Ep. 132: Closing Big Cases with Dr. Artin Barzgar
If you could ask anyone for tips on presenting big cases, Dr. Artin Barzgar would have to be high up on your list of candidates. An MGE Power Program graduate and Senior Seminar Instructor, Dr. Barzgar has been performing implant placements, full-mouth rehabilitations, and full-arch prosthetic cases for over twenty years in his incredibly productive Maryland-based practice. This is a must-listen for all doctors wanting to see more comprehensive cases in their offices!
Links:
Payment Options Sheet – https://mgeonline.com/sample-payment-options-form
The MGE New Patient Workshop – https://www.newpatients.net
The MGE Communication & Sales Seminars – https://mgeonline.com/mge-communication-and-sales-seminars
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Questions From This Episode
What's the very first thing that has to be true before a doctor can genuinely present a large case with real confidence?
The doctor has to be clinically confident they can actually deliver the final result, whether performing it themselves or through an associate, since any private doubt about that delivery quietly undermines the presentation itself. Dr. Barzgar found that even when an associate was clinically capable, if he had any doubts about the quality of their work, he couldn't comfortably present the case to the patient.
Why does Dr. Barzgar use a physical payment option sheet instead of just verbally explaining financing to the patient?
Writing out the full treatment cost and each specific payment option, with the monthly amount for each, in front of the patient turns an overwhelming decision into something closer to a simple multiple choice question, letting them physically check a box rather than verbally commit. It's especially useful for older patients who are already tired from a long appointment and don't need more spoken information layered on top.
What does Dr. Barzgar actually do after asking a patient which payment option they'd prefer?
He stays completely still and silent, without fidgeting or filling the pause, and simply waits, sometimes two or three minutes, for the patient to actually answer. Interrupting that silence, even with a follow-up suggestion, resets the patient's decision-making process instead of letting it finish.
How does Dr. Barzgar handle a patient who says they need to think about it once they've heard the cost?
He goes back through the treatment explanation itself rather than negotiating on price, since hesitation after hearing the cost usually means the patient hasn't fully internalized why they need the treatment, not that the number itself is the real obstacle. He presents it again with a different visual or angle, sometimes focusing specifically on the consequences of not treating it, and has a personal rule of going through the full explanation at least three times before considering a case lost.
What's the single biggest piece of advice Dr. Barzgar gives to a general dentist who wants to start doing and closing larger cases?
Build genuine treatment planning skill first, the ability to look at a full mouth, understand what the patient actually wants, and mentally see the finished result before ever presenting anything, since a confident, coherent treatment plan is what makes everything else, the presentation, the financial conversation, actually possible.
Episode Transcript
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Jeff: For this week's episode, I have the privilege of sitting down with my good friend, MGE Power Program graduate, and one of our senior seminar instructors, Dr. Artin Barzgar. He and his wife and partner, Dr. Desabeh Pakpour, became MGE clients back in 2002, and in short order built two highly successful dental practices. One of the first things I ever heard about Dr. Barzgar, from Dr. Winteregg over 20 years ago, was his clinical excellence and his ability to perform genuinely complex cases, back in the early 2000s, when very few of our clients were doing that kind of work at all. With over 20 years of experience presenting and closing these larger cases, I thought it would be a great topic for this week's episode, specifically, what's actually different about presenting a larger case versus a smaller one, and how to do it successfully. So without further ado, I'd like to introduce you to Dr. Artin Barzgar. How are you doing?
Dr. Barzgar: Good, good, how are you, Jeff?
Jeff: Doing great, and thank you so much for coming on.
Dr. Barzgar: Of course, thank you for having me, I'm excited to be here. It's been a long journey, but it's always good to see you.
Jeff: Great to see you too. Probably the best place to start is your story. How did you get into all of this?
Dr. Barzgar: Sure. I've been an MGE client for 22 years now, I can't believe it. I have two practices, my wife is a dentist alongside me, and early in my career I went through some special implant training, at the same time as Dr. Pakpour, which really triggered my interest in doing implants and full mouth reconstruction. That was back in 1999. At the time, very few GPs were doing that kind of work at all, you'd normally have to go to a specialist. It was almost like a full year of residency-style training for general dentists specifically, and it really brought my skill level up. I'd always had a real interest in surgery, so it gave me the confidence to actually pursue it.
