Episode #247: Dr. Kianor Shah – AI, Autonomy, and the Future of Dentistry

Dr. Eric Block: Welcome to the Stress-Free Dentist Podcast. I’m your host, Dr. Eric Block. As always, I want to inspire, entertain, and educate you on the best tools and technologies out there. My goal is to help make your practice and career more profitable, efficient, and most importantly, more enjoyable. And check out all of my nonfiction and children’s books on Amazon and check out the stress free dentist.com for any upcoming events. And if you’re feeling you’re a dental professional that’s burnt out, or you just feel stuck or want to get to that next level, visit the International Academy of Dental Life Coaches or www.iadc.com, and we’ll get you matched up with a life coach that understands dentistry. I also wanted to thank our amazing sponsor, Ekwa Marketing. They have helped me and my practice over the years to improve with SEO and website performance. And to find out how you can make your practice dominate in your area, go to www.ekwa.com/msm to book your complimentary meeting. Again, that’s www.ekwa.com/msm. Welcome back to another episode. I’m joined by a recurring guest, Dr. Kianor Shah. Thanks so much for joining us. Again.

Dr. Kianor Shah: Thank you for having me, Dr. Block.

Dr. Eric Block: And, wanted to thank you also for you contributed to one of my books, stress Free Dental Implants, which is up there in my library. and that was a pleasure doing that with you. That was a few years ago. and man, you are a, practicing dentist, you’re up to a lot. I love what you’re up to. I just first wanted to get your story of first, how did you even decide to become a dentist?

Dr. Kianor Shah: Oh, thanks for having me on the show, first of all. and, this goes back ways to the college years. One of my, best friends I used to study with, I wanted to be a cardiology, a cardiac surgeon. And he wanted to be a dentist. Used to go to the library and argue, which lifestyle will be better down the road. And, here we are . I ended up going after he got accepted dental school, I ended up for following. And, solely applied to one dental school and got accepted and started.

Dr. Eric Block: And where’d you go to dental school?

Dr. Kianor Shah: Southern Illinois University School of Dental Medicine.

Dr. Eric Block: And, after dental school, did you do a residency? Did you do a specialty? Did you go right into private practice? Did you associate, what was your story there?

Dr. Kianor Shah: I went into private practice and took my, bought a practice within six months outta school. I believe we doubled or tripled, the revenue in that office and bought a second practice and doubled the revenue there. And then, built four more practices. And then, I got out of those practices, went back to school, got an MBA, did a couple of fellowships for implants, and, gained the ICI diplomate status and all of those things over the years. So it’s been quite a, quite a run.

Dr. Eric Block: And you’re in, is it Palm Springs?

Dr. Kianor Shah: Yeah, at Palm Desert, California. It’s sort of like, a suburb of Palm Springs, if you will.

Dr. Eric Block: And I just wanted to go back. So six months after school, is that where you, bought your first practice? Was it in that area? Yes,

Dr. Kianor Shah: In Illinois. Pretty close to school.

Dr. Eric Block: And how did you said you doubled, the revenue. How did you do that so quickly?

Dr. Kianor Shah: Well, when you get out of school and you are under tremendous financial distress, and now you have a license, and now you have the opportunity to generate revenue, I was working six days a week. And, at that time I thought, working harder versus working smarter was the thing to do. But then at the same time, they gave me quite a bit of liquidity to do things I wanted to at the time, very early on.

Dr. Eric Block: And, from there, you said you made that jump from one to two dental practices. what was, what was that like, going from one to two?

Dr. Kianor Shah: One to two is very easy. you have a practice in your, primary market, and then you wanna draw patients from your, from a secondary market close by. You can travel to it, you can monitor it, you’re physically there. After two, it gets a bit, rocky, especially if there’s distance. And you have to rely on others to perform certain operational tasks as well as your clinical expertise. See, nobody’s ever gonna care as much as you care. So, the first two were booming and then, the subsequent four became very challenging. and, I, over the past 20 years of, having practiced, having participated in over 30 build outs, having worked with probably two dozen of leading organizations in dentistry, I reached a conclusion that you don’t need an empire to have a good life. All you need is one practice, really, and focus your entire energy in that practice and, take care of your patients and make more money out of one practice now than when I had six.

