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Building a 48-Location Implant Empire with Dr. Alex Sharp · Dental Mentors

• Dr. Alex Sharp Full Episode MP3 : And now we're at the point where we're at forty eight locations, opening about one per month. Eventually I learned that what I was doing was a commodity. And no matter how good my fillings are, how good my crowns were, I was doing something that wasn't all that differentiated from the guy down the street. How are patients gonna know if I'm taking the same insurance and charging the same fees? What's different? How do I stick out? As Peter Thiel says, competition is for losers. So you want to do something that sticks out in a good way. And so for me, I started doing implants. I started training in implants and started seeing the the impact that dental implants could have on. on people's lives. It was something that was different in dentistry and that people were clamoring to pay for it. It was the best thing ever because people that had been told no or been told that they had to do a root canal or a bridge, but they wanted an implant, it was something that people were happily tripping over themselves to sign up for. Hello, and welcome to another awesome episode of the Dental Mentors Podcast, Building Wealth and Dentistry. I'm your host today, Matt Ormstein. I'm here with a very special guest, Dr. Alex Sharp. He is the CEO and co-founder of Shared Practices Group, Dental Implant Center. So this is going to be an amazing episode. Alex is one of the few guys that's taller than me, six foot seven, two hundred and forty-five pounds. So it's a pleasure to have you here, man. Thanks for coming on. Matt, this is a joy for me to be on with you. as we were talking about before we hit record, I heard you on the Dykema stage. It had to have been three or four years ago, and and hearing about your journey and and how much you've accomplished as a non-dentite in the in the space, not a native dentist, and just just hearing how you have your perspective on the industry, the reverence that you have for the industry as a non-dentist. it's been really inspirational to hear you speak at various functions over the years. I know recently you spoke at one of the the the smaller off cycle Daicoma meetups. I think it was the Dallas one. And just really enjoy all the content that you put out. So thank you for having me. Yeah, man. Thanks for thanks for coming on. This is gonna be an a a fun one for sure. so I'd love you to just take a couple of minutes and tell everybody who's watching or listening a little bit about yourself. when you started shared practices group, what was the vision? And, I know that was five years ago and where you are today. Love love to give a synopsis of that, please. Yeah, it's so crazy to look back because I I graduated dental school in twenty fifteen and I did what most people did back then, which was try to find a job. And when you're coming out of dental school into what I would call an undifferentiated sort of position You don't really understand, am I doing what I'm meant to be doing? Am I just s hitting the ball right down the fairway? Or am I just struggling to exist? It's hard to know because you don't have a lot of reference points because you're playing a single player game essentially. So I started off as an associate in a very Medicaid heavy practice. And I got really good at getting people numb, taking teeth out, doing surgery, getting efficient. And then I bought a general dental practice late 2017, early 2018. And it was a definite step up because I got exposure to I would call sort of the bread and butter world of general dentistry, fillings, crowns, hygiene, a more regular measured pace, a little better profitability. And eventually I learned that what I was doing was a commodity. What essentially no matter how good my fillings are or how good my crowns were, I was doing something that wasn't all that differentiated from the guy down the street. How are patients going to know if I if I'm taking the same insurance and charging the same fees? What's different? How do I stick out? as Peter Thiel says, competition is for losers. So you want to do something that is that sticks out in a good way. And so for me, I started doing implants. I started training in implants and started seeing the the impact that dental implants could have on people's lives. It was something that was different in dentistry and that people were clamoring to pay for it. It it was the the best thing ever because People that had been told no or then been told that they had to do a root canal or a bridge, but they wanted an implant. It was something that people were happily tripping over themselves to to sign up for. And so I was getting hot and heavy into implants and then COVID happened. at the time of COVID, I I linked up with my business partners who, you know, we did the shared practices podcast kind of on the side as as we were practicing. And we decided, hey, now's the time to merge. all all of what we're doing, put all of our practices under one umbrella and we started shared practices group because we saw the writing on the wall. We saw consolidation happening across the industry and we saw consolidation being done