Latest / My Dental Playbook / 034 45 Dental Operatories?!?

Transcript

034 45 Dental Operatories?!? · My Dental Playbook

0:00
SPEAKER_01: You know those Tom Clancy movies that had all of these lawyers at a big firm and they're like, I'm just working to make partnership.
0:06
SPEAKER_01: You don't buy into partnership, you earn it.
0:09
SPEAKER_01: So you have to reach a specific production hurdle or revenue hurdle.
0:14
SPEAKER_01: That's how you earn equity in the business.
0:16
SPEAKER_01: And it's not for everybody.
0:17
SPEAKER_02: Welcome back to another episode of My Dental Playbook.
0:20
SPEAKER_02: I'm your co-host, Gary Bird.
0:22
SPEAKER_02: Along with my friend Dr.
0:22
SPEAKER_02: Blake Hamlin, we're diving deep into his office to talk about how he's double collections over the last 12 months.
0:28
SPEAKER_02: But today, we're not going to be diving into his office.
0:31
SPEAKER_02: We have a special guest, Dr.
0:33
SPEAKER_02: Jason Tenori.
0:35
SPEAKER_02: Now, he doesn't really need any introduction.
0:38
SPEAKER_02: He is very well known in the dental space.
0:40
SPEAKER_02: And if you haven't heard of him before, you're going to absolutely be blown away by this episode.
0:44
SPEAKER_02: We're going to be talking about how he's built out his office, multiple locations in New York, as well as how he's expanded, what his ownership structure looks like, as well as his leadership, org chart, associate model.
0:59
SPEAKER_02: Also, he's going to be talking about his legacy practice and how he's probably not going to be selling.
1:04
SPEAKER_02: And then also at the end, the best part, he actually shares how he's building out a 45 op location.
1:12
SPEAKER_02: This is amazing, like a monster practice.
1:15
SPEAKER_02: You're going to learn so much.
1:16
SPEAKER_02: Dr.
1:17
SPEAKER_02: Blake and I just absolutely pepper him with questions.
1:19
SPEAKER_02: And he was gracious enough to come on and share the ins and the outs.
1:23
SPEAKER_02: I think this is something that you'll learn a lot from.
1:25
SPEAKER_02: If you want to grow, this is the show for you.
1:28
SPEAKER_02: Now, down below, make sure you check out our sponsor, Cherry.
1:31
SPEAKER_02: They do an amazing job of helping practices grow by using patient financing.
1:36
SPEAKER_02: If you're not using them, you're losing out.
1:38
SPEAKER_02: We have special pricing right down below, and they help us sponsor this podcast so we can just keep airing it every week and helping you grow.
1:45
SPEAKER_02: So stay tuned for this one.
1:46
SPEAKER_02: You're going to love it.
1:47
SPEAKER_02: All right, we are live for another episode.
1:49
SPEAKER_02: And you can see that we have a special guest today.
1:53
SPEAKER_02: And this is going to be a really exciting episode because we're going to be talking about things like legacy practices.
1:59
SPEAKER_02: We're going to talk about a 45 ops, which is kind of a small practice.
2:03
SPEAKER_02: You know what I mean?
2:04
SPEAKER_02: So we're going to talk about that.
2:05
SPEAKER_02: We're going to talk about expansion strategies, owner structures.
2:09
SPEAKER_02: And I'm excited because we have the one, the only, Dr.
2:13
SPEAKER_02: Jason, and you have a really cool podcast.
2:16
SPEAKER_02: So I know you and Dr.
2:17
SPEAKER_02: Blake, you guys just did a podcast, right?
2:19
SPEAKER_01: It was kind of like a pseudo-podcast.
2:20
SPEAKER_01: You know, I was, I was very selfish, and I just wanted to suck this info from Blake and from his operations person.
2:27
SPEAKER_01: So we we recorded it and I could probably edit it in a way where it'll be a good podcast.
2:31
SPEAKER_01: But selfishly, I was just trying to, you know, take a piece of his brain and and use it in our operations.
2:37
SPEAKER_02: Yeah, the the patient financing, right?
2:39
SPEAKER_01: Right, right, right, right.
2:40
SPEAKER_02: That's huge.
2:41
SPEAKER_00: Jason's been a huge huge help for me.
2:43
SPEAKER_00: I met Jason through DSI, but we became friends just as we learned that we think similarly and stuff like that.
2:50
SPEAKER_00: And so it was really easy for me to be willing to give him that time.
2:55
SPEAKER_00: He's he's given me way more than I gave him in that short phone call.
2:59
SPEAKER_02: That's great.
3:00
SPEAKER_02: I appreciate you saying that.
3:01
SPEAKER_00: What's the name of your podcast?
3:02
SPEAKER_02: Just for everybody, so everybody can check it out.
3:04
SPEAKER_01: The Dental Lighthouse.
3:05
SPEAKER_01: It's just kind of a real world.
3:06
SPEAKER_01: We just talk about everything and anything, leadership, systems, accountability.
3:11
SPEAKER_01: I like to have kind of regular dentists down and talk through their pain points and stuff like that.
3:15
SPEAKER_02: That's great.
3:16
SPEAKER_02: That's so awesome.
3:17
SPEAKER_02: Well, let's let's talk through just tell the audience.
3:20
SPEAKER_02: So for those that live under the rock and haven't heard about you, tell them a little bit about like your practice, where you're at, what you're trying to do, and some of your goals.
3:30
SPEAKER_01: Yeah.
3:30
SPEAKER_01: So I've been at it for about 25 years, did a de novo right out of residency, and it's slowly but surely grown to eight practices.
3:38
SPEAKER_01: I've had about 165 employees, 23 doctors, and just trying to figure it out, just trying to, you know, deal with little fires that come up on a regular basis and just continue to scale and do it the right way.
3:52
SPEAKER_01: And it is fun.
3:54
SPEAKER_01: It gets me out of bed.
3:55
SPEAKER_01: So I enjoy it.