Dr. Eric Block: That’s been my formula. I got one wife, two kids, one dog and one practice, and, one ping pong table. and that’s been my formula. I don’t think I could handle anything more than that. but I feel like a lot of dentists, they compare themselves to others. Their friends are opening up a second office, a third office, they hear about the, these, multi-practice, situations, and they’re selling to DSOs. and I’m, I’m personally glad I never jumped into that, because I’ve heard just so many issues and stresses from that.

Dr. Kianor Shah: Wow. What do I even start? I’m a big proponent of private practice transitioning between a senior doctor and a, and a and a younger generation doctor. I’m very strongly against the entire DSO concept as a whole. DSOs came with the contention of increasing access to care and then reducing administrative burdens. That’s how they sold the entire legislature, the government, the boards, the schools, which, was not what they were actually doing, and what they’re actually doing now. And, you know, our colleagues look at it and say, oh, you made millions and millions of dollars by owning so many practices and turning it into a private equity ordeal. And a marketing function. Dentistry is more than that. you cannot separate the business side from the clinical side. I would wage it. It’s impossible.

Dr. Kianor Shah: If, people are, want to make, everyone happy, maybe they should be in the ice cream business, not in the healthcare business. The decisions that you make clinically, they trickle down chairside, from your material selection to your staff selection to the way you like to practice. That’s not the same thing as a, some office manager hired by corporate telling you to go into this room, do two crowns, and go into this room and do this two fillings. It’s completely, the entire concept of autonomy and benevolence and beneficence are all just go right down the trash. And, they come in, they take your equity, your take, your ability to really, make a career out of it. You work for a percentage of revenues that are collected. They set daily limits, which I believe is highly unethical.

Dr. Kianor Shah: We have to produce X amount of money today. and we got a little bit of a carrot for you here, and a bonus, this is all just completely flipped upside down with what we learned in dental school and what I went to the profession for. So I highly recommend, and it’s not all that rosy. The DSOs are in big trouble. Private equity is, drying up. if you were in a, in a pyramid or a Ponzi scheme situation, eventually the money runs out. not saying they are, but I’m saying that they, should never own any equity in a healthcare setting. and they should never control anything in a healthcare setting. They should be working for a fee for service, a LA card. Here are the services we provide.

Dr. Kianor Shah: This is what I, you pay us not, hey, if you’re gonna take over all the assets, not the charts on you and, liability on you. And we just kinda sit back and profit. So I have a lot of opinions about the DSO and given ai, now, I think the DSO model will be obsolete. A, they don’t increase access to care. Clinicians do. B, they provide office back support. AI can do everything they do for pennies on the dollar, everything. There’s nothing that the DSO can do that AI can’t now. So we’re changing back to an operator model. and I believe that no matter what, they integrate, and they’re so big, some of them have 500 offices, even if they wanted to change the technology, it could cost ’em billions of dollars. So they don’t have it. They can’t do it. so they’re gonna struggle to compete with the doctors that are, implementing AI in their practices. And I would anticipate to see a lot of that happening. A lot more DSOs going belly up. and that’s a signal to the private equity market.

Dr. Eric Block: And so just to confirm, when you had your six offices, you were still privately owned. It was you the dentist that owned, six offices. my personal interpretation of a DS O is that there’s private equity money involved. and, but in your situation, you were in full control. If you wanted to add, AI x-ray diagnosis, you could, you were in charge of hiring the staff, the supplies, your fees. Is that correct?

Dr. Kianor Shah: Correct. And that’s where, I actually gained a lot of knowledge about how these things are happening in the corporate world. Yes, I owned them 100% myself. I have no objection of a clinician that’s licensed that can take and handle more practices to own more practices. What I have a problem with is these private special, interests coming in, setting up management, operations in different states, and then pain essentially, for lack of better term, bribing doctors to put their name on the practice in exchange for a fee. And so it looks legal, and then coming in with all of their private equity nonsense and, interfering and, interfering frankly, with the patient doctor relationship and every form. so, those are two separate matters. If you go to school for 20 years, you should have the right to own multiple business if you wanted to.