well in some corners of dentistry. And we also saw some things about the the consolidation into the DSOs that we didn't love so much for dentists. And so we thought let's found a dentist-founded, dentist-led organization that Prioritizes the dentist as the customer, which then puts that dentist in a wonderful position to be able to overdeliver for patients. And so for us, it's dental implants, it's not having accounts receivable, it's it's not having to deal with insurances, it's just being able to have really great service rendered from the dentist to the patient. And now we're at the point where we're at 48 locations, opening about one per month. just welcomed our first private equity sponsor, shout out M1 Capital. out of Omaha and it's it's been a fun journey. I have more gray hair than you do. and and I think that's because of the last the last five years or so. But I'm I'm happy to be an open book and and help anybody out however I can. That's amazing. So you have forty eight implant centers right now. You're opening one a month. Thereabouts. It it averages about one a month. So we've we've been doing one a month for the past several months. And some months it's two practices, some months it's zero. I don't think we're opening one in in December because it's tough with the holidays, but on average it's it's one per month. Wow. Congratulations. That's fantastic. Thank you. Yeah. You're definitely in the in the sweet spot. a lot of demand and great great profit margins and great dollar mar dollar margins as well. Yeah, it's it's interesting because we I I don't know if this was the right way to do it. And and I think this is sort of like the the catch twenty two of of building a multi site platform is do you overbuild the corporate infrastructure and and trust like field of dreams that if you build it they will come? Or do you run ultra, ultra lean from the jump, get really, really uncomfortable with your lack of corporate infrastructure, stay more profitable earlier on. and then scale the corporate infrastructure as you go. We definitely indexed on building the apparatus and and we didn't achieve great profitability until we kept adding those incremental stores without necessarily scaling linearly the the the corporate spend. So for us, yeah, we've gotten to the point of having good margins and stuff, but it it was a very I used the term messy middle earlier, definitely a a big messy middle that that was that was challenging. And I think what What makes it hard for a lot of people that want to do the multi-site healthcare game is they can't get past that that no man's land of five to ten locations where you're trying to do everything yourself. You can't really yet afford a lot of strong central support. So you just have to gut it out almost to get to that point where you can have the solid profit margins on at the other end of the tunnel. Yeah. I agree. What what advice would you give to someone else who came to you and said, Should we run the corporate office lean and a bit scattered until we really have the money to staff it properly and thoroughly, or should we put the extra capital out earlier and get ahead of the get ahead of the needs at the corporate office, which is a drag on your cash flow and profitability for a while? Yeah, I I think I would definitely say don't be too lackadaisical with your spend, but If you actually are shooting for the stars and you have every intention of getting to 25, 30, 40, 50 locations, you almost have to do the field of dreams approach where you just have to build it and and you have to bet on yourself that way because it's so easy to find these stumbling blocks where you trip over your own shoelaces. And one of those ways to do that is to be a a little too cheap on the front end. And and I think that's what happens, and that's where people start to stall out because they start to say, Hey, when I went from eight locations to ten locations, that's where it broke. Well, why did it break? It might have broken because you weren't adequately supporting the eighth, ninth, and tenth locations to the same degree that you're supporting the first, second, third, and fourth locations, because you were able to be in multiple places at once, maybe early on. And you couldn't do that later. So I think that you just have to go all in, burn the boats. And I and I think the the challenge is to make that transition. If you're a dentist doing this and you intend to be the leader of the org, then you have to be comfortable knowing that for a long time you're not going to make a dentist salary doing doing the corporate stuff in general. Like you you're if you're used to making very high six figures as a producing dentist or as a practice owner, it's hard to replicate that same amount of comp. while you're in scaling mode. I think that was that was a rude awakening for us just because we're you know you're used to being a dentist, you're used to owning your own shop and having good margins. And so I think that's something that I would tell people is expect it to be rocky, expect it to be lean when you're in the growth phase, because it's hard to simultaneously grow and and allocate capital towards growth and Pay yourself the way you're used to. So