Special List #16: Long-Game Strategies For Thriving Practices with Dr. David Lee Hill

Dr. Souyias (00:00):
Thanks for listening to The Special Lists presented by Referral Lab, the podcast for dentists and dental specialists.

Cameron Full (00:10):
And welcome to another episode of The Special List. I'm here, Cameron Full with my co-hosts Dr. Jason Souyias.

Dr. Souyias (00:18):
Good evening.

Cameron Full (00:19):
And we like to refer to Seda like Madonna. He's only got one name, Seda.

Dr. Seda (00:23):
Soon to be the symbol.

Dr. Hill (00:28):
That was my recommendation by the way.

Dr. Seda (00:29):
I like that. That was David's little nugget earlier.

Cameron Full (00:33):
So tonight we've got a close personal friend of mine, Dr. David Lee Hill, the C-E-O, O-M-S of Chapel Hill Oral Surgery. He's got a long bio.

Dr. Hill (00:45):
Let's skip it. Let's get into this.

Dr. Seda (00:48):
It's going to be in the show notes anyway.

Cameron Full (00:51):
Show notes. Let's just do highlights here.

Dr. Hill (00:53):
See show notes.

Cameron Full (00:56):
He deserves for us to give him some kudos here.

Dr. Souyias (00:59):
Yes, he does.

Cameron Full (01:00):
He, diplomat of the American Board of Oral Maxillofacial Surgery, member of American Association, oral Maxillofacial Surgeons, international Congress of Oral Implantologists and a whole bunch of other stuff.

Dr. Hill (01:10):
Perfect.

Cameron Full (01:11):
Okay.

Dr. Hill (01:11):
Perfect.

Cameron Full (01:11):
David Lee Hill's, wonderful, incredible surgeon. He's an active sportsman, deep sea fisherman, cyclist, enthusiast of the UNC Tarheel fan. Enjoys spending time with his family, his wife, Olivia, his son, Remy, Oliver, and daughter Violet.

Dr. Hill (01:27):
Violet, 1.5. She's in bed.

Cameron Full (01:30):
Notable achievements and awards. I'm not going to list them all. Doc,

Dr. Hill (01:36):
Please don't.

Cameron Full (01:36):
A four. Center of Excellence, exceptional Leadership Award, 2021, received a 20. Let's the what? Seattle Study Club. Is that what that is?

Dr. Hill (01:46):
Yeah, we were Rookie of the Year. That's a while back.

Cameron Full (01:49):
Okay, that's cool.

Dr. Hill (01:50):
Yeah,

Cameron Full (01:50):
2022 XX guide. Which is the

Dr. Hill (01:53):
Yep.

Cameron Full (01:55):
Then what else is cool on here that we need to mention?

Dr. Hill (01:59):
Proud to be in my 12th year as Picos faculty with the Picos Institute in Florida, which of course I know you gentlemen are also related to in terms of your contributions to that organization. So real proud of that. Run a private practice here in Chapel Hill and I'm a proud dad. So that's my life day in and day out.

Dr. Seda (02:18):
Yeah, just an all around badass it sounds like.

Dr. Hill (02:21):
I'm blessed. I'm blessed.

Dr. Souyias (02:23):
Let's go.

Cameron Full (02:24):
So actually I've known David Lee for a little while. We were fortunate enough to meet through Referral Lab and I had never asked the question that I asked before the show, and I'm going to ask it on the show so that everybody else gets a chance. I said David Lee, I said, what would you prefer I call you?

Dr. Hill (02:41):
So I said, my friends or family call me David Lee, and if you don't know me that well, you call me David. So please refer to me as David for the rest of the night.

Cameron Full (02:57):
Well, where did it come from?

Dr. Hill (02:59):
It's unique. I'm a junior, I'm a junior. So I am originally from West Virginia. My dad is David Lee Hill, and when anybody wanted his attention, they would yell David and if they needed my attention or maybe I was being reprimanded for something, which was more often than not the latter, you would hear David Lee, if you heard

Dr. Seda (03:17):
I thought you were going to say your dad was a huge Van Halen fan or something.

Dr. Hill (03:20):
No, I have heard that before and I

Dr. Seda (03:22):
Can you imagine being named after David Lee Roth?

Dr. Hill (03:25):
I've heard that. And then I alluded earlier that in undergrad at WVU there were two personalities. There was David, the biology major that sat in the front row, studied hard, and then on the weekend guy was David Lee. So two different personalities, two different people. I'll leave it at that.

Dr. Souyias (03:42):
That's awesome. Love that story.

Cameron Full (03:45):
Well, as you know the premise of the show, David Lee,

Dr. Hill (03:49):
That's fine.

Cameron Full (03:50):
The premise of the show is for us to go through a special list. And so when we were putting this show together, and obviously now that you've heard a couple of our episodes, the gift of the show is for people like you to bring basically your special list of pearls to everyone. And what we've found over the last year of doing this is that the approach that we've taken has had a pretty incredible effect on a lot of individuals. Jason, myself and Seda.

Dr. Hill (04:24):
Can we just think of the symbol? I want to come up with a symbol.

Cameron Full (04:28):
We're at events and stuff and people approach us and I read, Hey, I recognize your voice and you must be Souyias. And let me tell you about this show. We were just at Seattle Study Club last week and somebody that I didn't even know came up and sat at the table with us and wanted to talk about one of the episodes and what he learned during the episode. And so that's this your opportunity, David Lee, to contribute in a similar way. No pressure, obviously. And the producers do a wonderful job of making you sound better than you actually sound.