3:57
SPEAKER_02: Yeah, that's great.
3:58
SPEAKER_02: So you what what does your expansion strategy look like?
4:01
SPEAKER_02: Because that's that is a pretty good size organization.
4:05
SPEAKER_01: Yeah, we have some internal metrics that we use to kind of put guardrails on our expansion.
4:09
SPEAKER_01: We want to grow revenue on a yearly basis by 20%.
4:14
SPEAKER_01: We have you know internal EBITDA and profitability goals and stuff like that.
4:17
SPEAKER_01: But that 20% revenue growth goal really kind of forces me to not look at every shiny object that comes across my desk.
4:25
SPEAKER_01: So we do that.
4:26
SPEAKER_01: We try to hit that 20% number through same store sale increases.
4:30
SPEAKER_01: And then if we if we need to expand a facility or if we need to acquire, do another de novo in order to check the 20% box, then we do it.
4:38
SPEAKER_01: But it's it's just been just it's pushed us just enough where it's challenging, but the wheels don't come off from a cultural or a clinical standard perspective.
4:48
SPEAKER_00: Jason, did you do that as a startup model, or did you do acquisitions, or was it a mixture of both, or what did that look like for you?
4:56
SPEAKER_01: It was a mixture of both.
4:57
SPEAKER_01: Our our general dentistry offices, our de novos, we've acquired two PO ortho offices along the way.
5:04
SPEAKER_01: And you know, as you guys know, those come up with challenges, but it's mainly been de novo.
5:10
SPEAKER_01: And I love the de novo strategy, especially with the cost of construction nowadays.
5:14
SPEAKER_01: But it works for us.
5:15
SPEAKER_00: I'm curious because so, and we've talked about this a little bit in the back channels, but being in Houston, being in a in a in an ecosystem that's a little more competitive than other other areas, my my tendency is to want to get a little bit um to to not want to take as much risk in different locations just because I don't want to split my time.
5:36
SPEAKER_00: Do you feel like your market allowed you to be able to spread your spread your eggs across multiple baskets versus doing kind of what we may talk about in the in a little bit about building one location and really building that location before you go and do others?
5:52
SPEAKER_01: Yeah, super good question.
5:54
SPEAKER_01: I definitely made some mistakes along the way.
5:56
SPEAKER_01: And I I've had a number of dentists want to be on my podcast and we kind of talk this through.
6:01
SPEAKER_01: And if I had to do it over again, what I would do is is grow my primary or flagship location as as big as I could and bring on those people that need to support the patient volume and the employee volume, like ahead of HR, like revenue cycle management, like ahead of I, all of those things.
6:22
SPEAKER_01: Doing it the way I did do it, to your point, to the at least to the point I think you're trying to make, we did spread ourselves too thin early on.
6:30
SPEAKER_01: So in retrospect, if I had to do it over again, I would probably grow a flagship to as big as I could, 20, 30, 40 ops.
6:38
SPEAKER_01: And then as soon as I maximize my footprint, I would feel comfortable opening up offices in other neighborhoods, other communities, because I knew I had the support staff behind me to handle all of the behind-the-scenes logistics.
6:51
SPEAKER_00: Yeah, that makes sense.
6:52
SPEAKER_02: That's so good.
6:53
SPEAKER_02: Because what I've uh to your point, what I think a lot of people miss, and this is not like a DSO pro or anti or any of that kind of stuff, but it when you're a single practice, you kind of split up all the insulary HR stuff and you know, marketing and all these insulary services.
7:11
SPEAKER_02: You kind of just kind of divvy it out and it kind of works.
7:15
SPEAKER_02: And you're at the center of it, so you can glue it together.
7:18
SPEAKER_02: But when you go to like multi-location, you need dedicated people that are focusing on those things.
7:23
SPEAKER_02: And if not, you drowned really, really quickly.
7:26
SPEAKER_02: So if I hear you correctly, if we could wave a magic wand, go back, start the first flagship, build those people that are going to run those insulary things so that that way when you start adding other locations, they have the bandwidth to handle HR or accounts receivable or insurance, you know, verification and or whatever it may be.
7:46
SPEAKER_02: So that way you can move faster.
7:48
SPEAKER_02: So go slower to go faster.
7:50
SPEAKER_02: Is that right?
7:50
SPEAKER_01: 100%.
7:51
SPEAKER_01: And and I always tell coaching clients, like, just because you only have 10 people or 15 people, you still have a head of HR, you still have a head head of IT, you still have a head of marketing, you're probably wearing all those hats.
8:03
SPEAKER_01: And and and the reality is you suck at it, right?
8:06
SPEAKER_01: Because you you're not good at it, you weren't trained on it, you don't want to do it.
8:10
SPEAKER_01: So, yeah, in retrospect, if I could have brought those people on as the demand grew within one location, the other advantage to it, as as you guys know, is the clinical team, right?
8:20
SPEAKER_01: So when you when you have your flagship as a six or seven operatory practice and it's maybe one or two docs, and you start to open up other locations, uh, it's just really difficult to onboard doctors that are gonna fit that particular style of practice.
8:34
SPEAKER_01: Whereas in our current flagship, we can have five or six doctors.
8:38
SPEAKER_01: We can hire, and this is what we do.
8:40
SPEAKER_01: We hire a doctor, he's in our flagship for six months, even though this isn't gonna be his final destination.
8:45
SPEAKER_01: He starts to drink the Kool-Aid and he understands how we do things.
8:48
SPEAKER_01: And then we can put him in one of these smaller offices and he and he just takes off.
8:52
SPEAKER_02: Yeah, I absolutely love that.
8:54
SPEAKER_02: And because I think the the what's so powerful about that, like you said, drinking the Kool-Aid is that a doctor coming in, even if you have the best organization in the world, they go to a little startup that you're just getting off the ground and there's bumps and stuff, they don't actually see the vision or the what's actually going on in real life in your organization, and spreadsheets don't really do it.
9:14
SPEAKER_02: You know what I mean?