Dr. Barzgar: My very first case out of that training was actually a full roundhouse case, which most people wouldn't attempt starting out. It was around a $40,000 case at the time, which even now is still a meaningful size.
Jeff: What would that even be adjusted for inflation.
Dr. Barzgar: Exactly. This was before all-on-four existed as a concept, so it was individual implants, about ten of them on one arch, followed by the crown and bridge work. The patient loved the result. She weighed maybe 90 pounds when she first came in, she couldn't eat properly and couldn't wear dentures because she gagged. After treatment, she gained about 40 pounds. She was so happy, our whole staff and my wife adored her. She passed away a few years later from an unrelated illness, but we'd genuinely changed her life in the meantime.
Dr. Barzgar: That became the trigger for me with larger cases ever since, the sense that I'm going to change this person's life. That's genuinely the driving force, because it takes real effort to get to know a patient and understand what they actually want and need. Once you genuinely care about that patient, you can work through whatever obstacles come up, because you want to help them.
Jeff: What eventually brought you to MGE?
Dr. Barzgar: Interestingly, that patient was actually my first case after coming to MGE. Before that, I had the clinical skill, but I genuinely couldn't close a case like that, I didn't know how to get a patient to actually accept and pay for that level of treatment. Just a few weeks after my initial MGE training, I met her, and for the first time I was able to really communicate with her and get her to want the treatment and follow through on paying for it.
Jeff: So that's usually the real barrier with big cases, not the clinical skill, but getting the patient to actually be able to afford it.
Dr. Barzgar: Exactly. She happened to be fairly affluent, so financing wasn't really a factor for her, we have a lot more financing options today than we did back in 1999. CareCredit existed, but their limits back then were maybe $20,000 to $30,000, nothing close to what's available now, which genuinely helps more patients accept larger treatment plans today.
Jeff: So you'd done all this advanced training and were ready to place these cases. Before you actually became an MGE client, were you the one presenting these cases to patients yourself?
Dr. Barzgar: No, I wasn't. I'd bought an existing practice, and the receptionist and office manager who came with it were actually MGE trained already, from the previous doctor, so they were the ones handling presentations. I had no MGE training myself at that point.
Jeff: So what finally led you to actually reach out to us? I think you spoke with Greg Winteregg initially.
Dr. Barzgar: What happened was, my wife was pregnant, and I'd bought this practice that just wasn't doing well. We knew how to do dentistry, but we had no idea how to actually manage a business. You buy a practice thinking you'll put your sign up and people will come because you're a great dentist, and that's simply not how it works. I was only open four days a week at the practice, so I took a Friday job working for another dentist just to bring in some income. One day he pulled me aside and asked how my office was actually doing. I gave the normal answer, fine, and he pushed back directly, telling me he knew it wasn't fine, since otherwise I wouldn't be moonlighting for him with a pregnant wife at home.
Dr. Barzgar: I told him he was right, things weren't going well at all. He said that was exactly why he wanted to refer me somewhere, and that once I went, he knew I wouldn't be working for him anymore. He gave me a number to call, and told me to go see for myself and decide. So I called MGE, and my wife and I attended a New Patient Workshop together. I was genuinely blown away. I remember thinking, how did I not know about this? I'm an educated person, I've traveled, I read constantly, and I'd never encountered any of it. It made complete sense, almost like common sense laid out clearly. I was honestly a little frustrated with Greg for not having told me about it sooner, that's how excited I was to finally have this information.
Dr. Barzgar: I knew immediately that was exactly what I needed, since I had no idea how to handle that side of the practice. That's genuinely the gap in dental school, we get zero business training. We're trained to focus entirely on the clinical and technical side, and even when practices get bought or sold, everyone focuses on production, never on what the practice is actually collecting or making. Coming to MGE was the moment I realized this is a business, and I had to actually learn the business side of it. It was life changing, because that's exactly what I was missing. Whenever I lecture at MGE now, I make a point of telling younger doctors that this is usually what's missing for them too, not their clinical skill. We're all perfectionists, most dentists are genuine go-getters, so when things aren't going well, it drives us to search everywhere for the answer. But the problem is you're only working with half the picture, the clinical half. Once you get the business half too, your clinical skill can finally speak for itself, because you actually know how to run the practice around it. It's been an extremely successful journey for me, and I'm genuinely grateful, including for the friendships it's brought, like this one.
