and we did a lot more dental alveolar and implants. And so, pretty quickly after I joined, we changed the name to Bay Center for Oral and Implant Surgery because it more accurately described what we were doing on a daily basis. We’re doing oral surgery, office based oral surgery. And we’re doing a lot of dental implants.
Jesse Jakubowski : [00:25:57] And so, not that implants is a niche to our practice because, obviously, a lot of practices do implants. But more specifically, within that niche and one of the things that I’ve grasped on, too, personally, are immediate implants. And I would say that’s my niche within a niche. You know, majority of the implants that I place are placed at the same time of the extraction. And this is something that I feel like I’m well known for in the area, that if somebody has a patient and they want to have the implant placed at the same time of the extraction, they’re going to send them to me because they know that if it can be done, I will be able to do it.
Jesse Jakubowski : [00:26:39] And so, I feel like that’s something that I’ve grasped onto and I’m able to provide that for the referrals, for the patient. You know, it’s less time of a wait for healing. When you’re looking at, you know, four or five months total versus eight or nine months total and you’re looking at less surgery, if you can do everything at once, ultimately, happier patients and happier referral, if you can do that at the same success rate and the same results, which I feel like I can. And so, that’s kind of my little thing that I do and I really enjoy doing. It makes the cases slightly more complicated, but I’m doing them all day, every day, and so I love it.
Patrick O’Rourke: [00:27:22] So, can I restate that in my own words to make sure I understand?
Jesse Jakubowski : [00:27:27] Yes, sir.
Patrick O’Rourke: [00:27:28] So, I’m the patient, what you’re saying is, let’s say, I need to have five teeth extracted out of the lower portion of my mouth – so I forget. Which mandibular – is that the mandibular?
Jesse Jakubowski : [00:27:42] Sure. The mandible.
Patrick O’Rourke: [00:27:42] The mandible. All right. The lower mandible. I can have them extracted and then you’re going to put implants on the same day?
Jesse Jakubowski : [00:27:53] Yeah. And, you know, obviously, I can’t do it for everybody. So, I’m clinically evaluating. I’m taking a CT scan on pretty much everybody to see what the bone looks like, making sure there’s no active infection, making sure there’s adequate bone to get me primary stability on the implants. And then, a lot of times, I’m at least immediately placing them. Now, this doesn’t mean that they get teeth on them necessarily the same day. That would be immediate placement and immediate provisionalization, which we can do in some cases. But you need to have a very compliant patient for that.
Jesse Jakubowski : [00:28:25] And so, immediate placement means that I can take the tooth out and put the implant in, and leave it in there for four months, and then they get a tooth back at the end. Versus a more conventional way, you take the tooth out, your bone graft, you wait four months, you’ll re-evaluate, you place an implant, you wait another four months, and then they get the tooth back. And so, that’s a conventional way to do it. But majority of the time, I’m taking the tooth out and I’m putting the implant in the same day. And in some cases, I’m taking a tooth out, I’m putting the implant in, and we’re putting in a provisional tooth on it the same day. So, it just kind of varies case-by-case. But I’m doing that, more than half of the implants I place are that way.
Patrick O’Rourke: [00:29:08] Well, it sounds like a whole lot of awesome as a consumer, because it’s one thing I can’t make more of is time. So, if I need something done, you know, I don’t want to wait for months and make a bunch of appointments. So, the more we can knock it out, especially if we have an established high degree of quality, you know, that’s attractive to busy people. You know, I mean, everybody’s busy. But as a business owner, time is money. I think that’s awesome. I learn something new every day about oral surgery. I did not know that you had the extraction, then you wait – then you put it in the screw?
Jesse Jakubowski : [00:29:49] Implant.
Patrick O’Rourke: [00:29:50] Right. Right. To a layman, right?
Jesse Jakubowski : [00:29:52] It looks like a screw, yeah.
Jesse Jakubowski : [00:29:52] Not all oral surgeons listen to this show. Tom Brady could be listening to the program.
Jesse Jakubowski : [00:29:58] He is. I texted him earlier, so he’ll be listening.
Patrick O’Rourke: [00:30:02] Antonio Brown is listening to it too. Listen, you guys are doing a great job as a lifelong and in long suffering Buccaneers fan. Bravo.