9:14
SPEAKER_02: Like, no, trust me, bro, we're we're doing it.
9:17
SPEAKER_02: I love that you come in, you indoctrinate them on this is who we are, this is what we're gonna send you to another practice, but this is like the future kind of thing.
9:26
SPEAKER_02: I think that's such a competitive advantage.
9:28
SPEAKER_02: Um, now that kind of leads me into the next question.
9:31
SPEAKER_02: How do you how do you keep those doctors around?
9:34
SPEAKER_02: Because that's the funny thing, you know, I remember for many years I would listen to everybody, and everybody was like, we're gonna add this much, we're gonna grow this much, we're gonna add this many new locations.
9:43
SPEAKER_02: And I started doing the math of listening to everybody, and I'm like, where are these dentists gonna come from?
9:47
SPEAKER_02: Like, how are you gonna like someone's gonna get left holding the bag, not having enough dentists?
9:53
SPEAKER_02: How do you what's your structure for ownership and expansion and keeping dentists around?
9:58
SPEAKER_01: Yeah, so it's a super good question.
10:02
SPEAKER_01: And and as some, as I know you realize, the number one deterrent to the growth that we want to occur is attention or associate turnover, right?
10:11
SPEAKER_01: So associate retention.
10:13
SPEAKER_01: So we do have a partnership model.
10:15
SPEAKER_01: Ownership is at the management level or the umbrella level, whatever you want to call it.
10:20
SPEAKER_01: Um, and it's an RSU model.
10:22
SPEAKER_01: And we can go into the weeds on what an RSU model looks like, but it's, you know, I whenever I'm trying to give a 30-second description to someone that's asking me about it, it's like, you know, those Tom Clancy movies that had all of these lawyers at a big firm, and they're like, I'm just working my ass off to make partnership, right?
10:39
SPEAKER_01: That's kind of like how it is.
10:40
SPEAKER_01: Like you don't buy into partnership, you earn it, right?
10:44
SPEAKER_01: So you have to reach a specific production hurdle or revenue hurdle, and then you're that's how you earn equity in the business.
10:52
SPEAKER_01: And it's not for everybody, but it's a model that works really, really well for us.
10:57
SPEAKER_01: Our our avatar for a partner or even for an associate is not a Dr.
11:02
SPEAKER_01: Blake, right?
11:03
SPEAKER_01: Because Dr.
11:04
SPEAKER_01: Blake's type A, he's gonna do it himself, he's gonna grow his own empire.
11:08
SPEAKER_01: I'm looking for good core value people that can lead by example and really don't have any interest in all of the headaches that come with entrepreneurship.
11:19
SPEAKER_01: If they want to, you know, say they're a partner and you know, and and make a good living and have most of the logistical things that owners have to deal with taken care of for them, then we're the place for them.
11:31
SPEAKER_00: How do you balance that with the other school of thought who says like if you're gonna be a partner, you need to be qualified to be able to help manage and and handle some of these business type operations?
11:44
SPEAKER_00: Whereas what what qualifies you in your organization would be you produce X amount, you can you can buy in and you're kind of giving them the golden handcuffs, which I totally understand.
11:54
SPEAKER_00: But how do you reconcile that with you're not adding any business help to me, Jason, as the owner of the practice?
12:02
SPEAKER_00: Or why should I give you equity into the business?
12:04
SPEAKER_01: Yeah, super good question.
12:05
SPEAKER_01: And I think I think it really just comes down to the partnership model that you're considering.
12:09
SPEAKER_01: So if it was the traditional, you know, one location, 10, 12 operatories, and you want to bring in one or two partners and you're gonna split it a third, then in my opinion, you need those partners to take on a lot of responsibilities away from the chair, right?
12:27
SPEAKER_01: It's like we've talked earlier.
12:28
SPEAKER_01: You need someone to wear the IT hat, the HR hat, the clinical director hat.
12:32
SPEAKER_01: And our model, because of our size and because of how we're trying to grow, all of those responsibilities are already taken care of by, you know, for lack of a better term, C-suite non-clinicians.
12:44
SPEAKER_01: So I just need these providers to come in, continue to grow the organization, and more most importantly, be a good core value fit, a good role model, you know, kind of lead by example.
12:55
SPEAKER_01: Um, but I 100% hear where you're coming from.
12:57
SPEAKER_01: I know we have a mutual mentor and he preaches that religiously, and I totally get it.
13:03
SPEAKER_01: So he's probably not a fan of our model, but for us and for our growth strategy and for what we're trying to accomplish, it's worked beautifully.
13:14
SPEAKER_02: That's good stuff.
13:14
SPEAKER_02: So tell me, speaking of that, like you you said you have a lot of these people already in their seats.
13:19
SPEAKER_02: How do you structure the org chart and keep everybody kind of aligned on what your vision is?
13:26
SPEAKER_02: Because I I've seen in the DSO world again, where you know you have this culture that like all these C-suites, and they're like, we have the best culture in the world.
13:35
SPEAKER_02: And then down below it's like dumpster fire cultures of the offices that nobody stays there, no one wants to work.
13:41
SPEAKER_02: And it's like two really two different worlds.
13:43
SPEAKER_02: And I've seen people do it right too.
13:45
SPEAKER_02: How do you how do you keep that glue, that culture glue?
13:48
SPEAKER_02: Because I know that's really important to you, especially which we'll talk about your legacy goals and how you're gonna move forward with the practice.
13:55
SPEAKER_02: So, how do you how do you keep that all glued together?
13:57
SPEAKER_01: Uh, with duct tape and twine.
13:59
SPEAKER_02: Someone asked me yesterday, they said, What's your leadership style?
14:02
SPEAKER_02: I said ADHD.
14:04
SPEAKER_02: So I totally get it.
14:05
SPEAKER_01: Yeah, I mean, that's it's a super good question, a very nuanced question.
14:09
SPEAKER_01: And I'm really trying to develop my own leadership muscle where I'm I'm setting the example, but I'm not micromanaging situations.
