From Alaska to All-on-X: Dr. Barron on Dentistry, Sedation, and the Human Side of Smiles

Welcome back to the Roots podcast
presented by Lead Anesthesia. We have
Dr. Baron with us today from Brill
Brilliant Smiles and uh we're super
excited to have him and excited.
One of my favorite offices, too.
Yeah, man.
Yeah, we we'll keep it. I don't know
what I don't know how much to bring into
this conversation yet. So,
bring as much into it as you want.
Shoot. Bring it all.
You don't want all of it.
Dr. Baron, how long have you been
working with Elite Anesthesia?
I don't know. Probably almost three. Two
years for sure.
Yeah, two years, man.
Yeah. You were one of the originals,
I was going to Yeah, I know. It didn't
count for much, but how long have you
guys been here?
Just about two years. About the same.
Just about two years. About the same. Yeah.
I remember the day you walked in my
I remember the day you walked in my office.
office. Oh,
yeah. Like real real sheepish looking.
It's not the way you walk in now. Your
shoulders are
chest is puffed out. I'm raising your
chest is puffed out. I'm raising your feet.
No, you walked in. You're like, "Hey,
you know, could you give us a chance?
We're here in town and and I, you know,
thought this poor fella. I'm I I'm going
to try and help. Yeah. I'm going to give
him a shot and look out.
The best decision of your life.
That's what you're reflecting on now.
You're like, man, it's the best decision
I ever made.
I'm moderately beneficial. That's I
don't know. Best decision describes it.
But yeah,
your staff says so. Your staff's like,
dude, he's like a changed man. Ever
since he's been working with you, your
leadership and his life has been
That's true. finally has a a true north
to follow.
It's been quite the influence role
It's been quite the influence role model.
That's awesome.
Oh, that's great.
And how long you been in Seattle? That's
You're not from Seattle. From Alabama.
No, I think I've been here for
Are you from Alabama?
I am. Heck yeah.
Oh, dude. I didn't even know that.
I know. It makes you a little uneasy,
doesn't it?
It does. I know. Yeah. It's okay,
though. I grew up in New Jersey first,
so Okay. So, yeah. So, I'm very, very
diverse. Very, very cultured. New Jersey
and Alabama.
So yeah, here I think 16 or Yeah, 16 17
years now. Roll Tide. Well, I mean I
went to Alabama for dental school, but I
went to Auburn for my undergrad. So I'm
war eagle.
war eagle. Yeah.
Is that a thing? Do they let people do
Is that a thing? Do they let people do that?
Uh yeah, only for dental though.
Did you go to Auburn for dental school?
No, Auburn doesn't have a dental school.
So I did a um I did an engineering
degree at Auburn and then went on to
Alabama to get my doctorate. So,
So, you wait, you went to dental school
at Alabama.
But it's different. So, Alabama has like
the University of Alabama in Tuscaloosa
and that's like the cool place. And then
there's the University of Alabama at
Birmingham which is in the city of
Birmingham and that's where all the
medical dental everything is and that is
the uncool place. So, it's not nearly as
fun as Tuscaloosa would have been. So,
it's not like I
Football is not in Birmingham.
No. No.
No. Yeah.
I got it. So,
okay. So, then graduated dental school.
Did you do a fellowship or did you go
No, you know what I did? I I took a job
on the telephone. Uh it was like um it
was this like March of my last year
dental school and I'm like I don't know
what I'm going to do. And I don't know
where I saw the back of like a we have
this um journal American Dental
Association Jada Magazine. There's like
a ad in the back of it. It was like
looking in the back of a boy's life or
something. There's a little ad for like
to work in Alaska and and so I was like
okay. So, I called it and um I called
this guy and he sounded pretty cool. He
asked me for my driver's license and my
social security number, which I thought
was weird.
And you gave it to him.
I gave it to him. I didn't care at that.
It was a different world back then.
More trust.
And he called me back um he called me
back in about 4 hours later and he's
like, "Well," he's like, "You don't have
a criminal background. Um and there are
no felonies on your record perform."
He's like, "So, you're a candidate to
work in normal, Alaska." And so I I told
him I said, "Look, man, I don't know
what it's like there, but
I want to do something different, so
I'll come for a year." And I promised
him a year. And I ended up staying for
like six.
Oh, snap. You were there for six years.
Six years. Yeah. Yeah. So
you got some cool stories.
Nah, really baseline stuff like Yeah.
Bear stuff, moose stuff, fishing stuff.
Baseline Alaska stuff,
airplane stuff.
You fly? No.
No. Well, I flew for I flew No, I I I I
wouldn't say I fly, but we um flew
around these tiny airplanes and um
landed in these native villages and made
these these like bush clinics and stayed
for 9 days straight and like that was
the weird part. Like there's sometimes
the plumbing would freeze for like 3
months of the year.
months of the year. Oh.
So you're like crapping in a bucket for
9 days. Like that's your bathroom.
Oh man,
it was really wild. And
and it's a burnout thing though. Um I
just one really cool place and there's
these two islands in the bearing
straight. There's big dime little dimede
and the ice freezes between them and um
so you uh you land the airplanes on the
ice there
and uh that was one of my villages and
there weren't that many people there so
I felt like I could control it. Yeah.
man, I went out there one year and I was
like, work work. And I was like, man,
all these kids, pull them out of school
and do all their work and everything and
they got no cavities and I'm like, man,
when I come back next year, it's like
I'm going to go crabbing and this and
that and that. And I came back the next
year and it was like I was never even
year and it was like I was never even there.
Oh, snap.
Yeah. So, it was really it was
just not taking care of themselves at
Well, I mean, it's a deeper
conversation, but what did it um was it
Reagan who said like the scariest thing
you could ever hear is uh I'm from the
government. I'm here to help.