Jesse Jakubowski : [00:30:12] This is going to be an interesting year, that’s for sure.
Patrick O’Rourke: [00:30:14] So, to us regular patients, it’s a screw. I got to pull it out. You’re going to put a screw in there. And what happens is, I’ll walk out with a screw mouth?
Jesse Jakubowski : [00:30:29] So, you know, everything’s usually covered with tissue and bone when we’re done. So, you walk out, it looks like nothing happened. You look in there, you just see a hole where the tooth was. It undergoes a phase called osseointegration, which means the bone fuses to the outside of the implant. It kind of becomes a part of your body. And that can take around four months or so. And so, it just sits in there. Usually, you know, if it’s a front tooth, we get something temporary, removable made that you can wear while it heals. If it’s a back tooth, we kind of usually just leave it out and you just go without the tooth for four months.
Patrick O’Rourke: [00:31:03] Like Dracula teeth?
Jesse Jakubowski : [00:31:05] It could be. I mean, if you wanted it, we can make that happen. But usually normal teeth.
Patrick O’Rourke: [00:31:09] Gotcha. It’s all done. So, all right. I did know know that. So, you have the interim, then you come back, and then you’re putting on the top – which I’ve seen many times like almost. You know, I’ve seen the demos – and then you put the cap on, which looks better than my normal teeth, basically.
Jesse Jakubowski : [00:31:29] Yeah. Definitely. Definitely better than your teeth. Definitely.
Patrick O’Rourke: [00:31:32] Yeah. I’ll be coming down there. I need stuff. I didn’t know I could get it done that quick. We could do it over Thanksgiving. Yeah, I definitely need to. I know sometimes clients look at my mouth and I’m like, “Hey, eyes up here, buddy. Eyes up here. I see what you’re looking at.”
Jesse Jakubowski : [00:31:47] You have a beautiful smile. You have a beautiful smile.
Patrick O’Rourke: [00:31:55] Well, thank you. Thank you very much. I don’t want to be too pretty. You know, Frank Yeh, you can’t use Jesse’s.
Frank Yeh: [00:32:05] No.
Patrick O’Rourke: [00:32:06] So, you’re going to have to come up with something else that’s cool about your practice.
Frank Yeh: [00:32:10] You got it. So, no, we don’t do that. We are your typical wisdom teeth implants, dental extractions, but we don’t do nearly the volume that Jesse does. I feel like our niche here in our practice would be orthognathic surgery. And it’s funny that I got into a practice that does a lot of orthognathic surgery. In residency – oh, my gosh – that was not a procedure I enjoyed. I don’t know if you enjoyed it, Jesse. But doing it down there at Nova, I did not like it. It took us eight hours to do a double jaw. So, I got out of residency thinking I’m not going to do another orthognathic surgery. But things happen for a reason. I got into this office, it does a lot.
Frank Yeh: [00:32:58] We do, probably, about ten to twelve double jaws a year. And I found that I’ve grown to really enjoy it, to really like it, to change someone’s life by just changing their smile. Just putting their jaws in a better position. Correcting their bite, whether it’s a bite problem, a TMJ problem. Some patients come to me and say, “Hey, I have sleep problems. I have sleep apnea and I hate my CPAP.” So, let’s do orthognathic surgery. And I find that procedure in itself to be very, very gratifying, very life changing.
Patrick O’Rourke: [00:33:33] That’s interesting. I’ve heard that. So, orthognathic surgery, from what I’ve been told – we have a lot of oral surgery clients – is very satisfying and it’s also complex and very labor and time intensive. You have to create models. This is not a small procedure at all, right?
Frank Yeh: [00:33:52] No.
Patrick O’Rourke: [00:33:52] And it’s not one of the things – it’s a high frequency. So, I mean, I’m an insurance guy, you know, it’s not something that shows up in the claims report as, you know, a spike claim or something that has a high degree of cost risk. And so, it doesn’t get much of a second thought, really. So, the people that are doing the underwriting on it in medical, they’re dealing with dialysis, they’re dealing with chronic conditions, they’re dealing with, it’s not millions, but billions of dollars. So, orthognathic doesn’t get the time and consideration that it deserves. And they don’t have the time to, you know, compensate folks appropriately.
