Latest / Dental Mentors / Mark Lakis: What's Your Freedom Number and How Much EBITDA Do You Need to Hit It?

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Mark Lakis: What's Your Freedom Number and How Much EBITDA Do You Need to Hit It? · Dental Mentors

• Dental Mentors: You know, what's your freedom number? My freedom number is twenty-five million dollars. Okay. Well, how many practices? I can tell you how much hebata you need to accomplish that. We could a group of people would be able to tell you you probably need this many locations and there's lots of different math that you can run in terms of how have I engaged doctors, how much of the equity do I still own. But at Dental Mentors we're all about building wealth. We don't think there's anything wrong with dreaming big. And I actually think that what I see Is more the opposite, where they don't almost have enough ambition because they don't think it's possible for them. They're like, ⁓ I don't have my MBA and that's what you know private equity guys do, that's what that's what fancy business people do. That's what I thought before I got in the industry. Do you think there's some sort of mindset shift, or do you think there are things that they can do to kind of prepare themselves even to to see do I wanna do this or not? If you're a successful practice owner, then I'm gonna think multi-location growing. associate doctors within your portfolio, it's not just you, then you've already accomplished something pretty unique and entrepreneurial. And you've demonstrated that you're willing to make the bet on yourself. That for me is the mindset. Am I willing to make the bet with your own money? I just had a conversation with a doctor, has four locations, and just added an orthodontist full time. That's a big investment for a soul. That's the guy that's gonna win. Thank you. In today's interview, I sat down with veteran dental executive Mark Lackis. Mark has over 17 years of experience serving as CEO of some of the largest organizations in dental and is credited as the innovator behind many of the dental partnership models we see today. He scaled dental organizations from early stage rollups to multi state platforms, executed dozens of acquisitions, and delivered multiple successful entits. Moreover, Mark is just one of the most genuine and kind people that I know, and someone that I'm proud to call a friend. In today's interview, I asked Spark to outline exactly how he would go about growing a practice or DSO in today's market and to lay out his favorite no-nonsense strategies that he's implemented that he doesn't hear spoken about a lot in the industry. We dive into these topics and more in today's episode. Enjoy. Hey everybody, welcome to another episode of Dental Mentors. I'm your host, Neil Zemba. Today I'm here with the Mark Lackis. And Mark, I gotta say, before we kick things off here, ⁓ When I'm looking at your I'm looking at your resume, I'm looking at ⁓ a lot of your accomplishments here. No joke, when I looked at this or initially I thought this was five people. ⁓ but it's it's you know you're you're really you you know you you've really done so much in the space and ⁓ I I'm so so grateful to have you here today. We're really gonna get into some to some really interesting topics here. And that's very kind of you to say. Coming from you, that's anonymous. I appreciate that. Well, you know, to kick things off, I'm just gonna list some of these some of these accomplishments off and some things that that we have here. I know you started in the industry around two thousand seven. ⁓ you have run three DSOs, you've founded two DSOs, you've helped two private practice owners turn their companies into DSOs or turn their practices into DSOs. I really want to get into that because that's something that ⁓ I know a lot of ⁓ members are are curious about the ways that they can grow. ⁓ you know, should should should I go out and you know, buy more practices? ⁓ we just had a call earlier today about, you know, should I expand my my operatories out and just basically get more chairs first before I think some tough questions for practice owners and ⁓ yes, two of the ⁓ my partners I did work with them as they had to wrestle with those tough decisions and we were successful in making them into DSOs and it was a lot of fun. Yeah, I I I really want to get into that because I know that's something that a lot of people ⁓ are kind of looking for that that algorithm, you know, just kind of that that, you know, step by step framework, you know, so so to speak, of how how do I grow and how do I kinda think about that that process. And I know you you have a lot of experience with that. I would love to talk about it. You've completed dozens of acquisitions. ⁓ you've successfully sold three companies to private equity. In one case I know you you know just just your investors themselves got a seven X on their investment. I wanna talk about that. I know you've got some some tips and