So, yeah, they their their contribution
to um yeah, it's it's it's
not been great up there. So,
Anyway, but yeah, so it's cool. So,
yeah, from from there and I kind of got
bored of the work. I was just doing a
lot of simple stuff and
decided I wanted to come out and start
working on my career and that's when I
came out started training did my IV
certification actually in uh New Jersey
again. There's some charity hospital in
West Patterson and so did my implant
training in in Utah actually in Heber
Heber City. I did a lot of my implant
training there.
Who with white caps?
Yeah. Did you work with I think Mitch
Duckworth was doing sedation with them
at that time.
I might have cuz I've gone there and
I've done like uh we were required to do
like a um an every threeear brushup and
I think I went Yeah. Was he the guy at
I think I went Yeah. Was he the guy at Alominda?
Yeah, he was pretty good.
Yeah. Um
yeah, he runs a good program. There's
two He's a dental anesthesiologist.
There's a couple of them.
I was I was pretty impressed with that
guy. I thought he ran a good program. He
was the guy who um taught me how to bag
someone and gave me confidence that I
could bag a patient. It was Yeah, it was
pretty good.
But but yeah, and so then I just kind of
left Alaska, went to South Florida cuz I
wanted to fish and didn't love South
Florida, so came to West Coast and and
here I am.
So did uh did you buy a practice here?
Did you start one?
I did. No, I I um I bought a it's a
smaller four chair practice and it was
actually over here on 112
and um I just got to the end of that
lease and it was too small. I just grew
out of it so I built out a space. Um
and in that practice were you doing what
were you offering? Were you doing
general practice and uh all
No, no, just I was placing implants and
doing uh my own sedation and just a lot
of cosmetic work and stuff. Um
it's it's really interesting right now
and I haven't quite figured it out. It's
like all of these people just sort of
jump into all X like these these guys
just straight out of dental school. I'm
like you it's just maybe it's the right
way to do it. I don't know. I I sort of
organically placed hundreds and hundreds
and maybe thousands of implants before I
did an all-inx case. And when I did my
first allex cases, I was freehanding
And so and and now with the, you know,
the digital workflow, everything is kind
the digital workflow, everything is kind of
guided. Everything's guided.
Everything's a little bit easier. And I
think that's how guys jump right into
it. But
well, I had sort of the old school
introduction. I I placed before I did my
first full arch, I probably have done
one or 2,000 implants. And so yeah,
good good foundation.
good good foundation. Yeah.
Awesome. And what kind of practice do
you run?
It's kind of everything. Yeah. When I
met you guys or before you, I was doing
all my own sedation.
And um I feel like I have a very
appropriate view of like what I should
be doing when I sedate people, you know?
I So I'm permitted, right? What is it?
the permit's called uh um parental um
conscious sedation like key word being
conscious right
and so I I think people overdo that a
lot and um but it gave me a good basis
and so um
so I think police the like when you're
in for instance I'm always watching your
back making sure you're doing everything
right on the up and up you know
I don't want you
I don't want you supervision
yeah yeah it was sometimes a little
mentorship too Yeah.
Yeah. Things in life.
Yeah. Things in life. Yeah.
Whichever one's more relevant.
But yeah, but it's it's kind of funny
cuz early on I started doing all of my
own and
the most frustrating of times, right?
Cuz you're you're kind of even slower
when you're I mean, the more you do
this, the the faster you get, the less
stress you have cuz you've done
something a hundred times, thousand
times, like it gets easier. Um, but
yeah, it's a huge handful to go in and
take on the burden of, you know, taking
responsibility for the medical history,
getting them sedated, getting them
properly sedated where they're not too
deep, but they're sedated enough to be
comfortable, and then managing your
procedure and maintaining that sedation
level. It's just like, yeah, it's
madness. So,
yeah, it you guys are a godsend as like
elite anesthesia. And sometimes I wish
you were around for the deliveries.
Yeah. like the end thing. Um
because it's it's quite satisfying in
the respect that for me and um dentistry
has its problems. It's it's kind of a
high stress and it's it's there's a lot
of hats to wear and things, right? And
it's it's sometimes not the funnest
career, but now you have this
opportunity to give back to somebody
what they no longer have. And you know,
as as it becomes a problem as we age and
as we age, um social settings, family
dinners, um those kind of things become
very important to you. And if you have
to do it with a denture with no teeth,
it's it certainly dims the light, right?
it's it certainly dims the light, right? Yeah.
Yeah. So,
well, and you get that stigma placed on
you immediately, too.
Of course. 100%. Oh, you know,
difficult place to be. the guys I've had
who've come in and who struggled to pay
for the surgery, but then they come back
and oh man, I got a better job or or oh
man, you know, I when I go out and I bid
things. There was a cool story out of
Utah where a guy was talking about he
was just grateful
to be to have somebody agree to work
with him to where he had that
intervention done, you know, got
basically a functional smile back and
like you said, the stigma's gone
and um he's sort of bidding jobs for
what he's really worth at that point.
And so it just plays into this whole
self-esteem. And so if you guys are
around and like I always want you guys
to see the final product cuz it's just
freaking stunning. And and you see how
hard I work.
Yeah, for sure.
Right. Imagine me trying to manage that
Right. Imagine me trying to manage that sedation.
How long would I be there,
dude? I know.
I' I'd be there. It it it'd be
I' I'd be there. It it it'd be impossible.