it's it's hard to have both. Maybe it's possible, but for us that was a decision we had to make. It's like live lean leaner for a while in service of the pie growing. Yeah. Yeah. I think you're certainly spot on with that. you know, told me that you're basically all de novo, all of your implant centers, except for maybe the first two. are you growing with Just with equity, cash, or are you using debt as well for your growth strategy? We've used debt very sparingly over the years, and I think that's a wise move for people to emulate. And and we did it just because we had limited access to debt because a lot of your your debt lenders want to see years and years and years of financial proof of what of what you're doing. And we were growing so fast that we just didn't have rear view mirror looking performance to be able to substantiate people lending to us. So we've always been bootstrapped, very lean debt wise. You know, right now we're probably at a a one to one debt to EBITDA ratio and and not fully by choice. It's just kind of the way it shook out. and then you see all of these bigger DSOs struggling because of their leverage ratios being tapped out. And so then you realize okay, maybe it's it's a blessing in disguise that that we didn't have a lot of access to debt. So we we've grown just a lot with just cash and and opening the locations for fairly inexpensively. we we go into markets that that our model says is going to be ripe are going to be ripe for opportunity to where we have like a lot of our people that have similarities and parallels to some of our stronger locations. And so we just sort of cherry pick those locations relative to where they score on on our index. And then we find good real estate opportunities and then we plug in the the doctor. So y you gotta have all three and and I think the de novo strategy for right now, especially with interest rates still being really high, I think that's a muscle that most people would be wise to develop. Because if if you only have the the acquisition tool belt tool in your tool belt, then you're gonna be overpaying for for EBITDA that you might struggle to integrate or that might have a poison pill attached to it. I I just think that the De novo playbook is becoming more widely adopted, even in some of these legacy DSOs and for good reason. I agree with everything that you said. Everything that you said. That's amazing you only have a a one to one debt to EBITDA ratio. That's congratulations. Yeah, not not by choice. It it was, you know, y you it's just so funny how things change at the drop of a hat where when you have access to debt you don't want the debt and then like a year ago you would have like done horrible things to get access to the debt. It's just funny how life happens that way. Yeah. Well you're you're growing the, in my opinion, the smartest way that you can that you can grow. When you got started, I I know you told me you're thirty-seven, when you started shared practices group five years ago, so you were 32. Initially with your co-founders, what were your goals when you started this? Do you guys have like a five year vision, a 10 year vision? And if so, what was that? We definitely thought we would hit the point that we're at, which is like almost at the cusp of fifty locations. We thought we would hit fifty locations way sooner than we did. Part of that was the irrational exuberance of youth. Part of that was the fact that we were just coming out of that zero interest rate period. And I think we we still had we thought there was more wind at our sales than there actually was, in terms of like the macroeconomic climate. And so we just had our heads down and we were like, you know what, we're gonna open twelve to fifteen a year. There's one year where we open twenty. And and then we ended up slowing down and and and strengthening our current base business in 2024, 2025. So we opened about half as many as we thought we would in those years. So from that context, we're a little behind schedule of where we thought we would be. But I think it worked out as well as it could have because you almost have to overextend. It's kind of like a big extended split test. You overextend, you see what works, you see what markets are are ripe for what we're doing, you see what markets aren't. You you learn about the different variables in the process. And so it was it was an expensive way of learning. But once you gather all that data, then you can make more dispassionate moves in service of future growth because you had the the misfires in addition to the home runs. Yeah. I have a I have a question for you 'cause a l a lot of people ask me this. When I'm at conferences or on like webinars, at what point did you decide to bring in a private equity partner and why? That's a phenomenal question. So I for a long time, that was just the path, or at least in the circles that I've run in, conversations that I've had, that was just part of the growth path of a DSO. was was to do that, was to find a private equity sponsor to to get you to the point of being able to grow further than you could w by yourself. And for us, we'd been left to our own devices for so many years that I think we were just ready for some