Associate Relationships with Bryton Nield of Dentist Partner Pros

Am I personally actually ready? Am I ready to share as a practice owner? Am I ready to share my team, my equipment, my space, my patients, the production? Am I willing to share all those things? Because if I'm not, it's not going to work out well and you're going to be the problem.

This is Growth in Dentistry, a dental intelligence podcast where we ask the question, What does growth in dentistry mean to you? I'm Steve Jensen, a data dental nerd and your host. Welcome back everyone to another episode of the Growth in Dentistry Podcast. Today, today we are gonna jump into one of the biggest problems that faces dentistry today and is not a problem that's going away. I'll share more about that in a second. Before I do, a quick shout out to the marketing team at Dental Intelligence for sponsoring this podcast week after week after week. I say it every time, but a lot of work goes into this. And I'm super grateful for them. As always, they have a promo for listeners. Uh, what they're offering right now is a $50 gift card just for taking a demo of Dental Intelligence. If you've never looked at the platform, they do everything from giving you like a business x-ray of your practice, helping you understand your numbers, all the way to helping you communicate with patients about unscheduled treatment, about confirmations, about their unpaid balances. Like, you name it and they help. With most every problem in the business when it comes to like data and patient communication. So super cool platform, definitely worth checking it out if you haven't. And if it's been a while, lots of new enhancements that they've made, definitely worth taking a look again. All right, with that being said, today I have Brighton Nealed on the podcast with me. Brighton and I met, man, it's been over a month now at ADOM. And Brighton helped found one of the coolest up-and-coming businesses in dentistry, in my opinion. So here's how I'll frame it, and then I'm gonna bring Brighton in quick here to help frame the problem. But here's what I've seen on my side. I'm looking at ADA data all the time, and the volume of dentists has continued to increase in the US year over year over year. It's a pretty boring thing to watch because every year we're getting more people into dentistry, and then the retirement age has also been going up, which means we have a bigger supply of dentists now than we have ever had, and that's been a claim I could make every year for the foreseeable years in the past. Okay, like we've always had more dentists growing with our population size. Now, here is where the problem lies though. When you look at the Bureau of Labor Statistics along with an independent study that DI did with a group called L.E.K., we discovered that the number of actual dental practices, general dental practices, has remained flat for pretty much the last 3, 4 years. So what that means is that we are hiring more associates than ever and that there's more associate relationships than ever before. And the thing that got me super interested— this doesn't surprise me, but the thing that got me super interested in my conversation with Brighton and why I'm having him on is when we start doing a lot of something that we've never done before, we're probably going to make a lot of mistakes. So there. So Brighton, do you mind? Welcome to the show.

Yeah, thanks for having me, Steve. I'm stoked to be here. Thanks for having me.

Yeah, for sure. And I know you've got some stats around like associate success rates and some of the things like that. Do you mind kind of sharing some of the stuff you found? Just so you guys know, Brighton and his business partner Bob Spiel, they've got over 20 years of experience in dentistry, in practice management consulting, speaking at some of the biggest stages in dentistry. So these guys definitely know what they're doing. They've been around a long time and they identified the problem and were like, we've gotta make a service specifically focused on this to make sure we don't have these massive missteps and solve 'em as early as possible within the space. So Brighton, do you mind sharing? Yeah.

You know, a little bit more about the problem. Yeah. Oh, thanks for the intro. I appreciate it. Yeah, so it's fascinating. So we started hiring pros as a consequence of a conversation that my co-founder had with an OG practice management consultant, Linda Miles, years and years and years ago. Yeah. Okay. And they, realized that there's this huge problem in dentistry, which is hiring and retaining associates. And as we dug into this problem more and more, because if you've talked to any practice owner that's been around for a long time, they've probably had 1, 2, 3, 4, 5, 6 different failed type associateships and all sorts of different reasons. And so as you dive into this problem further and further, you start to uncover data like Dental Economics has reported a number of times that the average associateship fails 75% of the time within the first year. And so that means only 1 out of 4 are lasting longer than a year.

