Building a Full Scope Oral Surgery Practice w/ Dr. Steve Yusupov

In this episode of Let’s Talk Teeth, we are joined by Dr. Steve Yusupov. Tune in as Dr. Yusupov shares his path from NYU dental school to a six-year OMFS/MD program at Kings County Hospital/SUNY Downstate, followed by a head and neck oncologic fellowship at the New York Head & Neck Institute. He explains what drew him to oral surgery after seeing major head and neck cases, and how his early associateship in a hospital-based practice shaped his surgical scope and business skills. 

Dr. Yusupov describes his journey in launching a de novo oral surgery practice on Long Island, doubling its space and adding an associate, and maintaining full-scope private practice work including orthognathic, TMJ total joint replacements, oncology, and full-arch surgery with prosthetic workflow. He discusses referral building, direct-to-consumer marketing for full-arch, digital dentistry’s impact, pathology referrals, advice on associateships and avoiding rushing into ownership, future growth plans, and closes with guidance to follow your passion and embrace change in dentistry.

Don’t miss this conversation exploring full-scope OMS training, practice-building, and the future of full-arch implant care.

00:00 Meet Dr Yusupov

00:37 Training Path to OMS

02:08 Oncology Fellowship and Dream Job

03:56 Perio vs OMS Decision

06:23 Why Head and Neck

08:06 Leaving Associateship

08:46 Building a De Novo Practice

12:15 Full Scope and Full Arch

15:53 Advice for Residents

19:14 Marketing a Referral Practice

21:57 Why Full Arch Is a Unicorn

23:32 How Full Arch Patients Find You

24:49 Restoring Full Arch Confidence

25:38 Digital Workflow Game Changer

27:32 Pathology Referrals and Competition

31:03 Learning Business After Training

35:29 Practice Growth and Hospital Goals

37:45 Wild Trauma Call Case Study

42:21 DSOs and Dentistry’s Future

47:14 Final Advice and Wrap Up

Transcript

Meet Dr Yusupov

Saad Alamgir 0:07

All right everyone. Welcome back to another episode of Let's Talk Teeth. Today we have Dr. Steve Yusupov. Dr. Yusopov first and foremost, I just wanna appreciate, you know, you taking the time to come and speak to us, and it means a lot to us and our listeners. But with that being said would you mind just kind of introducing yourself, telling us a little about your background, where you went to dental school, where you went to residency at, and we can kind of just roll from there.

Training Path to OMS

Dr. Steve Yusupov 0:31

Yeah. Yep. Yep. Well, pleasure to do it. thank you guys for reaching out. That was a pleasant surprise. My background I'm originally from a Soviet country. It was Stan. I don't say Russia anymore. But it's a Soviet country. My first language Russian, but I pretty much grew up in New York City. Queens guy spent most of my life. Did, you know, high school, college dental school. So I did NYU for dental and. As you mentioned earlier, you mentioned you wanted to do perio. I actually initially was thinking do perio,

Saad Alamgir 1:04

Really.

Dr. Steve Yusupov 1:05

Kind of very quickly into my second year, I realized that I think I'm more interested in oral surgery and decided to do oral surgery and really traumatized by the private school tuition.

Saad Alamgir 1:19

Yeah.

Dr. Steve Yusupov 1:19

So I ended up in Kings County Hospital, SUNY Downstate dual degree program in Brooklyn. So still New York. Did my six year program there, did my med school there. state tuition, middle of Brooklyn, you know, trauma heavy kind of city hospital resident run program. And we are like county guys always talk about what it is about Kings County that attracts our graduates to fellowships. There's so many Kings County guys that ended up in head, neck and all other, you know, but there's a lot of, guys outta county ended up doing specialties, subspecialties, so I'm

Victor Razi 1:55

Sure.

Oncology Fellowship and Dream Job

Dr. Steve Yusupov 1:56

maybe it's that exposure to a lot of surgery from a trauma perspective, but not really a lot of elective stuff. So I, I felt like I needed to do more. So got very interested in oncology and oncologic surgery and, trying to stay in New York for my entire training. I just, you know, we have no oral surgery fellowships in New York City, so I ended up

Victor Razi 2:21

Oh wow.

Perio vs OMS Decision

Dr. Steve Yusupov 2:22

super, super lucky and getting into a program under an ENT surgeon. So I did my, I had neck oncologic fellowship at New York Head Neck Institute, which was based at Northwell Lennox Hill Hospital at the time. And it was an amazing year. Learned a lot, did full gamut. Basic skull surgery, full scope, head, neck, endocrine, thyroid. And once I was done with training, I got probably my first dream job. I ended up associate with this guy David Hoffman, who was my mentor. Was neural surgeon that did subspecialty work. He was a cleft and craniofacial trained, very heavy TMJ practice. Funny things that my co-interns where I, when I started my residency, ended up doing a single degree, no fellowship. So she was about three years ahead of me in practice. She was already working at the practice. So my first job was essentially a dream job. It was a practice gig that was physically based in the hospital. So we were in hospital disease, we shared, you know, space with everybody at the hospital. I could walk down a flight of stairs, be in the operating room did a ton of surgery, essentially extended scope, you know, I did trauma ton of cancer major cancer stuff, working alongside, you know, a friend of mine and a mentor of mine. So it was like a perfect setup. So that's kind of my background of training and,

Saad Alamgir 3:56

sweet. So kind of going back just a touch, you mentioned your, you know, between perio and oral surgery during dental school. What was kind of that motivating or pushing factor to you wanting to end up deciding to do, OMS and on top of that and wanting to do a six year OMS over a four year?

Dr. Steve Yusupov 4:16

Yeah, so I guess stuff is what attracted me. I'm guessing sur surgery was what I found interesting. And period guys at NYU at least were cool. So I was like, you know, I could hang out with these guys and I went to clinic, I saw what they do, implants, you know, some bone grafts. I thought that was interesting and that's what I thought I wanted to do until I saw what oral surgery had to offer. You know, you go to oral surgery clinic. At the time, perio had a newer clinic. Oral surgery was the older facility. It was kind of cooler to be in the new spot. I was kind of, yeah, leaning towards per, until I saw the hospital end of things. NYU at the time was one of the fewer places. Now it's, you know, everybody's catching up. But it was one of the fewer places that did oncology and did major neck stuff. So one of the few first few surgeries I saw. Where head neck cases and just, you know, having, you know, like a neck dissection. All the anatomy you learn in dental school and,

Saad Alamgir 5:16

Yeah.

