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Dentist2Dentist
Join Dr. Mike Miyasaki as he talks dentist to dentist about the trends, products, and clinical applications in dentistry today.
Dentist2Dentist
Mastering Dental Practice Management: A Blueprint for Success with Industry Leaders Garrett Caldwell and Stephanie Burrell
Ever wondered how a few strategic tweaks can turn a dental practice from average to outstanding? Get ready to absorb the wisdom of industry titans Garrett Caldwell and Stephanie Burrell, as they unveil the transformative power of financial analysis, expense control, and streamlined management. This episode is a treasure trove of actionable insights, revealing how even the most minor operational changes, such as scrutinizing leases and equipping your team with the right tools, can massively elevate a practice's profitability.
Diving into the heart of dental practice dynamics, our expert guests highlight the profound influence of a positive workplace culture and the sometimes tough choices that shape it. We explore the magic that happens when a team's daily efforts align with the practice’s vision, creating efficient workflows and a patient experience that's as smooth as freshly flossed teeth. If you're seeking not just to survive but to thrive in the competitive dental industry, the guidance shared here on leadership, continuing education, and the dentist's role as a dynamic team leader will be your compass to success.
And because no practice operates in isolation, we tackle the art of marketing with a blend of traditional charm and digital savvy. Learn how community involvement and leveraging online reviews can be your secret weapons to attract new patients. For those facing the challenge of turning around a struggling practice, we dissect the back-to-basics approach that can lead to profitability in a matter of months. This episode doesn't just scratch the surface—it's an intensive masterclass in dental practice management, helping you chart a course to financial success and beyond.
Hey everybody, this is Michael Miyasaki again, and I am so excited about this podcast. So many different topics are going to be covered Now. Our guests today are Garrett Caldwell and Stephanie Burrell.
Speaker 1:One of the things that we have done the three of us we've worked on different businesses and I have seen these two go into businesses and create these turnaround situations, not just in dental, but in different industries. And what I've learned is basically, if you take a business and you look at it, at the numbers, and you can analyze those numbers and correct the numbers, and a lot of times it's just going to control on your expenses. So what we're going to talk about today is how can you take the average practice not a booming big practice, but an average practice or a booming practice, the informational kind of pertain to both and make some small adjustments in what you do. And Stephanie and Garrett are going to share some of the key things that they will look at when they look at a business, and we're going to focus on a dental business. So I hope you enjoy listening to this recording or this set of recordings. There's insights from Garrett and Stephanie that I think are very valuable.
Speaker 2:You know for a DDSO, which is really all this comes back to. If you ask yourself just to look up as Mike says as a pilot sometimes, just look up and look out the window. If a DDSO buys or practice and pays a doctor between 30 and 32% of the collections, there must be profit left there. But in the general practice that we see there's very little profit. And that's not including collections at 98%, which drops your overhead by which drop increases your overhead by 2%. So if you just do some basic fundamentals, where this discussion tonight ends up is how do the DDSOs or how do guys like us go out and buy three or four or five practices and operate them with a profit and still pay the doctor a fair wage that they want to get paid? And the margins are thin and it comes down to business operations. It comes really down to managing the business well. It doesn't need to be a tyrant. It just means that every element of the business needs to be looked at and managed a little more closely and that doesn't really cost any money to do. It's just something that we can say doctors aren't trained but they'll take the time to do. You can make a lot of mistakes if you take the time, but you make 100% of the mistakes 100% of the times if you don't take the time. So when we look back through this first part of the segment, we talked about what you can do, what we look at when we buy a business. As we look at the lease, we look at the debt that the business is carrying, we review the existing financials to try to understand if there's some meat left on the bone there, if there's some areas of weakness that we can improve on ourselves. We create an operational budget and we include actual and target goals. So we look at that and say that we really believe this and we really believe this.
Speaker 2:But next we identify does the staff and does the team have the equipment they need to do the job that they're hired to do, that they're expected to do? And we see in a lot of practices we look at that there's deficiencies in the equipment and everything from the equipment that the hygienists use and old tools to not having up-to-date equipment to do some of the procedures that you can make the extra money on. We talk a lot about not just going and diving into buying all that without knowing what to do with it, but that's where education comes in. But we identify how does the practice look in terms of is it modern, is it up to date to be able to provide those procedures? And then finally do an updated patient software and business software, because we can talk about all this, but unless you have the software to go in and pull all these business elements out, you really are.
Speaker 2:And Stephanie says we talked a little bit about this. Stephanie says, well, most practices should be up to date, but the majority of practices we look at are using software that they've had for years and years and years. So those are the fundamental things, steph. Well, I think that's a good point. I think that's a good point. Those are fundamental things, steph.
Speaker 3:Well, it's not necessarily the day-to-day dentrics or Eagle Soft. It's not taking advantage of some of the tools that are out there that are live insight into your patients and who's unscheduled and who didn't get their recall, and all that pending work, the cancellation, and it's very interactive. There's so many cool softwares that help you stay on top of that that a lot of practices are not taking advantage of.
Speaker 2:We look at those things as those are free, those are easy, those are things Stephanie and I can go in and we can get paid to identify all those, and we'll look at the doctor looking like the bobble head in the front dashboard of your airplane, mike, saying yes, you're right about all this stuff, and none of that cost any money.
Speaker 2:It really is just a little bit of time and that has huge returns. It has huge returns because it gives you information, and without that basic, fundamental information on the business side as we start, we really can't move forward with the rest of it. So the next thing we'll just jump to is team. This was a big, important one. So when we talk about team, we'll talk about the integration into and behind a unified plan and the set of goals. So, with that, what Stephanie and I tend to run into is these challenges, which are dominant team members with bad habits. We talked a little bit about that with Dr Smerthwaite and how he and what his expectations are for this team right from the very beginning and a lot of doctors are afraid to confront that especially.