professionalization. We were ready fr for an outside voice to to impose order where there might have been chaos, to to take some expertise that they'd honed in in various multi-site pursuits over the years and see what's cross compatible between between other portfolio companies and and what we're doing. And I'll that's been the case so far. I mean our our deal closed three weeks ago, three and a half weeks ago. So it's still it's still pretty fresh. But we've already had a ton of meetings and and a lot of just mind melding to to be able to to learn what opportunities there are for us to keep growing and and improving. So for us, I think we we just saw that we needed support and sophistication. And that was one great way to do it. And we we talked to so many different sponsors. I mean, we we talked to over 20 sponsors over the course of our our go-to-market process. And it's it's hard to find the right fit. And for us, we just we never had like the greatest warm fuzzies talking to the the first cohort of sponsors until we met M1. 'cause for us it was just instant one plus one equals three. We wanted minority. more minority was mattered to us a lot just because we didn't s want someone to come in and start changing stuff up or or like screwing with how we compensate our doctors, because that's just a a a death knell for for any healthcare services company is for a private equity sponsor that might be well intentioned to come in and start just cutting stuff that that doesn't help the actual provision of of the service. Because at the end of the day, dentistry is purp people working with people on people. And so if you do stuff to to mess with that, then you just don't you you don't have a product at the end of the day. So for us, we we knew that we needed the extra shot in the arm of professionalizing a lot of what we do. And so we made that decision. I know that there's plenty of people out there that have grown in a way, maybe more methodically, that has allowed them to circumvent Taking on private capital like that, growing with debt. I think that's great. I just think for us, we valued external voices for people that were more financially savvy than us. Yeah, that makes sense. you know, it's interesting. I've contemplated this a lot, like how can you build like what's the most optimal way to actually do a DSO and exit with the highest internal rate of return, a return on equity, and a great dollar amount. And I have thought about this very, very deeply. If I was gonna advise a group these days It would be start with buying a a group with five million of EBITDA. That's really well run, general dentistry, general dentistry, and then add on enough acquisitions, not paying more than five times EBITDA until you get to ten million of EBITDA, and then cut it loose because at that ten million of EBITDA, you're gonna You're gonna you're gonna get a ten to twelve times EBITDA multiple. Minimum ten, you might get twelve. and there are a ton of buyers out there for ten million of EBITDA. You know, if once you go to twenty, thirty, fifty, a hundred million, the the amount of buyers that are out there start to shrink. So the buyers have more negotiating power on e and and putting pressure on EBITDA multiples. But the most profitable way to do it is what you guys are doing, and that's de novo. if you have the time and the expertise to to do it de novo, obviously you're gonna come out with the highest margins. I've also contemplated finding a private equity partner. And this this is easier if you're going de novo, but a private equity partner to just fund everything with cash and no debt at all. No debt. I mean, and even if you're using debt and you're paying five times EBITDA. You're still getting a twenty percent cash on cash return, which is fantastic for that acquisition. So in that format, it would be hey, we're shaking hands, locking arms, and s and doing de novos underwritten by the private equity sponsor, and then in exchange the the cap table is equilibrated such that it's worth it for the PE sponsor to just write the checks to underwrite. the the startup expenses with the expectation that with each incremental startup that you do, it's going to create that much EBITDA, therefore that much enterprise value. So it's just kind of like an advance or like a bet on I'm going to get this share of this future big engorged cap table. Yeah. Yeah. Love that. I love that. Yeah. but you know, if I had to do it again, man, I would have did did what I said. Buy a platform with five million of EBITDA, grow it to ten, be very selective, not pay more than five times EBITDA for any add-ons, and then sold it when we were at ten million of EBITDA. That that's what I advise people, you know, that ask me that question. I'd also keep the debt to EBITDA ratios, if at all possible, three or under. Yeah. Because you're not gonna get if you have a decent operational team. you're not gonna get into any troubles with any covenants in in it from any of the lenders. If you've got a three to one, even with high interest rates, you have great free cash flow. So if you guys are doing it right though, man. I mean, you guys have dialed it in. Do you feel do you feel like it's feasible to maintain if you're in if you're an acquisitive growth platform primarily, you're not in a position or you you don't have the the desire to do de novo growth. Do you feel like the market is such right now to where an acquisitive based platform could pay the four to five X EBITDA prices and stay within that three to one debt to EBITDA ratio? Do you feel like the the the prices now are allow for that? 