Dr. Kianor Shah: but what you don’t have the right to is coming in without a license as an entity, without being a doctor, having that hippocratic oath in the back of your mind and start making business decisions in the dental office. so two big different things to distinct, but, it’s very hard to, actually absorb that for the, for the public. They’re like, oh, yeah, this capitalism, this, that. But, at the end of the day, if you really deep dive, deep dive into it, the dealer source should not even exist and the way it is existing to marketplace today.

Dr. Eric Block: And then, so after you had, you actually sold your offices and you went back to school, to get your MBA, tell me about that decision.

Dr. Kianor Shah: I was, moonlighting, when we moved from Illinois to California. And, I practiced in more than, 300 offices, probably. just going from doctor to doctor, doing all their endo, doing all their impacted wisdoms, things of that sort. And I would get to talk to them and get to know them a little bit and learn about their, challenges. And, it used to be the same pattern, insurance, third parties interference, regulations, just all of these people that have gained a lot of power in the last 50 years. They didn’t even exist or for thousands of years. It was just the patient, the doctor, and the tools and technology that was living around from, the stones and rocks to AI today. so, now I’m observing all of that, and I’m, I’m trying to figure out what is the solution for this.

Dr. Kianor Shah: So MBAI was taking it to improve my business skills, which I thought was one of the greatest moves i made in my career. because they don’t teach you anything by default. These schools, they just, throw you out in the, in the lines den, and you get out and you have to figure all this stuff for yourself. That’s a flaw in our entire educational system that these third parties, likely endorse, lobby for and benefit from. so, an MBA business education was very important. At nighttime, I would do my MBA during the day, I would, a moonlight. So I learned a lot from my colleagues about what they want and what their main complaints are. insurance being hands down, number one. But, these third party interferences and financial interests aren’t too far behind.

Dr. Eric Block: Yeah. It sounds like, you went out there, you built some practices, you sold it, but then you dove back into education. You got your MBA, you did a bunch of fellowships, but now you have another practice. tell me about the practice that you have now.

Dr. Kianor Shah: So in order for, to be a winner, to all my younger colleagues, newer generation is you cannot succeed if you don’t fail. you can succeed and you don’t appreciate it as much. Also, I’ve accumulated everything I’ve learned and to doing something that was, better. I have a practice in Palm Desert, California on Al Paseo, location. It’s like the rodeo drive out here. And I’m the only dentist out there. and, I have five star reviews on all platforms. I generate more money than I did in those six offices. I take more home. my patients are happier. I’m happier. I have a balanced life. I only practice three days a week. I have other practitioners in my office. I have specialists that come through from time to time, for endo, for oral surgery, for things of that sort that I don’t want to do anymore.

Dr. Kianor Shah: I used to do a hundred percent of the endo. I used to do all of the oral surgery, I do less now. and, we have a GP partner. It built in a very short amount of time. instead of going and out and taking a half a million dollar loan, I did it for a fifth of that. I started when I started 10 years ago in this practice. And, just gradually build it every year at about a rate of 30% in increase. And we went from nothing to being a multimillion dollar practice. so, and you can do the same. You don’t need to join the DSOs. You need, to have this kind of a situation. You need to, a, take advice from senior colleagues that have made mistakes so you don’t make the same mistakes.

Dr. Kianor Shah: B, go out. And if you’re scared to set up your own practice, which I understand, affiliate with a, with a senior doctor, private practice, learn the bad and good from them. You don’t have to absorb everything and use that as your stepping stone to have your own practice. C, go out and find a good location, do your studies. Meanwhile, take a year two, whatever it is, find the right location. Don’t go into a skyscraper where you have to, tremendously spend on marketing. Get patients up to stairs. Go into high foot traffic areas, mall type settings, and find yourself a location that you believe, to have good, exposure to the public. Be to foot traffic or driving traffic. And then set up your own practice slowly. Don’t give up your day job. start with one day, start with two days, just make sure you can manage the rent payments.

Dr. Kianor Shah: And then, and then, and then I did it with a hundred, a hundred grand. I kid you not, I made an agreement with the CT company to install a CT in my practice, and I would start paying X amount of months in. Once I started generating revenue. I only started with two chairs instead of buying five chairs, without having the model verified. And, gradually start building. ’cause once you own your practice, you own equity. That’s your retirement. You own, you own, nobody’s stealing your equity away. You can work as much as you want. You can work less than you want, and you can actually have some self-respect and autonomy over and decide and decide your future. determine your desires, your future. You wanna get married, you wanna have all of these things.