Patrick O’Rourke: [00:34:36] So, for those of my insurance friends that are listening to the show, hello. And there you go, there’s some work to do on orthognathic. I realized it’s not a slice of the health care cost buy, but it does make a difference in patients’ lives. And I’ve heard this from several oral surgeons across the country and they struggle with it, they stopped doing orthognathic surgery because the reimbursements are so awful. They just can’t afford to put in the time and labor to do it right, which is sad.
Frank Yeh: [00:35:07] Absolutely. That’s one of the biggest downfalls of orthognathic surgery. That’s why oral surgeons don’t want to do it. Let’s face it, you spend about five or six hours in a hospital to do a procedure, take on higher risks, where you probably just stay in the office and do two or three sets of wisdom teeth and make the same amount of money and take the lower risk. Here in our practice, we feel like we want to offer that service to our patients. Not just our patients, but to our orthodontist. You know, we know that not all patients can be corrected with braces or just Invisalign, so we want to provide that service to them.
Patrick O’Rourke: [00:35:43] Excellent point. I think that’s very noble of you. And you’re probably one of the very few to do that in the Greater Virginia Beach-Norfolk area, right?
Frank Yeh: [00:35:55] Mm-hm.
Patrick O’Rourke: [00:35:55] There you go. What are you guys seeing out there that is troublesome or that’s causing you to lose sleep at night? Jesse, we’ll go to you.
Jesse Jakubowski : [00:36:08] I would say, in general, from a business standpoint, and not from COVID or from the election or things of that nature but from a business standpoint, the expansion of DSOs buying private practices and converting, just in the seven years I’ve been in practice here, I think between our three offices, there’s, maybe, around 200 practices that could refer to us that are in our area.
Jesse Jakubowski : [00:36:40] And I would say over seven years, I’ve seen close to 10 percent of those sell out and be bought out by a DSO. Even if it’s a smaller one where they only have four or five locations, in seven years, seeing almost, probably, around 10 percent or close to 10 percent of private practices not being private practices anymore. It’s a disturbing trend that, ultimately, from a specialist standpoint, you know, when you say, “Well, why does that matter to you?” Well, obviously, there’s less people referring us patients. You know, I don’t know if people know this, but most of DSO’s model is to keep all procedures within the practice. And that usually means that they are hiring an outside oral surgeon or periodontist to come in to their four or five locations and do all of their oral surgery. And someone else to do all of the perio and someone else do all the endo. So, they have their own specialists.
Jesse Jakubowski : [00:37:44] And so, although DSOs aren’t buying specialty practices, they don’t want to. They don’t need to. They want to buy dental offices and then put specialists inside of them and increase revenues secondary to that. And so, that’s probably the biggest threat out there to a private practice. Not just oral surgeon, but specialists in general is, as more dentists get bought out by DSOs, there’s going to be less and less patients referred out to us. And if I saw 10 percent go in seven years, does that mean in, you know, within 70 years that everything’s going to be DSO? Probably not. But you see where the trend is going.
Patrick O’Rourke: [00:38:30] And so, what’s your observation, would they bring in specialists in-house? Or they own the general dentist to do the implants and put people to sleep? Or are they going to get the kid that’s got half-a-million dollars in debt and having them run six practices all over Pinellas, Hillsborough, Hernando, Pasco Counties?
Jesse Jakubowski : [00:38:49] Yeah. I mean, some of them will try to get the dentist to do as much as they possibly can. So, if the dentist can do implants, if the dentist is going to take a weekend sedation course, you know, different things like that, they might try to do that. And then, like I said, a lot of them will hire somebody, a specialist, to come in and do the special treatment that needs to be done and not refer that out.
Patrick O’Rourke: [00:39:15] Can I learn to put people to sleep in a weekend?
Frank Yeh: [00:39:21] To quote, “Yes, you can.” There are courses out there, you can do it in a weekend.
Patrick O’Rourke: [00:39:30] That, I could. Right? That’s disturbing.
Jesse Jakubowski : [00:39:33] Well, not you. But, you know, there are courses for general. So, Frank and I went to residency for four years, where we were sedating people on a daily basis for four years, where we were doing a four month rotation in an OR with an anesthesiologist intubating patients and sedating patients. And this four year process to get to where we are, and that’s where our training came from. That’s how we learned how to sedate patients safe. And there are options for people who don’t go that route to do continuing education courses and get certified in conscious sedation as a general dentist or as a different specialist. So, you can undergo that training and get a permit for conscious sedation as a general dentist. Yes.