You know what's crazy? Uh, I remember
this study came out about Ozimpic and it
was talking about like how much Ompic
would um increase people's salary just
because they would be more valued as
somebody that wasn't as obese. They
would be looked upon differently and so
on and so forth. and they they rolled
out this case study and it was like man
the the numbers were astronomical like
uh just across the board and you've got
to believe it's kind of the same concept
for people's dentition
even yeah
probably more
I maybe I'm just biased but yeah I think
for sure more I mean I don't know it it
my heart really goes out to the people
yeah who need that and and so it's
really cool and and I keep talking about
I keep saying you guys access to care
and like um there's lots of us who
couldn't do what we do unless we had
somebody in there managing that sedation
and then coming back into like my
opinions on everything and I never
really hide them like if it's not me and
really hide them like if it's not me and you.
Then it's going to be this teamed effort
between Oh man, this is I'm getting into
dirty stuff here. like it's this team
effort between like a prostadonist and
oral surgeon, which how it was
traditionally done a long time ago.
And um
it just gets it gets harder and you got
one guy planning the implant placement
and then another guy trying to manage
the prosthetic rebuild. when if one
guy's planning the implant placement and
doing the prosthetic rebuild if an
implant need the idea that an implant
needs to be tweaked goes in be before
the implant ends up in a bone instead of
looking at it after and you're like oh
what do I do with this and
what do I do with this and um
yeah but without you guys
you're saying that one person doing it
brings a lot more cohesiveness to the
I think so I think so a lot of people
would agree with me a lot of people
would say I don't even have the right to
do what I do and that's fine I'll I'll
fight them
I think that's an old way of thinking.
Yeah. But it's prevalent.
I mean, but
hasn't gone away, but it's
Yeah. Yeah. You don't want to get me
going. I think sticking to the point of
is is you guys make it possible like for
me to do what I do for these people and
what I'm doing with these people, I
think, is is meaningful and and that's
what I that's what I really like.
Yeah. But going back to it, I'd be
selling bait on the end of a pier
somewhere. If if I had to just like do
crowns and fillings, I'd just be like,
"Okay, that's enough of this."
You know, it's interesting, man. Uh we
talk about you know um what it takes
away and removes from somebody when they
don't have the confidence of their
dentistician. And it always makes me
reflect. I mean the best stories and the
best laughs, the best memories I have in
my life are always around the kitchen
table. Like they're always around
some aspect of food and drinks and
holidays and so on and so forth, man.
And it's crazy when we talk to these
patients, that's what's been removed
from their life the most. They've been
sheltered away from that. And often
that's what makes it so emotional. Like
when when they wake up and you show them
their new smile, like those tears, I
don't even see the final delivery all
the time, but I see that initial
reaction and it's powerful, right?
Because like I can't imagine not having
those memories. Well, and it's just um
you don't even have to see their
reaction like like some some of the pe
it's d it's dramatic. Yeah. Some people
show up with with a pretty
pretty terrible condition and then by
the end of our day, you know, when we
look at what we get there and it's just
Yeah, it's awesome. And it is really
wild if you really connected the dots on
all of this. Um
a lot of what you guys do wouldn't even
be possible without sort of digital
workflows. you know, and because digital
workflows have sort of when everything
was analog, the the um it was so much
more cumbersome.
Just to get people to
the range of provider that can do it.
Yeah. They're like, well, it's just uh
it's it wasn't even the range of a
provider, too. Uh Sam Almanfrey did a
really cool thing. He was doing a
podcast and and I try and remember this
all the time because things can be super
frustrating, but he talks about a lot of
super smart people who are not
successful and and he talks and he goes
on to talk about
on to talk about um
one of the you know one of sort sort of
the key performance indicators on
whether you're going to be success or
not is your tolerance for stress,
your tolerance to overcome adversity. A
lot of people are really smart and start
and they hit the first wall and it stops
them, right? They're the guys who will
climb that wall and climb the next,
climb the next.
Doing this in a in sort of an analog
standpoint was like like stying a lot of
really smart people and and so now you
have digital workflow and so now a lot
of people it's just much more
predictable and controllable and I mean
but even at that there's still a lot of
crap. I've never thought about that, but
I, you know, I've always just attributed
kind of our growth over time. I mean,
outside of us opening in new locations
inside of the our own areas that we're
in, um, the expansion that we see, um,
just to more more dentists doing the
procedures, more dentists doing surgery
in general, but I actually haven't
thought about the workflows behind what
actually contributes to that being
possible. Well, it's it kind of blows
your mind too because going back to
the technology like you said and then
the technology like you said and then what
you know what what was sort of the the
pre to a lot of this you know what
photoggramometry like you know I it
I don't know for sure but I know it's
the same kind of uh trigonometry that
the GPS systems use
right and so
um having like global positioning
systems and like and like algorithms and
software out of that be applied to you
angular photographs and it's it's just
it's just really wild how we landed
where we were but just a good point. How
old are you?
old are you? 35.
Yeah. Maybe you know it or maybe you
don't know it but the corporate these
corporate entities that perform these
cases they're new. You know they're 20
years old. You know tops and
we work with we work with them.
Yeah. That's why I hate them just a
little bit. That's why I hate you just a
little But I don't know why you do that
to people, but you know, you're
contributing. You know, we talk about
contributions and if that's what you
want to do, then
Well, it's it's what got us started into
it, honestly. And my my opinions about
have changed over time. It's not grew
into the hand that feeds you, man. Don't
don't knock that pinky off, man.
You're the hand that feeds us now.
Yeah, for sure.
We've we've been down that road before,
but I
Yeah. Whole different discussion.
Yeah. And that's a like kind of for you
guys like what I know you do primarily
all on like that's probably got to be
the main stay, but what other kind of
stuff do you get called? Every once in a
while I'll call you for like a wisdom
toothcase or something, but um
to be honest with you, it's
this is the most surprising part about
this journey that we've been on. You
know, we started I started doing dental
in 2018, so it's been sevenish years.
Elite was founded in 2020.