Dr. Kianor Shah: With the debt you’re in, you will be in full control. and that’s my recommended path for our colleagues. don’t buy into cheap marketing claims that never materialize. in these settings where finances and private equity play, you’re just a number. I heard some company generate over a billion dollars, and all of the doctors combined had less than 10% of that. so you can just imagine, they’re bringing and making someone else’s dream come true versus yours. So I’m a big proponent of going back to the private equity, private, practice model with the licensed doctor being in charge of all the decisions being made in the practice without exception, really.

Dr. Eric Block: Yeah. And you and I feel very similar about, you had six practices. You were doing all these procedures that maybe you didn’t like doing. I personally, I went fully outta network, two years ago. I have one practice, and I don’t do procedures that I don’t feel comfortable doing anymore. and I’m growing. And, I, as a privately owned practice, I can make all the decisions. I can have a party for the staff if I want to. I can buy a 3D printer. we have, same day crowns. I have a laser. I love all that stuff. what about yourself? What kind of technology do you enjoy in your practice?

Dr. Kianor Shah: Well, I’m big into aesthetics, off the practice itself and the technology, that’s another, differentiation between myself and others in the local community. I open on Saturdays, I take off on Mondays, the opposite of what everyone else is doing in the area. So, for me, we just have all the latest technologies, really. we play a lot with our CT and scanner and, our laser and, all of those things, control this and all that, and really increases, a case acceptance by my patients. And I have AI integrated also into the management software. So I have a secondary, verification of my diagnosis, or at least, I can have disagreements with ai. But, we have that tool, you know, when intraoral camera chemo, that was a big deal with case acceptance.

Dr. Kianor Shah: Now this is even a bigger deal. ’cause on top of that, it gets created into an opinion based on, what, the common standard of care is. So patients are sitting there and they’re like, wow, this is, this is great. reduces any kind of confusion, creates additional documentation, and, really helps my patients for case acceptance. So we are high on tech. If I can find, I, now, I’m working on something mind boggling, that I may, I suppose I can give you a little taste, of integrating a holographic concept into the management software as a, so the front desk can focus more on patient, customer service versus of dealing with insurance and all those other things, all done by a holographic concept. I can also answer patient, questions. So, working on technology myself in that regard. And also, if I see new technologies come out, I’m always keeping my eyes open for robotics, things that could impress patients. so yeah, I’m all tech. I reinvest a lot of the funds that we generate every year into improving the practice. That’s a pillar around here.

Dr. Eric Block: I am the same way. And I think it’s great for, you know, the patients, the business, but it’s great for me. I love it re-energizes me when I added, AI x-ray diagnosis. I, it made me give me a spark when I added same day crowns when I added sleep apnea. it, if you’re doing the same thing over and over and over again, you’re stuck on that hamster wheel, you’re gonna burn out. and when you add new technologies like this, it’s, it’s so awesome. And patients will sense it, those, I’m outta network, so I need to impress my patients and make them understand that they’re in the best place with the best technologies and we spare no expense. so I totally agree. And, to piggyback on your mention about the x-ray diagnosis is, I’m now pretty comfortable reading X-rays.

Dr. Eric Block: When I first got outta school, I was a hot mess. And, reading an FMX was one of the most stressful things I did. so now, it helps you, it’s a great second opinion, but it’s great for patient education. I’ll show that X-ray and I’ll say, Judy, there’s a big red area air there that’s bad. We need to fix that. Or, these numbers, there’s, periodontal issues. We need to talk about your perio. And that transcends language. It transcends experience. It transcends the dentist’s ability to communicate. It just makes, my life easier.

Dr. Kianor Shah: It’s, exactly what it is. And, a lot of these third parties have created a distrust between us and them because they came in, smelled a bunch of profit and money, and then the game started becoming market. And, instead of, Hey, take care of your patients first, try to figure out the best way. How do you empty your patients’ pockets? And that’s where the industry has led. I think the AI can fix that because we are getting truthful answers. And then the patients don’t sit there and think, oh, dentists are a bunch of crooks trying to empty my pockets. You can start reheal the profession slowly by saying, Hey, ma’am, here are the photos. You see what I see, here’s the standard of care. Here’s the AI saying the same thing on top of what I just shown you in the picture.