tricks there. ⁓ about how you were able to to to achieve that outcome. and ⁓ when you were an executive when you when you when you were heading up Southern Dental Alliance ⁓ I know that you sort of created the what is what is the foundation of now what we call the sort of partnership model or the or the or the founder model. ⁓ and maybe maybe we should start there. It's kind of high level but I'd love to just kinda jump jump right in and c can you talk about what kind of inspired that? Sure. ⁓ I did start in the industry in two thousand and seven and it I came into a national platform, a lot of standardization, not necessarily as quality focused. but I then went to a private practice and learned, ⁓ this is the way care is supposed to be delivered. A lot of that energy came from the founder, the doctor who created it. And as I moved into r building and running DSOs, it be became pretty clear that ⁓ keeping that person, whoever that founder was, was absolutely cli critical. And not the here's a contract, you have to work here for two years before you leave, a true investment and a partner. So as we did acquisitions with Southern Dental Alliance, we required that the partners roll over thirty, forty percent and wanted to be part of the company long term. and yet we eventually ended up calling that the founder model. And what I'm pr pr most proud of is all of those doctors that were in that founder class, when we sold the company five years later, every single one of ⁓ stayed and and went on to the next ev evolution of it. and yeah, I've seen that concept, you know, be built upon Just to how do you retain and motivate and align with doctors? I think that's fascinating too, because especially in in kind of the current, you know, market now, you know, we see from private equity and you know, there's this kind of ⁓ notion that, you know, let's get the clinicians ⁓ almost out of the way, I have to say it like that, right? But you know, there's this kind of battle sometimes between like There can be. Like the you know, should the clinicians stay, there's ⁓ sort of a a s a stigma sometimes from w at least what I can see of, you know, when a clinician stays on as a founder, they'd rather get the sort of MBA type to kind of run the show and kind of get the founders out of the way. I'm very pro founder. ⁓ you know a lot of my my my friends are folks that are are sort of the entrepreneurial dentist. And so I love that you're you're saying that and that that was something that I was always, you know, fascinated by, you know, the fact that you sort of you know, ⁓ it's a really It's not hard to see. It's not hard to see how better how much better the organization is, how much better it operates when you maintain that energy. Yeah. A a pure kind of associate model, you don't get that, you know, owner mentality. Yeah. And in the DSOs I've been a part of, it's been progressively more you know, founder oriented. And While that's difficult for a private equity group to manage, the really good private equity groups understand. You know, our business is those doctors. Yeah. We need to keep the best doctors. That's the hardest part of my job as a CEO is recruiting and retaining great doctors. So that's the logic behind this. And what would you say, I mean, I would assume and I I see it myself as well, like the cultural impact that that has to have on an organization. You mentioned as as the organization grows. How are you structuring that? So so so you know, I presume you you start off with an organization that's smaller than you'd like it to be eventually. You come in, you start to grow the organization. Are there contractual things that you're doing with that fund? Or now you just mentioned kind of some of the some percentages that you like to see when they kind of roll in. ⁓ what are the expectations that you set with them and what does that process sort of look like as as the as the as the group grows? It has been different in each of the companies I've run. the one I was with the longest, Southern Dental Alliance. That's the best way to s at least sketch out. So any private equity group is gonna pay roughly the same thing. And so it's about the structure. And what I like is the aligned incentives part. And some of the components of purchase price are very private equity favorable an earnout or a holdback. Those are those are good motivation tools for the doctor to keep performing in the short term. It's the key for me is how much equity are they willing to roll over? This is the balance between I want to put cash in the bank right now versus I'm willing to bet on the next Entity, which is what we're doing together. So when a doctor talks about, you know, I'm not willing to roll over more than ten percent or twenty percent, it's just not the right people. Right. So you have to have more conversations to find those doctors that are confident enough in their practices that they think they can drive more value. unique bird, but yeah, it comes