Dr. Steve Yusupov 5:16

was for you guys for me when we took, you know, the neck section in anatomy, I think it was like first year in dental

Saad Alamgir 5:22

Mm-hmm.

Dr. Steve Yusupov 5:23

super cool and super intense and like all these things that you have to talk about and point with your finger. You know, when I saw a real negative dissect, it was like, Hey, you gotta do this on the living person. And you know, the blood in there, you know, and the big blue and the big red going to somebody's brain and you gotta make sure you don't like in like, that was just like super fascinating. And that was just like the, you know, the moment, you know, once like it clicks, you are like, this is it, this is what I wanna do. And after that's it. It was just no way. No going back. Right.

Saad Alamgir 5:53

Yeah.

Dr. Steve Yusupov 5:54

I, in terms of six versus four, I was, I applied to both and there was some four year programs that I ran higher. Ended up matching to a six year spot, which is probably for the better.

Saad Alamgir 6:06

Mm-hmm.

Dr. Steve Yusupov 6:06

But I was truly applying based on like the scope of the program, of the training of over, if it's a six year or a four year, that was

Saad Alamgir 6:15

Yeah.

Dr. Steve Yusupov 6:15

thing.

Victor Razi 6:17

For sure

Dr. Steve Yusupov 6:18

Yeah. But in retrospect,

Victor Razi 6:19

Steve.

Dr. Steve Yusupov 6:20

yeah. Sorry, go ahead.

Why Head and Neck Oncology

Victor Razi 6:22

Yeah, no worries. What I know you brushed on it a little bit, but were you considering other subspecialties or were you pretty confident that on college head and neck was what it is you for sure wanted to do?

Dr. Steve Yusupov 6:33

Yeah, I think I was pretty set on doing head and neck versus

Victor Razi 6:38

Mm-hmm.

Dr. Steve Yusupov 6:39

I don't think. I would've strongly desired to do anything else. I did entertain the idea of doing all the fellowships, mainly of desire to wanna do more surgical training. And

Victor Razi 6:54

Sure.

Dr. Steve Yusupov 6:55

story was actually I had a couple kids. I was married, you know, I had my first daughter when I was graduating dental school. by the time I was finishing residency, I had two kids and it was just, I felt like not very fair to my family to like relocate them. You know, the discussion I'll be having with my mentors. It's like, yeah, if you do head, neck, it's cool. You probably taking a pay cut. It's not, you know, so a approaching

Victor Razi 7:20

Sure.

Dr. Steve Yusupov 7:21

that perspective. Am I making things better for my family or am I being selfish wanting to train in

Victor Razi 7:27

Sure.

Dr. Steve Yusupov 7:28

kind of being less selfish. I didn't wanna remove my family outside of New York and,

Victor Razi 7:36

Right,

Dr. Steve Yusupov 7:37

you know, before I got the ENT spot. I was thinking maybe I'll do a fellowship on a different subspecialty. We had some options in New York to do an orthognatic fellowship at the time, so I kind of gave it a

Victor Razi 7:50

right.

Dr. Steve Yusupov 7:50

did I do truly think extra surgical training is definitely helpful, I never had

Victor Razi 7:56

Sure.

Dr. Steve Yusupov 7:57

strong preference to do it. I really always preferred oncology. That's what, you know, always interested me.

Saad Alamgir 8:03

Yeah.

Leaving Associateship

Victor Razi 8:04

Yeah. Awesome.

Saad Alamgir 8:06

I had a question about, so you mentioned that you know, you kind of got your dream job as an associate with Dr. Hoffman. Are you still in that position now or how is that?

Dr. Steve Yusupov 8:15

no, not really. It was a positive, separation but the distance was a little too much. Same back to the same, you know, families from a

Saad Alamgir 8:25

Yeah.

Dr. Steve Yusupov 8:28

And I spent four years there. The commute got progressively worse after pandemic. People started taking less public transportation, I'm guessing.

Saad Alamgir 8:36

Mm-hmm.

Dr. Steve Yusupov 8:36

And my commute became like, you know, two hours. And it

Saad Alamgir 8:39

No way.

Building a De Novo Practice

Dr. Steve Yusupov 8:40

difficult. at some point I just had to say, you know, I, I can't do that anymore. So after four years, I basically started my own practice, a startup. At the time, it seemed like almost impossible to reach that level of, you know, we had amazing staff. We had amazing facility. Dr. Hoffman always took pride in the way his office was built. there are several surgeons you'll go in, even clinics in training. You'll go in and it looks like a dental facility. His office was built like an OR,

Saad Alamgir 9:16

Oh wow.

Dr. Steve Yusupov 9:16

his practice. I was thinking to myself, I don't think I could ever re rebuild something like this. And I did it. I

Saad Alamgir 9:26

That's awesome.

Dr. Steve Yusupov 9:27

but I did it. I built an office. It was initially three. Three surgical rooms. Started in a very competitive market on Long Island. There hasn't been a startup oral surgery practice in, you know, decades probably before me.

Saad Alamgir 9:40

Yeah.

Dr. Steve Yusupov 9:41

practices are generational and I just came here thinking, Hey, what the hell a dream facility from scratch? Build it the same way Dr. Hoffman had it in Staten Island. Or style, you know, operat room table, everything centralized. And picked it up. Now I have an associate, we doubled our space. We added three additional surgery rooms, so office kind of doubled in four years. It's been four years since I started and thank God doing same thing. You know, my big fear the associateship was that I won't be able to do full scope surgery and remain in prime practice.

Saad Alamgir 10:19

Yeah.

Dr. Steve Yusupov 10:20

That's kind of the thing you hear a lot. In training that are you gonna be academic surgeon or are you gonna be a private practice surgeon?

Saad Alamgir 10:27

Mm-hmm.

Dr. Steve Yusupov 10:28

a lot of times the

Victor Razi 10:29

Right.

Dr. Steve Yusupov 10:29

is academic surgeons will be doing the or big stuff, and the private practice guys will be doing dental al viola

Saad Alamgir 10:36

Mm-hmm.

Dr. Steve Yusupov 10:36

it's kind of set stone. That's what people do. I like to pride myself that I kind of broke the barrier a little bit. And there are,

Victor Razi 10:44

Yeah.

Dr. Steve Yusupov 10:45

as many, but there are guys like this. I'm a private practice. I don't work for any hospitals and I do full scope. Oral surgery and I continued to do it. I was doing a little bit of higher volume when I was an associate because I took, I was younger and less busy

Saad Alamgir 11:02

Yeah.