Dr. Hill (04:57):
So edit the heck out of this. It's going to go great.

Cameron Full (05:01):
So let's jump into the first item on the specialist on your specialist. Now I visited your practice.

Dr. Hill (05:08):
Yes, you did. When that was that recently. That was a wonderful surprise

Cameron Full (05:11):
And walked through and was taken aback because I've been in 160, 170 practices. I don't know a lot and I've never been in a practice like yours.

Dr. Hill (05:21):
What makes you say that?

Cameron Full (05:22):
Well, because of your first item. So tell us a little bit about what your AAAHC status,

Dr. Hill (05:30):
Triple A HC. It's a mouthful.

Cameron Full (05:33):
What is it? What the hell is that and why does it make your practice unique?

Dr. Hill (05:37):
Okay, let's just say what it stands for. It's an acronym for the Accreditation Association for Ambulatory Healthcare. Here's a way to think about it. So if you're a part of a hospital, then you're going to have certain type of accreditation standards. The most familiar of what you'll hear is called jco. So if you want to think of it as a, there's all these surgical centers. There's different clinics across the US that are non-hospital affiliated. I mean, I'm in Chapel Hill, this is the mecca of UNC healthcare, but I don't fall under UNC hospital governance, if you will. So all of us are dentists or have backgrounds in dentistry, and then some of us go on to different specialties. And so you fall under different accreditation committees in terms of your standards, in terms of your governance. So for me it would be the big one would be ABOs, American Board of Oral and Maxillofacial Surgery.

(06:29):
There's American Association of Oral and Maxillofacial Surgery, I'm sure for Jason and say that there's similar things for perio, aaa, Seda, right? Jason? Both of them. I would think so. Anyway, what it is is it's accreditation standards for a non-hospital affiliated surgical center. Now, there was no grand vision five years ago that we needed to be a AAA HC center. It evolved and it evolved very organically, and I'm happy to tell the story because pretty passionate about it because all of us are trying to do the very best we can by all of our patients. I mean all of us are regardless of this status or not. So the reason we actually were drawn to this type of governance, it had to do more with expanding our own surgery center in Chapel Hill. So

(07:26):
We knew that at some point we would want to have an associate in the practice and we knew that we would be expanding our footprint. And so in doing that, there was going to be a remodel involved. And when we started going down the rabbit hole of remodeling, and that was during a simultaneous time in North Carolina where there was a lot of questions going on in the world of anesthesia particularly, we asked ourselves, what can we do to basically future proof? That was the question, what can we do to give us the best chance of being state-of-the-art? Not now, but 5, 10, 15 years from now. And that's really where it started. And then talk about a rabbit hole. I mean what we thought was going to be a six month plan and then a six month renovation. It turned into a two year project. There was a lot of stop and go.

(08:16):
We gutted our entire clinic. We were not prepared to do that initially, but we ripped out the med gas went to a whole other level of med gas systems. So it's not that we didn't originally meet the criteria set forth by the board of North Carolina, but with what we did now, we basically have Tesla battery packs and power walls behind our walls. So that, I mean, true generator power, whether we were to hit or if we were to ever lose power in the main class A medical grade building, we wouldn't lose a beat. So you just take that philosophy, you extend it to every single aspect of the clinic, and that's what you saw from having an anesthesia machine in every operatory. I think we're in about our 10th year now. We've been doing it for almost 10 years where we have a true dual team model. So board certified surgeon, board certified CRNA on every sedation case or anesthesia case. So it's just part of the package. Yeah.

Cameron Full (09:13):
How does that affect how you promote your business?

Dr. Hill (09:17):
Well, we start by promoting our business internally by living and breathing our core values. And as cliche as it sounds, I mean the core values of our practice drive every single decision, not only clinically, but also from a business standpoint. As you can tell, I like acronyms. It just helps me remember things. So SWIM is the acronym that we came up with, and it stands for safety, wellness, integrity and mastery. And the safety part of it we looked at it and we said, is there anything that we're not doing that we could do better? And I'm not talking about the basic aspects of keeping patients safe and patient care, but really taking it to another level. And so we highlight it. I mean, we're very proud of it. And this is a very educated patient population in Chapel Hill, North Carolina. I mean, there's a local coffee market, Cameron, and we refer to the folks who visit that coffee market as sadophds, and it stands for Sons and Daughters of PhDs. So they just kind of sit around and talk philosophy. So this is a very educated patient population. I think they appreciate it, they seek it out, and who doesn't want what's best for them and their family, and we're trying to do everything we can to provide that.

Cameron Full (10:36):
I imagine that that approach, especially with some of your more complex treatment, really appeals to people and makes them feel more comfortable, especially if you get a second opinion.

Dr. Hill (10:48):
Sure. Yeah. I mean, I'm still credentialed at a hospital. I still go to the hospital some I still operate. There are certain cases that are better suited for a hospital setting, complex trauma cases, certain complex reconstructions. Some of our pediatric cases would much rather be in a hospital setting, but it sure is nice having this level of facility to treat a very large percentage of the patients that come in the door. We feel like it's best practice, and I think the patients receive that very well. It's welcomed. Yeah.

Dr. Souyias (11:24):
David Lee, excuse me. Where does your passion for this come from? Where did it start?

Dr. Hill (11:31):
Oh, Jason. I mean, the easy answer is that my tastes are simple. I'm easily satisfied with the best, but I'm also a bit OCD and neurotic, so that probably has more to do with it. But I think all four of us on this podcast right now are.