Okay. That's so painful.

It's horrible. Like if we looked at it, if our implants— like, could you imagine if 75% of implants were failing? We would be having an uproar. But for some reason we've just come to accept that. Just kind of is how it is. Like, it's just— you just kind of go through a few to find the right one. And I just don't think that has to be the case. So that's really what—

one of the things that I mean, doctors, if you've experienced this, you know exactly what happens. Like, I had a friend of mine called me. This is probably a month and a half ago. And he says, you know, he's got a number of locations that he owns. And so he's been— and he's been hiring associates for years now. But he has an associate call him up over the weekend and says, hey, just so you know, got a better offer from another group. And they've got a— they've got an employment contract. So like contractually, this doctor is supposed to work for several years more. Totally. And the dentist was like, yeah, I don't really care. I'm just leaving. Like, I'm not working at this practice anymore. I'm going to go work at this other practice that promised me some bigger and brighter things, hopefully, right?

Yeah.

What happens in practice is this dentist friend of mine, all of a sudden, guess who's going in and trying to like piece that schedule and dental work together? It's him, like working extra hours, asking other dentists that he knows to come in and like sub in as best as possible. You know, so it's such a, it's so painful when it happens. And Brighton, I think where people are gonna really want to hear is like, you know, you guys have some expertise on how to avoid that. Like, so let's maybe let's just like shift to that. I don't know if you want to, but like, How do I think about hiring an associate? When does it make sense to hire an associate? Like, where do you want to start? Because yeah, I mean, we have so many earlier, you can hire an associate, you know, too late.

We can go in so many different directions, but I think you hit on a good point. I think to really start to solve the problem, we first have to define what's even causing it, right? And so a lot of times I see the two most common issues or reasons for hiring an associate is one, we just lost one. Or two, we're so busy that we can't keep operating in the way that we're, we're doing it now. And so we need another, another dentist, another person with a license who can actually come in and expand what we're doing. And so oftentimes what happens in those two situations, they both hit the same point. They hit what we call a panic point where this change of staying the same is way too painful and is, is wor— is The change of staying the same is worse than the pain of finally changing, if that makes sense. Yep. And so they finally say, okay, I'm going to get another doctor. And usually this happens especially with the— they either hired the wrong person from the get-go. And so they, they just had an associate start 3, 6 months ago. Next thing they know, they get that text over the weekend, or they finally are— have been putting off the conversation since week 1 of letting them go, and they finally decide to do it. And Ends up leading to this panic point decision of like, okay, we need someone in here yesterday. And so let's talk to everyone and anyone, like, and I don't care who they are, but most likely it's a family member. It's a cousin's friend's nephew who's coming outta dental school. And it's like, hey, I know you. We have some things in common. Let's just try it out. Like, I need someone in here. And before you know it, they've brought on someone without much forethought. And it just ends up repeating the same cycle of the associate revolving door.

Yeah, that's so, so interesting. So let's talk through, maybe give us some of the like common missteps. So like you're coming in, I'm thinking some of the questions I have is like, okay, is it because am I losing these guys because I'm not— these dentists, associates— because I'm not giving equity in my business? Is it because the comp plan's wrong? Is it because like I didn't do a good job at understanding like their personality and their goals, their career and life. Like what's— I don't know if there's one magic bullet.

Yeah, it's a good question.

Or maybe even talk through like the process. Like how do you guys think about— because you guys, I know, have a really high success rate. Like when you help get an associate hired in a dental practice, they stick around. And so, you know, I'm kind of hoping to glean some of that, that—

Oh yeah, yeah. Let's get into it. For sure. So yes, we have over nearly a 90% success rate compared to the 75% failure rate, right? So something that we do with like over, with over 100. Yeah, yeah.

Like lots and lots and lots and lots of, we're statistically significant at this point.

Yeah. Yeah, yeah. So it, it, it definitely, the process definitely works. The, the, I think the first box you have to check, so we, we specialize in private practices, like we exclusively work with private practices. And one of the first box any practice owner has to check is, am I actually ready to bring on someone? Yeah. Too many people prematurely do it, or they just jump in thinking like an associate's gonna solve all their problems.