Dr. Steve Yusupov 11:03

in the private, in the office. So I took trauma call and did everything else. Now I cut trauma out, so my overall case numbers went down a little bit. I don't take trauma call anymore. I think it's for the younger folk. And my pretty much caseload now is orthognathic some TMJ major stuff. Pretty much only just like total joints and oncology stuff. Both mal and benign

Saad Alamgir 11:30

Yeah.

Dr. Steve Yusupov 11:31

Yeah. So that's pretty much

Saad Alamgir 11:32

Yeah.

Victor Razi 11:33

Yeah,

Saad Alamgir 11:34

first I wanna

Victor Razi 11:35

Steve.

Saad Alamgir 11:35

that's very incredible for you to have started a de novo practice in Long Island doing full scope oral surgery. Like, don't think people really understand the significance of that, but that is. Really impressive that you're able to start that and have, you know, success that you had. You know, in four years you've already had an Associate Double Joe's office space. Like, I just wanna say that's, that is really incredible. So kudos to you.

Dr. Steve Yusupov 12:02

Thank you, and thank you. I mean, it's definitely

Victor Razi 12:04

For sure.

Dr. Steve Yusupov 12:05

but, and a component of luck of something from above, you know,

Saad Alamgir 12:09

Yeah, a hundred percent.

Victor Razi 12:10

Yeah.

Dr. Steve Yusupov 12:12

I like

Victor Razi 12:12

Yeah. Yeah.

Dr. Steve Yusupov 12:13

you know.

Full Scope and Full Arch

Saad Alamgir 12:14

Yeah.

Victor Razi 12:16

You're, so are you doing any dental alveolar too, or are you mainly just doing what you

Dr. Steve Yusupov 12:21

full scope. I do everything from wisdom teeth, single tooth extractions. And, you know, my involvement with Orca, obviously a lot of full arch. If somebody told me I was in training, especially like when I was, you know, a full year on general surgery away from dentistry or full year on

Victor Razi 12:39

sure.

Dr. Steve Yusupov 12:40

under ENT, somebody told me the amount of prosthetics that I, you know, that I'm doing these days. I'll probably laugh back then.

Saad Alamgir 12:48

Yeah.

Dr. Steve Yusupov 12:49

But it led me, you know, just kind of, you know. I got here, I don't know how, into the full arch world and I do it from A to Z we could probably

Victor Razi 13:01

Yeah,

Dr. Steve Yusupov 13:01

podcast on the full arch topic alone.

Victor Razi 13:04

Sure.

Dr. Steve Yusupov 13:05

whether you are a GP or perio or neurosurgeon, I think to truly fully master full arch and do it well, you should know both aspects. Surgery and prosthetics. And I think that probably makes a difference from both clinical perspective and business perspective. So I was lucky again with the Dr. Hoffman's practice. We had a prosthodontist there who would do all the prosthetics for us, and

Victor Razi 13:33

Sure.

Dr. Steve Yusupov 13:34

I wasn't, I guess, I don't know how to phrase it, lazy or disinterested not to learn from her. And I did learn from her and I picked up all the pro skills. When whatever pertains to full arch, of course, and we pretty much do A to Z in our practice now. up to

Victor Razi 13:51

That's awesome.

Dr. Steve Yusupov 13:52

You know, we obviously refer, we still a referral based practice, so we refer final restorations to the dentist. But I think a big component, big, you know, d clinical difficulty is in temporizing. You know, if you're doing a

Saad Alamgir 14:03

Right.

Dr. Steve Yusupov 14:04

You gotta give them, you know, proper occlusion, proper aesthetics, phonetics. That's

Saad Alamgir 14:09

Yeah.

Dr. Steve Yusupov 14:10

Prosthetic roots

Victor Razi 14:11

For sure.

Dr. Steve Yusupov 14:12

surgery is are surgical. You know, you mentioned you're doing a denture setup. That fundamental knowledge is what you're gonna need,

Saad Alamgir 14:19

Mm-hmm.

Dr. Steve Yusupov 14:19

you know, don't you know, I remember my denture class time I do F large, you know, those fundamental

Saad Alamgir 14:28

bad memories right there.

Dr. Steve Yusupov 14:29

skills. It.

Saad Alamgir 14:33

Yeah, man that's

Victor Razi 14:35

That's awesome.

Saad Alamgir 14:36

You know, knowing that. You know, the fundamental things that we're doing in dental school still has, you know, application even at the, much the highest level there is to, you know, pros things like that.

Dr. Steve Yusupov 14:53

I mean, we tend to separate things right into specialties, and we think of prosthodontists doing this and oral surgeons as doing that. But in reality, if you think about it, you know, as an oral surgeon, you know you're doing orthognatic surgery, you know, and you have somebody's maxilla in every dimension, right? How's that different than a prosthodontist setting a set of teeth for a maxillary denture?

Saad Alamgir 15:18

Mm-hmm.

Victor Razi 15:19

Sure.

Dr. Steve Yusupov 15:19

it's very similar, or, you know, now take a full arch into account. So as dentists, we'll need that background. You know, dental knowledge of occlusion and aesthetics and phonetics and just function of maxillofacial region. What then distinguishes us is prosthodontists have their fancy ways of, you know, taking impressions. Surgeons have their fancy ways of sewing somebody's maxilla, but ultimately the concepts are very similar. The basics are all kind of taught now where you guys, you know, in dental school

Saad Alamgir 15:47

Mm-hmm.

Victor Razi 15:49

for sure.

Dr. Steve Yusupov 15:49

roots are there.

Advice for Residents

Victor Razi 15:52

Right. Hey Steve I wanna backtrack a little bit'cause I think a good thing that you brought up that I think would be good advice for some residents that are listening to our podcast. So it sounds like what you do is relatively original, you know, I feel like most oral surgeons graduate and they either do dental alveolar or they're working in the hospital. So with your unique circumstance what advice would you give to residents that. Kind of in the mindset of, I don't know if I wanna do just inta alveolar. I really do like the hospital work. You know, what you did is pretty unique. So do you have any advice on to residents that are listening on how they can better navigate that? You know, is doing full scope really that possible, or are you really busting your ass to really make it work?

Dr. Steve Yusupov 16:42

So very cliche answer I'm gonna give you, you probably heard this, but follow your passion is the answer. And

Victor Razi 16:50

Yeah.