Um we were very All onx f f f f f f f f
f f f f f f f f f f f f focused for the
first couple of years um in that
corporate allx world. Uh and as we've
expanded and gotten more into the
general dentist office,
the range of of cases that we sedate
people for has expanded dramatically.
Really? Yeah. I mean, you'd be shocked
at the number of cleanings we put to
sleep, amount of root canals, the number
of single implants. I mean, absolutely
anything. And I think just the, like
you've mentioned, the expansion of care
has kind of opened eyes to being able to
deliver procedures in the way that the
patient wants. If they don't want to be
awake for cases, they don't have to be.
Yeah. Yeah. I've done it. It's a bad
Yeah. Yeah. I've done it. It's a bad idea,
you know. I think I think just the fact
that it's an option has changed
everything. I remember growing up, man,
like it's interesting how basketball has
changed today. Um, everybody says
basketball is now kind of like this rich
man sport where like you have to get
training and there's these camps and
there's these clubs and you know all
these things you go to and you have to
learn. Um, and in my day there was just
a black top, right? Like there was one
option, man. If you want to get better,
you go outside and you and that was it.
And I think dentistry was kind of the
same way. Like, you know, I told my mom,
I was like, "Man, if everybody was tough
as you, I I wouldn't have a job." And it
was just because she grew up in that day
and age where like she didn't have a
choice. Like she had to get her mind
right. That no matter what the case was,
whether it was root canal, a crown, a
filling, tin feelings, like she was
going to get local and that was it. And
she's she conditioned herself to that.
And and that's and that's what it is.
But I think now that we have more
options, it's cool that people can
choose and we're getting into general
dentistry more. I I think that's
probably one of the largest sectors of
of our growth now is people saying, "Oh,
man." I remember I flew into Utah and it
blew my mind. It was a 18-year-old that
was like, "Put me to sleep for a deep
cleaning." And I was like, "What?
That's crazy."
I thought it was crazy, too. But for
him, he said, "Dude, I'm I just don't
like it." like like and he had like
tattoos so like I was like oh snap but
for this it was a fear factor and he was
like why wouldn't I choose it if it's
available and I was like you know what I
guess you're right
you guys should get into like some sort
of hypnotherapy like that you know for
people like who do things like that and
when you sedate them you'd be like stop
being a millennial
be tough
when you wake up you know you know when
Wake up. You're
Man, who am I, right? Who am I to judge,
man? I mean,
oh, I don't know. Yeah, I know. I am. I
I wish I felt that way.
I was telling them earlier, I had a
dentist that we've worked with for years
text me 3 days ago. Said, "Hey, man. I
need need to talk to you guys." And I
was like, "Oh, no. I thought like a case
went bad or something."
went bad or something." Yeah.
So, I called him and he's like, "Hey,
I'm getting a root canal done next week.
I'm just wondering if you'll if you'll
put me to sleep for it." Wow.
put me to sleep for it." Wow. Wa,
Wa, dude.
He's like, I I've needed it for a while
and I'm just I just don't want to do it.
Wow. That's impressive. Happy to help.
I mean, I guess it's hard for me not to,
but I'm not going to.
I mean, it's it's kind of crazy. I mean,
you see you see like, you know, a lot of
changes just in the space as far as as
you know, tattoo anesthesia is a thing.
You know what I'm saying?
That would be awesome. Have you guys
ever done that? Yeah.
Mhm. No way. Really?
Yeah, we have.
Yeah, we have. Wow.
That's that's growing.
But it's crazy because like some people
would say the most valuable thing in
life is time. And whether it's tattoos
or dentistry, like if you were going to
do if you were going to do 25 crowns on
a person, how many sessions would you
break that into if you were just doing
break that into if you were just doing local?
Oh, yeah. Probably definitely two. Yeah.
I don't I I could do it one. I wouldn't
want to do it in one. they probably
wouldn't want to do one, but I've done
25 crowns on a patient under general
anesthesia in like, you know, six, seven
anesthesia in like, you know, six, seven hours,
and they wake up and they're just like,
"Oh my goodness, thank goodness this is
done." Right. So, like like a time
factor. I It's It's crazy. My mom was a
single mom growing up and one of the
hardest things to come by was time off.
Like she just couldn't get time off,
man. She had me and I was like basically
three people, you know? So when she had
to get things done, she had to cluster
it. And I see that so much like in a
patient population.
Well, you do make and like it's a fair
point to make in the sense that your
whoever you're working with can move so
much faster when you're there versus by
much faster when you're there versus by themselves
and and dentistry is really weird. And
I don't know how it happens like this,
but for whatever reason, it's
compartment compartmentalized and like
it's like one thing at a time.
it's like one thing at a time. Yeah.
Right. It's like you need a crown. Okay,
come get a crown. It's like, okay, you
need an implant, come get an implant.
You need a,
you know, and I've kind of even in my
patient population, I try and give them
like the the one day to done option
where they come in, if they need their
implant or their root canal, I do it
all. Um, not everybody needs to be
sedated for that. But just from a
mindset standpoint, you're you're right,
the time off and and
all that all that matters, man. I mean,
you know, the one thing that isn't
happening is like things aren't getting
cheaper. like it's harder to get times
off time off. It's harder to make up
missed time. Um, so you know, when we do
stuff for general dentistry, I've done
crowns, fillings, a root canal, and a
deep cleaning because they're already
asleep and might as well get it done
during this one visit. And when they
wake up, they don't have to come back.
Well, it's just true. And it's just the
mental too for them like oh man I got to
go get and then they go and like let's
say they get a crown done
and biology is biology. Maybe there's
some variant. Maybe they're hard to get
numb. Maybe they don't get totally numb
and maybe it's miserable for them.
and maybe it's miserable for them. Yeah.
Bad experience.