Speaker 2:We see practices that have had team members for decades and how do you get them to change? The first thing they do I remember talking to Bill Blashford about this is Bill opens up with. The first thing your team does when you come back from a program is to say how long has it been taken to get over this excitement so we can get back to the same old thing? And we got to get past that. We have to get past that. So dominant team members, bad habits and strong personalities versus weak personalities. So when we look at this last practice, we have that situation. We see that that that exists. We see a lot of pushback for change. We see a lot of positivity in team members that want to do good things that are held back from the more dominant long term. So, steph, talk to us a little bit about how important or what the habits are and the challenges there with team yeah, I mean specifics.
Speaker 3:In this case we had a couple. We lost a couple people had some turnover because they weren't. They weren't on board with some of the changes in our kind of our plans for growth. And you know, it wasn't over opposition to the plan or confrontation. I obviously that would be a lot easier to make the change.
Speaker 3:It was those subtle things that we would see, where it's just maybe lack of engagement in the huddle or in the team meetings or consistent excuses on why, you know, something that was we were trying to implement didn't get done, and just the lack of just weren't proactive in helping to, you know, implement, implement these changes. And never specifically thinking of one person, it was just. It was never trying to find solutions, they weren't objections that were helpful, it was so. There was never to that end, it was. It was just the little little drops of rain on the parade and it was hard. These are people who were there for years. So you know it, those are hard decisions, hard decisions to make. I think sometimes to your point, gary, those are the people maybe that are the least open to the changes, but boy was it worth it.
Speaker 2:It was painful. When you made those changes, what was the result?
Speaker 3:Yeah, when we got the right people in place, when you they're motivated, that good energy and ended up being sort of the person in this example that got was a replacement, is now sort of the ambassador for the, for the, for the whole practice. So, yeah, it was painful but it is. I would say 100%. It's worth the gut check to make sure you have the right people on the bus, because you shouldn't be having to push the ball uphill. It won't work. It's going to be just a weight on the trajectory of any goal you make. If, if, if you don't have that kind of buy in.
Speaker 2:So I know it's tough, mike. We have our partners in the pack, we have our partners in the lab, our doctor partners, and they say to Stephanie and I boy, you guys are so good at, you know, keeping relevant and you guys are good at going into making changes and everything you do. I wish I did in my practice, but I just I've had this person for so many years or I just I just don't want to have that confrontation. But I think these days, with you know, you can look at dental insurance and you can make that the excuse for why things are going bad and you can look at a lot of things. But you can look at a lot of internal things, that small changes, with team getting on board and then opening up.
Speaker 2:I know, stephanie, this particular practice. We made a few changes in the folks that were there that were positive, were so excited about being able to talk about things that they want to do and and share with the doctor, things that which we're going to talk about next with you, mike. But so team meetings. So, steph, so we talked about that did this particular practice? First of all, how many team meetings should take place on a weekly basis and what do we talk about? Those team meetings? And in this particular case, if I recall, there was no team meetings taking place.
Speaker 3:No team meetings, no huddles yeah, so I mean huddles should be daily, 100%. You should be reviewing your schedule for the. You know we review the goals and where you're at month to date and then specifics on that schedule so who's coming in, who is a revenue opportunity, who needs, you know, collection or whatever it may be. So those should be happening and they can be quick, but they should be happening every every day and then month at least monthly meetings, depending on if you're trying to implement something new, maybe more often, but generally I think you should do monthly meetings to review the month past and and celebrate the wins and and revisit something that didn't hit.
Speaker 2:And so, Mike, we, Stephanie and I. The next category for us is the new patient experience scripted new patient experience and again, scripted is just like a blue business blueprint. It's the same thing when you have a new patient coming in, what are the processes and why are you implementing those processes and what's the goal? And the same thing for existing patients. We have practices with our packs and the backpack members that are just do such a great job at this. We've been into practices where it's too scripted and it feels to you're the same patients seeing the same movie Every time you come in. Stephanie. What's the importance of that and how does it relate to? I think in this particular instance we had, there was no plan when a patient came in, new or existing. They came in, they said they saw the doctor left.
Speaker 3:This was actually pretty powerful, I think, for the team. I mean so when I went in and we didn't have anything in place certainly not a script, and I'm not sure we ended up with an exact script, but but the workflow of the patient what should happen before the appointment, what should happen the moment they walk in the door, what does that handoff look like to the doctor and back to the front office and what's the policy and financial arrangements. So those kind of things where we penciled that out and in writing so that a new employee comes in it's there, people can reference it. But I think for what was really great for me and for the team was we sat down and it maybe it was easy to do because it was kind of new. But I think everybody should probably revisit this and sit down with the team to kind of review what they think it should look like.
Speaker 3:And it's interesting the different perspectives, of course, because your front office has a different perspective than your back office and they see different things. So we walk through it all together. It was pretty collaborative on what it looks like and what it should look like. You know what improvements can we make, what are the challenges, and I think it was a good team building exercise. But I also think it's important for buying of that process that they got to be part of it. So I think it's huge those little things are so important to the patient experience and also, ultimately, treatment acceptance.
Speaker 2:Mike is your practice a ballet, or is your practice a circus?
Speaker 1:I think we're a three-wing circus.
Speaker 2:Okay. So the last part of that is so, with regards to team, is sharing the profit. I know, dr Smirth, they talked about that, but money doesn't. I'm a big believer only because of the way I've looked at this is that bonuses are great, money is great, but money doesn't motivate people. People think money is a reward. It's exciting to have a win and that's a great reward, but bonuses are a big part of it. But you can't have bonuses unless you have process, unless you have goals, unless you have a way to get there. So I think bonuses I know, dr Smirth, we talked about this they put a small amount of money each month away above their minimum goal, and that goes for a group function or a trip or a cruise. And then they also have bonuses, which I think are important.