14:18
SPEAKER_01: So I'm a huge proponent of meetings, I'm a huge proponent of scorecards, I'm a huge proponent of of just getting feedback and giving the frontline employees every possible avenue that they can have to give feedback to their office manager, upper management.
14:34
SPEAKER_01: But to answer your question, you know, it's me and my operations person that are kind of the, to use EOS language, the visionary integrator.
14:42
SPEAKER_01: We have a director of finance and HR person that are also on our organizational leadership team.
14:49
SPEAKER_01: Then below that is a couple regional managers.
14:51
SPEAKER_01: Then below that, each particular office has an office manager, and that office manager is ultimately responsible for the leadership of their particular office.
15:00
SPEAKER_01: But I have, or we have, a very good cadence of communication with them on a regular basis.
15:07
SPEAKER_01: I meet with the office managers and person at least once monthly.
15:11
SPEAKER_01: My operations and regional managers meet with the office managers weekly via Zoom.
15:16
SPEAKER_01: Uh, and we're just constantly trying to give outlets to everybody about speaking how they feel and and talking about what's working and what's not working.
15:24
SPEAKER_01: We're also huge proponents of informal one-on-ones on a monthly basis.
15:29
SPEAKER_01: You know, when I do tons of coaching, I bring this up and they're like, oh my gosh, I have no time for that.
15:33
SPEAKER_02: And you know, those are everybody says that in every business everywhere is like, I don't have time for one-on-ones.
15:39
SPEAKER_02: It's like, oh, you're gonna you're gonna make time for them later then.
15:42
SPEAKER_01: Yeah, exactly.
15:43
SPEAKER_01: Because those are the people that are now, they have to now make time to update their job ad and and do more interviewing.
15:50
SPEAKER_01: And so we we place a huge emphasis on one-on-ones and just trying to really get to the heart of what's driving people and what's keeping them motivated and and stuff like that.
16:01
SPEAKER_01: So it it it works for us, don't get me wrong.
16:03
SPEAKER_01: I mean, we have some some headaches for sure, but we've really gotten better at hiring, we've gotten better at turnover, I've gotten better at uh, you know, accountability and just making sure everyone understands what winning looks like for the seat that they're in.
16:17
SPEAKER_01: So it's been good.
16:18
SPEAKER_01: It's been good.
16:19
SPEAKER_00: So, Jason, for for the listener who feels like your practice is just they will never reach it, right?
16:26
SPEAKER_00: Like there's no way that they're gonna be completely non-clinical, have time to do what you're doing.
16:31
SPEAKER_00: And then maybe an intermediate where my practice is, where I'm still pre producing dentistry, but I I've created some CEO space-time to work with the team, manage and lead the team.
16:44
SPEAKER_00: Uh, I know I've talked about on the podcast, but I I'd love for others to hear kind of what was that breaking point for you to where you said I've got uh maybe maybe both both times, right?
16:54
SPEAKER_00: So the first time when you said I've gotta stop doing everything, I gotta stop doing all the dentistry, and I've gotta make time to meet with my leadership team and and form leaders so that I don't do all this stuff.
17:06
SPEAKER_00: But then also, maybe selfishly for me, what was the next step when you said I'm not getting out of the chair because I want out of the chair, but I'm getting out of the chair because that's what's best for the organization so that I can help lead and manage these people.
17:21
SPEAKER_01: Yeah, such a good question.
17:22
SPEAKER_01: And I think it comes down to vision and not to sound like subjective or granola or tree hugging and stuff like that.
17:29
SPEAKER_01: But like I mean, the reality is like what's gonna get you out of bed?
17:33
SPEAKER_01: What's gonna motivate you?
17:34
SPEAKER_01: And I got to a certain point in my life where just prepping cow pre prepping crowns and placing implants was was, you know, meh.
17:41
SPEAKER_01: Like it was, I just I wasn't motivated by it anymore.
17:45
SPEAKER_01: But what was really motivating me was how can I serve as many people as possible, both both team members and patients?
17:52
SPEAKER_01: How can I get back to to certain communities at an irrational level?
17:56
SPEAKER_01: And I didn't have answers to those questions.
17:58
SPEAKER_01: So that's really what motivated me to get to the point where I'm at.
18:02
SPEAKER_01: And as I've gone through this journey, I've been so challenged in a good way, right?
18:08
SPEAKER_01: Like it's like I really feel like what I'm doing on a regular basis is moving the needle.
18:14
SPEAKER_01: Growing my leadership team, like you're probably in the process of doing right now, was very, very difficult.
18:20
SPEAKER_01: But I've I've done that.
18:21
SPEAKER_01: Not that I've accomplished accomplished it.
18:23
SPEAKER_01: It's not like any finish line you get to, right?
18:25
SPEAKER_01: It's a it's a north star.
18:27
SPEAKER_01: And now I'm realizing as we get so big, it's developing the next line of leaders, right?
18:33
SPEAKER_01: It's it's not only teaching the leaders that directly report to me, how do I coach up those people to grow the people that report to them?
18:42
SPEAKER_01: And man, that's where it's getting even more challenging.
18:45
SPEAKER_01: But again, I I I just love the challenge and I I love being able to just serve as many patients, team members, communities as possible.
18:54
SPEAKER_01: Um, so that's why I've chosen that.
18:56
SPEAKER_01: But when I to your point about when someone hears our story, if that's not for you, then don't, you know, don't, you know, don't do it.
19:05
SPEAKER_01: Yeah, like you you have to, and that's a you know, whenever people reach out to me, they're like, what should I do next?
19:10
SPEAKER_01: I'm like, I gotta ask questions.
19:12
SPEAKER_01: Like, I I can't, I'm I'm not gonna be able to answer you.
19:15
SPEAKER_01: Like, do you want a lifestyle practice?
19:16
SPEAKER_01: Do you love clinical dentistry?
19:18
SPEAKER_01: Like, what are you really trying to accomplish here?