Yeah. And then come back
or if they do they got to like oh god I
got to get the implant. I got to get
this and that. And so yeah it doesn't
matter when you when they're going to be
sedated and asleep. It's going to be a
great experience no matter what.
Yeah. You know, it's interesting too.
Like I think one of the things that Dr.
Baron does do is like he stays in touch
with all the latest. So he'll text me
and he'll like, "Hey man, like this
person was doing their own sedation and
this happened or this such and such did
you hear about this?" And it's kind of
crazy how common some of these stories
are where um like just things happen.
They can kind of happen fast to
practices that have been doing kind of
their own thing for x amount of time.
Um, I know you've you've kind of just,
you know, it it's what bothers me that
what doesn't bother me, but it doesn't
matter doesn't matter how perfect your
due diligence is. Like I always tell
patients, they ask me, you know, about
implants and failures and this and that.
And it's just like I tell them, I said
this would all be awesome if it wasn't
for biology, right? We're at the mercy
of biology all the time. And there are
there are identifiable diagnosed or
diagnosible conditions and there are
underlying unidentifiable undiagnosible
conditions and man if you encounter that
and and you're not equipped or prepared
and and you're not equipped or prepared that
yeah that goes really
that goes really bad. Yeah. Which is
really comfortable like and and the
thing I really like is where we do it
here like you know um I wouldn't do this
here like you know um I wouldn't do this in
Ellensburg or Yakima. It's a hard choice
to try and do it there because your
response time is so much longer and so
your responsibility to manage the
patient all the way through a crisis is
an emergency response. You're saying
you don't have the resources out there
you don't have the resources out there to
No. And and I mean it for us and we've
called a couple of times not for sedated
patients but people walking up to the
front desk in chest pain or something
and those guys are man they're amazing.
They're at my door in
two and a half minutes you know
just driving around waiting for
just driving around waiting for something.
But yeah, and so when you look at it,
you know, it's it's always funny.
Everybody always people love to point
the finger at at medical practitioners.
Every time something isn't perfect, it's
you know, there's some sort of
malpractice or something happened. And
um the the unfortunate truth of it is,
in my opinion, is is like we just we
endure that responsibility and that
risk. And like that's why I really like
having sort of the team approach, having
anesthesia there, having properly
trained assistants and and even like,
you know, I think to a certain degree
properly trained doctors, you know, but
it's being prepared for the unexpected,
too. Like I How many times do patients
lie to us?
Oh, yeah. Absolutely.
All the time.
Oh, are you kidding? Yeah, I know.
Yeah. Like
me and you banter about it all the time
and and it's crazy, man. And I think if
patients were always completely honest
about everything they're doing,
everything they're they're taking, every
every extracurricular activity, then it
would be so much easier for any
practitioner to care for them. But I
think the reality of today is that's not
that's that's that's that's not the
norm. And
people feel ashamed for some reason.
Feel ashamed. Yeah, man. Like there's a
stigma. Um
think we're there to get them in trouble
or something.
Yeah. They think you're going to That's
me 100%.
Yeah, right.
I mean, I'm there to judge and shame
you. Even when I walk in like a hygiene
room, if you had flossed your teeth,
don't lie to me.
Oh man, I'll be like you. I'll puff my
chest out. I'll stand a little taller
and be like, "Really? No flossing? My
teeth bleed when I get floss."
Oh, man. But I think that's that is the
biggest thing. And I mean, we even
encounter it a lot as as anesthesia
providers, man. Like, you know,
something doesn't look right. And you
know, how do you manage that situation?
It's it's it's definitely a part of the
craft and I know, you know, I handpicked
my team here in Seattle and one of the
things that I wanted was a lot of
experience. I wanted a lot of exposure
to kind of what's happening in the real
world cuz that's what you encounter all
the time in these outpatient settings.
Yeah, it's it's definitely a part of it.
Um and like goes back to like myself and
having my own experience sitting on
patients. It's terrifying. And and it's
funny because you I'm always asking you
questions when we're in there, right?
I'm like, James, what what is that?
What's going on there?
He is super attuned to like the pock
He is super attuned to like the pock and
well, but a lot of times it's not
anything, but when
you know I this is kind of funny. This
is embarrassing to admit, but I've
invented my own realities. like I've
decided that versed um you know
contributes to like cardiac arhythmias
and it's probably just cuz my monitor is
you know the patient moves around a lot
or something. I'm like oh what's that?
What's that? And
What's that? And Right.
Yeah. It's really hard and and and
having to um
you have to be overly cautious when
you're there by yourself and it's just
Yeah. No. And then I think what we're
landing in on is just what's appropriate
and what's not appropriate, you know,
for, you know, ethical behavior and how
should we be taking care of our
should we be taking care of our patients.
Yeah. It's just
um no one can argue that it's as safe
um no one can argue that it's as safe with
I mean
my sedation training was like probably
120 hours over the course of like 3
weeks, you know. What was your sedation
weeks, you know. What was your sedation training?
Super intense, man. And I mean I did 5
years in ICU and then three years in
anesthesia. So I mean
it's so I mean
you just can't argue like if it were me
or my family what what would I want?
Would I want a single practitioner doing
the anesthesia and the procedure or
would I want a team of people you know
and it's just
you called me this weekend.
What did we do this weekend? I don't
You were like hey will you uh do the
sedation for my daughter?
Oh yeah.
And I was like hey man that's always a
badge of honor when like
there's there's no way
Yeah. No way would I sedate my daughter
and do that surgery. It's crazy.
I probably shouldn't even be doing the
surgery, but we'll see.
What uh what do you like in terms of
deciding whether or not you're going to
do your own versus work with somebody
like us?