Patrick O’Rourke: [00:40:30] Got it. All right. So, if somebody is not a doctor, “I don’t have any health care background. I can’t do it.”
Jesse Jakubowski : [00:40:34] You still have to become a doctor first and then take the weekend course.
Patrick O’Rourke: [00:40:38] Being a doctor would make my mom real proud. Hi, mom. But none the stars for me. Okay. Well, that makes me feel a little bit better. And I was like, “What can I learn in a weekend? Get a rubber mallet?” I know how to do that now, anyway. But I don’t know what the actual health care outcome would be. All right. So, that makes sense.
Patrick O’Rourke: [00:41:06] And so, if they’re keeping everything in-house, I can see that. Not really any solution there except to be vigilant and make sure you do a good job. And, you know, luckily you’re in a pretty good market and you’ve got a mean well-oiled machine going on.
Patrick O’Rourke: [00:41:28] Frank, is it the same thing for you or is there anything else keeping you up at night besides COVID, the election, your kids, and corporate dentistry buying up all of your referring general dentist practices?
Frank Yeh: [00:41:42] Yeah. You know, so we got DSO here too. For Tom Brady, if you’re listening, DSOs are just basically business ventures, you know, non-dentists businessmen who are going out and buying dental practice to put on their portfolio. So, the difference in that mindset is, they’re business first and then patient care second.
Frank Yeh: [00:42:05] Whereas, Jesse and I, we’re always about patient care first. Yeah, we’re business minded folks, but we’re about patient care first, then we’re about the business. We got DSO here in the area as well. They’re kind of getting big. I think my CPA once told me, you either get succumb to it or you play their game. And, hence, I went ahead and bought another oral surgery and bought out his office. And I considered doing that here in the near future. Not so much to have the same business model. It’s just to have a bigger presence in the area. And that’s less to worry about if DSOs are coming in and and taking up all these dental offices.
Patrick O’Rourke: [00:42:51] Market power.
Frank Yeh: [00:42:52] Market power, absolutely. But I think what really keeps me up at night is, like I texted you a couple of days ago, where we got this nice little postcard from one of our insurance carriers that said, “Hey, we got a deal for you. We’re going to get some new patients for you.”
Patrick O’Rourke: [00:43:11] New patients. Good news, new patients. It’s always new patients. That’s bad news, baby.
Frank Yeh: [00:43:18] I’m like, I’m sold while we go online and find out our fee schedule has been decreased about 10 to 15 percent. And it is so demoralizing, because after COVID, as offices – I know, Jesse, you’re the same way – we’ve taken on more expenses with PPEs, gloves and gowns. The prices have gone up and the medical supplies have gone up. The medications have gone up. To run a business, everything has gone up. Now, to hear the insurance companies kind of reimburse you less and less, that’s what’s really disheartening. And that’s what really keeps me up at night.
Patrick O’Rourke: [00:44:01] Well, that would make two of us. You know, thank you for bringing that up. Actually, it’s something that we’re trying to get the word out. To my friends and colleagues in the insurance industry who may be listening to this, this is the challenge, right? So, I can see Frank right now and his beautiful face. You guys can’t see his face. You guys are all in board rooms. You’re making decisions. And I’m a little bit disappointed and some of us being in the insurance industry that, you know, I figured that COVID would kind of bring us all together and we’d be somewhat reasonable and not use it as an opportunity to – you know, I get it. Hey, it’s business. You got to control your costs of care. We see an opportunity that we can bring our costs of care down for years to come. I get it.
Patrick O’Rourke: [00:44:55] At the same time, you got business owners out there doing the best that they can and they’re buying all this equipment. And it’s not like they’re charging your full fee. I’m familiar with the contracts. The discount is fair. And so, now, we’re going to slice them even more. You know, and I’m sure to be fair to everybody and respectful, I know that there’s two camps in that boardroom. I know there is. And there’s one camp that says we’ve got to do what we got to do. And the other camp is like, “You know what? Our product here is the doctors. It is the network.” And the last thing I will say to all of you who are listening, you can only tax the people so much before they throw your metaphorical tea into the harbor.