19:20
SPEAKER_01: Right.
19:20
SPEAKER_01: And until they get a little bit of clarity on that, it's impossible to to kind of coach or advise.
19:27
SPEAKER_02: Yeah, I love that.
19:28
SPEAKER_02: And I and I think in my experience, just working with people, the younger you are, the harder it is to get answers for those questions because you just don't, you don't even know what you want yet, right?
19:37
SPEAKER_02: So when you're starting in dentistry, it's like, I want what that guy has, and you have no idea what you're even asking for.
19:43
SPEAKER_02: And then you start building it, you're all no, no, no, never mind.
19:45
SPEAKER_02: I want this.
19:46
SPEAKER_02: And you have to structure things in different ways.
19:48
SPEAKER_02: And that that actually pops something into my brain that I've that I have struggled with from a number standpoint over the years, because there was a really cool trend for a while where everybody was like, centralize everything, like take your call center, centralize it, marketing, centralize it, HR like centralize everything.
20:05
SPEAKER_02: But then I started uh people, the PLs kind of caught up with people, and the CapEx on that was like crazy.
20:12
SPEAKER_02: And it was like, oh, we made no money on paper because we centralized everything.
20:16
SPEAKER_02: And then there was a trend back the other way where it was like, no, no, no, let the office do everything and don't centralize almost anything unless you absolutely have to.
20:25
SPEAKER_02: Where did you fall on that tree with different things?
20:28
SPEAKER_02: Like, I'm sure some were like, Oh, this is perfect.
20:31
SPEAKER_02: We should centralize it, it's better for everybody, and other things not.
20:34
SPEAKER_02: Like, how did you figure that out and how where are you at on that?
20:37
SPEAKER_01: Yeah, it's so interesting that you asked that question.
20:39
SPEAKER_01: Like, you were a fly on the wall during all my failures over the last 10, 10 years.
20:44
SPEAKER_02: Well, every I think everybody, I think everybody, I I know for me, I've I don't have a multi like we do marketing, but it's like there's certain things where we're just like, oh, I wish I wouldn't have structured it this way, and then it's way better that way.
20:57
SPEAKER_02: And I've gone back and forth on some where I thought it would be better.
21:00
SPEAKER_02: So I it's it like I I think everybody goes through that, even like huge organizations, and you've you're you are a GOAT.
21:08
SPEAKER_02: So I I'm so interested of where you're at with that.
21:11
SPEAKER_01: Yeah, so we did exactly what you said.
21:13
SPEAKER_01: We we drank the Kool-Aid and we were like, okay, we got to centralize everything.
21:17
SPEAKER_01: So we centralized insurance, revenue cycle management, call center, IT, I mean, literally everything, everything that we could centralize, we did.
21:26
SPEAKER_01: And I don't want to say it didn't work from a profitability perspective, but it definitely didn't work from an engagement customer service perspective, right?
21:39
SPEAKER_01: So our call center was an could be an hour away from one of our other locations.
21:44
SPEAKER_01: And Mrs.
21:44
SPEAKER_01: Jones calls in to cancel her appointment, and the person at the call center would be like, okay, well, call us when you're ready, right?
21:50
SPEAKER_01: But and that would have never flown when I was the main doctor at one location because the person that was answering the phone didn't want to walk down the hall to tell me that Mrs.
21:58
SPEAKER_01: Jones had canceled.
22:00
SPEAKER_01: So they were that's such a good point.
22:02
SPEAKER_01: That's such a good point.
22:03
SPEAKER_01: They were trying everything possible to save the appointment.
22:07
SPEAKER_01: But when you have people answering the phone that are an hour away, like there's no like no understanding of the repercussions.
22:15
SPEAKER_02: Well, you might have a you might have a blizzard at one location and in like and then over at the other location it's sunny and it's like that's a big problem because you need to be more compassionate to the people who are stuck in the blizzard than your call center that's in Miami or something, you know?
22:30
SPEAKER_01: Exactly, exactly.
22:31
SPEAKER_01: So we we've gotten away from that.
22:34
SPEAKER_01: So we we want all of the calls being funneled to the particular offices because we want the patient to understand who they're gonna see when they come in.
22:43
SPEAKER_01: And and we just have found that the people at the front desk of those individual offices just care more.
22:49
SPEAKER_01: Like I and I wish it's probably a leadership failure on my part, but I couldn't never get the contact center or call center to care as much about all of the locations as I could the people that were like on the front lines answering the phone at that particular location.
23:05
SPEAKER_02: So it's really hard to do.
23:07
SPEAKER_01: Yeah, we've gone full circle on that.
23:08
SPEAKER_01: So we've all calls are now at each individual location.
23:12
SPEAKER_01: But to Gary's point, there's some things where it just makes total sense to centralize.
23:16
SPEAKER_01: So our insurance department, revenue cycle management, AR, IT, HR, like those all of those things are are still centralized, and and we've been successful doing that.
23:26
SPEAKER_02: That's good.
23:28
SPEAKER_02: What things worked?
23:29
SPEAKER_02: What things uh what else do you centralize?
23:31
SPEAKER_01: That's pretty much it.
23:32
SPEAKER_01: Insurance, revenue cycle, AR, um, HR, IT, marketing.
23:39
SPEAKER_01: Now we'll we'll work with the office manager to get feedback on certain things.
23:42
SPEAKER_01: Like from a marketing perspective, of our eight locations, I have ones that are very, very rural, I have ones that are very, very urban.
23:49
SPEAKER_01: So you can't paint with the same broad brush.
23:52
SPEAKER_01: So we'll we'll have our marketing team work with the office managers.
23:56
SPEAKER_01: You know, what do you think is going to work best here?
23:58
SPEAKER_01: Is it a direct mail thing?
23:59
SPEAKER_01: Is it SEO?
24:00
SPEAKER_01: Is it, you know, so we're just constantly collaborating with the actual individualized offices, but we just never had success with the centralization of answering calls.