down to Are we aligned financially? What I've used primarily is equity at the total ⁓ DSO level. It's the most valuable. It's the private equity group doesn't want to give that away because it's the most valuable. ⁓ But if the doctors are willing to own that, then we're all literally doing the same thing. Let's drive value for when we sell this thing. Well, and you just said it's it's it's a unique bird and you know we we all hear that a lot. I'm almost wondering, are there character traits or 'cause I imagine there there's there's probably, you know, doctors watching or listening to this right now that they have the ambition of of the growth. They know that they want to get big, whether it's for financial reasons or or what have you. And at Dental Mentors, we're all about building wealth. We don't think there's anything wrong with dreaming big. And I actually think that what what I see is more the opposite, where they don't almost have enough ambition because they don't think it's possible for them. And so I almost wonder if like folks are getting caught in this almost trap of like I I don't I don't think they see enough ⁓ You know, they don't have a ⁓ a mentor, maybe that's that's a doctor that's that's done it before, or right? So so they don't that's typically what I see, like they don't see themselves as that person. They're like, ⁓ I don't have my MBA and that's what you know, private equity guys do, that's what that's what fancy business people do. That's what I thought before I got in the industry. do you think there's some sort of mindset shift, or do you think there are books that they can read or or things that they can do to kind of prepare themselves even to to see do I want to do this or not, right? Like what does this road actually look like versus, you know, how what do I think it looks like? any any guidance that you have for those folks? I think just in general, if you're a successful practice owner, and I'm gonna think multi location, growing, associate doctors within your portfolio, it's not just you, then you've already accomplished something Pretty unique and entrepreneurial. And you've demonstrated that you're willing to make the bet on yourself. That for me is the mindset. Am I willing to make the bet with your own money? I'll be honest and tell you, I'm personally not. I'm scared of throwing my own money on the table. I just had a conversation with a doctor, has four locations, and just added an oral s I'm sorry, an orthodontist full time. That's a big investment for a soul. That's the guy that's gonna win. so you need to make sure you get things right, but if you've already succeeded, make the right investments. This is self-serving, but one of the investments is management talent. Dentists didn't go to school to be CEOs. I did. And there are people like me. At a certain point, it's worth that investment. Now also interestingly, there are people like you. And your other founders who share their experience and knowledge. So you can rent this, you bring in a consulting group to help you think about how do you make these decisions. I think the world of both you know Matt and Eric. So you've got some great partners and there are others. So my advice is get some make the investments ⁓ and particularly around advisors. I love that too, 'cause it's like I mean, I you know, I'm not a dentist myself, of course, and ⁓ I always joke with dentists I'm like, Yeah, I have the luxury of being out of the chair 'cause I legally can't go in the chair. I can't be in the chair. And there's a lot of folks, you know, like yourself that, you know I mean what about just you know, I I I kind of advise, you know, dentists sometimes too. I'm like, go out just j just pitch ⁓ Like maybe they can maybe you can hire them hourly. Maybe you could work with somebody on a contractual basis. That's just done these things. You know, one of my favorite things that that I feel like I learned in the Silicon Valley sphere was like there's this phrase that you can just do things, you know. You can just do things. There's no I think Dennis get in this sort of credentialism mindset because they come from such an academic universe. And there's nothing wrong with that. Right. There's pros and cons, but I think the con that I always find is like the a lot of people are so scared to just talk to people, ask the questions, put yourself out there. The worst that can happen is somebody says no. I That's a really good way to put that. And that tha that is you have that attitude and mindset. I'm not even sure I do, but founder doctors do. And the people that are gonna really drive their own wealth, I think, can make those decisions. Let's make those investments. Let's take the the risk. Yeah. and there are far more doc doctors that are not in that class. And I think your platform i is is likely to help people see that. ⁓ so let me just reiterate my message that there are wealth management experts, there are tax experts, there are great