'Cause I think there was a period where some of these DSOs got out over their skis by overpaying for practices and And trying to add dollars of EBITDA, and they probably overpaid at the single site level and and overestimated what the arbitrage would be for the overall platform. So do you feel like the the etch a sketch has been shaken sufficiently to where we have a fresh start and you're able to do that now? Yeah, I think it's just been I don't know, maybe like in the last 12 months, maybe the last eight months, people are accepting reality, EBITDA multiples. have come back down to where they should be, rational. So the buyers are are buying at a fair multiple and can keep their debt to EBITDA ratios in line, can have enough free cash flow to handle CapEx and you know, pay the interest and amortization on their debt. But yeah, I I I think so. Now, you know, buying practices at four to five times EBITDA, either the practices Has some problems or the dentist doesn't want to stay on for very long, the selling dentists, or they're or they're well run practices and they're just have low levels of EBITDA, right? Maybe 200,000 of EBITDA, something like that. You can do it. It's just they're harder to find. they're harder to find. I mean, typically if you're buying, you know, a decently run single practice, you're gonna be paying it today, normally like at least six times EBITDA. But you can find them at three and four. You can still find them. And then generally the trade-off is location might not be optimal, might be harder to staff. There's stuff around the edges that might not be as desirable. Yeah. Because honestly, what what kept us like what the inflection point for us that kept us from going the acquisition route, aside from no access to capital, as as we talked about, It just scares me trying to integrate practices into into the fold because I don't know if we're control freaks at SPG or what it is, but we like having this is the playbook for this, this is the playbook for that. When you open a practice with us, this is the way it's done. Kind of like a franchise. Whereas if you're trying to superimpose playbooks over a practice that's used to doing things their way for twenty five, thirty years, I don't know if I have the leadership acumen to be able to get that done. And and I guess there are people that can do that, but trying to integrate a a a an individual practice into a new fold, you have to have so much willingness on the part of the seller. You have to have an an immense amount of flexibility for the team. And and I just I think that that's such a tall order compared to the skill set required to just open practices. So for me, like this feels easier than integration. But you know, others may dis others may disagree with that. I agree with you. It is very challenging that, we have integration teams at at Oak Dental Partners. Very, very challenging. so you're doing it, in my opinion, the the optimal way. And I I also think the longer term when you exit, the most profitable way, you know, to to grow to grow a practice group. When you start, I have a couple of interesting questions. When you guys started out Did you have a target like when we get to this level of Ebita, we're gonna sell? We we had we had some loose targets and throughout the journey I think our definition of those targets evolved. And so I think your your what you're saying, what you said about that five to ten range of of like ten kind of being this this sweet spot, that was sort of our inflection point to to considering, you know, having discussions and and and going to market. And so I think that is the the magical sliding door of like you get through that and then all of a sudden things open up to you. And if you're trying to transact meaningfully lower or meaningfully higher, you you might not have the same results. but we we had a loose idea for us, it it was a little less scientific than that. We just felt like we've we've built this big presence, this big footprint. I mean, we're in 30 states now, and we we realized that. in order to get where we wanted to go w which is to meaningfully multiply, you know, the the impact that we have every single year, we we just needed to profess professionalize pure and simple and just find the people that were like our people, that were great cultural fits, that that would be able to to offer that one plus one equals three sort of relationship. And and early on all all signs point to us having found it. But but I really think that when you're dro if you're I'm sure a lot of your listeners are growing groups, thinking about growing groups. They're in the middle, they're in the messy middle right now. And and I really think that one thing that helped us that we didn't always realize that helped us was just being extremely narrow and focused. I think a lot of people stumble when they try