24:11
SPEAKER_01: It just it just didn't work for us.
24:13
SPEAKER_00: For for us, we we've had similar failures where we've tried to outsource things or insource things.
24:20
SPEAKER_00: And what I've found and what I believe is true is if it's patient-facing, it probably needs to be more individualized.
24:28
SPEAKER_00: So, like you said, call center doesn't really pass a smell test because they don't know they may be in Miami and there's a snowstorm, right?
24:38
SPEAKER_00: But anything that's not patient-facing, so insurance verification, stuff like that, you can have people in the Philippines doing that.
24:44
SPEAKER_00: You can have yeah, and you can have a marketing company in the Philippines if you want to do that.
24:49
SPEAKER_00: Like if you're trying to do it uh do it yourself type of deal.
24:52
SPEAKER_00: And so I found that if it's patient-facing, it's just really hard to pass the culture along.
24:58
SPEAKER_00: Just like you were saying, like your your associates start in your practice for six months and go somewhere else.
25:03
SPEAKER_00: You've got to give them the virus of finger legs, finger legs dental before you go send them off.
25:10
SPEAKER_00: And it's hard to do from a from afar.
25:12
SPEAKER_00: So that that's kind of the rule I've learned.
25:14
SPEAKER_00: I don't know if you've experienced something different, but that's that's where I'm at.
25:18
SPEAKER_01: No, spada, exactly the same experience.
25:20
SPEAKER_01: Yeah, I just had to learn it the hard way.
25:22
SPEAKER_02: Awesome.
25:23
SPEAKER_02: So tell me a little bit about your 45 ops.
25:26
SPEAKER_02: Like, why are you crazy?
25:28
SPEAKER_01: Yeah.
25:29
SPEAKER_01: Well, that's a whole nother podcast episode of why I'm crazy.
25:32
SPEAKER_02: But uh No, it's exciting.
25:34
SPEAKER_02: Like, I've I've never got to talk to somebody building this big of an operator.
25:38
SPEAKER_02: So, like, how did you even get to that point?
25:40
SPEAKER_01: Yeah, our flagship office has 20 operatories, and we're blessed to be super busy.
25:44
SPEAKER_01: It does about a million dollars a month out of this location and uh just busting at the seams.
25:49
SPEAKER_01: And you know, patients are scheduling eight, nine months out for hygiene.
25:52
SPEAKER_01: It's hard to get in, period.
25:54
SPEAKER_01: So we just had to make a decision of adding more footprint, found an opportunity down the street.
26:01
SPEAKER_01: Uh, and then the nuanced conversation was how do we create this hospital and not make it feel institutional?
26:09
SPEAKER_01: So it's a unique design where there's four separate reception areas, four separate waiting rooms, and the office is built with pods of 10.
26:19
SPEAKER_01: So each each pod will have 10 operatories and be manned by two doctors, four hygienists, and four assistants.
26:26
SPEAKER_01: And the hope is that patients will constantly see the same faces when they walk in, see the same faces when they're getting treatment and cleanings and stuff like that.
26:35
SPEAKER_01: And, you know, will it work?
26:37
SPEAKER_01: Who the hell knows?
26:38
SPEAKER_01: But we we're hoping that it works because we just don't want the patient to feel like they're, you know, walking into some type of institutionalized, you know, hospital or something like that.
26:49
SPEAKER_01: Uh, so that'll make up the 40 adult operatories.
26:51
SPEAKER_01: And then we have a pretty strong pedo ortho arm in our group.
26:56
SPEAKER_01: So we'll also have a five-share pedo ortho bay in the flagship as well.
27:01
SPEAKER_02: That's amazing.
27:02
SPEAKER_02: I'm sure it's gonna work because everything else you've done so far has worked, or you've pivoted and made figured out how to make it work.
27:08
SPEAKER_02: And that and I think a lot of times in in business, it's like you you just have to keep going.
27:14
SPEAKER_02: That's the name of the game, right?
27:15
SPEAKER_02: And it's like, I'm gonna keep moving forward, I'm gonna keep trying new things.
27:18
SPEAKER_02: And the reason I said, you know, the crazy it's crazy 45 op is because most doctors hear that and they just like you might as well say I'm building a dental practice on Mars because how are you gonna do that?
27:30
SPEAKER_02: Where are you gonna?
27:31
SPEAKER_02: But when you're going from 20 to 40, that's not like that crazy, right?
27:36
SPEAKER_02: Like you're already a really, really big practice.
27:39
SPEAKER_02: So, like, what are my question would be like, what is kind of scary about doing that though?
27:44
SPEAKER_02: Like, what is scary?
27:46
SPEAKER_02: Your practice is already big and you're going to even bigger to to help more patients.
27:51
SPEAKER_02: So that's a great reason to do it.
27:54
SPEAKER_02: And I heard, I heard you you don't want it to feel like a hyper, like, you know, medical medical center, you know what I mean?
28:00
SPEAKER_02: Like that does not, that's not a good feeling.
28:02
SPEAKER_02: What what else are you looking at when you're going, okay, we're gonna build this, we're gonna break their ground, we're gonna build this big building.
28:08
SPEAKER_02: What what are the things that you're like not keep you up at night, but just like go, you have to keep replaying through your head to figure out how to make it work?
28:15
SPEAKER_01: Yeah, great question.
28:16
SPEAKER_01: And to be honest with you, saying this with as as little ego as possible, I'm not too worried about it.
28:21
SPEAKER_01: I know we have a pretty successful flagship now, and a majority of of that patient base is gonna transition over.
28:28
SPEAKER_01: The doctors and the hygienists will transition over.
28:31
SPEAKER_01: I know we're not gonna be busy enough to fill the 45 ops from day one, but we'll we'll grow into it.
28:37
SPEAKER_01: Um, so it it really doesn't keep me up at night as much as you know, I I acquired a pedo office from from an older pediatric dentist, and I just cannot get to get on board culturally, right?
