Comment by jacquesm | Hacker News Reader

Comment by jacquesm | Hacker News Reader

This story is fictional, I know the real one: the guy described really does exist (and he probably exists in just about every country). He was a dentist that taught himself how to program (domain expertise really counts for something in almost every profession) and built the ultimate dentist software (dogfooding it) in visual basic. He then marketed this software to his colleagues and it spread like wildfire, capturing a very large portion of the market in a surprisingly short time without spending a single cent in marketing, because it was exactly what the dentists needed.

Because our dentist/programmer was a smart fellow (he'd have to be, given that he's active in two different complex fields) he foresaw that selling the software once was a nice proposition, but selling it repeatedly would be even better.

Hence the annual 'maintenance fee', of about 1,000 euros per dentist using his software. Do you know how many dentists there are in nl?

So, instead of going for venture capital this dentist-wannabe-programmer built himself a money printing press that printed more money than he and his extended family will ever be able to spend. At the end of every year the maintenance payments roll in and he's laughing all the way to the bank. This money machine has been printing since the early 90's and does not look like it will stop printing any day soon. And no VC made a single cent on any of that. He's so solidly entrenched that trying to attack his position is a losing proposition.

I like the avc blog, but it would be nice if stories like this were grounded in reality rather than fiction.

I've seen (and supported) some dental software, and you're missing a detail: since your tooth-pulling coder is so solidly entrenched, no development beyond OS updates and imaging interfaces ever takes place. Therefore everyone suffers through mid-90s-era GUIs (and not the cutting edge from that time by any means!) until the dentists are all replaced by robots.

The person I'm talking about was actually quite aggressive about staying with the times and was researching (when I first got to know him) how to embed live video in his application so surgeons could look over his shoulder at the patient prior to transfer to save everybody a (potentially useless) trip. I was very much impressed with this and the current release of that software has very little in common with the software of the mid-90's.

Quite possibly other dentists/programmers figured that they could sleep their way through all this but in that case they more than likely found themselves upstaged by a newcomer that did get with the times.

Perhaps another way if looking at it is that he was replaced, multiple times, by his next version of his software.

Perhaps that is the real lesson of DentalSoft and Dent.io and dental.com - disrupt yourself before someone else does.

Except dentists don't actually care about any of that, just on how well it actually works.

Here's the thing: for many so-called niche industries, the requirements change about as infrequently. People aren't even considering the 90s-era GUI - they have a tool that gets out of their way, they're familiar with it, and it gets the job done quickly and well.

I've gone this route replacing a niche software product running on MS Access with a newer, better, faster one. It met all the requirements. It fixed all their pain points. It followed the latest usability guidelines. If this office had adopted it and referred it over to other offices, I would have been as well-off as the dentist described by GP.

It fell flat. They paid me for the product, said it was really great, but ... none of their reps wanted to make the changeover. It was not that the learning curve was too high - it was that any learning curve was too high.

To clarify: anything different from what they were doing every day for the past 10 years meant that they had to think about the software they were using and not the job that they were doing. And that slowed them down - the fact that it would have been a temporary slowdown was irrelevant.

I've seen the same thing played out in my eye dr's office. THey had an old 3270-based system that they used via emulator - and they could fly with that. They knew all the shotcuts, didn't even have to look at the csreen.

Over the period of a year and a half I watched them get a new system in. It had all the same features and a ton more. And it slowed them down to a crawl.

They reverted back to their 3270 based system by the time a year had passed.

So you make an assumption that newer is better - but remember that's your assumption, and it's not one that the targe audience (ultimately the end-users, not just the people you're selling to higher up the chain) will necessarily share.

It's a generational thing as well.

My wife is just out of residency running her own medical practice. She went with the latest-and-greatest electronic medical record system that's all either web of iPad based, with all her records stored in the cloud and fully integrated with similarly advanced billing software. It's pretty good, and does most of what we need well. It's definitely head-and-shoulders above any other software out there that's specific to her specialty.

Right now she's considering buying another practice, and during the pre-purchase process the ~65 year old doc was talking about how fantastic their medical record/billing software suite is. Does everything they could ever want it to do, everyone in the office loves it, etc..

So, I ask for a demo, and he loads up a Filemaker database running off the server in the back room. Looks like it was designed in 1996, offers zero web-connectivity, and they're 100% happy with it.

That practice would never consider "upgrading" to the software we use. We'd never consider the software they use. There's a generational gap in medicine and dentistry, just like everything else. The more young docs come out of medical school, the higher their expectations will be for things like GUI, UX/UI and mobile connectivity.

Depending on how you mean generational - if the implication is that younger generations won't be susceptable to this, then I disagree. If instead you mean that it's generational in terms of software generations and the systems we first learn to use - with that, I definitely agree.

For your wife, in ten or twenty years that all-touch cloud-based system will be as the Filemaker system is for the 65 year old doc, when the next generation of latest and greatest comes around.