Yes.

But it's just doesn't work that way. So like there's two boxes. First, am I personally actually ready? Am, am I ready to share as a practice owner? Am I ready to share my team, my equipment, my space, my patients? The production? Am I willing to share all those things? Because if I'm not, it's not going to work out well, and you, you're going to be the problem, okay? You, you'll be the one that once you bring them on, you'll start moving production from your column— from their column back into your column. You'll have a hard time passing off that patient to the new, to the new associate, and that's just a complete recipe for disaster. So if you're actually abundant-minded and you want to bring on someone, practice with another person, that's the first box you need to check. The second one is, is your practice actually ready? Like, could you actually realistically— do you have the volume? Do you have the space? Do you have the production, the collections, the patient flow to be able to bring someone on? So I call it the Associate Readiness Matrix. And there's like the 4 main things. It's, it's patient volume. It's so it's busyness, it's overhead, it's op space, and then just overall new patients as well. So you've got to have total active patients and new patient flow coming in to be able to keep people busy and make sure you're busy enough, right?

Yeah, that makes sense. I'm like, as you're saying the things out loud, I'm imagining, yep, I could see how if we don't have enough patients, then new associates not busy enough. Which means they're probably having to split days, different practices. And ultimately they probably just want a landing place where it's like, dude, I'd rather not have to like split my time. I'd rather just like be full-time somewhere and like really commit. So maybe some of that kind of stuff. Operatory space, if they feel like clinically they could do more but they don't have the op space to like get it all scheduled, then that can be frustrating. Or if they're having to like kind of share space. So yeah, yeah, the things you're saying, it's like, yeah, those all make sense.

They make sense. They're, they're logical. But oftentimes I, I just talk to so many practice owners who think, I'm just busy, I'm burnt out, and so I just need another doctor in here and all my problems will be solved. And that's just not true, like, at all. I'm just trying to save you hundreds of thousands of dollars of mistakes when hiring and hiring the wrong person. So don't just jump into it thinking it's going to work out and it's going to be all happy-go-lucky dandy, because oftentimes it's It ends up being the opposite. Every team member we work with is an amplifier, right? So they either amplify good or they amplify the bad. We've all hired and worked with people who, when we bring them on, it's like magic. Like our lives are better, everything's running smoother, our patients are being served more, or in just general business, our teams are just performing at a higher level. And then the opposite happens if we bring on a wrong fit. All the wrong things are amplified. Those culture things you're trying to leave behind, they bring in that toxicity, they bring in the gossip mill, uh, all those things happen. And when you bring on a doctor, those things are 10x amplified. And so you have to be very, very picky about who you want to bring on into, into your family, if you will, um, because they're going to make a huge, huge impact. So yeah, so if you can check those two boxes, your practice is ready and you're ready, then you should seriously consider bringing on another doctor.

The practice readiness stuff, that conceptually makes sense. On the me being ready stuff, are there any like extra bars you would sing there? Like what are the things I need to think about for my own personal self?

Like, you know, I talk to a lot of practice owners, young and old, and there's definitely this, this paradigm that needs to shift in those that started practicing 30 years ago. And I don't say that as, 'cause I'm obviously a younger person, I'm just Observing what's happening. There used to be this, this world where as a dental student you'd come out and you had to build your own book of business, right? It was kind of expected you come in and you're gonna have to work really hard, you're gonna have to sacrifice for a while. That's just not how it works anymore. Big groups have changed that dynamic. And so now graduating and younger dental associates have higher expectations of their employers. That's just how it is. And so they don't plan to come into a practice and have to start hustling and filling up their own column. It just isn't reality anymore. And so there has to be a paradigm shift of realizing, as a practice owner, I'm going to have to probably take a short-term loss. I'm going to have to take a short-term loss when I bring on this person. I'm going to have to sacrifice in my column, my production, my collections and push it onto them. But when we do it well, all the things that you're wanting to happen will happen. You know, that, that freedom of autonomy, the increase in wealth, the, the more patients we can serve, that all happens. But you have to sacrifice as the business owner first before you can expect them to just come in. So there's this big, there's this big kind of debate we have with practice owners that have been around for a long time who are thinking of bringing on their associate, and they're like, well, that's not how it was when I got out. And yeah, that's probably true, but that's how it is today. And so we can't really fight it or go against it. We just have to embrace it and learn with the times. And that's one of the big things that practice owners have to do.