Speaker 2:But, mike, to your point, do we look at the business manager differently now than we did 10 years ago or 15 years ago? Does the front office manager need to have a different set of skills? Because we manage six businesses ourselves and I spend a total of about an hour a month with Stephanie managing those businesses as the owner, meaning if I'm the doctor, you don't need to do all this, but you do need to have somebody who understands what needs to be done and prepares it for you and can quickly, in a half an hour, go through all the fundamental numbers with you and then just focus on the things that aren't working. So to me, your business manager is probably the most important person in the dental business other than the doctor producing the clinical work. You have to have a strong business manager. I cannot imagine any dental practice, big or small, having a front office manager that doesn't have at least some fundamental business management skills and a business degree now. So I don't know how you feel about that.
Speaker 1:I absolutely agree. But I think one of the things that we're up against is just that most practices let's say they're making 600,000 a year in revenues maybe top down at a million. I mean there are those that do 6 million a year, but usually they're multi-doctor type practices. But if you're a single doctor and you're doing between 600 and a million, you're probably doing pretty well. And in order to get somebody of, let's say, stephanie's quality who could help me run my business so I don't have to do that Now my salary expenses are going to go way up, right, because I've got to compensate somebody with that knowledge and that talent.
Speaker 1:I think that's where we as dentists that's why a lot of us I have met a lot of doctors over time that had their right-hand person was that COO, cfo person who could gather the numbers, analyze it and then just tell the doc you know this is what we need to do, and they kind of managed the practice to achieve that. But they were making and this is even 20 years ago. I ran into doctors that had, you know, an admin person like that. But even 20 years ago they were making six figures and most practices couldn't afford that. So I think that's. I don't know if you guys have any solutions of how do we find people that are willing to do that, where we can afford to have them and keep our numbers in line. I think that's just the conundrum we are in as a small business.
Speaker 3:Well, I kind of wanted to go back to that discussion just on the percentages and the goals, because I do think you know we threw out some numbers there. So I do think that 45 to 50% should be your goal for your cost of goods sold. Beyond that your fixed expenses is going to be a case-by-case basis, so your and that percentage obviously becomes a lot less as you produce more, because that stays the same, approximately the same dollar amount. So that's all going to depend. You want to do your budget to determine sort of your break even and then say, okay, well, if we can hit to your point now about when and how to afford that next level of management, whether it be a higher paid front-office manager in your practice or paying for somebody outside to do it.
Speaker 3:I think it kind of goes back to that. You know individual analysis and goals and I think you can just pay. Maybe it could be where you're paying just a bookkeeper to make sure you're keeping the books correct and doing a monthly meeting, and that wouldn't be as much of an expense as having somebody who is going to be more involved in the day-to-day, but it would still be that right step. So I don't know what you think, garry, but yeah, I think.
Speaker 1:Go ahead, Mike. Well, no, real quick. I think there's a thousand doctors listening to this right now and they all want Stephanie, so that's right.
Speaker 2:So let me tell you how you get Stephanie. I have a solution for that. Okay, so a practice analysis. It should be good, does not cost a lot of money. You can hire. There's great consultants out there that you know. I've worked with Bill Blatchford, I've worked with Kathy Jamison. I've worked with a lot of great consultants out there. My only complaint is you're in for a penny, you're in for a pound and I don't agree with that.
Speaker 2:I don't believe everybody needs $58,000 worth of consulting, Just like Stephanie said. If you're a $600,000 in our practice and you're struggling, how could? Maybe they'll argue, hey, $58,000, you need that more than anybody to go borrow the money. My argument Maybe you just need to get a practice analysis and focus on these four fundamentals. This could literally be a one-night meeting after the analysis is done by Stephanie. This could be a one-night meeting saying a lot of things we can improve, but let's just highlight the fundamental things and we walk through it piece by piece by piece. At that point, those goals could be set and given to your bookkeeper as simple as that and say I always want to meet with you at the end of the month and tell me what these metrics are, because I understand now because Stephanie told me this should be at 12%, this should be at 6% and when those things are out of line, whatever's in line, leave them alone, Whatever's out of line, focus a little bit of time on that and then break it down deeper and deeper. I don't think you need a six-figure CFO at the beginning. I think if you're at the $2 million or $2.5 million practice, you probably should be investing in something like that because you have a lot more to protect and you'll have a lot more potential to grow. But if you are a $600,000 practice, I think of simple practice analysis and getting someone to help you identify what's broken and fixing it piece by piece. Hopefully there's enough runway left for you to fix the practice If you're in that much trouble.
Speaker 2:But I think that's a simple answer. I really do. I think it's. You don't need to look at everything. It's too out of need and an elephant, one by at a time. It really applies here. We're really basic.
Speaker 2:When we buy a business, we look at the fundamentals. I say Stephanie, if we buy this, can we keep it, break even? Because if she says yes, I'm pretty confident that's my first question pretty confident it'll break even, Gene and even make a little bit of money. Okay, at that point I'm all in. Now I go to work and we start digging into the little things because that's what's ahead of us. But until we get that thing breaking in and making money for a doctor that's taking out their 30% and having 5% left over for the team and having another 10% profit, how do you get that? How do you get those overheads down to 50% instead of at 70 or at 65? That 15% lives in this area, in those basics. So that's the short answer.
Speaker 2:I want to talk to you, Mike, about the doc. These are questions for you, so we're going to put you on. So we talked about the business, we talked about the pre-purchase analytics. We talked about the business, we talked about the team and next up is the doctor. And so when we do an analysis of our practice, obviously the person that we hear the most complaints about from the team often is the doctor not responsive, doesn't follow his own procedures, is not attentive, is not there, takes too long, won't come and see my patients, blah, blah, blah, blah. So we can talk a lot about the team, but we talk about the doctor.