attorneys, use them. You know, pay for them, they're worth it. and you know, the asset protection attorneys, that's important. I didn't know how important that was until I helped my first part partner. become a member of a DSO and get forty million dollars. Yep. That's a whole different world. Yep. so yeah, make those investments in in the good invest advisors. So let's say that, you know, I'm someone who I'm a doctor, I am at that sort of two million dollar mark in production and I've kind of I've I've taken the first steps to scale and I wanna I want to Go further, I want to get as as big as I can, but you know, sort of conservatively. What are the next steps that you'd recommend that I take? I know I keep repeating myself around the idea of investment. One thing I think doctors do that hold themselves back is short-term focus. the best example is I've got an office manager that I've kind of thought of as my right hand. Pay her $60 or $70,000 a year. Well, you're getting $60 or $70,000 a year worth of executive support. Go find yourself the $90,000 or $100,000 a year person. Give yourself some more time to think like only you can as the entrepreneur. Is it right to bring in a associate? Is it best to open a new location? You need somebody to rely on more than you generally have. So that's probably the first step. And then you've got a laundry list of potential growth strategies. If you've got space in your building, you absolutely want to add doctors, whether they be part-time doctors that do other specialties, which I love, or the associate kind of model. Then you get into let's buy or build. And there's plenty of opportunities to buy practices and fix them up. as a DSO, that's not something I like. But as an individual, that can be very financially rewarding. And when you when you mentioned that, I I'm fascinated by this topic too. Like you mentioned the the ninety thousand, hundred thousand dollar employee. What are you what are you looking for? Are you looking for kind of I I always go back to kind of the the the EOS model, right, of the integrator and the visionary. Are you looking for kind of the yin to your yang, the Batman to your or the Robin to your Batman? Or are you looking for that? You know, what what it presumably like they may they might not have, at least in my experience, they haven't done it quite before. Like maybe that person hasn't managed multiple locations. Is it important for to you that they have managed multiple locations or who's that person? Okay. But I'm I am. I'm looking for somebody that I can take an entire piece of my business and just turn it over to them. In general, I really want somebody that I can, you know, make ninety percent, eighty, ninety percent of my decisions. Just bring me the ones that, you know, you really need the tiebreaker. That person tends to have a college degree. That person tends to have not quite MBA. Not necessarily. Then you're getting into the $120,000. That's a good point. There will be point where you need that. Yeah. But you're not there yet. ⁓ So ten years of experience in some professional capacity, a chunk of which is in dental. ⁓ If they've run multiple locations, great. Tough to find. So you're probably looking for somebody that has run another large practice. And how many practices will that nucleus, let's call it, that management nucleus what is there a production dollar amount? What's the KPI there? You're trying to get to four practices. Greatness. Great question. And then and then who do you hire? We've just hired what will become a regional manager. Okay. And a regional manager has a span of control that's reasonable. And once you get beyond six locations, it's hard for that regional manager to Bring on the seventh. So the span of control is pretty. Is that real number? Six six locations? Absolutely. Six to eight. Okay. And it depends on size. Yeah. If you've got a four million dollar office, no, that person's not managing six of those. Right. But you know, million, two million dollars. Five to eight ops per location, maybe something like that. Yeah. so you will have made an investment that you can really scale. One of my buddies owns a company And he's basically a fractional CFO. And you maybe you just made me think about this because his rule of thumb is seven. S like seven seven locations before you should have a dedicated CFO. Would you agree with that? what do you think in terms of like the the management of of of finances? When should you bring on a fractional CFO? When do you need a full time CFO? I've been a CFO, so I've got a little bit of a preconceived notion here. Although I've been a CFO, I'm really an operations person. So if your CFO is really an operations person, then making the investment with seven locations, that's probably a great idea. Might be a little early to just bring on a bean counter, mm-hmm, which frankly I don't support in general. so depends on the person, unfortunately. Should you have a dedicated controller up to