Dr. Steve Yusupov 16:51

had this in the back of my mind all throughout my training. I remember talking to oral surgery residents when I was a dental student. And I was asking the same question, and then in residency I was asking the same question. Hey, is it possible to do all this? Is it possible to continue operating, you know, all these cool things we do in residency? Is it possible to do in private practice? You know? Yeah, everybody said the same thing. So we tend to kind of keep things where they are. Human nature is not to make a lot of change. So a lot of people

Victor Razi 17:27

Right.

Dr. Steve Yusupov 17:28

and they kind of just follow how things have been done.

Saad Alamgir 17:31

Mm-hmm.

Dr. Steve Yusupov 17:31

I'm always the

Victor Razi 17:32

Sure.

Dr. Steve Yusupov 17:32

questions. I'm always doing one to challenge things. And I, you know, said to myself, why does it have to be this way? I wanna be private practice, I wanna be independent. I don't wanna depend on, you know, hospital bureaucracy. I want to have freedom of buying my own instruments and, you know, buying my to toys and tools, whatever I want, and be private practice at the same time. Do the cases that I want. I think it's possible. And here, you know, here's an example of my practice. I'm doing it. Is, am I

Victor Razi 18:02

Sure.

Dr. Steve Yusupov 18:03

Am I struggling? Absolutely not. Obviously I

Victor Razi 18:06

Right.

Dr. Steve Yusupov 18:07

to train. I speak to, you know, I have rotators all the time. I have dental students, residents, college students rotate to the office very frequently. And, you know, I get this question all the time. Is this possible? Do I need to do fellowship? I mean, if you're gonna invest time you better like use it, right? If you're going

Saad Alamgir 18:27

Yeah.

Dr. Steve Yusupov 18:28

time getting the extra training, the subspecialty training, and then you're gonna go and private practice and not use it. I think that's such a waste. So

Victor Razi 18:36

I agree.

Dr. Steve Yusupov 18:38

thought that way. I said, you know, this is my passion. This is what I want, and I kind of chased it. Did I suffer along the way? No. Was there a big component of luck? Maybe, but again, like since my associateship. To my, you know, startup practice. I did it in two different places, and I think it's definitely feasible. I have colleagues across the country who do this, and I think it's definitely feasible. I truly think it's just the old mentality of, you know, that's what somebody else did, and now that's what you gotta do. I think if you challenge it and change it, it's totally doable.

Victor Razi 19:13

Yeah,

Saad Alamgir 19:14

Sense.

Victor Razi 19:14

huge.

Saad Alamgir 19:14

But Speaking of your practice, you know, you know, building it up and associateships and all that, I was curious, you know, especially with you being a de novo, you know, referral clinic. How does, how did that work? You know, just. Because, you know, there's a lot of dentists who have had a referral for, you know, X amount of years and, you know, you're the new kid on the block. How was it first, you know, marketing to dentists to refer to you for some of these cases as well as just, marketing to some patients who, you know, might come to you directly when it comes to, maybe they see a ad for, you know, a full arch or something like that. How is the growing pains, I guess, essentially of a new clinic?

Dr. Steve Yusupov 19:57

It's a great question. I actually had this discussion with I call him my partner. He's not my business partner, but surgically he's my partner. I had this discussion with my partner, you know, today actually. to quote a little part of the conversation,

Victor Razi 20:12

Thank.

Dr. Steve Yusupov 20:12

We're saying how we gotta show our referring dentist school that we better than average that. The stuff that we do, you know, differentiates us. And, you know, it's not coming from like a pompous place. We just, you know, truly think we could deliver, that kind of care. And the line was, well, that's only 50% of it. That's only, you know, being able to do something better than somebody else is only 50%. The problem, the rest. The rest of it is how do you market, how do you convey that? How do you know, teach that to the referring?

Saad Alamgir 20:51

Yeah.

Dr. Steve Yusupov 20:52

And that's the challenge. That's the challenge. And I think, you know, just scaling back, going, you know, to the original roots of classic oral surgery we're, at the end of the day, a referral based practice and knocking on doors, being available, offering your services

Victor Razi 21:08

Sure.

Dr. Steve Yusupov 21:09

where it starts. And that's what I did, and that's what my partner's doing, and that's what works for the most part. Visiting dentists, creating

Victor Razi 21:17

Sure.

Dr. Steve Yusupov 21:18

and reinforcing that by delivering excellent patient care. And not only, you know, sometimes our patients don't even know how good or bad the care you provided to them, like the actual you did on them is, so in addition, you want to give them. A quality experience, right? You want this, in today's day and age, people want that hospital hospitality like experience. So, you know, that's what you

Victor Razi 21:44

For sure.

Why Full Arch Is a Unicorn

Dr. Steve Yusupov 21:45

So, you know, combination of those things, you know, people start finding out and referring to you and next thing you know, your practice is growing, but what I practice is a little bit of a unicorn. another example. I was talking to somebody who attended a full arch conference recently and they said, you know what? I was so surprised. The person tells me that I'm so surprised. There were only few oral surgeons at the conference, and this was a full large surgical conference. And I said, you know what? That's the truth. Oral surgeons in this country don't do full arch. If you ask most oral

Victor Razi 22:24

All right.

Dr. Steve Yusupov 22:24

they will say, I do it, but they don't truly do it. I define, implants in somebody's jaw is not doing forge. And again, I'm not saying it in a

Victor Razi 22:33

All.

Dr. Steve Yusupov 22:34

way, not that oral surgeons can't, most oral surgeons could do it. They want it to, but most oral surgeons don't do it. So what I, you know, back to what I was saying originally, we are a little bit of a unicorn of a practice is because we do full arch the way, I mean that we do full arch. One

Victor Razi 22:50

Right.

Dr. Steve Yusupov 22:50

do full arch at volume. we're currently doing 100 arches a year. Two is, we're independently doing it without need of a prosthodontist. And, you know, that one line, you could have a, you know, just a huge discussion on that. having a restorative dentist or Prosta as part of the team, it's important, but a lot of times it limits you. What I'm ultimately getting to is having full large, as part of my scope, or forces us to market to the public. So we are a referral based practice. We market to dentists, but at the same time we have very heavy campaigns marketing to the public.

Saad Alamgir 23:32

Right.

Dr. Steve Yusupov 23:32

So full large patients come to us from the street to very give you like a very cliff notes kind of summary of full large patients mentality. that comes from

Victor Razi 23:43

Sure.

Dr. Steve Yusupov 23:44

and their research.