Speaker 2:We look at a couple of things. So, Steph, I just listed five which are the doctor's daily habits. That's very broad, and the morale that that creates amongst the team. So the doctors that are listening will understand what I mean. Mike, you surely do Do those habits, day-to-day habits, negatively affect productivity.
Speaker 2:We look at remakes, we look at the actual remake percentage and hopefully we can get that data before we go on and look at Biopactus 4. We go on and buy any business. We take a look at the remakes, the laboratory. It's a big deal. We need to keep our remakes down below 2% because we'll have angry clients and we'll have obviously a loss of profit. So we look at remakes for the doctor and the practice patients he's seeing over for the same procedures. We do a chart review at the start, but there's lots of money in undiagnosed work that's in those charts. So how often does that look that?
Speaker 2:We look at patient communication and I call that best practices. What type of dentistry are you delivering, Mike, day-to-day? I know you're delivering the best services to your clients. I know that about you. How is that patient communication coming from you and are you encouraging your patients to get the best services, or do you look at that as selling them. We talked a little bit about that. I, as a patient, I want to know the best thing I could get and then maybe there's other options for me. But as a doctor, are you doing that? And then passive and active marketing We'll talk about when you answer some of these questions. So, first of all, daily habits, Mike. Would your team, if I interviewed them, say that you have great daily habits that attribute positive effect to the productivity? And what do you see and what do you hear out there with other doctors regarding this? And Stephanie, same question for you when we bought this practice, how did this honest meeting? What did they say about the doctor? No-transcript.
Speaker 1:Yeah, well, as far as I go, you know, I think I think you're obviously right the daily habits of the doctor affect how everybody in the rest of the practice feels. You know the uh, I, I personally try to get to the office an hour early. You know, even if we start at seven o'clock in the morning, I try to be there at six o'clock in the morning just to get the office, in order to kind of get my mind, in order to review the chart. So I know it's coming up for the rest of the day, and so by the time the team starts rolling in and I'm able to kind of give them some directions and if I have questions about patient treatment I can.
Speaker 1:I know that when we have our morning huddle because we do do a morning huddle every day that we can discuss what the patient's expecting to get have done that day. Are the finances a concern to the patient? And so by the time I think it's part of that experience by the time the patient comes in and they're uh, welcomed when they come in and then taken to do the operatory for treatment and we walk in, everyone's pretty calm and you know, the assistant's kind of know what to expect what's going to happen, and many times what they'll do is they'll seat the patient down, we'll do the blood pressure, let the patient kind of settle down and then the assistant many times will ask the patient. So you know, let me review what we're going to do and so my assistants they'll go through it and then when I walk in I kind of restate it and, you know, just ask the patients if there's any um questions that they have. But I think you're absolutely right.
Speaker 1:The day they have it is many doctors will run in the door 10 minutes late and now everyone's stressed out because the patients has been there. Maybe they got there 10 minutes early. So then the patient's now waited 20 minutes and the doctor's kind of frazzled because they just walked in. You know, they got to put their coat on and get the loops Where's the battery, where's the camera? And every all of a sudden it's just a different type of day. So I try to avoid those types of days.
Speaker 2:So I'm sorry. Mike is the guy we all want to work with.
Speaker 1:So let's talk about the reality now.
Speaker 2:So let's talk about this particular practice, Stephanie. What was the staff's reaction to the doctor's daily habits and did they feel that it was positive or negative effect on the productivity?
Speaker 3:Yeah, no, I think it's the common complaints, um, that you mentioned, um, and maybe lack of consistency in in some of, like, all those things that we're talking about wanting to implement. If the doctor's not leading by example, you're going to lose, you're going to lose the staff and there's some frustration with that, of course. If they're, if you're holding them accountable to something that the doctor's also not backing up their end. So, yeah, no, I think. I think it has to start with it has to start with the doctor.
Speaker 1:So, yeah, and I think that's one of the frustrations that the doctors have, because they're not really leading the team.
Speaker 1:They're just kind of, you know, they're too busy, they just walk in, they expect the team to be able to have everything ready to go and then when something's not, uh, able to happen maybe because the team may not know exactly what the training plan is and so they don't set something up right Now the doctor gets frustrated by that, and then those things just kind of happen during the day and it's snowballs, snowballs, snowballs, whereas I think we, as the dentist or the practice owner or you know, whatever our role is, as the one of the head of clinicians, we have to kind of take that leadership role and give, give our team direction, and that just changes.
Speaker 1:I mean, basically, we're like the quarterback. You know, if you took a football team and you told the team go out there and play football and there was no quarterback there or anybody that they were going to listen to, there's no way that they would win. But you have a great quarterback and we've seen this, uh, you know time and time again where the quarterback can go from one team to the next. Or in basketball, you know, lebron's moving from team to team to team and every time he moves that team it's the championships. So you know it really is that they just the team needs somebody to to be able to follow somebody who gives direction. You know you wouldn't send an army in to fight a war without somebody at the top understand what needs to get done.
Speaker 2:Yeah, so for the doctors that are listening, I mean, obviously it's difficult, but when you take a look at your practice and say how do we do better or why are we not doing as well as we should be doing, these four or five elements that we're talking about obviously include some self-analysis and correction if necessary. We talk a lot about education in our, in our podcasts here, but remakes, I know, is something that we look at in every practice, that we evaluate that's. You know, how often is the patient coming back for the same, for the same crowd or or the same procedure? And is that is that? Is that number bigger than it should be? And how do you, how do you address that? How do you direct that proactively as the CFO, ceo of your practice, as a dentist, how does a dentist look at that? Do you look at that, mike, do you take a look at? Is that one of the active elements that you look at? Yeah, I mean.