28:49
SPEAKER_01: Those are the things that keep me up at night where I'm just like, how do I communicate with this woman and try to get her to like understand that my intentions are pure and the way she's been doing it for so long is ass backwards?
29:03
SPEAKER_01: And and like I, you know, that that's what that's really what keeps me up at night.
29:08
SPEAKER_01: Like, at what point do I have to like draw a line in the sand and be like, okay, I'm done being kind, I'm done showing you all this empathy, like you're starting to hurt us.
29:17
SPEAKER_01: Like those are the things that like like that I struggle with.
29:22
SPEAKER_00: So, so I there's there's some commonalities that I see in people like you, Jason.
29:27
SPEAKER_00: And you are building this thing to help people, like, and you can hear that in your voice.
29:33
SPEAKER_00: Like when you talk, you can feel that.
29:36
SPEAKER_00: And so as you build a 45 lot practice, there's a lot of new grads, there's a lot of people coming out of school that are like, I want to build that, and then I want to sell that one day for a lot of money, right?
29:47
SPEAKER_00: And I know that that's not your goal.
29:50
SPEAKER_00: Like, I know that your goal is really just to help as many people as possible, but I also know that you'd like to make some money along the way.
29:57
SPEAKER_00: And so I'm curious, like, as you think about what your exit plan may be, like what does that look like?
30:05
SPEAKER_00: Do you do you think that a sale makes sense for you?
30:09
SPEAKER_00: Or do you think that because I know you've got family that has been a part of the business as well?
30:14
SPEAKER_00: Like, is this something like the book built to sell?
30:16
SPEAKER_00: Like, like, are you building it so that you never even want to sell it?
30:20
SPEAKER_00: I I'm always super interested in that because I feel like that's the model that I'm creating is I want to build something that I could own and my kids can own forever that just spits off cash flow and can support our family for forever.
30:34
SPEAKER_00: But I also get to where I I understand where you would want to build it and then sell it to a DSO or something like that at some point.
30:41
SPEAKER_01: Yeah.
30:41
SPEAKER_01: My intention is a legacy play.
30:43
SPEAKER_01: I mean, I would be lying to you if I said I wouldn't entertain offers, but I'm truly trying to grow something that's independent of me.
30:52
SPEAKER_01: And over the last two years, I've been super intentional with my time as far as pulling back from the day-to-day and allowing people to figure it out, allowing people to lead on their own.
31:06
SPEAKER_01: So, you know, my operations person, finance, the regionals, all of those people, they they're treated like owners.
31:13
SPEAKER_01: They make decisions like owners.
31:15
SPEAKER_01: And I probably put in 20 to 25 hours a week on the dental business.
31:21
SPEAKER_01: And I'm going to slowly but surely reduce that time over the next three or four years.
31:26
SPEAKER_01: And if I can maintain the same metrics, if I can maintain the same culture, uh, the same morale, the same level of clinical care, then to your point, I I will just kind of use it as a, I'll be an absentee owner.
31:40
SPEAKER_01: Uh, I I will just kind of live off distributions or or whatever it spits out.
31:45
SPEAKER_01: I do have five children.
31:46
SPEAKER_01: None of them are interested in being dentists, but we're structured in a way where they can become non-clinical owners, they can have C-suite type positions.
31:57
SPEAKER_01: And if I had to, you know, wave a magic wand and and what would be my dream scenario?
32:02
SPEAKER_01: It would be just that.
32:03
SPEAKER_01: It would be two or three of them running this thing for the next 30 years.
32:07
SPEAKER_01: Worst case scenario, I would consider even like an Aesop or something like that.
32:11
SPEAKER_01: But I just What's an Aesop?
32:13
SPEAKER_02: What is that?
32:14
SPEAKER_01: It's like an employee uh shareholder plan where yeah, you take out like shadow stock.
32:21
SPEAKER_01: Kind of, yeah, kind of.
32:23
SPEAKER_02: Sorry, I didn't mean to interrupt you.
32:24
SPEAKER_01: No, no, no, no, not at all.
32:26
SPEAKER_01: So I'm not I'm not depending on the sale of this thing to like fund my retirement.
32:31
SPEAKER_01: I'm blessed to be in a in a pretty good position financially.
32:35
SPEAKER_01: So I'll just gonna ride it out and and if I can have it be a legacy play, then then that's the box I'm gonna check and we'll kind of go from there.
32:43
SPEAKER_00: Yeah, and I think I think you hit on it earlier.
32:45
SPEAKER_00: Like you're you created something that you love so much that you'd be crazy to leave it.
32:50
SPEAKER_00: You know what I mean?
32:51
SPEAKER_00: And my my father-in-law owns some car washes, and and that's what I see is like he's worked so hard his whole life to build something that's really, really awesome, but now he doesn't love it as much.
33:04
SPEAKER_00: And so now he's like, I think I want to get out of this.
33:06
SPEAKER_00: But what I hear you say is I love this so much because I've literally created as your life has changed, your job has changed as well.
33:15
SPEAKER_00: And you've just blended all of those things together to where you could quite literally do this until you die and be happy.
33:21
SPEAKER_01: Yeah, that's so true.
33:23
SPEAKER_01: And over the last couple of years, as I started my own coaching group, uh and I get to help dentists across the country, it's like I still have like a testing ground of of how things could work.
33:35
SPEAKER_01: And and you know, Blake and I were on a call just before this one, and this that's a great example.
33:41
SPEAKER_01: Like our case acceptance is good.
33:43
SPEAKER_01: We get a a lot of people to say yes, but if I can, if I can pull this lever, if I can tweak this knob and I can get the case acceptance to go up another three, four percent, holy shit, with the amount of dentistry that we present, like that's a real game changer.
33:57
SPEAKER_01: And if I can refine that system and then present it to my coaching clients and change the trajectory of their practices, I mean, that's what I mean, my heart's like beating quickly because I just love that idea.
34:11
SPEAKER_01: I just like, hey, try this.
34:12
SPEAKER_01: This will work for you.