Saad Alamgir 23:46

Mm-hmm.

Dr. Steve Yusupov 24:05

if they were treated by a dentist for a while and they feel like they're overwhelmed and they, you know, just can't get the result they want. Dentists that did all this work for them to them's kind of subconscious feeling is that. They're cheating on the dentist and the dentist kind of feels the same sometimes it was somebody else's patient, they'll say, maybe you need full large, but a dentist that has done all that work

Saad Alamgir 24:29

Yeah. Right.

Dr. Steve Yusupov 24:29

bad having done all those root rounds. So what that kind of leads to is full large patients will go around their dentist. You will not most likely get a referral from your dentist. So full large patients will go online start Googling dental implants all on four. So

Victor Razi 24:49

Yeah,

Dr. Steve Yusupov 24:50

of the field that those patients come from direct to consumer marketing. that was a big component of my growth in my practice that, you know, since day one with the direct to consumer marketing for full large, I'm a referral based practice, we would do the surgery, temporized them, and that was now my secondary way of creating relationships. I would at that point, refer a patient for final restoration.

Saad Alamgir 25:16

Yeah.

Dr. Steve Yusupov 25:17

of the

Victor Razi 25:17

Sure.

Dr. Steve Yusupov 25:19

and the challenge was that a lot of dentists don't how to restore full large. You know, prosthetics is scary. You guys are probably dealing with this now. You know, they'll tell you something like this needs to be like postgraduate level. most dentists heard that in they're dental schools and now they're afraid to do cases like this.

Saad Alamgir 25:37

Yeah.

Victor Razi 25:38

so true though.

Dr. Steve Yusupov 25:38

today's day and age technology with digital workflow with photogrammetry, anybody could do it. You know,

Saad Alamgir 25:45

Mm-hmm.

Dr. Steve Yusupov 25:46

the rules of prosthetic world. You know, you learn how to do things it's not

Victor Razi 25:51

Sure.

Dr. Steve Yusupov 25:51

You really don't need to be a prosthetist to know how to do it. If you know your denture lecture in and out, you should be able to do full arch, you know, if you know basics of

Saad Alamgir 26:01

Good deal.

Dr. Steve Yusupov 26:02

You know, to removal. Back to removal, man, that's where the concept come from, and

Victor Razi 26:08

Yeah,

Dr. Steve Yusupov 26:09

former world of dentistry, when you had to index, implant and take these fancy impressions, you really needed cross residency to learn that. You know, now

Victor Razi 26:18

sure.

Dr. Steve Yusupov 26:19

with fancy computer gadgets, you know, you really just need to know that. dental knowledge of occlusion and function and aesthetics and all those things like taking impressions and doing indexing, multiple implants within maxilla. You don't need that anymore. You know, it's cool to know it. You know, I've kind of graduated from conventional and you know, indexing implants and converting dentures to guided now digital workflow. With digital workflow. That's probably what you guys are gonna be doing once you're in practice. It's really, it became seamless. You know, we could deliver, you know, a set of teeth on the same day and not even own PVS or alginate in the office. Like I don't even have it in the building, you know, and we do all the time. So the digital technology really allows us to do this.

Saad Alamgir 27:10

Yeah.

Victor Razi 27:11

Yeah,

Dr. Steve Yusupov 27:11

kind of like

Victor Razi 27:12

that's all.

Dr. Steve Yusupov 27:13

of, you know, going from like the cancer stuff and

Victor Razi 27:15

Yeah.

Dr. Steve Yusupov 27:16

you know, to dentistry

Victor Razi 27:17

Yeah.

Dr. Steve Yusupov 27:18

you know, kind of, it's a, it's an interesting kind of dichotomy within my practice.

Pathology Referrals and Competition

Victor Razi 27:24

Yeah, man. You have eggs in every basket. It seems like having the startups, the business side, I'm sure wheels are turning there. And then full arch side, and then you have your path side that you deal with and all these variables you know, not to stay on the topic of referrals, but is your pathology mainly coming through dentist as well for referrals or? Is that more so hospital?

Dr. Steve Yusupov 27:50

Coming from dentists I mean, of my pathology probably at the same volume as any other oral surgery practice. Reality

Victor Razi 28:00

Sure.

Dr. Steve Yusupov 28:00

as friendly as I am with all of my oral surgery, you know, neighbors. I don't get much referrals from my oral surgery colleagues. Not sure,

Victor Razi 28:11

Really.

Dr. Steve Yusupov 28:12

we could have a. A brief chat on topic of competition. I'm a believer in healthy competition, but I think

Victor Razi 28:20

Yeah

Dr. Steve Yusupov 28:21

maybe out of fear of competition, my oral surgery colleagues don't refer pathology to me. most of my pathology comes from dentists. I imagine my pathology flows probably the same as any other oral surgery practice. only difference

Victor Razi 28:35

sure.

Dr. Steve Yusupov 28:35

oral surgery practices, once they biopsy something that actually needs, you know, Care or major resection and free flap reconstruction, they would refer at that point. I tend to do it myself. On topical, the

Victor Razi 28:50

sure.

Dr. Steve Yusupov 28:50

that I mentioned I'm a believer that there's enough for everyone. I am also very

Victor Razi 28:55

Me too.

Dr. Steve Yusupov 28:56

You know, my, my next door oral surgeon, neighbor could call me and I'll tell'em which marketing company I'm using and who's filming my content. And,

Victor Razi 29:04

Yeah,

Dr. Steve Yusupov 29:05

you know, you know, and it happens all the time. You know,

Victor Razi 29:08

sure.

Dr. Steve Yusupov 29:09

come and watch me do Zigas and tes and I'll show my prosthetic workflow. I'm not a believer that. You know, you need to compete by not showing someone the, your things or, you know, low blowing your colleague.

Victor Razi 29:21

Yeah.

Dr. Steve Yusupov 29:21

At the end of the day, we're all colleagues. There's enough work for everyone. The way we compete is providing, like above and beyond care to the patient so that we win the competition by patients wanting to come to us and then it's wanting to refer to us.

Victor Razi 29:35

For sure.

Dr. Steve Yusupov 29:36

reality is I'm not getting much referrals from my oral surgery colleagues. Most of my oral surgery pathology referrals come from dentists.

Saad Alamgir 29:44

Yeah,

Victor Razi 29:45

Yeah. That's interesting. I feel like that's not a. A topic that really gets brought up enough. You know, everybody talks about GP referrals and things like that, but, you know, at least in, in our world, and we'll have the people we've got on the specialty to specialty referral is an interesting field it seems, you know.