Yeah, that makes a ton of sense. And I totally understand like how someone would be like, oh man, I don't know if I'm ready to decrease my earnings temporarily. Yeah, that makes a ton of sense. You know that there's going to be— there's going to have to be some give and take there. As you're bringing a new associate in?

Yeah. Yeah. So once you decide to bring someone in, I could, I can go tactical. I know we, we have a short time here, so like I can start going if we want.

Please do it.

Yeah. So step 1, anytime you're looking to hire a team member or of any, any level, too often I think people just jump into it without really a clear picture of what is going to be successful. They might have something in their mind of like, yeah, I want someone that's a good dentist. We want someone that's kind, obviously someone that's honest and has integrity. And to me, those are great. I agree. But those are just kind of human expectations. Like none of us are going to work with someone that's dishonest and doesn't have integrity and things like that. Right. And so those are just kind of pay to play. You got to have those if you even want to be considered. Yeah. I would take it a step further. And the way that we do it is we create what we call the ideal avatar of the candidate.

Okay.

What does that look like? Um, For us, the ideal avatar of the candidate, any position, there's 4 main things. You have skills, culture, uh, character, and commitment. Okay. Skills, culture, character, and commitment. And when you build out what we call the ideal avatar, uh, you want to think of what are the absolute essentials across all 4 of those categories. So let's say it's a general dentist practice. We need someone that's gonna be able to do bread and butter dentistry, and that's like an essential. Maybe we want them to be able to do some implant work or some endo or something like that. That would be more of a maybe not a has-to-have, not absolutely essential, but it would sure be nice. Okay, so we check those two boxes in skills, and you can go deeper. Culture is what is our, what is our business culture? What's our practice culture actually like? What do we prioritize? What are the behaviors that we experience? And how would we know what when someone walks in that they just fit right in with the rest of the crew. Um, that's, that's what you want to know. Um, and I would encourage practice owners to, to get team feedback on that. What's most important to us? How do we prioritize it? What behaviors do we recognize? What ones do we, uh, look down upon? All those things. So dive into the culture. And then character is kind of like the catch-all. That's what are the extra characteristics that someone needs to be or to embody to be really successful at this role. So if we want someone that wants ownership abilities, then it's like, okay, they gotta be pretty interested in the business side. Do we want something that's super CE-driven? Obviously, do we want someone that's a leader or have some sort of management experience? That's all the other things. And then the last one's commitment. Do we want this to be a pathway to partnership or pathway to ownership? Are we okay with someone coming in and out in the next year or two? We want to just kind of build some sort of mill of grooming or— I don't know if I like grooming, but developing, developing younger, younger doctors. What does that really look like? So once you start to take pen to paper and actually write down, these are all the essential and, and nice-to-have characteristics across the skills, character, or skills, culture, character, and commitment. And you write those down, you're gonna have a much clearer picture of who's gonna be a good fit.

Yeah. I'm gonna ask, I'm gonna ask, can I ask a question about like where you're finding some of these? Like, cuz you guys have a great placement rate. So do you guys, you know, like are, are we trying to find dentists straight outta school? Are they like more moldable? They're more like gung-ho.

Yeah.

So don't know what they don't know. So like there's also like a lot of learning and training there. Or am I better off if I'm looking for an associate to say, hey, like, I know what it was like after school. Like, you kind of just get pitched on this idea that you're going to go work for a big DSO for how many years and then kind of bail after that. So am I better off trying to find like someone— do I look at like the Aspens and Heartlands around me and be like, okay, who can I go pick off?