Jeff: This is great. So let's actually get into larger cases specifically. What are the major differences between presenting a couple of crowns versus a genuinely large, multi-unit case, an all-on-four, a full occlusal rebuild, something like that?
Dr. Barzgar: I think it comes down to a couple of things. First, your own willingness to actually take on the big case, which requires both training and real confidence. It's genuinely hard to get someone to accept treatment if they don't feel you can deliver it, or, more importantly, if you yourself don't fully believe you can deliver it. You have to reach a point where you're personally confident you can take this patient all the way to the final result, comfortably, and get them fully healthy. For me, it's always about picturing the final product first, and then working backward from there.
Dr. Barzgar: I learned this the hard way over the years. I've had associates over time where I had some private doubt about whether they could fully execute a certain part of the case. Even if they technically could, if they weren't quite at the level I wanted, I noticed I genuinely couldn't present that case comfortably to the patient, because in the back of my mind, I had doubts about the delivery. That's the real foundation, knowing with confidence that the case can actually be delivered, whether that's you or your associate doing the clinical work. Once that's solid, everything else, the actual presentation, becomes considerably easier, because you genuinely know what you're doing.
Dr. Barzgar: Once you have that foundation, the next step is making the patient feel comfortable, which is directly tied to your own confidence. If you're comfortable with it, that comes across naturally. Patients can sense that confidence, and in large cases specifically, that matters enormously, they need to feel that you genuinely know what you're talking about. That doesn't mean talking yourself up, it comes through in how you handle them and communicate, almost like you exude certainty. That's what gets a patient to actually accept the case, in a lot of ways, before the financial conversation even starts.
Jeff: You actually touched on something during your lecture this morning that I thought was fascinating, building value. You used an example with a pen, telling the room it cost $10,000.
Dr. Barzgar: Right, that's a great example of exactly this. I told the room a specific pen cost $10,000, and everyone looked at me like I was crazy, until one woman actually said she wanted it. So I explained the pen was made of platinum with a sapphire on top, and if you pressed the sapphire, any country in the world would roll out the red carpet for you. At that point, about ten people raised their hands. Then I added that you'd also receive a million dollars when you left the country, and nearly everyone wanted in.
Dr. Barzgar: That's the whole point, value. When you tell a patient a treatment plan costs a certain amount without building that value first, there's a real disconnect, they expected $5,000 and suddenly it's $30,000, and it feels like it makes no sense. But there's genuine value behind dental work, real value to a patient's health, their confidence, their smile, how they eat three times a day, the impact on their digestive health, their overall longevity. If you don't communicate that, the patient just hears, I'm paying this much for teeth, and it doesn't add up to them. But they're not just getting teeth, they're getting your expertise, your time, your care, and the confidence that comes with not having to take their teeth out and put them in a cup at night. Once you help them genuinely understand all of that, they become far more willing to move forward.
Jeff: That connects directly to the story you opened with, the patient who gained 40 or 50 pounds after going from 90 pounds. If more doctors really looked at cases like that, not just the cosmetic result, but the actual health and quality of life impact, I think it would genuinely build their own sense of value in what they do.
Dr. Barzgar: That's completely true. Dentists are perfectionists, and when one case doesn't go perfectly, we beat ourselves up over it, even though we have countless cases that go beautifully and genuinely change someone's life. That's what we need to focus on. It builds real value in your own mind too, recognizing that we're not just fixing teeth, there's a whole person connected to those teeth, with feelings, concerns, a family. You're affecting all of that. It's genuinely a remarkable profession, and I'm grateful to be in it. I've wanted to do this since I was four years old.
Jeff: That's great.
Dr. Barzgar: It really is something I enjoy. And honestly, the part of doing larger cases I enjoy most isn't just the clinical work itself, it's getting a patient through to genuinely accepting and paying for that treatment. That's the harder part for them, and those are the patients who, years later, come back into the office just to hug me, because I changed their life. If I hadn't persisted with them that first day, none of it would have happened. Those moments make all the difficulty of this profession genuinely worth it.
Jeff: So mechanically speaking, presenting a small case versus a large one, I'd imagine more time is the obvious difference.
Dr. Barzgar: Definitely more time. I actually allot generous time for every new patient, since I assume going in that it could turn into a big case, if you build for it, it tends to show up. Most of my patients are older, they've raised their kids, put them through college, and now they're ready to invest in themselves. Beyond time for diagnosis, the extra time mostly goes toward handling cost-related objections, and often genuine fear, fear of the dentist, fear of having work done. We've gotten very good at handling fearful patients specifically, since they often won't go anywhere else. Taking the time to work through that turns them into genuinely great long-term patients, because they come to feel comfortable in the office and with me specifically, and the fear fades.