Dr. Souyias (11:49):
We definitely,

Dr. Hill (11:51):
I would say the passion has been fed Jason and it's been fed by really acknowledging the trailblazers that came before me. I mean, even getting the opportunity to train at UNC Chapel Hill was such a blessing. I felt like it was the best experience. My residency experience, I actually look back on it with extremely fond memories. The co-residents that I had. I mean, when anyone asks me, what do you think of such and such doctor from this area? And they trained at UNC, I'm like, well, that's easy to say. They were trained phenomenally. They're going to be a great surgeon. They're going to take great care of you. So I'm always happy to offer a second opinion, but I know that they're going to be in good hands even if they go elsewhere with the training background here in Chapel Hill. So that certainly fostered it. I would say mentorship, then that's what opened my world. This is a side answer, but we might as well dive into it. All of my best decisions came from making the wrong decision or something not working out first. So I mean, literally everything. I don't know that I've ever gotten the right decision on the first try. It takes me a couple of times.

Dr. Seda (13:02):
Can you give an example? Honestly, it's such a deep point, actually.

Dr. Hill (13:06):
I'm happy to talk about this. So I was the guy in residency who I saw senior residents not for sure know their job. They didn't have their job completely figured out until their chief resident year. And since three of us on this podcast, no offense camera, have done these residencies, we all realized that that last year of residency, that chief year is the most intense. And I always thought it was kind of odd that some of my co-residents waited until that last year to shore up their job. So I was the young brash buck who thought that I would have it all figured out by my second or third year when I was a junior resident. And I actually did two residencies at UNC. I did one in oral medicine for a couple of years, and then I did OMS after that. So I just wanted it figured out before I graduated. And you grow and you mature a whole lot in those last couple of years. And the decisions that you think you're going to make early on aren't the decisions that pan out. And all of this resulted in me graduating residency and not having a job or a place to work. And so best laid plans,

Dr. Souyias (14:08):
Right.

Dr. Hill (14:10):
I literally, not a lot of people know this actually. I literally picked up the phone. I was desperate, and I called every OMS contact I knew in the state of North Carolina basically pleading for work. I had no income, I had no job. Everyone else had this plan. They were going to be an associate and they were going to get board certified as soon as possible and all of these things. And that just wasn't my, that's not how it worked out for a variety of reasons. And so I called every rural surgeon I knew asking him for a job, and no one needed a full-time associate, but a lot of them needed a part-time associate, meaning come in for a day a week, come in two days a week, come in three days this month. A lot of 'em wanted me to take call for them sometimes in the hospital.

(14:54):
And so I just said yes to everything, Jason. I said yes to everything. And at the time I was, I don't know, I felt like a little bit of that I hadn't planned things out. Well, I felt like not a failure, but I felt like I wasn't doing things the right way. But in hindsight, man, I learned so much from these oral surgeons. So I was basically a traveling surgeon for two years, and I always worked in an OMS office. And I got to tell you, I really, not that I didn't already love my specialty, but it grew because these OMS surgeons just opened their doors to me. And again, it was almost less about clinical. It was more just how to run a practice, how to run a business, how to treat patients, how to actually live in a private sector as opposed to the ivory tower of UNC, chapel Hill.

(15:52):
Those were my growing years. And because I didn't have a family, I was basically a bachelor in essence. And I had

Cameron Full (16:01):
You were David.

Dr. Hill (16:02):
I was David, yeah, I was David. And so that's when I started doing CE. And I did my first years, I was doing between a hundred and 150 hours each year, just a weekend warrior every weekend doing ce. That's how I got involved with all the key things that influenced my life. So that's a long answer to the short question of where does your passion come from? I mean, we just came off a symposium that was basically, I think the title was Standing on the Shoulders of Giants. Well, I don't know that I stand the tallest of others in my field, but for sure, however tall I do stand it is because of the giants that showed me the way. Yeah.

Cameron Full (16:46):
So for those that don't know, David Lee is tall.

Dr. Hill (16:50):
I'm tall. I'm six foot three, almost six foot four. I'm getting shorter. Picking up a one and a half year old. Will you get down to their level real quick?

Cameron Full (16:59):
Well, you were taking your residency very seriously. Jason, do you have that picture handy?

Dr. Souyias (17:05):
No. Oh, no. I do not. This,

Cameron Full (17:07):
Jason, can you send that to the producer so they can

Dr. Souyias (17:09):
Put Yeah, no, we're not doing that. Yeah, I want see,

Cameron Full (17:13):
After we get off, he's going to text you if it's embarrassing.

Dr. Souyias (17:15):
I've lost it. It's gone. The pictures gone.

Dr. Hill (17:17):
Il'l save it as his photo.

Cameron Full (17:19):
He has this Greek

Dr. Souyias (17:23):
Fro

Dr. Hill (17:23):
Greek fro.

Cameron Full (17:24):
He's got the chain, he's got the hair coming out, and that's what he was doing.

Dr. Hill (17:28):
That's awesome. Good for See. See. Well, let's say he made all the right decisions early on. He didn't do Jason, his path.

Dr. Souyias (17:36):
All the wrong decisions led me to where I needed to be. That's right.

Dr. Hill (17:40):
It's true. It's true.

Dr. Souyias (17:41):
It's true. That's what I say when I get to speak on stage. I said, the reason I'm up here presenting is because I've done it wrong more than the rest of you.

Dr. Hill (17:49):
That's my material right there. That's it.