Dr. Steve Yusupov 30:05

Hey, it is I mean. There's enough, you know, to go around, I think, and even pathology, even implants, I mean, more people are after implants, but, there's some competition for pathology too.

Saad Alamgir 30:21

Mm-hmm.

Dr. Steve Yusupov 30:21

again, I don't think anybody's hurting for cases. You know, if anybody is, it's probably transient. They're probably just starting out, or, you know, either starting their practice or start starting their, you know, associates to ship somewhere. think very few people that are truly like, you know, pathologic and just can't have patience. I don't think we'll have that much in, in our field.

Saad Alamgir 30:45

Yeah.

Dr. Steve Yusupov 30:45

people, at least around me here, are pretty normal and get enough cases.

Saad Alamgir 30:51

There's

Victor Razi 30:51

for sure.

Saad Alamgir 30:53

in the population that you're in. Definitely, you know, long.

Dr. Steve Yusupov 31:03

Yes,

Saad Alamgir 31:03

had a, yeah, I had a question about, you know, you seem to be like genuinely like a unicorn when it comes to all this, you know, you're very surgically advanced. You've started a business now, marketing and everything. How was, guess my question is, you know, obviously you've trained, you know, for a number of years on the surgical aspect. How was the business and marketing side of it, was that something that you kind of just picked up as you started a business, or was that something that you had to. You read up on, or, you know, hire like a consultant or, you know, things like that because that's the whole area.'cause in dental school, you know, and obviously through certain residency and everything, you learn how to be the best clinician. And so, you know, you become a very competent clinician. But then you go out in the real world and, you know, as far as, you know, dentist goes, goes, you know, they'll sign. And they don't really understand what they're getting themselves into until it's too late. So how did you, delineate that line and learn but the dentistry and surgery?

Dr. Steve Yusupov 32:08

Yeah. This could be easily its own residency and. you said, we don't learn this in dental school and unfortunately we don't learn this in residency and we don't learn this in fellowship. So I personally learned it in my associateship. I was there on a partnership track, so that was my kind of perspective on things, to be a partner there. And my partners kind of worked with me in a way for me to be a partner. So I was involved. You know, with all those decisions, marketing and of learned on the job it's the same with everything. It's the same with surgical skill and you know, you think you probably know the most, like you guys are gonna be seniors in a few months. You gonna think that you know as much dentistry as you could potentially, that you're at the peak. Fast forward by a few years when you in residency or finishing residency, you'd be like. What the hell, I knew nothing. I was a baby.

Saad Alamgir 33:07

Right.

Dr. Steve Yusupov 33:08

how entire life is. And same thing with business side of things. So when I was an associate, you know, a couple years in, I thought like I know billing and I know codes and like I learn all this stuff and I thought I was a G now in business world and then two

Saad Alamgir 33:23

Yeah.

Dr. Steve Yusupov 33:24

by how I knew nothing. like every day you learn kind of on the job. I think advice for somebody starting out. I think don't open a practice at a training. That's probably the best advice I could give. We all tend to rush, we all tend to reach that final result and be done. You know, be a board certified surgeon or whatever, you know, be the practice owner. But you know, my advice is don't rush. I think once you're done with training. Being an associate is a huge benefit. You're definitely gonna learn a lot and you're gonna learn a lot of business end of things. And marketing is one of them. Billing is the other. you structure your notes, how you document things. You definitely, you definitely need to know it before you open it. Can you open a practice right away? I know people have done it and were successful at it. You're probably gonna lose a lot of money on your own

Saad Alamgir 34:22

Yeah. Right, and that's the thing too. Just learning like that, that's kinda what I was getting at. Like I guess whenever you're starting a business like. You're kind of forced to learn it because if not, you're gonna lose a lot of money really quickly. You know, especially in your situation with, you know, private school, dental tuition, and then school and then having to support a family and all that. Like your back's against the wall essentially. And gotta learn that stuff quick.

Dr. Steve Yusupov 34:52

It's very easy to lose a lot of money. You know the moment you open a P, the moment you graduate and you have a license, you know, attached to you, you got a whole bunch of people calling you. You know, Dr. So and so, you know, we could give you this loan. Take all the money you want.

Victor Razi 35:08

Right,

Dr. Steve Yusupov 35:08

these toys, we'll give you this equipment. You don't have to pay us. Next thing you

Victor Razi 35:12

right.

Dr. Steve Yusupov 35:13

leveraging yourself. You know, you're

Saad Alamgir 35:14

Right.

Dr. Steve Yusupov 35:15

thin. You gotta pay all this money back, and you don't wanna end up in that

Victor Razi 35:19

For sure.

Dr. Steve Yusupov 35:19

Yeah. You wanna kind of plan ahead

Saad Alamgir 35:21

mm-hmm.

Dr. Steve Yusupov 35:22

about what you getting yourself into.

Saad Alamgir 35:24

Yeah.

Practice Growth and Hospital Goals

Victor Razi 35:25

Yeah, for sure. So, Dr. Oh, no worries. Moving forward do you have any goals you have for your practice? No, not necessarily a specific goal, but any general goals moving forward, let's say within the next year or five years on, on how things are or are you. Pretty content, I guess, with kind of how things are operating now.

Dr. Steve Yusupov 35:47

Always up slope. There's always up slope. So, kind of, our immediate. Plans, goals that are already kind of, sort of in motion we have a second office cooking and

Saad Alamgir 35:59

That's awesome.

Dr. Steve Yusupov 36:00

more.

Victor Razi 36:01

Congrats.

Dr. Steve Yusupov 36:01

you. Thank you More. Kind of on the grand scheme of things, the reason, you know, for the second office on the growth, I do wanna grow on the hospital arena a little bit more. And in order for me to do so, I don't wanna step away from the office because. I'm alone, I'm stepping away from the office. The office is not doing anything. So I wanna more people on board you know, get my partner to spend more time at the office so that spend more time operating. not that I personally want to, but as a group, I'm hoping to get back into taking trauma call. I'm hoping for my younger to get on that. And right now we're kind of a little bit, you know, understaffed to do it, I do wanna get back into that, not because I wanna be on primary trauma call, but I would like my group to do that. And then if, you know, my, you know, they have bigger cases need help with, I would, you know, be glad to help'em trauma experience as, as an attending, it was probably more interesting than in training. I mean, not that it wasn't eventful training at Kings County Hospital, but take trauma call for my first, probably five, six years in practice back when I was an associate. And then few years when I owned my own practice, I took a trauma

Victor Razi 37:24

Sure.