Patrick O’Rourke: [00:45:54] And I will leave the rest of the conversations to be in private. But thank you very much, Frank, for that. That definitely keeps me up at night. There’s not just one carrier right now. There’s a couple of them. And some of them, you know, to be fair, carriers are all different. They’re not all doing the same thing. Some carriers are doing really awesome things, helping out the provider community, helping out the member community, helping out their own local communities. And some of them are using this as an opportunity to be unfair, and I’m being as polite as I can.
Patrick O’Rourke: [00:46:36] So, with that, let’s see here, what else do we want to talk about? What is unique about the Virginia Beach ecosystem? You know, your market there, what do you love about Virginia Beach and Norfolk?
Frank Yeh: [00:46:58] Oh, my gosh. So, you know, first I had no ties to Virginia Beach whatsoever. I am a Pennsylvania guy, so I grew up in Lancaster, Pennsylvania. I went to Pittsburgh for eight years for undergrad and dental school. And then, I moved down to Fort Lauderdale for all sorts of training. When I got out, I realized, man, Fort Lauderdale was too damn hot. Pennsylvania is too damn cold.
Frank Yeh: [00:47:23] So, I literally took a map and I told my wife – my fiance at the time – I said, “Listen, let’s look on the map. Virginia Beach, North Carolina. In the middle between Pennsylvania and Florida, so that’s got to be the best of both worlds.” So, we took a shot and came up here and we’ve been up here for seven years now. We just love it. So, living in Virginia Beach, we got, obviously, the beach. When you want to go to the beach, it’s right down the road. But if I’m tired of the beach, I want the mountains, I drive three or four hours west of the pier, past Richmond to Charlotte, I got the mountains. If I want to go to D.C., it’s a four hour drive up north of D.C. So, it’s got a little bit of everything here. It’s a great community to raise kids. There’s a lot of cool events and farms that kids love up here. So, from a community standpoint, we just love it up here. There’s so much to do.
Patrick O’Rourke: [00:48:17] That’s why I like that area too. And being from Florida, it is too hot. That’s why I’m here. And then, you keep going north, there’s snow. I can’t. This is as far north as we’re going to get. My wife is also a native Floridian from Broward County. She’s East Coast Florida. I’m West Coast Florida. There is a difference for those of us that are Floridians know. Jesse, are you native Floridian? Are you from the sunshine?
Jesse Jakubowski : [00:48:44] No. I’m from Wisconsin.
Patrick O’Rourke: [00:48:47] Okay. So, you got down here like, “Holy smokes, no snow. This is awesome.”
Jesse Jakubowski : [00:48:54] Yeah. So, I did move to Florida just with the thought of getting out of Wisconsin for a while. And then, I would go back to Wisconsin, where my dad was a dentist and I would join his practice, and the rest would be history. That being said, I ended up in dental school, decided I wanted to do oral surgery. I also met my wife, who is from Clearwater, Florida. And so, we set our sights on the West Coast after residency. Ended up in St. Petersburg.
Patrick O’Rourke: [00:49:28] West coast of Florida, you mean.
Jesse Jakubowski : [00:49:30] West coast of Florida, correct. And you’re right, there is a difference. You know, the East Coast, and particularly Fort Lauderdale and Miami, people are not as nice as they are in the St. Petersburg area. I will leave it at that. So, we ended up in St. Pete’s, closer to her family. And the same thing, I love it here. Summers are hot, okay. But, right now, for the next eight months, it’s going to be beautiful here. You know, just get out on the water. You know, I love fishing and we’re going to be doing the big King of the Beach Kingfish Tournaments this weekend, so I’ll be doing that with some friends, which are fun. And, you know, we’ll be fishing while everybody else is shoveling. So, you know, we got that going for us.
Patrick O’Rourke: [00:50:18] I’m coming back home. It’s gotten gotten cold all of a sudden, I’m like, “Okay. We’re going back to Tampa for a little bit.” My son loves fishing. That’s the only thing he loves more than video games. I don’t know. He just digs it. He watches, like, fishing shows and stuff too. Like every chance I get to, you know, I take him out fishing. He digs it.
Jesse Jakubowski : [00:50:40] Awesome.