So, since I've been working with you
guys, so I a lot of times I did a lot of
my own IV stuff. And now, um, about the
only thing I'll do is oral conscious
sedation, which is like a, you know, um,
two staggered doses of of an oral med
like Hion, maybe Valium if it's a longer
procedure, but that's all I want to mess
with, you know, because because I
consider that super safe. Um, if it's
not super safe, you know, I I think,
you know, from management of
complications, if I had to bag a patient
for 3 minutes until paramedics got
there, I'm very comfortable doing that.
The probability of having to bag a
patient for giving him houseion is
pretty low. It's possible. It's pretty
dang low.
So, I just and then I um if I'm doing
like a veneer case or or an arch of
crowns or something like that, um I'll
just do some oral sedative and that's
it. and and I have kind of in my um tool
chest, it's like if it's not working and
they're they're on the monitor and their
heart rate's ticking along too high and
I know they're just freaking out. I
mean, I can put an IV in and give them a
little bit of introvenous, but never
again will I try and
sort of land the airplane, you know,
hook them up, put an IV in and sit there
and try and get them to like five or six
milligrams of Versa,
100 mics of fentanyl to try and put them
in some spot. Which the other
frustrating thing for me is is with
those drugs and the drugs that I'm
allowed to use, they're unstable
in the sense that they don't stay in
that spot.
that spot. Yeah.
You know, and and and so I
You know, and and and so I shortacting.
That's what I mean. So, yeah. And so
then I've got to go and try and work and
get this done and now they're starting
to fidget and I can tell I need to
manage this and
it's just not worth it.
So, yeah, it's a lot to think about. I
can't I can't imagine. I mean,
it's a lot for us.
it's a lot for us. Yeah.
To manage, you know, dental's pretty
reasonable in terms of an anesthetic,
but to think about that and then
something that's 100 times more complex
like ax case or veneers.
Well, and also think about what's
impossible and think about like the um
just reaction time in in decisions.
Let's just say you have some usual and
customary like um like a hypertensive
crisis. just the reaction time to sit
there and be like, well, you know, do we
get it? Do we do we get a beta blocker?
And I don't give people beta blockers.
So, I don't know how to mix it up in an
efficient way. And I haven't delivered
it a thousand times. It's just
inappropriate for me to manage something
like that in my opinion.
People will think differently of course,
but um yeah, I just don't have to do it
just because you guys are here. It it
feels like dentistry is kind of in a
transition period right now where uh
there's like an evaluation going on of
what should or shouldn't be done. And I
I don't know that it's all entirely like
greed driven or ego driven. I think some
of it came out of necessity
for sure.
Elite anesthesia wasn't always here and
and implants and all has been going on
for much longer than that.
It's true. And and I think even from the
standpoint of like an access of care
standpoint, um yeah, and I didn't know
if it's just me and what I do in my
career, why I'm I'm doing a lot more
sedation cases, right? Or is it
something that's just becoming more
common throughout the entire field? Um I
mean, I personally think you guys have
contributed a lot to it. I I don't know
if you've thought about it or or if you
know, but how many anesthesia
practitioners have you made available to
dental practices in the state? You know,
you guys must have the same number of
people under your roof as maybe there
were in the entire state when you showed
up. And so, so access to care and
getting somebody going. um
uh it is changing but but I think you
can't ignore the fact that some really
sad stories have come out of some very
credentialized individuals you know
situations where you have anesthesia and
pedo or um you even have you know oral
surgeons MD oral surgeons who have
terrible outcomes and it and it's
you know you you don't want to judge
anybody's operation from an armchair.
But when you hear and you read about
things, a lot of times it's just
things, a lot of times it's just complacency.
I don't even know if it's complacency,
man. I think it's so interesting. You
can have the same letters behind your
name and have completely different um
skill sets behind that. I I came from uh
an anesthesia group that didn't train
specifically for dental when I first
started. And I had already had like 10
years of anesthesia experience and I got
thrown into this dental space and I
didn't necessarily know completely what
I was doing and I was figuring out on
the fly and and and I learned a lot but
like there's also a learning curve,
right? And I remember when I signed up
with Elite um after that experience um
they were like, "All right, man. Let's
get you let's get you out to Utah." And
I was like, "Oh, for what?" And they
were like, "Oh, man. we're going to
train you up. And I was like, "Oh, no,
no, no. I've kind of already learned
like I've I've I've learned on the fly
and I figured things out and I've been
practicing for for, you know, 12 years
at that time." And uh and Sean was like,
you know, "No, no, no. We're going to
we're going to get you trained up the
elite way." And I flew out there, man.
And I was like, "Ah, what am I really
going to learn?" Dude, I learned a ton.
Like there is there is such a difference
in anesthesia in the outpatient setting
versus the hospital. like somebody that
does anesthesia full-time at the
hospital, you know, 90% of the time and
does this on the side, they're bringing
kind of hospital anesthesia into the
outpatient setting and it's just
completely different. So, like I think,
you know, it's so crazy how, you know,
people like, "Oh yeah, I use an
anesthesia provider or I use a sedation
provider or they have a little bit of
experience, but but it isn't the same."
And I think kind of one of the cool
things about Elite is it's definitely
specialized for the space.
Yeah. And I think it has to be um when
you think about it, too. And I mean
it's not that hard for me. I mean I just
try and set ground rules and I always
call you stupid questions.
They're not stupid questions though.
but but you know I'm like hey man I
don't know this you know this I know I
have this p certain patient and then you
know I have this like uh BMI concern or
something like that. Is that appropriate
for the setting? But I think you can
never lose focus of
what's appropriate in that setting.
Yeah. Cuz because you're not going to
necessarily And I don't even know if you
guys do. Do you guys have crash cards?
guys do. Do you guys have crash cards? Yeah,
you have a crash car. So if you if you
had to defibrillate somebody, you can
defibrillate somebody in there.