Dr. Barzgar: So really, it comes down to talking to the person, not just the teeth. You have to slow down, observe, and understand why this patient let things get to this point, why did they wait so long? That requires a real, open conversation rather than a purely clinical one. Once a patient genuinely opens up to you, you can actually address what's going on. If they don't open up, all you'll hear is, let me think about it.
Jeff: So walking through your actual schedule, how much time do you set aside for diagnosis versus the consultation itself, say for a full arch or all-on-X case?
Dr. Barzgar: About an hour for the consultation. My office is only open three days a week, I do surgeries on Mondays, and see new patients exclusively on Tuesdays and Wednesdays, so I can give them my full, undivided attention without worrying about someone else waiting on me mid-procedure. My associate handles production on all three days. My front desk and treatment coordinator can present smaller cases in the meantime if I'm tied up with a larger one, so the schedule doesn't back up if I run long. Typically it's about half an hour for the exam and an hour for the consultation. Early on, it used to take me two hours or more for the bigger cases, simply because it took longer to work through that open conversation. With experience, I can get there much faster now.
Jeff: When you're actually presenting the treatment plan for a larger case, is your treatment coordinator in the room with you?
Dr. Barzgar: No, not at all. I present the case myself, handle any objections myself, and once the patient is genuinely agreeable to what I've explained, I go over the cost with them directly too.
Jeff: Let's unpack that a bit, since I know people listening are wondering exactly how you pull that off. Starting with objections, what's the most common one you run into?
Dr. Barzgar: The one I dislike most is, I need to talk to my spouse. I generally try to head that off before the patient even comes in. When my front desk is scheduling a new patient, we always ask them to bring along whoever helps them make decisions like this. So often the spouse is already sitting right there in the room. If they're not, and the patient raises it, I usually ask if we can call them right then. Sometimes that works, sometimes they're unavailable. If we can't reach them, I'll ask directly whether they think their spouse would actually object to them taking care of their own teeth, since I know my own wife wouldn't object to me getting necessary care. Usually that opens things back up and we can proceed. Occasionally it genuinely is a dead end, and we simply reschedule.
Jeff: Have you had cases where the spouse actually comes back for a second appointment?
Dr. Barzgar: Yes, plenty of times, though not always. When we do get them back together, we go over the treatment again, but I generally don't get into cost until I know both of them are genuinely able to make that decision together.
Jeff: What about, I want to think about it, do you hear that often?
Dr. Barzgar: Usually that comes right after I've gone over the cost. If they say it before that, it typically means they didn't fully understand the treatment itself yet. Once we've covered cost and they say they need to think about it, I go back through the treatment explanation again, using a different visual or diagram, and lean more into what actually happens if they don't move forward, how an infection could spread, how the bone changes over time, whatever genuinely applies. I keep that second explanation a bit more concise, but usually something clicks for them the second time that didn't land the first time, maybe something they simply didn't fully absorb initially.
Jeff: That's an interesting point, because I remember the first time I suggested that approach to someone, going back over the treatment plan again, and getting a strange look in response. But it makes sense, the same way you might see the same commercial dozens of times before it actually registers, the repetition itself is what builds it into something real.
Dr. Barzgar: Exactly. Going over it again, or showing it from another angle, builds more value each time, and it often wakes something up in the patient that they'd missed before. My personal rule is going over it at least three times before I'd consider a case lost, sometimes more, especially since my patients tend to be older and need a bit more time to fully absorb everything. But I can point to plenty of cases, worth $30,000, $40,000, $50,000 or more, that were only accepted after that second or third pass. If I'd stopped after the first no, I would have lost every one of them.
Jeff: Let's get into the actual financial conversation, since it sounds like things are going well at this point, the patient is showing real interest.
Dr. Barzgar: So I personally go over the finances directly with the patient, not my staff. I already have the treatment plan sheet prepared by my team with the final total, and I use something I call the payment option sheet, which I'm happy to make available as a download.
Jeff: We'll absolutely put that on the episode webpage, thank you for offering that.