Speaker 1:I think we want every visit the patient has to be a positive move forward, you know, and if we're having to redo work or a fulfilling, having a lot of sensitivity or crowns are falling off all the time, you know, I think that's we're trying to avoid that through improving our clinical skills. I think we are always trying to do our best, but we have to accept that everyone's human and our work, once it goes in the mouth, is being used thousands of times a day. So, steph, how?
Speaker 2:hard is it to keep? How hard is it, stephanie, for you? How hard is it to keep good staff if the staff recognizes that doctor doesn't have top much skills?
Speaker 3:Oh, yeah, that that very hard, right. I mean, if your staff doesn't believe in, or the staff doesn't believe in, the doctor, then then it's going to be very hard to maintain them. So, yeah, you want to make sure, yeah, the team has, the team has to have clinical confidence.
Speaker 2:Well, the reason I ask that question is because we go into a lot of practices when we get down to the honesty and a lot of the team members will say I don't feel my doctor is delivering the best care or the type of care that I would like to see our patients getting.
Speaker 2:And that's difficult when you're yeah, nobody wants to work for, for somebody who wouldn't actually so the reason I bring this up is that if you want to have great staff, you have to be a great clinician and you have to be relevant, and we talk a lot about that, with education and material sciences changing daily, not just material science and not just the new materials themselves, but the doctors. Now, mike, we want I want you to talk a little bit about this. I was talking with a doctor up in Seattle, that KOL. I mentioned his name, but he said Garrett, I was looking at my numbers 10 years ago and 10 years ago I was. My practice was like 64 percent restorative and now it's 11.
Speaker 2:And I have six different departments that have implants of this and that and all these other departments that he said I can't imagine if I was doing the same dentistry that I was doing 10 years ago today. I would be out of business, I would be broke. So he's had to learn and implement all these new processes and procedures in his practice. So can you talk a little bit about that? Because it's constant learning and constant changing to be competitive and just to stay alive as a business. So what's your input on that?
Speaker 1:No, I'm absolutely right. You know, I think once we get out we we had that conversation with the dental students and my comment was you know, the dental education or dental school education will will make you a living. But it's really what you learn after dental school, all the courses that you take to to increase the skills that you have. That will make you a fortune in dentistry. So I absolutely agree. It's we talked about earlier. It's a leverage is, if I could do, I was talking to some doctors this last weekend. I was I was doing an implant surgery course and I was trying to emphasize because we had doctors that that had never placed an implant. I said if you've never placed an implant before or you're not offering that service within your practice, you know I think you're going to have a very hard time the next 10 years. They are predicting right now that the the dental salary is actually going to decrease 13 percent and part of it's because of a large supply of dental graduates coming out of dental school. So I think we have to be competitive and we have to be able to leverage.
Speaker 1:So I asked the doctors in the room. I said if you do a class to composite filling, you know what are you being reimbursed? And most everybody, I think, if not all of them, were contracted with insurance companies and they're saying, well, maybe one hundred and fifty, one hundred and seventy dollars for that, and I said so how many could you do? Maybe an hour if you had two separate patients? Probably two of those, right. So let's say you're making three hundred dollars an hour, versus you place an implant and you place an implant in that same hour time, you might be making two or three thousand dollars, and so that's a 10 X return. So if you are just doing feelings all day long, you'd make what? Three hundred dollars times eight? You'd be say doing twenty, twenty four hundred dollars a day, whereas if you were placing a two thousand dollar implant eight hours a day and doing one, one an hour, you'd be at sixteen thousand dollars.
Speaker 1:And so you know, what we have to do is we have to take the education, and the education will help us leverage our time to provide what I call the platinum role, to provide the services that patients actually want. And then so they're. They're willing to come to our office for that service, they're willing to pay for that service Things like implants today and it really will help you, I think, survive at least the next ten years. You know, just doing feelings and crowns, which are very commoditized services. You've got CEREC where you're doing crowns in a day. It's becoming very fast, very commoditized but there's nothing to really differentiate us at that level anymore. It's very hard to do. So I absolutely agree with you Get the education, and the education will help to help you really to succeed financially.
Speaker 2:OK. So staff, I know that some of the practice that we've gone in and consulted with and help buy in or sell, in many cases We've seen a lack of that progression of services with the doctor. But we've seen the new doctor come in and take a good fundamental practice and introduce his or her skills and take that practice to a whole new level. In some cases 20, 30, 40 percent increase almost immediately in revenue and I think that relates directly back to this situation. So the last, so what Mike is talking about. So the last thing in here I know this is the doctor elements. We talk about daily habits. We talked about remakes and we talked about don't stressing over stressing over what you're doing, but making sure you're doing good dentistry and providing best services and understanding patient communication and making sure you're delivering relevant services. But the next thing is passive marketing and active marketing and this relates directly to the doctor. So we often have doctors say I just need to do more marketing. What does that mean? Most people think of marketing as radio ads or TV ads or putting something in a magazine. But what Stephanie and I have found? That we go in, we ask the doctor and the team what do you do to market your practice? How do you are you? Are you relevant? Like what does that mean? And mean relevant? Are you known as the cosmetic doctor in your community and how did you get that status? Are you known as a great family practice? Are you the fun guy? Are you a community guy? Are you on city council? Like, where do you get all your patients from? Where do you? How do they come?
Speaker 2:In our case, many doctors we have doctors on one of the spectrum that don't enjoy talking about their profession with their friends. Hard for me to believe, but these are phenomenal clinicians phenomenal, I mean, some of the best in the country and they're uncomfortable telling their friends that they're dent about dentistry, and pretty much everyone I talked to and I'm not a dentist, pretty much everyone I talked to says do you know a good dentist, garrett? So you know that's what I call passive. I just you know what you do day to day. So some of the one pearl that I wanted to share was the first spend time, not money, marketing your practice, meaning you've got to do the things that are basic and simple in your life to make sure that people around you know that you're a dentist and some of those things for the doctor in this case.