Dr. Souyias (17:52):
It's exactly the reason I'm up here.

Dr. Hill (17:52):
That could the title of the podcast.

Dr. Souyias (17:53):
It could be right. I've done it wrong before you.

Dr. Hill (17:57):
At least this episode. Right?

Cameron Full (18:01):
Let's skip to number two here.

Dr. Hill (18:02):
Okay.

Cameron Full (18:03):
CHOS anesthesia model, what it is and why we did it.

Dr. Hill (18:09):
Well, we talked a little bit about that. This is a hot topic, and I understand why it is because you're talking about life and death, right? I mean, it should be a sensitive topic. Oral and maxillofacial surgeons have an absolutely amazingly safe track record. Statistically speaking, it is one of the safest models. In essence, we're boarded in surgery, and then anesthesia is a huge component of our board certification, and we should be extremely proud of that model. And I am as well, the model being during surgery, you're operating and you're also running the anesthesia management. I went to Portugal to train with Paul Malo. This was pretty early on in my career. But when you're over in Portugal in Lisbon training, everyone's nasally intubated like every single patient is. I mean, Paulo Mala walks to room from room to room to room, and they're all nasally intubated.

(19:07):
And that's where we learned zygoma surgery, that's where we learned all these surgeries. And so when I came back to Chapel Hill and I was trying to incorporate some of these treatment modalities to help our patient population, I found it to be very challenging to have to be 100% focused on the complex surgery at hand, and simultaneously a hundred percent focused on the complex anesthetic needs at hand, whether they were, I'm not talking about nasally intubated or not. I'm just saying I, generally speaking, the cases I was trying to do, were not getting easier, Cameron, and maybe I'm the only guy in Chapel Hill, I don't think that I am. But who else can say that their patients are either older, sicker, more medically complex, more comorbidities, and or have any of us read the book, the Anxious Generation? Are you kidding?

(20:00):
This is a new era. Times have changed. So two things can be true at once. OMS can have an extremely safe track record with anesthesia. And for us in our clinic with what we were doing, we found real benefit in having, I like having two pilots in the Learjet. If you're flying a Learjet, I like having two pilots. I like having copilots. It's a misnomer to say you're just giving away your anesthesia training. No, in fact, it's quite the opposite. You're flying with somebody else. And I would say that my anesthesia skillsets improved. So again, it wasn't a grand vision. I was trying to do more complex cases and really struggling to manage that or the patients and the anesthesia simultaneously. And so if there's an option, I've done it from anesthesiologist MD to dental anesthetists to CRNAs. And it's the same thing with surgeons.

(20:59):
They're not all equal. Not all anesthesia providers are equal. You've got to find the right model for you and your practice in your clinic. But when you do find the right one, stick with it, emphasize it, grow with it. And for us, it was having a board certified CRNA in the room for every single sedation. So we are now in our 10th year of doing that model. And do I think everyone has to do that? Or if they're not doing it, they're doing it wrong? I would never say that. I'm just saying that that works well for us. And I think our patients have appreciated that model.

Dr. Souyias (21:32):
So I mean, are you doing the full spectrum from light conscious to sedation to intubations in your office with that?

Dr. Hill (21:40):
Routinely.

Dr. Souyias (21:41):
Routinely,

Dr. Hill (21:42):
Yeah. Yeah. And then the part of the triple HC accreditation, talking about med gas, we have an OR theater, which is lovely in terms of just the size of it. You just can spread your wings. And there's

Cameron Full (21:55):
What shows do you play in the theater?

Dr. Hill (21:57):
Mainly James Bond films of the Daniel Craig and or Sean Connery era.

Dr. Souyias (22:04):
Yes.

Dr. Hill (22:06):
And we play a lot of BPM music. So the OR is plumbed, the plumbing is for not just standard med gas, but also medical grade air. So all of the things that you would have in any surgical true surgery center, anesthesia machines in every room.

Cameron Full (22:23):
Do you ever bring anybody in or Seda for surgery, anesthesia wise?

Dr. Seda (22:27):
I do. That's the only way we do IV sedation in my practice is with anesthesiologist.

Dr. Hill (22:33):
There you go.

Cameron Full (22:34):
Souyias you don't.

Dr. Souyias (22:36):
I do not. We completely stick to just light conscious sedation where our state patients are still awake, but just more relaxed for what we're doing.

Dr. Seda (22:45):
I mean, I think the scope of what we do in perio is different than OMS in general.

Cameron Full (22:51):
Sure. Doesn't Stoner bring somebody in and he runs two columns with a

Dr. Souyias (22:55):
He does. He does.

Dr. Hill (22:56):
Yeah. It's funny, the first time I had, so again, I mean, I've tried just about everything and there was a dental anesthetist to have a ton of respect for, a ton of respect for in this area. He's probably done more pediatric. I actually think he's done more pediatric nasal intubations than anyone else in the state of North Carolina, because he does five to 10 a day. He's extremely smooth. And so I brought him in to do some of these more complex cases or full archery reconstructions. And then we were done with the case and I'd say, well, what are you doing with the rest of your day? He'd say, I don't know. I'm going to go chill out. I appreciate the case. We had a good time this morning. Great, great collaboration. I'm going to go hang out wherever. And I'm like, well, are you free? I got three or four third molar patients that I'm about to go sedate. He's like, yeah, I'll hang out and do those with you. Well, then you get a taste of that and you're like, I'm not going back. Are you kidding? So I would try to book him for the bigger cases, but then I would line as many cases as I could up after that. And he finally pulled me to the side one time. He is like, David Lee, you're not going to move away from this model. You should just fully commit to it. This conversation we're talking is like 11 years ago, 10 or 11 years ago, I had this conversation

(24:14):
And I was like, well, what do you think I should do? And he goes, you need to start interviewing really good CRNAs. Find the one that has a bunch of ICU experience, a bunch of experienced on all the things and is ready to then settle down into a private practice. And that's what we did.