Wild Trauma Call Case Study

Dr. Steve Yusupov 37:25

pediatric Level one Trauma center. I mean, it was overall a level one trauma center, but it was also a pediatric level one trauma center. I did some crazy trauma cases that I'm now in retrospect looking at, and I'm like, I don't think I would've ever seen, you know, there was some unique cases that I miss that a little bit. You know, like, so for example, one day, you know, I got called, a 15-year-old kid found unresponsive, or somebody calls an EMS, they find this kid. There's blood around him. There's no external signs of trauma. He's completely unresponsive. EMS brings him to the hospital follow protocol'cause he's not responsive. He meets a certain criteria they intubate him and they don't know what's going on. They have no idea. They scan him from head to toe and they see a bullet in his TMJ and there's no external science. So er does what? ER does. They stabilize the guy, they scan him, they saw a bullet, they call us. So my resident sees the patient, says, you know, like you spoke, we have a gunshot wound. We have no idea how it happened. So, you know, after some investigation and we figured out, so are the odds? He gets shot with a small caliber bullet and the bullet goes right into his nostril leaving

Victor Razi 38:44

my goodness.

Dr. Steve Yusupov 38:45

burn on his a lab. But there's no entrance wound. And the bullet

Victor Razi 38:49

Yeah.

Dr. Steve Yusupov 38:49

through like his sinus, through his maxilla and hits his condyle flowers, the condyle, and gets lodged right in the glenoid fossa. So

Saad Alamgir 39:01

my.

Victor Razi 39:01

Oh my goodness.

Dr. Steve Yusupov 39:02

they manage to intubate this kid if hyper optics. So they pass a camera, like, just like a COVID test, you know,

Victor Razi 39:10

Yeah.

Dr. Steve Yusupov 39:11

they pass a camera through his nose. I don't remember if it was the same side, but. They pass a camera and intubate him, and now they can't extubate him because his mouth doesn't open. So he has this,

Victor Razi 39:23

Yeah.

Dr. Steve Yusupov 39:24

condyle that is just stuck. His mouth won't open. So they call like, Hey, you know, so I'm thinking like, in retrospect, you know, putting my training into the equation, you know, I could manage this guy, you know, so he needs a surgical airway. He needs, you know. It's essentially a baso skull exploration. That's where the bullet is. It's medial to his condyle. You know, if I haven't trained the way I trained, like I probably would not be comfortable treating this case A to Z on my own.

Saad Alamgir 39:53

Right.

Dr. Steve Yusupov 39:54

But this is the kind of stuff, and like, so what we did for him is with traum, because you know, even if I take the bullet out, how quickly is his, you know,

Saad Alamgir 40:04

Mm-hmm.

Dr. Steve Yusupov 40:06

You know, is he extricable? So we get him in the trach. Besides that, you know, we need to take the bullet out so we explore, you know, I explore the area A TMJ approach end up getting the bullet, you know, had my plan BS if I wasn't able to get it through a small preauricular incision. But we fix his condyle and, you know, that involves wiring him shut, putting him in MMF. So more reasons for a trach. So we tricked the guy and you know, now I'm thinking, you know, how, you know, cool of a case was this, you know, and obviously now police is involved and to bring our technology into the mix a little bit, 3D printed models on virtual planning. So we had these 3D printed models police ended up essentially getting from us to, you know, to show the trajectory of the bullet. So,

Victor Razi 40:58

Right.

Dr. Steve Yusupov 40:59

unique cases

Saad Alamgir 40:59

Oh.

Dr. Steve Yusupov 41:00

is. Unique cases like that is what I miss. You know, from, you know, taking a hospital call. Obviously for every case like this, you probably need to do like 20 mandible fractures, you know, I doing, but I don't miss it too much because

Victor Razi 41:15

Yeah.

Dr. Steve Yusupov 41:16

those like on a Saturday or like after your office hours and. It's not something I wanna be doing right now, but, you know, cooler cases like that just described probably what wants me.

Victor Razi 41:27

Yeah,

Dr. Steve Yusupov 41:27

The reason I wanna come back to, you know, trauma call a little bit more.

Victor Razi 41:31

for sure.

Dr. Steve Yusupov 41:32

I'm an associate who are interested in that. I would certainly kind of back'em up and you know, take

Victor Razi 41:37

Yeah,

Dr. Steve Yusupov 41:37

jointly and do cool stuff like that.

Victor Razi 41:41

for sure, brother. What?

Dr. Steve Yusupov 41:43

You know, those are my

Victor Razi 41:44

That's wild.

Dr. Steve Yusupov 41:44

Keep my practice as my playground and things that I initially

Victor Razi 41:48

Yeah.

Dr. Steve Yusupov 41:49

a kid. So

Saad Alamgir 41:50

Yeah,

Dr. Steve Yusupov 41:50

meaning male

Victor Razi 41:51

Yeah,

Saad Alamgir 41:53

man.

Victor Razi 41:54

That's wild. That's pretty similar to slides, that removable case he's working on actually.

Dr. Steve Yusupov 41:59

Listen,

Saad Alamgir 42:00

Man that is.

Dr. Steve Yusupov 42:01

connection. You could always find connection, man. Removable is probably one of the most use useful things you're gonna do now. So don't take it for granted.

Victor Razi 42:09

Yeah.

Dr. Steve Yusupov 42:10

You'll find use for it. It's gonna, it's gonna pay off somehow. to ask a

Victor Razi 42:16

Yeah,

Dr. Steve Yusupov 42:16

behalf. So I gave you my

Victor Razi 42:18

for

DSOs and Dentistry’s Future

Dr. Steve Yusupov 42:19

My goal. another thing that,

Victor Razi 42:21

sure.

Dr. Steve Yusupov 42:22

somebody a few years ahead of you, probably similar, like a new dentist would've asked, and you plan to join like a corporate or a DSO and like a lot of. Young surgeons that, you know, I talked to would ask me that is that, is there a plan? I personally am not ready yet, so I don't think I, I have that on my horizon, but that's a huge, that's a huge field right now that

Saad Alamgir 42:46

Yeah, it is.

Dr. Steve Yusupov 42:48

dentists, specialists, oral surgeons are talking about. not that it's

Victor Razi 42:52

For sure.