It's not about the abilities of the technology, IMO, but about people's resistance to change for the sake of change. If what they have works well for them, there is very little impetus to accept change, particularly when technology is not their actual business.

Except that with a cloud-based product, she won't have a choice. She'll wake up a morning and the product will be different, she'll have to accept it.

Just like all the changes in gmail are not welcome by everyone, but you can't just choose to stick with the 2004 version.

Or, maybe, she'll get an email saying "we're sorry but we'll shut down the service, the company is closing". Or "we're glad to announce we're acquired by our competitor, see how you account will be migrated."

YES! I think the generational aspect of it is more that the older practitioners have been burned more by the new-fangled thing, and what's most important to them is a system they can trust.

There is a finite number of times that a small business owner can say the words, "I'm sorry, I can't schedule your appointment right now because our system is down" before never saying that again becomes their number one software-related concern.

Programmers on HN have got to stop thinking that the most important part of a software product is how modern it is.

I can tell you after working with hundreds of different businesses and individuals that the things that HN programmers think is important about software is very different from what the end users think is important, especially in retail and service industries.

I know of a Fortune 500 company that has a completely enterprise critical application ( and permanently assigned operator ) which is '80s DOS code.

I doubt they'll ever change it.

The question begging here is, can I find someone with domain expertise and dogfood a brilliant service for them which we can then live off, or is there something about being both a domain expert and a coder that enables you to see what could be if only ...

It's just that life cannot be that simple otherwise I want to start a VC that just finds clever coders with middle aged domain experts and fires out dozens of winners and dozens more also-rans

Here's another real story: http://www.reddit.com/r/Entrepreneur/comments/25ycuo/ama_i_q...

Guy had 7 dentists in his family. Built a website for his dad's practice, started successfully selling it to other dentists.

I can confirm that this guy does exist in most countries. I know a few dentists-turned-programmers in the USA and India who have been making and selling dental software since the 90's.

Instead of dogfooding it themselves, these dentists should hire professional software developers to build custom software and tell them what features to build based on their knowledge and experience. Then again, everyone is a critic.

Before you edited it I was going to ask you about this statement: "Instead of dogfooding it, these dentists should hire professional software developers and tell them what features to build based on their knowledge and experience. Then again, everyone is a critic."

Isn't that against the HN mantra that everyone should do the development themselves? Perhaps that is why you deleted that part?

So, that's not why I deleted it. I deleted it because I had the wrong interpretation of dogfooding it. Now that you brought it up, I'll edit my original post.

I'm not familiar with any HN mantra that you're referring to.

it's a fable. it's meant to explain how we think about the world. it's not meant to be reality.

If fables are meant to be explaining how we think about the world then they should not directly contradict reality as we experience it. I understand that you're trying to paint a picture here but there is very little upside to the dentist profession in the picture you paint but plenty of upside for capital providers. As such it is a counter-example. A good example would show a win-win for the dentists and for the capital providers (and preferably the start-up founders too).

Many business models these days are 'x' on the web, where 'x' really does not improve by being on the web and practice management is a prime example of that. If you don't believe that try to explain to a dentist why they need redundant internet access to keep their practice running in case they have internet problems when right now they can do so just fine without any access at all.

Web apps have lots of upside but they also come with a set of requirements that is not always practical or even desired.

On top of that you discount domain knowledge which I think is a very important part of any successful business in an area like the one you describe.

Isn't part of what happens is that the expectations of customers change, so these providers (in this case, dentists) have to make these changes? It's not necessarily about providing a better experience for the provider (though it does do that in many cases), but a better, or 'expected' experience for the customer?

If customers expect to be able to book online (and as a user of services like ZocDoc, FreshDirect, Instacart, and Homejoy I do expect these things now), then providers who do (theoretically) provide these things will have an advantage of those who don't.

Not going to argue for or against the 'upside' part, as I do think that is debatable, at least in the short-term. A big part of this is avoiding 'downside' by not adapting, IMO.

The whole point is that expectations do change but so slowly that there is 0 incentive for a dentist to switch their practice over from what they know and what works well to your shiny new software which works with mobiles, tablets and so on.

You do have a market: new dentists. But old ones are just happily going to roll along with their gear until either they or the gear dies of old age. And then they or their heirs will sell the practice to a new dentist, who will have to wonder about re-keying all the old data into your shiny new software or to focus on what he's best at: dentistry.

Plot twist: the dentist built the app using MICROSOFT ACCESS! And everybody loves it and nobody cares!

The practitioner software I saw was built in dBASE III or dBASE III+.

I know a chiropractor and physical therapist who've done exactly that. It boggles the mind.

It doesn't boggle the mind at all. People want results and income, not elegant software. The more it does the more it gets in the way. Better crap software written by a domain expert than great software written by what a programmer thinks a practice needs.

Oh, no, I get that, believe me. It's millions of lines of code in Access--from the technical side it boggles the mind.

The business case is quite clear. :)

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