Yeah. Like, good. Yeah, it's a good question. It's— I'll just acknowledge it's tough. I mean, we've over the years have spent hundreds of thousands of dollars recruiting, and it's still hard. So I'll just put it out there, like, it is still hard. Um, with that being said, uh, there's some really great platforms out there that are super helpful. Um, still the best place is you should have a job ad, a very well-written, not a thrown-together back-of-napkin job ad, but a job ad that, that is— has some intentionality behind it, that actually like calls out who you're looking for, why they should be interested, and that should be posted everywhere. And that's not just saying Indeed. That's not just saying ZipRecruiter. That's, that's every job platform you can think of. And you should be spending money. You should be— we spend typically anywhere from $1,000 to $2,000 a month per job per month, just advertising the position. And you should spend money if you're actually serious about recruiting. Gone are the days that you could just throw up like a $50 Indeed ad and get overwhelmed with candidates. It just doesn't exist. It does not exist. Maybe if you're in downtown Austin, Texas, you'll be like—

That's a hot market.

Lots of people there. That's a hot market. But then you're overwhelmed with people anyways. Then the other places, there's some great dental-specific job boards like Dentist Job Connect is a favorite of ours. We really like that. Every state Every state has a local state ADO job board. They perform okay. Depends on the state and how active they are and things like that. And then we do a ton of head hunting. So like for us, we've bought a bunch of data and we've also gathered a bunch of data personally. And so we're reaching out to thousands of dentists a month to just have conversations about, hey, are you interested? Are you open to making a change? One of our favorite places to pull from is the 2-year DSO associate who's been burnt out a little bit and is ready to get back into what they— most people got into dentistry, which was to pursue some sort of practice ownership, have some autonomy, work the 4-day work week and get back to that, right? So yeah, anywhere and everywhere you can find them, Facebook groups, Reddit, your local church, we've done it all. So anywhere you can have conversations with dentists is the best.

I think—

oh, go ahead.

Sorry, a little cough. Can I ask, like, what, what are these younger dentists looking for? So you've written obviously a ton of these, you know, job descriptions. Like, what are they, what are they, what are they? And you've talked to tons of these candidates. Like, as they're looking through them, what are the things that catch their eye where they're like, yeah, that is, that aligns with what I'm looking for?

Yeah, it's a good question. Uh, and I would always filter where you go to recruit as the practice owner based on that ideal avatar. So if you know you need someone with some real clinical expertise, why would you go to your local dental school? And if you know you can't even— if a D4 is not gonna work for you, a new grad is not gonna work, don't waste your time, right?

Yeah.

So when it comes to attracting great people, what we found is Younger, younger doctors are looking for, the biggest thing they're looking for is mentorship. That is super, super intense, attractive to them. And mentorship comes across in two ways on a job ad is one is how are you actually going to mentor? 'Cause a lot of people promise quote unquote mentorship and it's like—

Correct. It's like kind of this, the blank phrase.

Yeah. Yeah. Yeah. And it's like passively aggressively judging how you did that last treatment plan. That would be, mentoring, or do we actually have like a, a mentorship plan in place? And so like one of our, one of our most successful clients, um, he owns a couple practices out in, uh, Texas, and he's developed a full like 3-year plan. He says, you come in, we're going to send you through these 5 courses in your first year, we're going to cover all the CE cost, and we want to basically make this the best place, uh, for you to come work. And so they invest a ton of money in their and the associate CE. Uh, that's— so that's something we always encourage our clients is how aggressive are we willing to offer in CE, and then how intentional will you be on your mentorship. Minimally, that should be like a monthly sit-down, one-on-one, kind of like case review conversation. Um, and the more often you can do that, the better. But if you can actually have a written out, this is exactly how we plan to get you busy, this is exactly how we plan to help you upskill, it goes a long, long ways. And the other big thing is, especially those that are about 3 to 5 years in their career and they've done the 1 to 2 years of kind of grunt work, they're now really looking for a pathway to ownership, especially in private practice. And so the— I think you're seeing it, we're seeing it, the shift of solo doc owners is definitely changing. We're seeing this new privately owned group model is really starting to take off. 'Cause people don't want to live on an island, they want to be able to practice, but there's massive benefits that come from having more than one doctor. You can actually, you know, leave the practice and don't have to shut down and make your vacation 4 times as expensive. Correct. Right. So there, there's tons of benefits. One of 'em is obviously, you, you get to, um, have a lot of collaboration on the clinical side and also the people leadership side. So that's something that people are looking for, is mentorship and then a pathway to ownership. If you can have those two things, you really set yourself up for success, um, especially for long-term relationships.