Speaker 2:I know, stephanie, we've talked to doctors that aren't, that are that are struggling in this case, that aren't involved in the Chamber of Commerce or Toastmasters or a Welcome Wagon or any of those community things that you can do to get up. I've asked doctors where do you eat lunch every day? Do you sit with a bag lunch in your office? Where do you go each for lunch and maybe go have a cup of coffee at the 10 coffee shops that are around your practice? If you don't drink and a lot of guys don't drink but go to a bar and buy a beer and get to know the people, go have a glass of wine with your wife but move around. Now I'm talking about a practice that is struggling to create new revenue, okay, and there's just things you can change that are free, that can create new business for yourself.
Speaker 3:The easiest thing now is asking patients for Google reviews and getting a Google. I mean, google is the number one thing right now. One checks Google for reviews and so get the word out there like that. I mean it's. I've seen that really drive patients, if you can get it.
Speaker 2:Do you ask for Google reviews? What, Mike? Do you ask for Google?
Speaker 1:reviews yeah, we ask for reviews, but our patients are so old they don't know how to get into Google.
Speaker 2:All right. So you have to stick to going and drinking wine and having coffee.
Speaker 1:I can't do that because it's going to throw off my expense percentages. I can't be buying coffees. That's five bucks for a cup of coffee.
Speaker 2:Okay. So I'm going to steal something from Bill Blatch, which is I'll buy the coffee but you give me half the revenue. Okay, all right. So seriously, I think being involved in the community is really important and there's a lot of fun things you can do with the team. The fire department in every community often has fundraisers. They have community events where the doctor and the dental team can get involved.
Speaker 2:And I'm stealing just because we, in this particular case, we have a doctor in the community that doesn't have a community presence and right next to her we have a doctor that's operating a multi-million dollar operation, who everybody in the community knows that doctor and none of that cost him anything. That's just being involved in the community. You talk about 10X. It pays 10X back If you're a great clinician and you're offering great services and the people in the community don't know who you are or where you are. It's really tough on the practice and it's really tough on the community. So also, I think, getting your team involved. You know we used to do I'm old so we used to do bowling team. That was a fun thing to do. We would go bowling, we'd have bowling shirts and go do that. But there's softball there's. I know, stephanie, I know your husband plays hockey. There's all kinds of ways to get your general practice out into the community, and I think it's really important for doctors to be able to do that, you've got to teach them to skate man.
Speaker 2:Yeah, you know. To me, when you just, mikey, said the doctors come in late and 10 minutes they go right in. Do they also just pack up their car and go home at the end of the night and that's the end of the day for business? Because if that's the end of the day for business, there's no business that I'm involved in, that I'm not emotionally emotionally attached to. I'm thinking about the laboratory, I'm thinking about dentistry 24-7. I'm laying in bed thinking about it at night. I'm trying not to worry about it. I'm always thinking about new ways, because I have Stephanie to run the businesses. I'm always thinking about new ways how do we create more revenue? And I don't want to spend money because I'm cheap. So what do you do, mike, for marketing?
Speaker 2:You know, I know you have a successful practice. I don't want to put you on the spot.
Speaker 1:No, you know, I will tell you, having been in practice now for 36 years, I think one of the keys is is we try and do a little bit of everything right. We ask for reviews. We do ask patients to share their experiences with their friends and send their friends and family in if they feel good about the way we've been treating them. I think one of the big things today is I just really try to care about each and everyone of our patients. You know just as people first and as friends first, and then you know as a customer or patient really second. I think patients really appreciate that perspective. So I really try to feel like every day I'm there to serve my patients in the very best way I can. I will tell you I do everything wrong. Everything we've talked about tonight I don't do. You know, I used to have the practice where I and this part will probably edit out but I used to have a practice that I used to run by the numbers. Every morning we'd sit down and if our goal for that day was $3,000 and we're at $2,500, we'd go through our schedule and say, well, you know, here's Sally's got pending treatment. It's a crown, and if we do that crown, we'll hit $3,500. So it's going to take us over a goal and that's the way I used to practice. Today I go in every month knowing what my BAM you know I bear asked minimum is that I have to make in order to pay all the bills and take care of my team. But that's all I go in with every month. And so if I split that up, if I let's say it's got a $100,000 goal and I know that I'm going to work 20 days, I need I know that we have to be somewhere around $5,000 a day, but I don't really do anything more than that and it's really become after all these years of practice. I just feel like I go into the practice knowing that the patients are going to come in. I'm just going to treat them the very best I can, provide all the services that I can that they feel good about too. We're not going to try to sell them on things. We're not high pressure. We don't say if I could get you to do that implant today and for only $100 a month, you want to do that? You know we tell them the straight up fee. So they really have to value and appreciate what it is that we're going to do, and I think that's where so we do everything wrong. But that's really the marketing that we have to make them feel like we really do care.
Speaker 1:I think that's what differentiates and I'm not I'm going to over generalize, but maybe a corporate type of practice that is run more for the numbers, where it's they've got big marketing programs and they're getting 100 new patients a month. You know, I think we mentioned this before If I get six new patients a month, I really have as many as I can handle, because by time we do our comprehensive exam, come up with a treatment plan, explain that treatment plan to them and then work through that plan with all the other patients that we're able to retain. I can't take on more than maybe six a month. So it really is kind of a different philosophy. And then what that does is that extrapolates down to the team, because I think you know, talking about analyzing the team, I think the doctor has to understand that when we go to enter our business and again this is just my philosophy, I know it can differ you know some doctors walk in and they're the king or queen of that practice and everybody is there to serve them. I think you know Simon Sinek especially says that you know, if you're a general in the Marines, you're the last one to eat.