Dr. Souyias (24:29):
Awesome.

Dr. Hill (24:29):
So yeah.

Cameron Full (24:31):
Why did you like it for thirds? Did it speed you up?

Dr. Hill (24:34):
I don't like using the word speed because slow is smooth. Smoother is fast. It's smoother. It's a lot smoother, Cameron. So yes, it's faster, but it's not because it's just smoother.

Cameron Full (24:47):
Got it. So let's talk a little bit about dynamic navigation daily.

Dr. Hill (24:50):
Sure.

Cameron Full (24:52):
Okay. Is it, and why did you transition to that?

Dr. Hill (24:56):
Okay. This is a fun topic. I alluded to the fact that when we opened, so we opened our practice, our first day of seeing a patient was 11, 11, 11. It's easy to remember, 11 11, 11 was our first patient. And so early on I wanted to try to figure out a way to differentiate Chapel Hill oral surgery from all of the other really good practices in the area. I mean, we're not Seattle, Washington, but the triad area. You've got UNC Duke, you've got NC State down the road, you've got Chapel Hill, Durham, Raleigh. There's a bunch of really good surgeons that are all trained well, because a lot of them trained at UNC. So I wanted to differentiate. And so I made a commitment early on back in the day, this will date me of being a fully guided surgeon, which Sadan and Jason are about to roll their out.

(25:43):
Like there's a lot of bad that can come with, if you're not able to pivot during these surgeries, it can hamper you. And they're right to think that. So I'm gaslighting, but technically I'm assuming you guys are thinking that. So we all think it. When we hear somebody say they're a fully guided surgeon, we're like, yeah, well, how do you pivot? Which is going to be my segue into dynamic navigation. So early on I was pouring up models, printing models, printing guides, you name it. I mean, holy moly, the stuff I was trying to do, it was archaic. Just to say I was static guided. It was goofy as heck. Jason would've been over my shoulder and be like, dude, just put the implant in. You are capable. Just use your, and he would've been right. But I was committed to this journey. I was totally committed, and I learned all the bad that there is with a static guide.

(26:35):
And there's a lot of good, you can plan the case. I think the best thing with a static guiding Cameron just for, I mean, everyone in the audience should know what a static guide is, but we're talking about literally printing something out and then you are committed to that plan a hundred percent. And so I'm not even going to get into the issues with tight opening and trying to get longer drills. And there's some nuances with static guides that you've got to be aware of. But there's also the concept of accurately inaccurate. So you can be accurately inaccurate. You can be very accurate in all of your data acquisition, but if you missed one thing, you're now going to be very accurate based on an inaccurate model. And you do a static guide surgery. How did the implant end up there on the radiograph? Well, something went wrong in your digital workup.

(27:21):
So anyway, we were committed to being static guided for years. And dynamic navigation came along, and I kept seeing it at trade shows. And I would ask people, what is this? And are you using it? And everyone's like, yeah, I bought it, but now I just put my cup of coffee on it. I never use it. They would literally be like, here, you can would hear this at trade shows. But then you really talk to the people who use it. And that's when you learn that there's the learning curve and you've just got to accept the learning curve. So Cameron, Cameron, it took me probably they tell you five to 10 cases, you'll have it malarkey. It took me 20, 25 cases. I'm a slow learner. It took me 20, 25 cases before I didn't want to throw it out the window. Why is that? Because we're such visual people.

(28:07):
As surgeons, we're so visually inclined. We're used to looking in the field. So it's muscle memory for us and for us now to look at a screen instead of in the mouth during the surgery. I mean, you occasionally are doing checks, but for the most part, you're looking at a screen, right? That's very unnatural. I mean, even if you talk about the DaVinci guys in the hospital, there's a learning curve with using the DaVinci machine. That's kind of like the DaVinci machine for us. But once you got it, once you get that muscle memory down, it's really special. So dynamic navigation is, in essence, my argument would be it's the best of both worlds. You're able to plan like a static guided surgeon, and you're able to pivot like a free handed surgeon. You're able to in real time have the dexterity. You can actually feel what's going on.

(28:55):
You can make a change live. You can actually make a change based on perioperative findings, which is what we do day in and day out. That's part of being a surgeon. And you can put that change, pause the case for just a second, take your gloves off, make the change on your virtual plan and go back to being guided with that change. If you need to move something a millimeter here, two millimeters there. And now with the world of photogrammetry and being able to do full arch cases, it's really this technology, I would argue, is just now really going to get going with photogrammetry. Yeah, it's a game changer. I love it. Absolutely love it.

Cameron Full (29:31):
Souyias you do guided stuff at all?

Dr. Souyias (29:34):
Static guides, not X nav or any of that kind of stuff, like the dynamic stuff.

Dr. Hill (29:40):
Have you experienced any of the challenges with static guides or

Dr. Souyias (29:43):
Hundred percent. What you said,

Dr. Hill (29:45):
Always perfect. And everything's always sleeved perfectly and nothing's ever off. And you never want to just snap

Dr. Souyias (29:50):
The guide never breaks,

Dr. Hill (29:51):
The guide never breaks,

Dr. Seda (29:54):
Never.