Patrick O’Rourke: [00:50:40] And he’s, like, not hating me for pulling him off of the video games or making him play basketball or something. So, yeah, this is the time of year where I really miss Florida. And, you know, sometimes people call me, like, from Cleveland or even Wisconsin and they’re like, “Hey, Pat.” – non-COVID times – “will you come speak at our study club or meeting.” And I’m like, “In February? Nuh-uh. No.” I don’t own the clothes that would get me, like, from the airport into the car and get around safely without freezing to death. I don’t think. You have to have special clothes and underwear. So, those of you that are up north, God bless you. I really hope that you are enjoying this show. We’re not judging. We’re just saying that you guys have it harder and so you’re tougher. Rock on.
Patrick O’Rourke: [00:51:31] Let’s see here, so before we wrap this program up, is there anybody that you would like to give special mentions to? We’ve already talked about the Virginia Society for Oral and Maxillofacial Surgeons. Laura Givens, how are you? The Florida Society for Oral and Maxillofacial Surgeons. Hank, how are you? The Florida Dental Association. I’ll give a little shout out to Mike being down there, the association partner. I’ll send this to you. I’d also like to say hello to the Catacali family, Aparicio, McCain Love Nunez, Mike Cole in Tampa, Argus Dental, the Zambrano family, my family, everybody in Tampa. I’ll be coming back soon. Anybody who like to say hello to, say thank you for your support. Frank, we’ll go with you.
Frank Yeh: [00:52:26] I just want to thank, first of all, Jesse, actually. Really, he was the guy who introduced me to you. So, thank you, Jesse, for hooking me up with Patrick. He’s done wonders here in our office in the past two or three years, and so we’ve really got to know one another. But, more importantly, I just want to thank my oral surgery program professors, my attendings out there, Dr. Coleman, Dr. McClure, Dr. Lopez. I mean, you guys are the ones who are the reasons why we’re capable of doing what we can do, teaching us the necessary tools and lessons that we can go and treat patients. So, thank you to them.
Patrick O’Rourke: [00:53:12] I like that. Jesse, you’re up.
Jesse Jakubowski : [00:53:16] Sure. Sure. Well, thank you, Patrick, for having us on your show. I appreciate that. And Frank Yeh for helping make that happen as well. And the same shout out to Nova Southeastern University and our faculty there. You know, they provided us with a great education and gave us the building blocks to build on for what we’ve become today. You know, obviously, my wife and kids as well for supporting me through my education and my career. And then, my partners at the practice for just giving me the opportunity to join and really join something special here in Pinellas.
Patrick O’Rourke: [00:53:57] Terrific. I’d like to thank both of you, not just for being guests, but for your confidence and, you know, your business place in Practice Quotient. I’m pretty sure you guys are happy with it. I appreciate your referrals and all the nice things that you say about me in public and in private. And I’d also like to thank John Ray and all the team at Business RadioX Studios for making things happen. They do a great job producing the show. And, of course, we need to thank our sponsor, Practice Quotient, PPO Negotiation and Analysis. A national firm that specializes in strategic guidance on all of your PPO, UDHMO, and EPO contracts. You need to talk to an expert when the stakes are high. So, thank you very much to Practice Quotient and everybody on the Practice Quotient team. Scott and Nikki, hello. You guys do a great job. Thank you very much. So, with that, this is your host, Patrick O’Rourke, with Dental Business Radio with the young guns of OMS signing off. Until next time.
About Dental Business Radio
“Dental Business Radio” covers the business side of dentistry. Host Patrick O’Rourke and his guests cover industry trends, insights, success stories, and more in this wide-ranging show. The show’s guests will include successful doctors across the spectrum of dental practice providers, as well as trusted advisors and noted industry participants. “Dental Business Radio” is underwritten and presented by Practice Quotient and produced by the North Fulton studio of Business RadioX®.
Practice Quotient
“Dental Business Radio” is sponsored by Practice Quotient. Practice Quotient, Inc. serves as a bridge between the payor and provider communities. Their clients include general dentist and dental specialty practices across the nation of all sizes, from completely fee-for-service-only to active network participation with every dental plan possible. They work with independent practices, emerging multi-practice entities, and various large ownership entities in the dental space. Their PPO negotiations and analysis projects evaluate the merits of the various in-network participation contract options specific to your Practice’s patient acquisition strategy. There is no one-size-fits-all solution.