Yeah, that whole thing's a crash cart.
Yeah. And that's,
you know, and that's that's deeper than
I ever want to go on it. But for me,
it's always like
you just follow the ASA rules.
And I think it's it I think more than
anything, it's it's kind of crazy, man.
Like a lot of stuff has been done in the
outpatient setting, but dentistry is
kind of the first where it's like it's
it's a unique space. I mean, for the
most part, like a lot of surgeries were
always done in in in hospitals or
ambulatory surgery centers and then
dentistry comes about and we're doing it
in the office and and it's like, man,
how do we bring that safety standard to
the office and there's just all these
moving parts. So, it's kind of cool to
kind of hear from you and your
perspective and
Well, even when you think about it, too,
like think of like the the the
contribution to access of care
cuz man, when you got to take somebody
to a hospital Yeah. Oh god, it's
impossible. And then the other thing is
is like once you have to go to the O, I
can't go to the O. Ah, yeah. Right. I
can do all these things, but now all of
a sudden, who can go to the O? What if
they need to be sedated for something,
you know, relatively benign like an arch
of crown preps or something?
of crown preps or something? Yeah,
you can take them to the O for that.
Then who's going to be the practitioner
in the O? Well, noral surgeon's not
going to do it, you know. Then you got
to find a prostadonist who has or
dentist who has um O pre and hospitals
just don't operate that way. So it's
just incredible contribution to access
to care I think is really cool.
Yeah, absolutely man.
Um so where what what's next for your
practice? Are you
plans ahead?
I don't know. Uh
he's trying to marry Rich.
Oh, that would be awesome.
Come on. Easy safe space.
Um, yeah. No, I I have no idea. Um,
you know, the marrying thing. I don't
Not for money, for love. James,
for love, man. I believe it. I'm a
classic guy, too, man.
Yeah. Um, we're sort of um have a
relationship trying to come together.
It's kind of interesting. She's in
It's kind of interesting. She's in London
and so she's in London.
Yeah. And she and it's really difficult.
She has a business in London and um a
really interesting
thing that would be really hard to
recreate anywhere else. And so I've even
looked at um potentially practicing in
Europe over there. I don't know. But
it's funny when I approached that, I'm
kind of like, man, first thing I thought
I was like, how who's going to sedate my
patients or or or can I even get my
patients sedated? And so
you talked about going international. It
might be the time to think about it.
Dude, I' I'd practice. Those Brits, they
need help,
dude. So, that's the thing. You wouldn't
have any shortage of patience.
Brits. Whoa. Did he just say he's
Brits. Whoa. Did he just say he's awesome?
Is this thing on
with anesthesia?
It's all right. When I go there, I'm
like, "Look, man. Tea Party is over. I'm
here. It's safe. Don't worry."
I can confidently say there are very few
British people watching this podcast.
That is true. And you know what? if they
were and they could find us. They're
they're actually some mean like quick to
swing guys. So,
I just get behind James.
Just keep James.
Yeah. No, so I don't know. Um
uh this is awesome and I love doing what
I'm doing and as long as I feel like I'm
helping people and and making a real
difference in their life, I think it'll
keep me in it. Um, but it's uh um
it's ch it's and I you guys maybe don't
feel it. It's a challenging climate and
and it just seems to be um
becoming more and more challenging. Like
I I just don't see things swinging back
and and you know, I'd love love to dig
on Washington State and you know, the
tax implications they're making, but
they're not making it easier for small
business and things like that. So So I
don't know. So, I think for me, you
know, as long as I I get that
I've done something for someone that I
feel like very few people could and and
I really feel like I've helped their
life, I'm going to keep going and, you
know, and until until I feel like I fall
off that plateau, man, and I'm and I'm
not performing the way I need to
perform, and then I'll be done. I don't
know. You know what's crazy, man? Uh, so
this is like legit my guy. like this
guy, he he's one of the practices that I
not only do I love going to cuz we just
have the greatest banter. Um, but he
also really cares. Um, it's one of those
practices where uh he he he's always
willing to go that extra mile. We had
one of the toughest patients ever. Like
not only was she tough from the surgical
standpoint, but she was tough from like
the emotional standpoint. Um,
oh god, don't tell this story. But but
it was crazy because, you know, she
didn't follow any of the posttop rules.
She didn't do anything that she was
supposed to. And uh and the next day,
this guy lives in North Bin, which isn't
close at all. And he he bought her food
and delivered it to her all the way back
in Seattle. Oh man, you just don't hear
that a lot. Like, you don't hear that
kind of like, you know what, man? Um I'm
going to see this through to the end. um
this patient just needs that extra TLC
and so he has this rough exterior
because he's from Gnome Alaska and like
he's been in Alabama but like you know
Birmingham but uh but he is like a a
tender heart at at his core.
You hope I am. That's not true man
because I've seen it man and I I do I do
value that cuz uh you know at the end of
the day like that's what it really takes
to deliver care today. like it takes
doing what it takes for each and every
patient. And not all patients require
that, but when it's necessary, man, it's
good to have it in your tool belt to
deliver it because at the end of the
day, like we want the results. We want
the patients to be satisfied. We want
them to get whatever they've paid for,
man. And and it's cool to be kind of in
that in that ring with you. It's uh I I
would say it's a tough you know you live
you your practice is in Belleview so
like like I think that is kind of a
harder area right because it's more of a
high-end area like I think marketing
becomes a bigger tool. Well, it is and
it's kind of interesting and and h
probably shouldn't say too much. We're a
little bit unique in what we do in like
the all-on world. And so, we're actually
reaching out and to um we think some I
wouldn't say starving markets, maybe
some underserved markets and definitely
markets where the kind of surgery that I
do doesn't exist. And we're trying to
create sort of a we're trying to reach
out to
hubs. Brits.