Mhm. Yeah. And I'll just say, you know, one of the things we've kind of watched in the background amongst the DI customer base is, you know, on average, how many how many dentists are working in these practices that we're working with. Because we've got this whole data solution with, you know, 11,000 practices, pretty sweet. And we have seen like this consistent uptick where it's like, now we're, our average is over 2 dentists per practice. I think it's like 2.3 or 2.4, you know, dentists per practice.

[Speaker:SEAN] Yeah.

[Speaker:BRAD] We're seeing, so it's like, you're right. Like it's the new norm to have multiple dentists in one place. And personally, just because I work with a bunch of my friends, like, It is fun to work with people that you like.

Yeah.

And to not feel like you're on an island. So I'm not— I like it. I think for private practice, it's a really good model to say, hey, how can we create a business that's more efficient? Because you do gain some business efficiency by housing effectively what used to be multiple solo practices with one Doc2Hygiene. Totally. We house them in one single location under one practice and you gain some economies of scale there. You gain some cost efficiencies by not having to pay two different leases and have a team that's in one that you're shared across multiple providers. But then also just experientially, it's awesome too. Now, anything else you want to tidy up? We're coming up on—

Yeah, I can't believe we're almost done already. I will just say this. I very, very shortly, more people I think end up spending more time planning their vacation than they do on who they're actually going to hire.

Yeah.

And probably because vacations are way more fun, right? Uh, but when we, when we help practices hire, uh, a, a, an associate, we spend anywhere from 100 to 200 hours of work across recruiting and vetting. And our vetting, we send people through like 10-point vetting process, all that stuff. Uh, and so the reason I would encourage you to take it more seriously is because while that vacation might only cost you $5,000, $10,000, $20,000 if it's a sweet vacation, hiring the wrong associate in particular could cost your practice $200,000 to $300,000 in hard costs and opportunity costs. And so, but the return on hiring the right person, years of return on them, is millions of dollars of return. And so this is a multimillion-dollar decision. That should be taken as seriously as that. Um, and so don't just gamble away the idea of just hiring someone based on complete gut and vibes. There's a process to follow. So if anybody wants to follow and learn our process, you can go to hiringpros.com and you could, or you can email me at Brighton@hiringpros.com and we have a fleet, a free associate hiring blueprint. We give it all away. Like, uh, you can have the whole process. Uh, the reality is most people don't follow it because it takes so much time and so much work, so much skills. So that's why we exist, is to help more, more people do that.

Yeah, and I'll just share with you, but we've been partnered with these guys for years. Like, we've known Bob almost since the very beginning. Yeah, Dental Intelligence, and have all the confidence in them. You can just get the sense from listening to Brighton, we're like, okay, this dude knows what he's doing, is super intentional about his work, and is going to make sure that things go really, really well for everyone that he works with. So just on a personal level, I just let people know, like, I've got all the confidence in what these guys are doing over at HiringPros. Definitely take them up on the offer. We'll throw the website in the show notes so that if you want to click on that really easy, that'll be right there, um, so you guys can get access to it. Brighton, it's been an absolute blast having you on the show. You're, you're the man. I love the problem you're trying to solve. It's one that's not going away, so we might have you on again for sure as I hear more more, you know, hey, how do you think about this with associates? And this, I might have you want to come in and speak to it. But thank you for joining today, and thanks to all the listeners for joining. This has been another episode of the Growth in Dentistry podcast. My name is Steve Jensen, your host and fellow data nerd. Keep growing, and we'll talk soon.