that point? Yes. Okay. And I'm making the distinction. If there's a skill set that the controller has, please don't try to make a controller your CFO. I was just thinking about that. It's it's not the earlier easiest concept to feel good about at least. But you're gonna outgrow team members. If you're successful in your growth, you're going to outgrow your team members. It's just a fact of life. Embrace that too. What is your academic difference between a controller and a CFO? controller is inward thinking I can measure what's happening. CFO is capable of outward thinking. I love that. And you know, what do we need to do together to bring in outside capital or communicate our story to an investment banker? Still knows all that being counting stuff. But not every controller can be a CFO. That makes sense. That makes sense. That rise we talk a lot about too internal data and external data as well and kind of the different members of the team that's that's looking at that data. And I think of like internal data as from when a when a new patient first comes in all the way through to collections. So basically your your your case acceptance, existing patients, things like this. And then I think of external data as how the the all of the data that measures how the practice engages and interacts with the community that it's in. Now for me that's ⁓ for us that's it's it's a marketing thing, but it's also kind of helps to dictate things like C E. Like what which which which treatment should I add? Well, what you know, what are the what are the what's the demand of treatment for your market? Sometimes you talk at an academic level that's a little over my head, so I've gotta catch up. But I just caught up. That makes a lot of sense. Well that's That external view. I mean literally literally a internal and external and you know, so it it's interesting you say that because I don't I don't often hear the reason I it made me think of that is I don't often hear people in dentistry talk about internal, external. Everything's internal. Everything is thinking inward. And I tend to believe that that kind of we were just talking about mindset earlier today. And it's just this mindset of I just think about it as a very defense mindset. They're just looking at, you know. Stopping bleeding, right? They're they're they're the famous kind of, you I think dentists. How's my schedule doing? And, you know, what's my production look like next week? Exactly. The guy in my seat is thinking six months or a year down sometimes five years down the road. If you're a DSO and you're owned by a private equity, that's my hold period. I I almost don't care what happens next week. I all I care about is what's the value when we sell it. Or whatever your ultimate goal is. Yeah. Which a lot of your target market of for this group is looking to sell. So yeah, no, I'm an external mindset is probably a good change to try to embrace. Think thinking about that that North Star, I mean that's that's I love I love thinking about that as well. Like what's my North Star? You know, you're thinking in such large swaths of time. And maybe that that's really I mean it's it's certainly gotta be very helpful for ambitious practice owners. Like start thinking, you know, two, three, four years out, or to your point, let's reverse engineer the whole thing. I want, you know, and ev I think w with what we can absolutely do. Yeah. Yeah. Sure. No, I mean even personal income, right? Like I want I you know, what's your freedom number? My freedom number is twenty five million dollars. Okay. Well how many practices I can tell you how much Hebata you need to accomplish that. And I can tell we c a group of people would be able to tell you you probably need this many locations and there's lots of different math that you can run in terms of how have I engaged doctors, how much of the equity do I still own. Those are big decisions. Yes. But yeah, if you start with this is where I want to get, go get the people that can help you drive here here's how I get there. This is something I really want to get into that I talk about privately all the time. I think it's considered a little bit I'm a little nervous about controversial. Well, I don't think it's to me it just to me it has to do with the state of the market. Like, for example, I've I say controversial just because I feel like half the folks I talk to are kind of saying that the dental market is not dying down, ⁓ and A activity is not dying down, the other half of the market is kinda like, ⁓ it's kind of a wet towel right now. Where are you at on that? Because you've been in you've been you've been in this space for so long. you know, investor interest, private equity interest, are people how how do they view dental right now? And can you almost I would love like honestly, selfishly, I would love like a history lesson from you over the past like, you know, ten, twenty years of like how, you know, w when when dental roll ups were somewhat new