Dr. Souyias (29:54):
Patient always opens wide enough to get the drills in. No, I just had one last week where I reviewed the plan. I look at it, I'm like, God, that's so beautiful. Let's do it. I start putting it in the mouth, and I go in with the first pilot drill. I'm like, damn, I am right next to that molar root. I had to move the implant two millimeters over where the guide was putting it. And I'm like, what in the world.

Dr. Hill (30:15):
Accurately inaccurate,

Dr. Souyias (30:16):
Accurately inaccurate. Something got wrong in one of the steps. This is what I find. I'm one of those people when something's not right. I want to know what went wrong and where it went wrong. And that's where I think I struggle with some of the digital stuff is it's hard to find that. It's hard to figure out. It's an, I go back to the lab and I go back to the plan, and I look at that and I'm like, okay, let's look at this. Let's look at that. And we struggle to figure it out because when something's wrong, I like to know why I'm a Y guy. And with that digital workflow, sometimes it's just like, we don't know. We don't know where it went wrong. And the good news is it's not frequent. Thankfully, it's not too frequent. Most of the guides are awesome, and they put the implants right where you need 'em.

(31:03):
Some of those times when you're threading the needle in a pretty narrow space with minimal tolerances on either side, it's beautiful. It does it better than doing it by hand. But then you've got to be cognizant, thank God I looked at that case and I pull the guide out after the pilot drill, like, man, that just didn't seem right. And I pull the guide out and look, and it's like, okay, if you didn't have that experience to be able to stop and look and check that it's doing it right, I would've put the implant inside that tooth because it would've just gotten wider and wider to include the molar mesial root that was there.

Dr. Hill (31:43):
So with the example Jason just gave, the only thing that wouldn't have been answered perhaps is the Ywhy because I'm curious what the why ended up being. But during surgery, perioperatively, if that had happened with dynamic navigation, you would've acknowledged that you are two to three millimeters off. You would've taken five seconds to change it in the plan. You would've gone right back into being guided. What I'm trying, the word is pivot. You would've pivoted, pivot, and then reentered. But I'm assuming what you did is you threw the guide and went free hand.

Dr. Souyias (32:14):
Correct?

Dr. Hill (32:15):
You had to. I had to.

Dr. Souyias (32:16):
You had to, right? I had to.

Dr. Hill (32:17):
So that's kind of what it is. Cameron, my advice to anyone getting into that arena, which is the last thing that most surgeons have as their core trait is patience, patience, patience. Don't be stacking up a bunch of surgeries that are all in the waiting room waiting. You need to double your allotted time and actually enjoy the process of learning something new. That can still be a pretty cool, fun thing to do, is just embrace the technology and

Cameron Full (32:48):
Yeah, we can't move on without you doing a subtle pitch to your upcoming course on guided navigation though, David.

Dr. Hill (32:56):
Oh, you got to throw that in your, that was a nice segue. I forgot about that. Well, so we've got a couple courses. So I mentioned earlier, I've been with Mike Picos. I'll give a shout out to Mike. Shout out to MAP. He's a,

Dr. Seda (33:13):
We call him the God. He's around, known to the Don father

Dr. Hill (33:18):
The, I haven't called him that. I was in his house a while back, years ago, and I saw this picture of him when he used to have the mustache and he had a lot more dark brown hair. I snapped it. Anytime he calls, it shows up. It's great. I'll share it to with you, Cameron.

Cameron Full (33:34):
I'm going to show you what it shows up when he calls me.

Dr. Hill (33:37):
Okay, we'll swap.

Cameron Full (33:38):
Not going to describe it on the podcast.

Dr. Hill (33:40):
So the reason I'm with him is because I'm a slow learner. I took his whole continuum in 2011 and I was like, wow, that was really good. I learned a ton. So then I signed up again for it in 2012. I took all the exact same classes. I went down there 10 times in two years, took all the classes again. Finally he looked at me, he is like, why don't you just hang out? Because since you're down here all the time, and I was doing all that ce, so I'd see him. We were both, he's still a CE Junkie, huge mentor for me. And anyway, so fortunate I get to be in some of the reconstructive courses. So we got sinus and we have advanced bone graft course coming up in March, and we're going to be showcasing dynamic navigation in the sinus course. Actually, I did two of these cases today, a trans crestal sinus lift with dynamic navigation with Jason and Seda. It is super cool to see the transgress lift on the computer

Dr. Seda (34:36):
I bet. I bet that's pretty well,

Dr. Hill (34:37):
It's actually pretty cool. Yeah, the audience kind of digs it. They love that. It's a sexy transgress lift then. And then you can also do open lift

Cameron Full (34:47):
About right now.

Dr. Hill (34:50):
Now you're talking about

Dr. Souyias (34:54):
The audience knows what you're talking about. It's just Cameron that doesn't get it. It's just Cameron that doesn't get it.

Dr. Hill (35:00):
If my staff ever does listen to this, they're going to be like, oh my god, he's such a geek. So anyway. And so those are the two courses. Then we're going to show some dynamic navigation cases for, and then we're working on something. It's in the works where we're going to do a soup to nuts, A to Z. How do I get into this? It's going to be a two to three day pearl session with live surgeries, with video surgeries that kind of just gets rid of all the frustration points and shows you how to get through 'em and get past them. So that'll probably be the course that Jason and Seda will come to. They'll be like, show it to me when all the kinks are worked out.