Dr. Steve Yusupov 42:53

make it sound like it's a negative thing, but

Saad Alamgir 42:55

Yeah, it's just

Victor Razi 42:56

Yeah.

Saad Alamgir 42:57

it's just, it's getting so corporate, you know, there's, I think

Victor Razi 43:01

Yeah.

Saad Alamgir 43:01

a statistic, I think in the past even five or six years, there's been like 12 new dental schools that have been built and then, you know, a lot of influx of DSOs and, you know, private equity into dentistry. So you wonder about. The future of our you know, and dentistry. It's just, there's a lot of people who aren't dentists who are investing a lot of money and having a lot of extra dentists, which isn't, you know, I'm not saying that's a bad thing by any means. Oral health, you know, should be treated. But at the same time, you know, it's just gonna create a bottleneck effect in our field. So it's a very interesting time in, in dentistry right now, more so than any time that I can remember.

Dr. Steve Yusupov 43:44

Yeah. Are right, but I think we as humans. Just a general generalization, tend to think of change as a little bit scary, so I think it's probably not as bad. So the way I see it, maybe I'm just too optimistic, but I think things are definitely gonna be different. don't think they're gonna be bad. But things are definitely gonna be good for a decade from now. our specialty, our field, everything's just gonna, I don't know how, I don't know where we're gonna land, but things are definitely gonna change. I don't think it's gonna be bad. So I think, you know, you guys should probably, you know, think positive. We'll always gonna be need, you know, for what we do. Whatever it is you're gonna end up doing, you're gonna, you know, probably be very

Victor Razi 44:34

Yeah,

Dr. Steve Yusupov 44:34

and enjoy what you do long as you have passion for it. but it's certainly gonna be different.

Victor Razi 44:39

for sure.

Dr. Steve Yusupov 44:39

SO world is different from what we do. Not necessarily bad, but it may be better for some. So I talk to, you know, young oral surgery residents and you know, this is change in. Generational change. I think, you know, when I was in training, all we talked about with my peers was how we wanted to do the bigger cases and we wanted to do more surgery. And I'm talking to, you know, a student who recently matched oral surgery and he's talking about programs to me and he says, I don't, you know, name's a program and says, I don't wanna go there. All they do is head and neck. They do all this major stuff. I wanna be a dental alveola surgeon. So again, nothing wrong with that. You know, some people, you know, wanna do that kind of stuff, you know, just be, you know, then I'll be all a surgeon. generational change is what I wanna highlight. You know, things change. There's a newer trend with the younger people where they're like, I don't wanna go. Like we talked about it now, you know? And knock on dentist door and deliver cookies and ask for referrals.

Saad Alamgir 45:50

Yeah.

Dr. Steve Yusupov 45:50

come to

Victor Razi 45:51

Right.

Dr. Steve Yusupov 45:52

I wanna take my lunch hour, you know, I wanna make myself a chai latte with protein whatever, and have that for lunch. And I know I wanna go walk my dog at five o'clock. You know, can you have

Victor Razi 46:03

Sure.

Dr. Steve Yusupov 46:03

kind of lifestyle and do what I do? Probably not gonna get far, so maybe SO position for somebody who thinks that way is the way to go. If there's gonna be a whole bunch of people that want. You know, to just come, you know, be a shift worker, put in their hours, probably gonna do excellent dentistry and, you know, place beautiful implants, but they don't wanna worry about a practice. Then DSO world is perfect for them. So there's a role for everything.

Saad Alamgir 46:34

Yeah.

Dr. Steve Yusupov 46:35

for everything. DSO

Victor Razi 46:37

Yeah.

Dr. Steve Yusupov 46:37

think is necessarily thing. It's just not for everyone.

Victor Razi 46:41

Yeah.

Dr. Steve Yusupov 46:43

Right.

Final Advice and Closing Remarks

Victor Razi 46:44

Well, Dr. We, we appreciate all your advice and the talk so far. I'm sure our listeners as well really respect all the things you got going for you, man. Like, it's really cool that you're also very pessimistic about your job and the career of dentistry and oral surgery, just in general, you know, but like, just some people aren't, and I think that the people are, that are more happy, generally are more optimistic. So, kudos to you too for, you know. Treating every challenge like an opportunity and you know, really staying ahead of the game. As we wrap up here do you have any advice for dental students or new residents in general on let's say oral surgery and then just dentistry in general? I.

Dr. Steve Yusupov 47:23

Like I said earlier, very cliche line, but I think it could be more true, man. Just really follow your passion. Do what you really like. And I think you're gonna be happy. Sometimes it's scary to take certain steps towards that, but don't be afraid. Think positive. You know, like when I was graduating dental school, a whole bunch of friends that came with me, you know, it was this big circle that came with me from undergrad. We all kind of came from the same college and when they heard I'm applying and, you know, ranking six year programs, they all look at me like, are you crazy? you outta your mind? And I was thinking to myself, they're probably right. What the hell am I doing? And it was scary. But don't be afraid, you know, to follow your passion. Ultimately, it's gonna pay off, you know, and I don't mean financially, but financial will tag on to other

Saad Alamgir 48:16

Yeah.

Dr. Steve Yusupov 48:17

once you're happy doing what you do, everything else will come.

Saad Alamgir 48:21

Mm-hmm.

Dr. Steve Yusupov 48:21

yeah, don't be afraid. Just follow and do what you like.

Saad Alamgir 48:24

Yeah.

Dr. Steve Yusupov 48:25

at it. And you'll be happier doing it.

Saad Alamgir 48:28

Yeah. Yeah.

Dr. Steve Yusupov 48:49

Well, thank you guys. Thank you for having me. I think what you're doing is great, and I'm sure a lot of people will benefit. From your podcast I've been listening to some of other and you guys

Saad Alamgir 49:00

Yeah.

Dr. Steve Yusupov 49:01

nice lineup.

Saad Alamgir 49:02

Sweet. Well, we appreciate the compliment and yeah, I just wanna iterate what said, man, you're, I mean, it impressive to see the things you've talked about and the things you do, and I'm excited to see the things that you continue. So it,

Dr. Steve Yusupov 49:19

Thank you. Thank you. If you ever in New York, you know, please welcome, stop by the practice.

Saad Alamgir 49:24

yes, sir.

Dr. Steve Yusupov 49:24

shadow, see some cases, you know, don't hesitate to reach out.

Saad Alamgir 49:28

Yeah. Good.

Dr. Steve Yusupov 49:32

Thank you guys. Good times.