to like You know, is it is it dying down? Is there still can you still get a great multiple? Has the multiple gone up or down over the past ten years? Well that depends on what you're talking about. Okay. That's one answer. If you're talking about DSOs, it's a very different answer. So DSOs have been through a heck of a hard time in terms of you know selling or getting the value that they want. And that's more than just Hey, interest rates skyrocketed. Yeah. It's there was a period where when I was in my early days in the industry and probably for a good ten years, people were building companies and with the associated infrastructure. Yep. As you get more practices, you need the CFO, you need an internal revenue cycle team. Somewhere in that, you know, just before, just after COVID time. We started to see more people just aggregating. Mm-hmm. Let me just buy a bunch of dental practices. And unfortunately, private equity investors were more than happy to buy that. Yeah. Pay a lot for them. It messed up the whole industry and we're still recovering from it. So good DSOs that have built a a quality infrastructure with great doctors, I think they're gonna do extremely well. ⁓ I'm very bullish. on the future but there's some h overhang and I hope the people that own those will start to recognize I'm not gonna get the value that I am hoping for. now if you're an individual practice owner, I don't know that that hit is hard because you didn't do that, you know, let me try to grow crazy. so I don't yeah, multiples came down around the interest rate. ⁓ increases and those are logical. So you can paint a pretty clear picture. If you've got this much EPAD, this is your multiple. If you've got this much y this is your multiple. I think that'll be the same next year and the year after that. Is that was that just kind of a function of like when private equity kind of first discovered, you know, dental roll ups, they just kind of didn't they weren't maybe as picky about, you know, what what they were rolling up, ⁓ the you know grouping GP because I I've seen some some groups that are in my view sort of almost oddly constructed where like you've got you've got practices that kind of have nothing to do with each other. You've got kind of a smorgasbord of specialties, but I feel like as I ⁓ over time I've seen that it's you know they're they're they're more in line with each other. I've absolutely watched and frankly, in one case been a part of a deal that just exploded and didn't ha didn't work and others because the business model didn't make sense, which is what you're talking about. There has to be some strategy behind it. Got it. Now the company I just left had a very broad group of specialists, but there was a very good geographic logic, there's a very good synergy logic to it. So there is a business strategy But if you've got a bunch of GP practices and you happen to buy a couple of pediatric dentists because you could get a good price, that wasn't a good business strategy. So you're saying that really you you you need a strong kind of central thesis and and you should you should honor that thesis and and kind of withhold that even if good deals pop up if you're trying to grow. Is that kind of the takeaway there? Yes, that is the takeaway. I will nuance it as smidge. that it's okay to change your thesis, but it has to make sense. Mm-hmm. Because I'm always thinking about selling something. I'm talking to a private equity advisor i i investor in my mind. Can I convey why they should pay for this thing? Mm-hmm. And yeah, that there has to be a lot of things about it that make sense. No, that that that makes perfect sense. And I mean what w what's a good example of a great thesis, would you say what's a what's a good thesis, what's a bad thesis? I d let me throw myself directly under the bus. I did not think that individual specialty roll ups made sense. When they started happening endo just ortho started with smile doctors, kind of that you know, just ortho. Okay. I was scratching my head thinking, how is that gonna work? 'Cause you want the you want the GP with you you think you want the GP with the ortho to a cross refer or something like that? just didn't think there was enough meat on the bone and that there was risk around the pati the patient referral source and I was dead wrong. Obviously those single ⁓ specialty roll ups have worked out very well. So very logical business model, executed well in a whole variety of cases. The ones that then, you know, pediatric dentistry fits great. with orthodontia and oral surgery. If you've got a periodontal practice in there someplace with a few GPs, I'm not even gonna come to the meeting to talk to you about why I should pay for it. That doesn't make any sense. and I do happen to love the I've got a lot of GP practices and I own the specialists around it. Got it. So yes, there's a piece of it that's feeding my own specialists. But really what I'm after is the geographic footprint. I