Dr. Seda (35:40):
Let's go. That's what we've got.

Cameron Full (35:42):
So it's sponsored by X nav.

Dr. Hill (35:46):
No kidding.

Cameron Full (35:47):
For more information, picos institute.com. Isn't that what it does itself?

Dr. Hill (35:52):
There you go. Thank you.

Cameron Full (35:53):
Let's flip to the, yeah, it's appropriate. Let's flip to the next bullet, CHOS leadership team. What it is and why we did it. I'm going to know more about this one. Transnasal, whatever the hell that was.

Dr. Hill (36:10):
Yeah, this is, some would argue, this is even more impactful because without this, you don't get to do all the fun stuff with all the toys. So this is the question about how's the sausage made. That's been a real learning process, and that's been a humbling process for me, recognizing that, number one, you aren't going to always be the person with all the answers in the room. And number two, know when to ask for help and know how to receive it. Knowing how to receive help is a learning curve for some of us, at least it was for me. And being able to accept change. I mean, I've had some amazing consultants for the practice. I'll give shout outs right now. Shout out to Jerry Gottlieb, Gigi coaching. I give a shout out to Kate Reed, give a shout out to Marnie Blythe, my fractional COO. And now she's moved into a different position here with our practice. So I mean, I've been surrounded by some, Mike Dravase with PBA, just some amazing, amazing people who've helped me with the culture that we wanted.

(37:18):
And it all starts with the leadership team. You live and die by the leadership team. So leadership team for us is composed of a practice manager slash COO role. It's composed of an integrator, think EOS entrepreneurial operating system. One of my favorite books is Traction would recommend that to any business owner. So incorporating that philosophy, having someone doesn't necessarily have to be an EOS trained to integrator. Ours was actually, but having an integrator who can help make things happen in the practice, the make it happen person. And it wasn't until I had, and then of course we have our director of anesthesia services on the leadership team, and then I'm fortunate enough to get to be on there too. So that's kind of our staple. So one of the things that even Cameron you've taught me is when to outsource, be really good at what you're good at and stay in your lane and outsource to other experts for their lane. I mean, gosh, shouldn't the same be true for dentistry? As a side note, don't the best outcomes actually originate when you have the best of multiple worlds coming together in a cohesive fashion and interdisciplinary planning on the benefit of a single patient.

Dr. Seda (38:32):
A hundred percent

Dr. Souyias (38:33):
Absoulutley true.

Dr. Hill (38:34):
Is it still really the holy grail of how we take care of folks. And so you apply that to the business model and again, you declare and live by your core values. And then you meet regularly. You talk about quarterly rocks, you talk about annual rocks, and you reverse engineer, where do I want to be one year, five year, 10 years from now? And I mean, yeah, I don't need a private equity based group to come in to tell me how to do that. No offense against the guys who do want that model. And I understand why it's appealing, but I would argue, establish your leadership team. Stick to your core values and outsource to the best. You'll probably get better people than some of these companies already have. In fact, I would argue you will when you find the right people to work with. So it is all about the leadership team at CHOS.

Cameron Full (39:31):
I think that a common thread with you, your commitment to investment. This is common through all of your bullets so far, right? Invested in your facility, invested in the patient's care through anesthesia and safety investment into dynamic navigation and the whole process of that investment into your leadership team. And I don't think a lot of people investment into all that ce. I mean, look at the time that it took to get to where you are. And actually Jason and I were just talking about this, what a couple hours ago. Good change isn't about, it is not about intensity, it's about duration.

Dr. Hill (40:16):
That's touche. Absolutely.

Cameron Full (40:19):
And so a lot of people aren't willing to, what's the Harvard or the Stanford study where you get the one kid you with the marshmallows,

Dr. Souyias (40:29):
Delayed gratification.

Cameron Full (40:32):
And so what you are, David Lee, is the epitome of delayed, delayed gratification. That's the reality of it. You've invested so heavily in all these things. There's expensive and time consuming to do all of this stuff. Result of that. Now 10, how long have you been in practice? 11 years. 11 years later.

Dr. Hill (40:53):
Since 2011. 15 years.

Cameron Full (40:55):
15 years later. Look at the result. But it took what it took to get there, not just clinically, but from the business perspective too. And so it's no surprise to me that your practice is what it is today, but I'm sure as shit, it took a little while to get there when you were building it the way you were building it.

Dr. Hill (41:13):
It's a journey for sure. And I don't know, Cameron, thank you for saying those are very kind and humbling things to hear about oneself. I think the highest compliment anyone, one of my co-residents who's like a pediatric cranio, maxillofacial trauma surgeon. I mean, he would out cutt me any day. He's phenomenal. He's an unbelievably gifted surgeon. And the highest compliment he ever gave me was he said, you really have perseverance. I said, okay, but I think that was it. So sometimes it's just perseverance and yeah, don't deviate from it. Stick to your goals. I didn't look at it so much as delayed gratification because I really enjoyed learning, even through the hard parts. I would come away from a hard thing and be like, wow, I really learned a lot from that. I'll take that to the next time we go do something like that. And so I loved it. I have enjoyed the journey.

Cameron Full (42:14):
Sure, sure. You kicked the can on profitability. That stuff was all expensive and time consuming and that costed you.

Dr. Hill (42:23):
I didn't have kids.