No Brits. Reaching out to the Brits,
man. They're too mouthy. Can't do it.
So, yeah, we'll see.
So, where's your practice headed? Is it
like where do where do you see your
practice in the next 5 years?
More of the same, really. You know, I
really feel like
it's kind of weird. I don't like to
compliment you, but I will. And it's
like you guys have really helped me
reach kind of like the pinnacle of what
I think. I mean, it's really cool.
There's there's a lot of dentists who
went their entire career who
can't really say I've like helped
somebody repair their self-esteem and
their confidence and I made them more
jobw worthy and I made them, you know, I
did all these emotional things for them
and and I'm really proud of that and and
I don't need to I really don't need to
go on to anything else and because for a
long time I just was hungry and I wanted
to do this thing and the next thing and
the next thing and that's how I kind of
landed here. But now, like working with
you guys, I'm in just such a comfortable
spot where I feel like um we're taking
the best care of patients. You know,
we're making great decisions on the on
on what we're executing and where we're
executing it and and we're making this
great difference that I've just sort of
um resigned myself to just more of the
same at this point. And just just, you
know, repeat repeat and just, you know,
find good people and try and help them.
And that's all I want to do.
And it's cool, man. I think you've
nailed in your marketing like your new
marketing campaign is really awesome and
like your volume's going up. Um, and
it's kind of cool to see like us work
together and you know you kind of like
dial it in to where you I I can
definitely tell you love doing surgery
like more than anything else. So to be
able to do more of it and do it at a
high level is is is pretty cool.
Yeah. No, I think it's it's it's cool
and it's funny. It's
Where else are you guys? So you guys are
here obviously Utah Salt Lake.
Salt Lake, Denver, Phoenix, Seattle,
Oklahoma City, Dallas.
Oh my goodness. Yeah.
Minneapolis, Houston, San Antonio,
Minneapolis, Houston, San Antonio, Austin.
Austin. Wa.
Wa. Chicago.
So, how many of you are there?
Between full-time and part-time, we're
like 150.
Wow. I think that's unbelievable.
Yeah, that's like Yeah, that's crazy.
And what's cool too is I mean like the
need for what he does is beyond
Belleview. Um I think he's had
aspirations, you know, he's he's always
bounced. I don't know how serious you
are, but he's like, "What if I moved
over here? Would you guys come with me?"
And I was like, "Yeah,
I do look at that and and you can't help
but do that." It's it's it's the it's
the greener grass syndrome, you know?
but it's kind of cool to know that we're
mobile enough to like
go where you are, dude. We'll go where
you are. Well, and it's it's it is funny
that you say that because my like latest
campaign like to reaching out to
underserved areas. Yeah. I actually am
just just not real smart with things
sometimes. And
I was like, "Yeah, let's maybe um
let's look for a good market and then
let's test run some marketing and, you
know, if I think there's a great need
there, then I'm going to go find a
facility and go there."
Um and my marketers are like,
"It's a $500 airfare." Yeah,
why don't you just recruit them into
what already works? And so, so hit that
market hard instead of doing like a test
thing. Hit the market hard, you know, um
different differentiate yourself in your
marketing for how you are and what it is
different about what you do and and try
and pull them in and help more people
that way. So that's kind of where we're
we're at with
Yeah. I think Randy I I I mean I don't
know exactly at this point, but I think
80 90% of his pat sometimes Randy
sometimes like I'll be at my house and
like I'll be like grilling steaks and
like potatoes and I'll make my plate and
I'll go over and put it on my table and
I'll walk away and I'll turn back around
and Randy will be there and he's
actually taking steaks off my plate.
It's just so you watch your back.
Yeah. Yeah. You got to watch them. They
are Randy and his brothers. Yeah. Yeah.
they're going to watch her.
Yeah, that's awesome.
But it shows you that that's a
But it shows you that that's a successful
way to go about it to a certain degree,
right? It's like a proven concept.
Yeah, it I I do think so. And it's I
don't know. We'll see what happens. But
my deal is is
I'm I'm operating from from one
challenge in a case to the next and just
find me a good person who needs it and
let me try and help them and that's it.
I think at the end of the day, we're all
trying to feel satisfied in our careers,
honestly. I mean, we do it all day,
every day. And
and I share very similar feelings to you
where before Elite for me, I was
bouncing around a lot. I think I looked
at jobs
at jobs everywhere
all day long while I was in my job. And
there's just so much satisfaction in
this that I I mean I' obviously I own
this company, but I
you know very early on I was just like
this is very satisfying. I I enjoy doing
this and I I can't see myself anything
And and I don't know for you guys, but
it's got to be different. Like the
hospital environment for you guys has
got to be a little bit of soul crushing.
It's awful.
Yeah. And and and what are you trying to
do? you're just you're trying to keep a
very sick patient, you know, alive for
the duration of a, you know what I mean?
You're you're not part of that.
Keeping someone alive versus delivering
something that's a life-changing
experience for them.
Two totally different things. Yeah, it's
it's really fun to be a part of.
Yeah, I'd Yeah, I think so. I would be
into it, too. Yeah. And so, it sounds
great. You make it sound awesome. So,
there's a um anesthesia school in
Tijana. I My application's in. So,
he always talks about
Can't wait.
Oh, that'd be it' be
it'd be awesome, man. We'd get you on
board, bro.
Can't wait, man.
So, if there was anything next other
than what I thought Yeah.
Golden slippers, man.
Work for my gold.
We'll take We'll take you.
Well, Dr. Baron, this has been super
fun, man.
Appreciate you coming and working with
us. And
thanks, man. Absolutely.
All right, Dr. Baron, uh, thanks for
joining us and and we'll see you guys
joining us and and we'll see you guys next