Dr. Kianor Shah: So patients are now going to be more reluctant about saying, Hey, I need a second opinion and I gotta go out of the practice, and the next dentist says something else to them, because they all do, often, there’s a lot of discrepancy between how dentists diagnose. we do have standards of care, but still, that’s a big flaw in our profession, and that creates reputational problems for us. I think that’s gonna go down with less and less. And there’s gonna be more and more talk on the street about, Hey, this doctor has all of this technology and, we don’t believe that this doctor is, over diagnosing or trying to do something unethical. So, and I think the standards will become a lot more defined. What is a cavity? Is it just a stick with your explorer, or is there more to it? Is there, is there, breakages and enamel? Is there AI that can verify those things? Is it just staining? All of those things that we have dealt with over the years, I think are gonna start becoming more addressed with artificial intelligence and lack of influence of third parties. So as a bright future ahead with ai, not so much with the third parties.

Dr. Eric Block: And, it’s also great for temp hygienists. I know it’s a major issue with temporary staff coming in, so it really helps, with temporary staff that come in and may not be, they’re not invested in your practice like, your regular staff. But, you mentioned robotics. can you explain more about robotics and dentistry?

Dr. Kianor Shah: robotics, I don’t expect that to become a major, point of contention in the next two years regarding what AI can and cannot do. But I’m starting to see models where ai, is integrating with robotics in a way that, a robot can prep your teeth in like 15 minutes. I think it’s perceptive that’s doing that. there’s another com company that particular robot can actually hold your jaw stable, prep the teeth, do fillings, do minor restorative work in a matter of minutes with accuracy. That’s mind boggling. then you have scenarios where, there are robots now that can, prep the veneers at creative veneers before you even start prepping. So, with the same technology accommodating for facial movements and head movements, which is wild stuff. medicine has taken a tremendous hit.

Dr. Kianor Shah: Now you have, hospitals in China, for example, that, there’s a, there’s actually one particular hospital that has zero staff members in. You go in as a patient, it’s like the Walmart self checkout, very disconcerting, for things that don’t have manual dexterity involved. You’re looking at, you are looking at, immediate effect, to them. But for us, it’s a little bit more complex. I think humans are always gonna want to have a human element in a dental setting. so I wouldn’t be too worried about robots, at least not for the next decade. I don’t think robots are gonna be sitting there with, then I’ll work. But is it impossible? No. they’re coming. They’re, they’re all coming. The innovations are coming. They’re all wanting to, see how they can eliminate us, but we’re not gonna let that happen, Eric, right?

Dr. Eric Block: ? Yeah. I, not in, I don’t see that happening and for sure my, not my career. But, there’s always that with dentistry that you need that human relationship. And, it’s, it’s what makes dentistry special and like, look, where else can you play with these awesome tools, like then having a dental office. But, I know you can’t get too much into it. Can you mention that the holographic thing you were talking about? Can you just gimme a quick, I’m just trying to picture what that looks like.

Dr. Kianor Shah: I wish I could discuss that on this, because it’s the first one, out there that exists, in the public forum. I don’t know if I want, but soon keep an eye on the things that I’m doing. I just engaged in a contract with a space company, their, details being discussed, about creating this product that my contention is when you have five girls up front that are calling insurance, dealing with this, dealing with that, you really lose touch with the purpose of them being there as customer service. You know, I would want the phone calls being answered by this concept. I would want a lot of the stuff done that is administrative and repetitive. So the actual front desk can be limited to one person that is focused on customer care only. Hi, Ms. Jones. Welcome. This is welcome to our practice.

Dr. Kianor Shah: Can I offer you something to drink? Would you, would you like this magazine? Would you like that? Whatever it is, check ’em in, see them in. And the holographic concept can do a lot of that as well, at least in the check-in side. but I think that would be a lot better of a model than what we have with a bunch of people on the phone. Everybody’s struggling. the whole format falls apart when calls, somebody calls in sick. and, those things will start becoming, nuisances that won’t exist anymore, I think, with what I’m trying to do. But yeah, just imagine showing up to an office with your id, putting your ID up, and the other side of the scenario will know everything about you in the system and your management system also, and would be able to answer any questions you have in the human form format. yes.