control this region. I I love that. And I think that so geographically speaking, this is a topic that I also really find interesting because is it tr this is just my own what I feel like I'm seeing, and I I I really wanted your thoughts on this. So I feel like before COVID in particular A lot of DSOs were just kind of discovering the cloud. You know, a lot of the the the their patient management system would be local to the practice. They weren't on Dentrix Ascend yet or Curve or Denticon or something like that. And then COVID happens and everybody's sort of forced to move into the cloud for various reasons. A lot of people have to work at home, certainly and what have you. And I feel like I've seen this this trend where ⁓ I For example, I would never pre COVID see a DSO that was like New York, Miami, LA, Chicago or something. But now I'm seeing these DSOs pop up and let's say you know it's a brand that's very trendy. It's a very trendy DSO, right? It's very like, you know, customer centric and it's you know there's an app and it's like a sexy interface, right? But they'll have LA, New York, Miami, Chicago, whatever. Now I get why they're in those markets because that's where those people live. But what are your thoughts from a I always wonder like from a from a I never would have seen that pre-COVID because then they're like you that you have to be in Atlanta. Ever all your practice or at least Georgia. And if you're, you know, for our our own you know DSO, we had these conversations for years. We can't go outside Michigan. And even if we do, we have to be in the Midwest. But now I'm seeing like I mean you you could have you could have four locations now. I'm seeing these with these groups, and it's like one's in a different state. I wouldn't know how to operate that. Technologically I understand what you're saying. It is possible. I like being able to share staff. I like being able to have a patient that is normally seen by this doctor but now goes and sees this doctor and they have the right information. So the cloud is doing more than just enabling me to work across the country. I have no problem with ⁓ regions that If your primary region is Florida and you then decide I want to be in Atlanta and I'm gonna have eight practices there, I'm all in. Because you've built your own mini DSO. You can share staff and you can take advantage of the technologies. But I do absolutely see what you see. There are some really cool DSOs that are building very different kinds of practices. I I guess I could see why you'd have them as distant as you do. Maybe that leads into the just discussion of I wonder what the future model of dentistry is going to be. Yeah. I don't think we know what it is yet. Yeah. Yeah. I I I'm seeing a lot more as well about, you know, certain ⁓ healthcare modalities, traditional healthcare modalities. I talk a lot about HR V heart rate variability, which is something that you know I'm kind of involved with on the medical side. Right. But as I understand it, Dentists potentially could be running HRV tests for heart rate variability. And and also from a I I really am sort of fascinated by I have a lot of friends that are DOs, I have a lot of friends that are even more, you know, naturopathic doctors. And they're always really fascinated about dental because there's so many different things in the mouth, you know, they're saying b basically oral health is much more ⁓ related to overall health than the kind of the current system speaks to? I think the the science on this is very well founded now. It's simply a fact. but it's so many different views. And again, how do you get at that? One of the largest DSOs doesn't even consider itself a DSO anymore. It's a healthcare operation. I think that's brilliant. I don't know that that's the model I would use. Takes a lot of capital. Maybe it's as simple as the doctors only see their patients once a year or when there's a problem, we see them twice a year. What can we do that will help that patient? Testing has a lot to do with it. We should be able to do some of these things. If you can help diagnose diabetes, you've helped that patient's life. I happen to have a preconceived notion that One of the best things dentists can do to help their patients is treat sleep apnea. And I frankly believe the oral appliance solution for the treatment of sleep apnea is significantly better than the CPAPS. There is an area where you have doctors can make an impact on population health. Yeah. I'm a bit on my high horse on that one. I just happen to love it. No, I think it's fascinating. I know we we we worked with a a mutual group that that does that and ⁓ I get it and it you know, I it it makes complete sense and ⁓ yeah. But I'm sorry, the general message is we as dentists or the dental industry can and absolutely should play a larger role in the overall healthcare delivery system and that will improve our whole healthcare system. I don't know how to do it, but that's a great direction for us all to head in. Well speaking of improving the system, insurance. Should we accept it? Should we not? Is it a race to the bottom? Should practices be like I'll give you an example. Let's say that let's say somebody really wants to be fee for service because they no see how much they could charge and they see how much they're getting kind of raked over the coals with. Are there KPIs that you'd look at to determine How how how could I determine how to make that decision? 