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Episode #526: My 3 Biggest Pet Peeves in Dentistry, with Dr. Jeff Rouse

the best practices show podcast Jan 18, 2023

  Aside from patients and insurance, there are numerous things about dentistry that can rile you up. Today, Kirk Behrendt brings back Dr. Jeff Rouse, one of ACT’s all-time favorites, to share three of his pet peeves in the dental space and the changes he would like to see in the future. If you're ever planning to meet Dr. Rouse, pay attention! To learn what not to say or do in his presence, listen to Episode 526 of The Best Practices Show!

Episode Resources:

Links Mentioned in This Episode:

Spear Education: https://www.speareducation.com

Dr. Frank Spear, Dr. Gregg Kinzer, and Dr. Ricardo Mitrani’s treatment planning course (December 2-3, 2022):  https://content.speareducation.com/2022-spear-live-art-of-treatment-planning

Main Takeaways:

Put in the effort.

Get rid of the defeatist mindset.

One course is not enough to improve.

Join a study club and be open to sharing your work.

Don't assign the value of an insurance company to patients.


“Whenever I saw Frank lecture, or Gregg — anybody lecture — I would always think, ‘I want to do that. That's cool. I want to be able to treat that.’ And, in fact, I'll even go back farther. In 1995, I saw John Kois lecture. And I said, ‘I want to do that. I can't do that right now. I'm going to figure out how to do that.’ I never, ever said I couldn't do those things because they weren't in my world. I just changed my world, and it started with me. I changed who I was and my confidence and competence to do the case.” (4:30—5:19)

“It’s such a defeatist attitude — and lazy attitude — to say, ‘Those case patients aren't in my world,’ because that's the easy way out. It’s not, ‘I'm going to go learn how to do it. I'm going to go find those patients. I'm going to figure out how to do that.’” (5:20—5:39)

“If you talk to dentists and they say they're burning out, it’s because they're not challenged. They're not getting any better. And if you don't get any better, I understand why you're burned out. I wouldn't want to do the same junk every day. You've got to be getting better. You've got to be putting some effort into this. You've got to have something that’s going to drive you to the next year, and the next 10 years. And so, for me, I'm more excited today than I've ever been to do dentistry. I love it. I love it right now more than at any other point in time in my 34 years.” (5:59—6:37)

“To take the easy route and just say, ‘Not in my practice,’ that drives me crazy.” (7:50—7:56)

“When I went back through and looked at all those people that we were doing very significant dental care on, you know what the common element was? They had been to a ton of other dentists and have been sitting in their hygiene program for years, getting exams that said, ‘Nothing is broken. Nothing is diseased. We’ll see you again in six months.’ So, when you're walking out of the room and you say to your buddy, ‘Those patients are in their practice, not in mine,’ no — they were in your practice for years. You just didn't bother to either learn how to diagnose it correctly or get them out of the hygiene operatory and actually have a more comprehensive view.” (10:43—11:29)

“Number one on my list of things that aggravate me is taking the easy way out and assuming that those people aren't in your practice, because they are there.” (13:13—13:24)

“What it really comes down to is when they're walking out of the room and saying, ‘Those aren't in my practice,’ it’s like they're saying your baby is ugly.” (19:42—19:49)

“I want everyone to have the joy that I get out of doing this kind of dentistry. I want everyone to experience that. It is so much fun. It is absolutely the best way of doing dentistry, in my opinion. And I want everyone to experience it so badly that when I hear them giving up that easily, it just kills me.” (20:02—20:23)

“You've got to put in the effort to get the benefit. And no one course is going to do that in treatment planning.” (20:48—20:57)

“You could take a course in some sort of software that you're going to use to plan implant placement. And you come home, and you use the software. That's not treatment planning. Treatment planning requires you to understand not only breadth of information but depth of that information. And an introduction like facially generated treatment planning at Spear gives you a taste of what is required in order to get there. But it has to be studied in more depth than that.” (21:36—22:22)

“In 1995, I saw John Kois. Went and heard Frank Spear lecture. If I had just gone, ‘Well, okay. I guess that's it,’ that would've been silly. No, I had to hear Vince Kokich lecture. I had to hear Dave Mathews on perio. I had to go travel all over the country to go to different courses. And I found certain people that all taught me the pieces that I needed to be able to synthesize that information. And then, working with Bill Robbins, all of his knowledge, my knowledge, all of that came together and I can start treatment planning at a higher level. But it took a few years. It was a handful of years involved in order to get to where I started feeling comfortable with it, to where those cases started coming around.” (22:25—23:23)