to add a bunch of stuff, add a bunch of procedures, add a bunch of ways of operating that aren't necessarily in keeping with what they're best at. And so sometimes it's it's more beneficial to cut stuff than add stuff. I mean, there's one DSO leader that I talked to want to say a year or two ago, that had some success in one specialty. And then they thought, okay, I'm just going to diversify. I'm going to seek synergy and I'm going to add another specialty. I'm going to bolt on this other specialty in addition to the specialty that I'm already really good at. And then Long story short, they ended up di divesting of the the second specialty because it was this distraction for the central team. It was outside of their core competency and they had to learn the lesson the hard way that we should have just focused on vertical growth within our existing footprint and held tight instead of having an itchy trigger finger to get new stuff. We're gonna hold tight and wait for the deal flow to come in our original specialty. And I think that's narrowing the focus going forward in dentistry, I think, will yield more results. than trying to broaden the aperture and be all things to all people, because that just seems hard to me. Man, you're very wise for 37. It's really great chatting with you. One of my favorite books is called The Science of Scaling. it's a phenomenal book. And that's one of the the the the main message in that is pick one thing that you are great at. Do everything you can to be the best in the country or the world. or your market in that one thing and just stay laser focused on being the best at that one thing and then scale the heck out of it. Don't get diluted. Just find your niche, become the best or the best that you can possibly be, and then and then and then scale from there. What is what has been your biggest challenge as a CEO of of a a growing DSO? Probably just learning to Learning the skills that are natural for a leader but aren't necessarily natural for an individual operator. So it's a classic case of what got you here won't get you there, and just knowing that you're constantly having to evolve and that you may be the bottleneck. Like as a leader, it's easy for the leader to become a bottleneck based upon his or her own shortcomings or blind spots. And so for me I think the challenging part is just staying ahead of that and and not imposing limitations on my team or or my company without intending to. And then for me also I think what has made that better is just having extremely capable co founders because th this has been a a team ethos from the beginning. I'm I'm just one of several co co founders and we all have indispensable roles that we play and and with my co-founders, there's stuff that they're good at that I could never in a million years be good at. And so I think the hard part is leading the company, but it's made better by having co-founders. And so that's what I would say too is if you're looking at scaling anything beyond the single site or across state lines, for example, find your people that are strong where you're not. Because no matter who you think about or if you think about Elon Musk as being the the prototypical idiosyncratic full cycle entrepreneur. Elon has people that are really good at all the stuff that Elon's not good at. And and they don't they don't necessarily get the the praise or the or the gravitas, but he's not a solopreneur doing all the stuff that he's doing, even if all of the press coverage indicates that that's the case or that's what he promotes or or or shows. So I I think find the people that are that are world class of what you're not and and that makes the the ride a little bit easier. Yeah. Dude, you're a very wise wise man. All right, here's a fun one. as CEO, what decision what was what was the the one decision that you can remember that had the highest impact and best result for your organization? The one decision you had to make where you made it correctly. I think for us it was a big one was going fully digital with our workflows to to bring it back into clinical stuff. because in our world in dentures and implants, you have two options. You can either do things the old-fashioned analog way, where you're taking impressions and pouring up dentures and hogging out the dentures and attaching the the denture to the implants on the day of surgery, or you go full bore into the digital workflow where instead of impression trays and goopy impression material, you're using intraoral scanners, you're using 3D printers. And so obviously the upfront cost is is higher to go digital, but the the user experience for the dentist, the patient experience is better. If a patient breaks their their healing teeth or prototype teeth, they can call the office and the office can hit print on a new set of teeth. And so the the service, the experience from top to bottom from dentist all the way to the team to the patient was better. And so when we made that that strategic shift to go from analog to digital, it was expensive, it was laborious, it was change, and some people are allergic to change, even if it's a positive change. So making that transition, I think, for us was really healthy and and now there's there's