Dr. Barzgar: It makes the payment decision genuinely simple for the patient to look at. These are long appointments, and my patients are often older and get tired, there's already a lot of information, sometimes unfamiliar dental terminology, thrown at them. So I try to make the payment decision itself as simple as possible. I write out the full treatment total, then list out each specific payment option with the actual monthly amount for that option, right there on the sheet. It becomes almost like a multiple choice question instead of an open-ended one, and I always say in seminars, nobody wants to take an essay exam if they could take a multiple choice one instead, so why put patients through that. They simply check the box next to whichever option they prefer.
Dr. Barzgar: After going through the sheet, I ask directly which payment option works best for them, and then I say nothing else. I wait. It's genuinely important to stay completely still at that point, don't fidget with your pen, don't shift around, just stay quiet and let them think. They might do all kinds of things while they think, pull at their hair, rest their head in their hand, put their hands in their pockets, don't interrupt any of it. It might take two or three minutes of silence, but you let them work through it. Eventually they'll say something like, I suppose if I have to choose, it'll be the no-interest option, and I'll have them check that box themselves rather than doing it for them.
Dr. Barzgar: Once they've checked it, I have the actual application right there in the room, and I place it in front of them immediately, without switching to some other task first, since it's important not to interrupt that decision-making momentum. I ask them to fill it out right then, and once they're done, I let them know my front desk will process the application and bring them the rest of the paperwork to finalize everything. That's genuinely the whole sequence, beginning to end.
Jeff: That's a great system. It actually connects to something we covered in an episode a few weeks back on closing techniques. There's a common piece of sales advice that whoever speaks first after asking a closing question loses. I've always thought that's a bit oversimplified, but what you're describing is the real, functional version of that. You've asked a specific question, and you're genuinely waiting for their answer, not filling the silence, not fidgeting, not rephrasing the question. That's a meaningfully different, and correct, use of that idea, and it's genuinely rare to see it done this deliberately.
Dr. Barzgar: I appreciate that, and I want to add one more piece, since you brought it up. If I go through the payment options and the patient says they don't want any of them, at that point I go back through the treatment itself again, not the payment sheet. That's an important distinction. We go through the same cycle, waiting them out again, but the treatment explanation needs reinforcing first, since they're clearly still processing something, and you need to help drive that home a bit more.
Jeff: That's exactly the pattern people tend to get wrong, someone objects to the cost, and the instinct is to start negotiating on price, when really you need to go straight back into the treatment conversation instead.
Dr. Barzgar: Exactly right, because the hesitation usually isn't really about the money at all.
Jeff: So to wrap up, if a general dentist wanted to start doing and closing genuinely larger cases, what would you tell them to actually do first?
Dr. Barzgar: First, get your clinical skill level to a point where you're genuinely comfortable performing these procedures, and make sure you're allotting real time on your schedule for it. You also need to work on your presentation skills and your ability to genuinely care for the patient through that process, all of that has to develop together. But probably the most important single skill is treatment planning. You need to know how to properly plan these larger cases, whether it's a full arch restoration on an empty jaw, or, what I find more common and more interesting, reconstructing a mouth that still has some natural teeth by combining implants with existing teeth, which is generally the best approach in my opinion.
Dr. Barzgar: That means being able to plan the full picture, moving teeth with clear aligners if needed, getting the gums into shape, placing implants, handling the cosmetic work, all of it together based on what the patient actually wants and what's genuinely in their mouth. Over time, that becomes second nature, when I examine a new patient now, I can usually already see the final result in my head. But it starts with having the right tools and knowledge and being able to say, this patient wants a cosmetic result, so here's how I'll combine implants, veneers, and gum work to get there. That skill, recognizing the situation and treatment planning accordingly, whether that means extracting and placing implants or building around existing teeth, is really the foundation for everything else that follows.
Jeff: This was genuinely great, thank you so much for coming on.
Dr. Barzgar: Of course, thank you for having me on the podcast. I've listened to your episodes for a while, and now I'm actually on one.
Jeff: I'll put a link to the payment option sheet on the episode webpage, along with a link to the New Patient Workshop, the course you and your wife first attended, and the MGE Communication and Sales Seminars, where Dr. Barzgar is one of our regular speakers, if you'd like to meet him in person. Thank you again so much for being here this week.
Dr. Barzgar: Thank you, this was great.
Jeff: Folks, that's all we have for you this week. If you'd like to learn more about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Have a great week, and we'll see you at the next episode.