“To think you're going to go to one course and have it — actually, I heard it the other day. And it’s someone I'm really close to that took facially generated treatment planning. I said, ‘We’re doing this other thing,’ and she said, ‘Well, I already took that course.’ And I'm like, ‘Oh. So, you got it? That one course, you got it all?’ She’s like, ‘Well, no.’ I'm like, ‘There. You don't. You need more.’” (24:23—24:58)

“One course may teach you how to do a better composite. One course is not going to teach you how to be better at doing interdisciplinary dentistry. That requires continued work, continued learning. And the best thing to do is commit to learning it, and then find a group, usually a study club, that has specialists in it that you can continue to evolve your ability to treatment plan. And then, you've got to do it. You've got to make the photographs, and collect the data, and present cases to that group.” (25:03—25:40)

“I think that's one of the bigger issues in dentistry is that we don't have a coach watching us all the time and correcting us all the time because we tend to be loners. And our practices are usually alone.” (26:38—26:52)

“I was an associate in a practice for a while. And if we’re an associate, we tend to not share as much as we should. And so, I think being open to sharing — like I had a second ago, the associate here in the office was doing a case that is unfamiliar with implants and how to manage provisionals and such. And so, we sat down, and I trimmed some of it, and they trimmed the other part. And that's a quicker way to learn the lesson than doing it on your own and having it look like crap, or fail, or whatever, and then you have to go, ‘Okay. Well, next time I've got to do this differently,’ and then having to evolve that way.” (26:55—27:42)

“It’s a sematic issue, but it’s the truth: the patient isn't a Delta patient. The patient is a patient. The patient has Delta insurance. And they didn't go out and buy Delta insurance, their employer bought Delta insurance. And I'm using Delta as a generic term, not a specific. It happens to be one of the bigger ones that I hear about, but it could be any insurance. The person isn't a Delta person, meaning the values of the Delta Dental insurance of having cheaper care, or whatever it happens to be. That may or may not be the values of the patient. And yet, when they walk in, you go, ‘Yeah, that's a Delta patient.’ Well, we kind of give up on them. ‘Yeah, I treat a bunch of Delta patients.’ I'm like, ‘Okay. The patients, they have needs. Right?’ ‘Yeah, but they're Delta patients.’ I'm like, ‘Dude, that doesn't stop them from making a decision independent of Delta. There are all kinds of ways to work around that.’” (28:59—30:15)

“If a patient wants care, they can get care. If they want what we have to offer, then they can do it. Absolutely, they can do it. And so, assigning the value of the insurance company to the patient drives me crazy, because it’s not right. There’s a bias when they walk in the door as to how you're going to go about treating them. And I think you [should] offer them the solution that you would recommend for yourself or your family and see where you go from there. Give them a chance to say yes or no.” (30:29—31:22)

“If you don't ever begin the process, you'll never get there. You will always do the same thing.” (36:17—36:22)


0:00 Introduction.

2:05 Dr. Rouse’s background.

3:41 Pet peeve 1: the defeatist mindset.

6:38 Why he loves dentistry now more than ever.

13:24 The beauty of interdisciplinary dentistry.

20:24 Pet peeve 2: not putting in effort.  

25:48 No dentist is an island.

28:30 Pet peeve 3: “I treat a lot of Delta patients.”

31:24 Advice for dentists.

37:43 Pet peeve 4: Buffalo Bills fans.

39:37 More about Spear, Dr. Rouse’s courses, and how to get in touch.

Dr. Jeff Rouse Bio:

Dr. Jeff Rouse is recognized as a pioneer in the field of airway prosthodontics — the impact that a compromised airway has on the stomatognathic system. Along with fellow Spear Resident Faculty member, Dr. Greggory Kinzer, he developed the "Seattle Protocol" to recognize, control, and direct resolution of airway distress in a restorative dental practice.

Dr. Rouse maintains a private practice in San Antonio, Texas, and practices with Dr. Kinzer and Dr. Frank Spear in Seattle. He is also an adjunct assistant professor in the Department of Prosthodontics at The University of Texas Health Science Center at San Antonio. Among his dental accolades, he has written numerous journal articles, including a portion of the “Annual Review of Selected Dental Literature” published each summer in the Journal of Prosthetic Dentistry. Most recently, he co-wrote a textbook by Quintessence titled, Global Diagnosis: A New Vision of Dental Diagnosis and Treatment Planning.

After graduating from dental school in San Antonio, Dr. Rouse completed a two-year general practice residency at the University of Connecticut Health Science Center. He practiced family dentistry for 12 years before returning to school to earn his specialty certificate in prosthodontics from The University of Texas Health Science Center at San Antonio in 2004. He is a member of the American Academy of Restorative Dentistry and American College of Prosthodontists, and past president of the Southwest Academy of Restorative Dentistry.


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