Cameron Full (42:26):
And that's the reality of your journey. Now, put that practice against a lot of the practices in the area. Now look at the result. Look at the team you have, look at the facility, look at all the ecosystem that is CHOS

Dr. Hill (42:39):
Chapel Hill Oral Surgery.

Cameron Full (42:41):
That is CHOS. And it's awesome. I love hearing the story and that's

Dr. Hill (42:48):
I love living it and being a part of it and then being affiliated with people like the three of you. I mean, really look at the number of doors that have opened. It's like every door opens another door. What? Look back on your life one day. What a way to live a life. That's what I keep saying. I'm so blessed and humbled by the whole experience just because of the doors that have been opened. So I owe a lot of people a whole lot. I will tell you that for sure.

Cameron Full (43:20):
Which is a wonderful segue into your last bullet, the importance.

Dr. Hill (43:24):
Let's do it. What is the last bullet?

Cameron Full (43:26):
The importance of working with best in class?

Dr. Hill (43:29):
Oh yeah. I'm passionate about that. Well, just don't settle. Don't settle at all. That's going to be my message to my own kids. I've got five-year-old Remy Violet's not going to settle for anything. She's an animal. But yeah, whether it's your mate in life, whoever that is, or your personal relationships, I really enjoy the fellowship of being around people who are passionate about what they do.

Cameron Full (44:03):
Absolutely.

Dr. Hill (44:04):
And I really, I treasure the authentic, it makes me sound like, I mean, I'm surprised because tonight I would just wore my CHOS shirt, but the people who are going to watch the podcast will be surprised. I'm not in a cardigan. Usually I'm wearing a cardigan. So I tend to relate to these old school guys who just love the relationship and enjoy the friendship and the comradery. And for me, it's always been what it's all about. And the best in class part of it is stay passionate, constantly learn. Don't ever be the smartest person in the room. I'm glad that I'm the least smart person here on this podcast tonight. So

Dr. Seda (44:48):
I never have that problem. I'm constantly reminded of it as well

Dr. Hill (44:54):
Seda and I might be battling for that, but he does what better

Cameron Full (44:59):
One per episode.

Dr. Hill (45:00):
Yeah. Anyway,

Cameron Full (45:03):
You and who was Souyias myself. We sat down a year ago at symposium and had a really hard,

Dr. Hill (45:11):
The three of us.

Cameron Full (45:12):
Yeah, really?

Dr. Hill (45:12):
Yeah, we sure did.

Cameron Full (45:14):
Hell of a conversation around it, referral analytics around data, around what Referral Lab

Dr. Hill (45:20):
And how powerful it is,

Cameron Full (45:22):
The power of our product. And I remember our first conversation about Referral Lab a number of years ago, and the fact that you got it right away, but you brought the conversation that you brought, it really was remarkable. It actually twisted my mind a little bit and to making sure that I was paying attention to everyone involved. And the gift of that conversation has, we just talked again about it, what, a week ago, right? You and I just talked about that same topic again. And so I love your comments about being around people that are passionate because I am equally as passionate about this side of the business that you are about surgery, about dynamic navigation. I can't get enough. I could zoom 12 hours a day helping practices with workflow management analytics. I could do it all day.

Dr. Hill (46:20):
You live it and breathe it.

Cameron Full (46:21):
I could do it all day.

Dr. Hill (46:22):
You're passionate about it.

Cameron Full (46:23):
Go to bed, get up, do it again. It's my surgery. And I think there's a lot to be said around paying attention to who you spend your time with.

Dr. Hill (46:34):
Oh, I mean, you've heard all the sayings, right? I mean, who are your three closest people? And you're going to know, I mean, our grandparents told us that. Birds of a feather. So yeah, intentionality is a big theme. Be intentional with who you hang out with and who you spend your time with and make the time count. I've got lots of room for improvement on that as well since I'm here on this podcast with you.

Dr. Seda (47:00):
Especially on podcasts. Yeah,

Dr. Hill (47:03):
Still excited about my first podcast. This is fantastic. I love it,

Dr. Seda (47:08):
Man. It's been a pleasure having you on, man.

Dr. Souyias (47:10):
This is great.

Dr. Hill (47:10):
Is it? It is our time up. Was that it?

Cameron Full (47:12):
Well, before we pop off you have Any last minute things you want to say? Any closing notes you want to leave anybody with?

Dr. Hill (47:20):
All four of us on this podcast have obviously been blessed with tremendous relationships. And I think striving to honor our mentors and the people who blazed the trail ahead of us is speaking of intentionality, it's both a blessing, but really a duty to carry it on and to pass it on. We hear that a lot. We hear that phrase a lot. But I'm super excited about an associate joining our practice because it's going to be an opportunity to just share and frankly learn from them as well. And I think all of us could. We keep doing that. I think this field of dentistry and oral surgery and perio and referral lab, we'll all continue to move in the right direction.

Dr. Seda (48:05):
Hallelujah, man.

Dr. Souyias (48:06):
Well said.

Cameron Full (48:07):
Wonderful. Thank you so much for a wonderful episode, David Lee, it's been wonderful hearing your story and thanks to everybody there for listening to an episode of The Special List. See you.

Dr. Hill (48:18):
Fun. Thanks guys. Take care.

Dr. Souyias (48:22):
Thanks for listening to The Special Lists presented by Referral Lab, the podcast for dentists and dental specialists featuring a special list from a specialist. Got a question for us? Send us a message at speciallists.com with two Ls. Transform your referral workflow with Referral Lab, the purpose-built platform for dental specialists to track, manage, and convert every referral. Request a demo at referrallab.io.