Speaker 1:And I think that's the kind of the way that I approach this is that I'm going into work every day to serve my team. I'm going there every day to serve my patients and I think if you go in with the attitude that you're there to serve your team, they know that you do have their best interest, their best interest in your mind and that's what you're trying to achieve, then they take that and they share that kind of message, maybe not a direct message, but in the way they treat your clients, your customers, your patients, and that, the same way that you know you are the one that we're the most concerned about. We really want what's best for you. And I think it just starts at the top, just kind of works its way down, and so that's our marketing. It's kind of the environment and the ambiance and the feeling and the way that you treat the patients within your practice.
Speaker 1:And then, once you get that down, now you go spend money to market, you do your Facebook ads and all that, because what will happen is if you don't have the inside correct and where you're able to make patients feel good about you and your practice, then you could bring in a hundred patients through. You know, in the day, going back to the old days, yellow page ads, right, so you get. You get these patients coming in. They're calling up. I saw your yellow page ads, I saw your yellow page ad today, as I saw your ad on Facebook. And they start coming in and if they don't have a good experience, they're coming in the door and they're going right back out.
Speaker 3:So I think Well worth starting your reputation with their ad review right Now.
Speaker 1:You just show yourself Right.
Speaker 1:Yeah, you're the practice of 3.5 stars, and so I think really what you have to do is work on the internal aspect, and that starts at the top the leadership that we talked about before.
Speaker 1:You get everything going within the practice so everybody feels good, your team feels like you're a good doctor, so they want patients to have care done by you, and then, once you get that cleaned up now, you start spending money and hopefully you get that 10X return. I think that's one of the things you have to look at is, when you spend $1,000 on a marketing program or $4,000 for direct mailers, you do want to try to get a fairly decent return. I think that's something that's important for the doctors to track, especially today, because, I see it, we're hit by it all the time hey, doc, if you sign up, we'll do an on hold message for you. Or Doc, hey, we can do a Facebook campaign for you, and doctors will sign up for that because they're getting squeezed and maybe feeling a little desperate. But really look at the numbers, what your marketing spend is and what the actual increase in your revenues are.
Speaker 3:Absolutely.
Speaker 2:Okay. So, mike, you wanted some numbers, just some quick numbers, and doctors this can be related, I guess. So we went into a practice recently that was on the Glideslope at Bankruptcy for sure and it was on its last breaths. So Stephanie and I went in and we reviewed the practice. We came up with a business plan. We interviewed the team and we tried to solve the team problems that they had and make it positive for them. We tried to create systems and processes that serve the practice of the patients. We tried to make sure that we had the right equipment, our business plan and our doctor. Everybody bought in. We really did nothing more stuff and you can confirm this. We really did nothing more than the fundamentals to just get everything, get a plan to go from today where what we're doing to tomorrow, what we're going to do, and really put to the test our fundamentals that we preach every day to the businesses that we get involved in. And these were the results. And, stephanie, we decided we're not going to share actual numbers but just to give an idea of percentages. So we purchased this practice. It was in dire straits. It was losing a significant amount of money. It was in the probably the negative 50 to 20% on gross sales every month. So after six months approximately, we became profitable, meaning we paid the doctor an average of 30% of the collections and we had an extra dollar. That's all I'm going to say. We actually had money in the till to actually put a put a plus sign behind the income statement. We have a huge money in it and it's what we're going to do.
Speaker 2:Worked on marketing but didn't push a specific marketing plan. We did not have a marketing budget. We could not afford that. But about six months in we were seeing 10 to 12 new patients, from basically one to two patients a month. So that was just our fundamental. After six months pardon me, after two years we grew the practice pardon me, after six months. We grew the practice approximately 20% productivity after six months, doing nothing other than implementing a fundamental structured plan, financial plan, and after two years we sold the practice for over 4x gross what we paid for it. You can kind of plug the numbers back into what you say, but we can take a dog and we can turn it into a shiny penny. We can do that without any extra money.
Speaker 2:Now, mike, you were involved in several of the businesses that were involved with it. You were involved in this particular model and it was never. It never went from 600,000 to 1.6 million, but it went to a good, solid practice and from there, the doctor that now takes over the reins brings in all those new services, brings in all those new philosophies which you're talking about, and now we're seeing the practice take off. So I think what Stephanie and I are really good at is understanding what's broken fundamentally and trying to help fix those things. And for the practices that we've seen I think practices in businesses that we've seen universally, where they've been challenges not addressing the fundamentals Once you get the fundamentals down and you're profitable and, steph, I'll let you finish up on this thought I think from there the sky's the limit and that's when you can start introducing. Go on education. What's first best, is it implants?
Speaker 3:Is it?
Speaker 2:ortho, what's best next? But, steph, what are your thoughts on that?
Speaker 3:Leave it to the CFO to say that again, I think it all starts with that understanding, understanding your numbers, where you're at right now, and it has to start there where you can see, where you have to know where you are now to before you can get a blueprint. So I would back to the start of this, but make sure you understand exactly what your numbers are and then set appropriate goals. I mean they can be small, but it starts with the numbers.
Speaker 2:So, mike, you've heard this before.
Speaker 2:So my belief is that we can take any practice that's struggling and in 30 days all of these things can be implemented without a lot of extra time and we can change the focus without creating a big climate disaster within the staff.
Speaker 2:So that we've walked into practices and we've introduced this and we've had people put it and it's been too much so it doesn't need to be that way and I think it really just starts with the doctor and the office manager, or maybe just the doctor.