'Cause then that's very tough for a lot of people. Sure. I think that dentist practice operate effectively, whether you take Medicaid or your pure fee for service, it's how you run them. And if you're built on a PPO platform and you decide I don't like insurance anymore and I'm gonna become a a fee for service practice, good luck to you. Mm-hmm. That is not easy. It's tough. There's a smaller population. So I'm a fan of insurances. Do I think that Some insurances, the largest that I shall remain nameless, aren't the best that you really want to have in your practice. And maybe you make a decision there, sure. And there's ways to do that. ⁓ but the idea of I I don't like insurance and therefore I'm not gonna take it is counterproductive. Yeah. ⁓ what I watched was Georgia lowered its Medicaid rates quite significantly. Lots of doctors decided, damn it, I'm not gonna take this anymore. They did nothing but hurt themselves. They just took a huge chunk of their revenue. And by the way, I was running a DSO that did a lot of Medicaid, I was more than happy to grab those patients. ⁓ so think about it and think about it in terms of how much money do I get to take home at the end of the day? Yeah. Is this decision gonna help me make more money? Right. I'm I'm my opinion is generally no. It's it's funny. I I I tend to, you know, ask practices to kinda do like a self awareness exercise and think about themselves like either a restaurant or a car. I'm like, are you a Kia or are you Rolls Royce? Like right, like where are you? Because if you're if you're gonna go full fee for service or like a re like restaurants, right? Fee for service it might not quite be Joel Rubichon, but it's definitely like a Roots Chris. To your point, you're dealing with a smaller pool and there's nothing wrong with Olive Garden. Olive frankly, Olive Garden as a as a corporation, or even like ⁓ what would be a middle round, like Cheesecake Factory, maybe, right? You know, it's like Cheesecake Factory makes a lot of money. Like not everybody you not everybody wants to be. I think there's three role Joel Rubishons in the country. I think you're right you're making the right point that only so many practices can be successful as a pure fee for service practice. Being associated with several of them. but yeah, no, it's it's if you're in a Olive Garden market, you should probably be in Olive Garden. 100%. Mark, I know we've talked a lot about it's not what you make, it's what you keep. I know you're very opinionated about this topic. I would love to just hear your high level thoughts on taxes, hiring the right person, which I know is a big theme of the day. What are thoughts on that? Yeah, I come across this both when I'm helping the practice seller, ⁓ but also when I'm buying a practice. It what I'd like everybody to focus on is how much cash do I get to put in the bank? So I don't care what the multiple is. I d how much cash do I get to put in the bank? And that's much more than just the value of your practice or your company. It's tax planning. There are people that are exceptionally good. at very advanced tax planning. you may think you know them and your work. I was very surprised when I found out the kinds of things that can be done. And I'm not talking about let's go do conservation easements. I'm talking about does your advisor talk about how do I buy tax credits and how do I use a structure of a trust to minimize my asset ⁓ maximize my asset protection. plays into the theme of what you're building here. Just use the right advisors, get the right advice, and keep as much of your money as you can. ⁓ so yeah, you're right, I am pretty passionate about this. It it part of it's just pure self serving. It's easier to get the deals done if I can help the doctor keep more of their cash. Mark, thank you so much for coming on. It's been a pleasure. It's wonderful to be here. Thank you for having me. If you enjoyed today's video, we'd love to invite you to join the Dental Mentors Facebook group. The group is completely free, but it is private at invite-only. The group is for practice owners, dentists, specialists, and dental CEOs. If that's you, we'd love to see you inside. As part of Dental Mentors, you're going have direct access to the brightest minds in dentistry and the brightest mentors and some of the greatest CEOs that have ever worked in the dental space. You're going to learn all the best practices that you're going to need. 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