there's no going back. Like just we're in twenty twenty six, time time to modernize a little bit. Yeah. Great answer. All right. Here's here's a fun one for you. People ask me this all the time. I'd like to get your take on it. What do you consider a really good, healthy EBITDA profit margin based off of collections at the practice level and then after corporate, so post corporate? There's the aspirational answer to that. my question is if if if if an office hit, if a if a location hit an EBITDA profit margin at their location, and you were talking to the dot the managing dentist there, you say, Wow, great job this this year. And then after corporate, considering all your practices, after corporate expense, what is an EBITDA margin that you could look back to your your entire executive team and say we have we have really good profit margins even after corporate expense. Yeah. We're we're starting my answer to that question now is better informed than it would have been a few months ago since I've just been so in the numbers. But in terms of what we're capable of, I would say major pat on the back for single site for a wall at thirty percent. And then, you know, corporate knowing that we're vertically growing and that we're and that we're same store improving, you know, if if we're if we crack twenty in just overall, like after after corporate expenses, then you know that I'll be I'll be a happy guy. And I know we're gonna get there. so I I think that it it's so interesting because a lot of in a lot of people in the industry struggle with same store improvements. And I think part of that is that a lot of these practices that get acquired Are already knocking on the door of their capacity. So by the time you buy them, there's only so much growth you can reasonably expect out of those existing practices because they've already had years to mature. Whereas when you start practices, they're starting from zero. They're starting from zero new patients, zero dollars. And even if you ramp them quickly, there's still so much meat on the bone to to keep growing. And so for us, I just think about I think every DSO should do this exercise of going through and ranking your practices in quartiles. So if you have forty practices, then you have the top 10, second 10, 3rd 10, last ten. And if you l rank them in terms of quartiles, then you can see the differences between especially the top quartile and the bottom quartile. And you think about operationally what's different, top 10 versus bottom 10. And the more you can spend time simplifying the operations for the bottle ten bottom 10 to be lifted, while at the same time leaving the ladder down for the top 10 to keep growing. If you do both of those things and you work on both sides of the barbell, then it's amazing what happens. But I think that's a challenge and acquisition based because they just there aren't as many growth levers for mature practices as there are as there are with these immature practices. They're still growing into their size and their cost structure. Yeah. Yeah, I think that's the gold standard. I agree with you. 30% four wall, 20% post corporate, if you're hitting that For your EBITDA margins, you are absolutely best in class. I've I got two more questions for ya. What are your top three KPIs that you follow for your organization as CEO in the in the r in the CEO role? Yeah. This this is unique to me, one of one, may not translate, may not be the the the best thing to look at, but it's just month over month EBITDA. And I just look at EBITDA in general, over the course of the month or the the quarter timescale, the annual timescale, the TTM timescales, EBITDA's one. new patients in our model, they matter everywhere. They matter in every company. But for us, we we are a direct-to-consumer marketing machine. And so new patients hang the moon for us. So I'm always attuned to new patients, again, daily, weekly, monthly, per practice. And then we also just look at revenue per new patient is a is a big one. It just talks about patient efficiency. how how much value are we creating for each patient that walks through the door on average? And and again for us, that's an apples to apples number that works for us that may not work everywhere just because we have the same model and the same procedure mix and the same roughly the same costs at every practice. So these these are these are numbers that make sense because of the apples to apples comparisons that we can draw in our model. Because every practice is the same, essentially. Whereas in a in a more normal acquisition G G P model, you may have to look at slightly different metrics to get the whole picture. Cause I think my metrics are kind of narrow and there's probably bigger picture metrics that would make more sense in these more diverse platforms. Yeah. Those are great ones to follow. Absolutely. What would your answers be, Matt? Because I'd I want to learn and get better. Gosh. one thing I do know that's absolutely critical for organic growth is the number of new patients per month. And that's a that's a data point that has been tracked by Mike Huffakert, Planet D D S. If you want six percent organic growth or better, you need at least thirty five new patients a