Speaker 2:But I really do believe in 30 days you can take any practice and really significantly improve it before you go out and spend tens of thousands of dollars of equipment and on education to understand the fundamentals. And this is not my, these are not my words, but I really believe in planning, creating policies, innovating, propagating that innovation and then delegating, and that allows them the doctor, to do what the doctor does best and have the team do what they do best and have the management side do what they do, and if you integrate all of that, then you have a winning formula and that's sort of what the basic outline we use and I think you know, I know in your practice and some of our partners practices, they're very well managed and really everybody knows what they're gonna do when they come in every day and they just see success after success after success and growth after growth. It's not that way at the beginning. And, mike, I don't know how long you've been practicing, but was it easier for you to practice when you started than it is now Does?
Speaker 2:it scare you. I mean, it's easy for us to talk to the dental students, but put yourself in their shoes right now, or in a doctor that's struggling.
Speaker 1:Yeah, you know, I taught the young dentists all the time and I tell them you know most of the young dentists today that I taught to they feel like they have the student debt and they do not wanna take on the ownership of a practice from both taking on more debt and then having to run a business. I tell them, you know, when we it's all relative. You know, when we got to dental school, I think interest rates were 27%. It was in the 80s and yet I couldn't wait to get out and have my own practice and see if I could run my own business. So I think the psychology today and again we had student loans and everything like that too it's all kind of relative. And I think today it is a little bit more difficult to run a practice because we do have more of the corporate practices instead of having, you know, just the sole proprietorship practices on every corner and that does present a little bit of a challenge. But you know, I really do hope that a lot of dentists who listen to this are encouraged. If you are struggling to make the ends meet every month, I hope you know. One of the things that Garrett talks about is this practice and I saw it happen where this practice was losing money. The same practitioner was kept in the practice. A lot of the team were some changed out, as Stephanie was talking about. But just by making better financial decisions, by collecting the dollars that were owed to the practice, reducing the accounts receivables, that practice did become profitable and very profitable, and it was not a large practice. So again, I think one of the things that amazed me, it wasn't a $2 million practice. It all of a sudden became profitable when it got cleaned up. This was below a million dollar practice that, once you cleaned everything up, became really profitable. I think most dentists would be happy with the profit that was coming from that practice and it was just really by how you decided to run the business financially.
Speaker 1:Stephanie again went into to get the numbers because, as she mentioned, we didn't start off with good numbers for her to even analyze and then it sort of takes a while to get all that cleaned up. She took a look, saw where things weren't in the proper balance. The two of you went in, changed some business systems to bring things into a better balance and all of a sudden, like you said, six months later, you're going from a practice that was very. It was struggling and now the doc was much more comfortable and it just got better after that. One of the questions I'd pose to you is, if I'm listening to this and I'm listening to the numbers and I agree with what you're saying, what's the next step? I mean you were saying maybe a consultant would be good, but sometimes they're very expensive compared to the extra funds that we have. Do we reach out to you? Do we find somebody like you and Stephanie? What advice would you give a doctor who's intrigued by what you've said so far?
Speaker 2:Well, steph, I'll answer this and I won't make sure your phone doesn't ring off the phone tomorrow. I won't over convince you any more than you are now. But, mike, so the Pacific aesthetic continuum, the PAP. We have, I think, great educational foundation and I think we offer a lot of opportunities individually and through the PAP. But we also support Dental Lab. It has a lot of clients and a lot of clients that start up through these exact same problems and one of the things we've done is we've built our business at the Dental Laboratory, not just off providing prosthetics, crowns.
Speaker 2:That's not how we really grew our business. We grew our business supporting our doctors. Somebody once told me, leach and Dillon was an old gold company. A gold company that was a business for a long time. Kevin Dillon was a friend. I got into the business 30 years ago and Kevin Dillon told me Garrett, you're going to have to find some way to be more important to the dentist than just selling them a crown. And I thought about that. He held his finger up. There's one thing you need to learn, and I'm not going to tell you what that is, but that's all I'm going to tell you. That's really a true story and I figured it out. What it is is that we need to support our doctors in more than just providing a product at a great price. Anybody can do that. You can always buy something cheaper and better and cheaper and better.
Speaker 2:What we like to do is we like to be more comprehensive. We offer all of our clients at Fordental App the opportunity to contact Stephanie and I, and we sit down with anybody who calls and we offer as much help and support as we can. We don't do that initially, at the beginning, for any kind of a fee. Now, if we have the time and if we think it's going to be a good fit, we will do some minor consulting, but for our clients we offer the service. We'll sit down any time and spend some time and listen to what's going on. It usually starts with me and then it transitions over to Stephanie so she can take a look into the systems and look into the numbers, do a short evaluation and we all get together and say here's the obvious things. We see we just did this for a very successful practice, very high volume practice, doing very well, very profitable.
Speaker 2:But this individual was really good at identifying that there are some things that he thought were out of lap and we went in and looked at it. We identified those same things, but in this case he didn't know how to resolve them and it was really no more than an hour or two on giving him the solutions. What I was so happy to see was that he implemented those the following two weeks and fixed all of those three or four problems. Correct, stephanie, the three or four issues that they had. They fixed them literally in a few weeks and we're talking close to $30,000 a month in expenses. We'll change that quickly.
Speaker 2:So there are some easy fixes and there's some challenging fixes, but the take home message is start with an practice analysis and ask find a consultant that you like that you can work with, and ask them for just a business analysis and ask them if they'll work with you without all the extras, just on those fundamentals. If they won't, then just call us and we'll help. If you're not applying to the laboratory, hopefully we can make you a client. And that's really our goal is to just be more comp. We're just trying to be more than just. I mean we're into education heavily, we're into consulting heavily and we make counts, and I think that's Stephanie. Is that a pretty honest statement?
Speaker 3:Yeah, absolutely.
Speaker 1:Well, that's great to hear, Garrett and Stephanie. Thank you very much for all this information and I hope everyone who's had a chance to listen to this. I hope you start to look at your practice, make some changes and have a better year. Thank you very much for listening.
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