Dr. Eric Block: Love it, dude. Just keep me posted on that. That sounds amazing. and tell me about the top 100 doc. What about that organization?

Dr. Kianor Shah: I’m the founder of the Global Summits Institute. was started as a very small operation, and an idea that has turned into a global endeavor now involving over 160 countries. the contention at the time was to create an organization where there’s exclusive collaboration between doctors, devoid of third party in France. You do not have anyone that’s not a doctor. We have one technology guy in our organization. Rest are all doctors, from all these countries. They’re well positioned, innovators, educators, important figures in the supply chain and the political arena and the academic arena and administrative arena, and the entire supply chain really. So the idea was to maximize collaboration, administrative, financial, and, academic sense as a three-pronged approach. And that has, developed over the years into a full, blown force. We do a world gala every two years where we bring in these doctors to Italy, of a, of an island of Italy in Sardinia, where we, discuss, all of our, ongoing, improvements.

Dr. Kianor Shah: The idea is to keep these third parties out of the health ry and, maintain the patient-doctor relationship. I invite you to look at our doctrines. We live and breed those doctrines. That’s on TOP 1 0. Do c.com for anyone who wants to join this movement that has similar minded to us. We have doctors, dentists, chiropractors, pharmacists, optometrists, and more in the mix of the 1100 current, high profile individuals. These are the movers and shakers of industry. I believe you were in a past class yourself, Eric, mm-hmm . podcasters. And, you don’t compromise for nothing. You don’t take sponsorships for any of the projects unless it’s a physical conference we’re doing, they wanna exhibit or something. You haven’t assumed money’s from anyone. We don’t charge the top 100 doctors to be part of it. You can’t buy it. You have to be nominated, you have to go in front of the committee and you have to be ratified. So, these third parties get really big, and the US and Europe in the last 50 years, we are gonna sort of, you need a global effort to, bring the two to the truth, to the forefront of the discussion and make sure that they don’t destroy our entire industry. so yeah, that’s what Top 100 Doc is about.

Dr. Eric Block: And, so you mentioned that where people can find out. I want to end up with two final questions. is there any way else to find out more about what you’re up to or get a hold of you? you can leave an email, a website, a phone number, whatever you wanna leave. And then the final question, although you’ve given, a ton of gems already, but, what final advice would you give to the young dentists out there?

Dr. Kianor Shah: Well ask you your first question kianor.shah@gmail.com. K-I-A-N-O-R dot SHAH@gmail.com. as to your second equation, be wise, sit down and evaluate all the factors. You’ve been trained all of your career to solve problems, and you’re gonna spend the rest of your life getting up from morning to night, and you will be solving problems. That’s why you’ll be doing critical thinking. Look at the entire spectrum of things. You are not in a good financial position. You just got outta school. You likely have debt. You’re looking at, buying a practice that will double your debt possibly. And, you’re being given all of these options. If the options are too good to be true, they’re probably are not good. don’t be afraid of taking risk and setting up a practice of your own where you have, where you have control of your destiny. if you can’t do it, I highly recommend you to associate with a senior doctor for a while, evaluate all the facts. You don’t need to take a big loan, you just need to do it strategically and step by step, baby steps, and, don’t make somebody else’s dream come true. Make your own dream come true. That’s what, my advice would be to my colleagues.

Dr. Eric Block: Love it, man. This is awesome. Dr. Kianor Shah, thank you so much for joining us. The next time I see you, I will have my ping pong paddle with me. not to toot my own horn, I have not lost, I’ve lost only twice in the last 13 years. so, I feel like you may be a good match, so let’s make that happen. and, thanks so much for your time.

Dr. Kianor Shah: Thank you. I’ll start practicing. I’m gonna give you, your money’s worth, though I used to play in the German League.

Dr. Eric Block: Thanks again for listening to the Stress Free Dentist Podcast. And don’t hesitate to get in touch with me at info at the stress free dentist.com. And if you haven’t already, please subscribe on your favorite platform and leave us a review. Until the next episode, I’m Dr. Eric Block the Stress Free Dentist.