34:13
SPEAKER_01: I I I've tested, I've cooked it in my kitchen and I have a proven track record.
34:18
SPEAKER_01: It will work.
34:18
SPEAKER_01: Like, just put in the work, right?
34:20
SPEAKER_01: So I just love how they play off of each other.
34:23
SPEAKER_02: That's so cool.
34:24
SPEAKER_02: This has been amazing.
34:25
SPEAKER_02: I I really appreciate you coming on and letting Dr.
34:28
SPEAKER_02: Blake and I do like ping-pong back and forth.
34:30
SPEAKER_02: You know, he's talking about like clinical operations, and I'm like talking about like KPIs and stuff like that.
34:35
SPEAKER_02: And you you handled it so well.
34:37
SPEAKER_02: And I think a lot of people will learn from this and have a big, a big it'll help them expand their vision in a way that will be healthy and get a good direction for where they want to go.
34:48
SPEAKER_02: Um, I I love that you coached Dennis.
34:50
SPEAKER_02: How is that something that's like open to people if they want to reach out to you and talk to you?
34:54
SPEAKER_02: Like, how does how does that work?
34:55
SPEAKER_01: Yeah, I mean, they can find out a little bit more information on our website, thedental lighthouse.com.
35:00
SPEAKER_01: I take on a select number of one-on-one clients, but we also have a group coaching platform, but we also encourage key leads to be in on that platform.
35:08
SPEAKER_01: So it's so funny, and I'm sure you guys can attest to this.
35:11
SPEAKER_01: When I'm having one-on-one coaching conversations with the doctor, I get half the story.
35:16
SPEAKER_01: I get partial truths, right?
35:18
SPEAKER_01: And then I start encouraging them like you have to bring your office manager on, you have to bring your operations first on.
35:23
SPEAKER_01: And then the doctor will talk, and then I can see on the other box on the Zoom call that the office manager's like, shake the red.
35:30
SPEAKER_01: And I'm like, I'm like, all right, doc, I need you to shut up for two minutes because I need to get the real perspective.
35:36
SPEAKER_01: And then and then the OM will opens up and I'm like, okay, now we know how to solve this because you've actually been honest with what the problem is, right?
35:42
SPEAKER_01: Yeah.
35:42
SPEAKER_01: So I I really, really enjoy it.
35:44
SPEAKER_02: You're like, you're like 12 steps ahead.
35:45
SPEAKER_02: We're we're building our little mastermind.
35:48
SPEAKER_02: And right now we're at the stage where it's like, okay, so it sounds like you need to hire an associate every single time.
35:53
SPEAKER_02: That's like that's the stage where we need to get to your level.
35:56
SPEAKER_02: That's like 12 steps down the road.
35:57
SPEAKER_01: For sure.
35:58
SPEAKER_02: Awesome.
35:58
SPEAKER_02: Well, thank you so much for coming on today.
36:00
SPEAKER_02: And if you guys haven't, go check out his podcast.
36:02
SPEAKER_02: I'm sure most people have, but if you haven't, go check that out.
36:05
SPEAKER_02: And uh thank you so much for coming on.
36:07
SPEAKER_02: This was super informative.
36:09
SPEAKER_02: And I got one more last question.
36:11
SPEAKER_02: So, what's the number one question that you get that we didn't ask you?
36:15
SPEAKER_01: That's a great question, Gary.
36:17
SPEAKER_01: You know, how do I hold how do I hold my team accountable?
36:19
SPEAKER_01: That's like the the number one thing that I get.
36:21
SPEAKER_01: Like how, you know, so-and-so's doing this, so-and-so's doing that.
36:25
SPEAKER_01: And I mean, again, that's a whole other podcast, but I would say at least half of the questions I get are leadership-based, accountability-based, which is great, right?
36:33
SPEAKER_01: I'd rather have them asking those questions than, you know, how can I prep a crown faster or how can I, you know, do that.
36:40
SPEAKER_02: And uh how do you hold people accountable?
36:42
SPEAKER_01: Yeah, so the elevator pitch is you know, you know, have core values that are well defined, make sure that and I I look at it from a perspective of there's two things I need out of people.
36:51
SPEAKER_01: They need to be a good core value fit and they need to manage the roles and responsibilities of the seat that they're in.
36:56
SPEAKER_01: So when you really just unpack that a little bit more, what are the specific roles and responsibilities?
37:01
SPEAKER_01: And you got to be crystal clear, right?
37:03
SPEAKER_01: The problem I have I find with a lot of prospective coaching clients is they have an office manager, right?
37:09
SPEAKER_01: But as you two know very, very well, office manager roles and responsibilities are so different from office to office to office.
37:17
SPEAKER_01: Like I'm sitting in my flagship office now, my office manager is never patient-facing.
37:21
SPEAKER_01: And then I have other clients and have other offices that have office managers that 60, 70% of their time is patient-facing.
37:27
SPEAKER_02: They're TCs, half the time they're in the TC for large treatment.
37:30
SPEAKER_01: Exactly.
37:31
SPEAKER_01: So just decide what hats these particular people are wearing, train them up to exceed at those expectations when they do fail, which they will, decide if is it a coaching issue?
37:43
SPEAKER_01: Is it a situation where you haven't given them enough tools and training?
37:46
SPEAKER_01: Is it a competency issue?
37:48
SPEAKER_01: They just don't have the the competency to manage what you're asking of them.
37:52
SPEAKER_01: And you know, you kind of go from there.
37:53
SPEAKER_02: I love that.
37:54
SPEAKER_02: Capability versus capacity.
37:56
SPEAKER_02: Yeah, that's great.
37:57
SPEAKER_02: Awesome.
37:58
SPEAKER_02: Well, thank you so much for coming on today.
38:00
SPEAKER_02: And this is a great episode.
38:01
SPEAKER_02: People are gonna love this.
38:02
SPEAKER_01: Yeah, I really enjoyed it.
38:03
SPEAKER_01: I appreciate the invite.