month. If you want to get nine percent organic growth or better, you need seventy five new patients a month. If you follow the data on that. So new patient acquisition i is is absolutely critical. Man, there's so many. There's, you know, production per doctor. I mean, obviously, you know, organic organic growth on the EBITDA side has to be tracked. new patients. And I agree with you, you know, revenue per new patient. New patients statistically, lot more valuable than existing patients that have been there for two to three years. So man, it's just it's a lot. I mean, from my end of it, there's probably ten that I like to look at. but if someone says like, you know, top three, new patient, number of new patients per month, our EBIT a growth, orga organic EBITA growth. is critically important. And then another one that I think is really, really important is you know, what the reviews you're getting from your patients. You know, as I I had s Sam Zarabi from Rodeo Dental on yesterday. And Sam's top two KPIs are his Google reviews and the time it takes from when the patient checks in until they're Until they've paid and they're out the door. He likes to keep that under 70 minutes. So it's interesting. Every CEO has slightly different KPIs that they like to track, but fortunately we have access to a lot of them. This is a question I get from a lot of people, and I I you're like one of the perfect guy to answer it. A lot of dentists, they want to start their own, they want to own their own practice. Either they're gonna they're gonna take one over, they're gonna buy one or go de novo. but they're nervous and they're scared, obviously, because they've never done it before. What advice would you give somebody else that wants to, start a a a a group and grow it? Let's just say go from one practice and then grow it up to whatever, five, ten, twenty. What advice would you give that that dentist who's on the bus but really wants to but is nervous about it? The first out advice I would give is get clear on what itch you're scratching. By doing that. Because if you're a dentist and you have one really successful practice and you're meeting a lot of your income goals, just realize that it might not be a perfectly linear increase in your take-home pay for the foreseeable future. Sometimes it is that simple. Sometimes it is just like stacking rent houses and and like one is just the other, and it's a perfectly linear correlation between your your income and and what you outlay. But in dentistry, it's not always that way. Cause you have to think about the catastrophe of what happens if I go from one practice to two, two to three, three to four, and then we have a mass exodus of doctors. And then we have these these shells of these practices just sitting there, you know, sucking up your your cash flow. because if you have a catastrophe in one practice and you only have one practice, then you can just work a little harder and figure it out if if the second doctor quits or something and it's and it's not that big of a deal. But when you have catastrophes happen in multiple locations, you have to have the the structure in place to be able to solve those problems and get them back on the right footing quickly. So just test your why. And that that sounds so trite and overused, but if you're if you're doing it to make a lot of money every single year, that's probably not the way to go. You're probably better off growing your single site, moving your single site to a bigger footprint to be able to do more within four walls. I think that's a far more attractive option than a lot of people give it credit for. I certainly didn't have that perspective I gained that I gained that perspective when the boats were already burned and and we were doing this. so if you're if you're building something that has a true underpinning of a purpose and you want to get to 10 to 15 locations, 20 locations, and you have a different angle of approach on the DSO space that just isn't in existence in your area, then great. But if you're doing it to make a quick buck or to to juice your your annual take home, it may not work that way. You may be better off just doubling, tripling, quintupling down on your single site. Yeah, that's great advice too. I was chatting with somebody about that. you know, it's a lot easier if you have, you know, if you can have a single site with 20 operatories in it or 30 or 40. And I know people that do that. Yep. And they're crushing it and they've got one facility to manage. And it can be done. It just depends where you live and what the demographics are. So well, listen, this has been fantastic. You're a very, very smart guy. I really loved having you on here. You definitely dropped a lot of words of wisdom for everybody who's gonna watch and listen to this. Will you stay on just for a minute or two after I I end because I have a quick question for you that's not true this, but it was a been it been a pleasure. Dr. Alex Sharp Shared Practices Group. Dental implant centers dropping on dropping wisdom left and right. Thank you so very much for being on here again. It's Matt Ornstein, the Dental Mentors Podcast, Building Wealth and Dentistry. 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