121: How To Scale in Multiple Areas with Sarah Sharfstein, VP Category Development & Strategy, Aspen Dental

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Hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott, and today I have Sarah Scharfstein, VP of category strategy at Aspen Dental, here with us. And we're really going to be able to dig into some of the strategic work that's happening at Aspen. I'm very appreciative of Sarah being on because Aspen has done a lot of thinking, a lot of progress around how to scale in multiple areas when it comes to supporting clinicians and scaling practices. And Sarah was nice enough to come on the show today to give us some of that inside scoop. So, Sarah, first of all, welcome to DSO Secrets.

Thanks so much for having me, Ahmed. I'm excited to be here today.

So we've got a lot to cover. I mean, you're involved in multiple associations, women in dso, which I'm very excited about, the American Teledentistry Mobile Dental Association, a lot of progressive groups. But let's dig in first with what's going on at Aspen, because if you could give us a little bit of your background. But you came from Invisalign and now you're developing or have developed an internal product for Aspen, which is really interesting. Called motto.

Yeah, absolutely. Well, thanks. So just my background. I spent about 12 years at Invisalign in a variety of different roles. I started out as sales leadership, moved into more marketing leadership, and then spent some time on educational pathways in the orthodontic channel. So naturally, it was a good fit for me to move over to an organization like Aspen, who really didn't have a clear aligner or orthodontic category developed. And so I saw it as a great opportunity to spend some time there and really think through how do we not only develop an orthodontic category and drive utilization, but how do we get general dentists to deliver that orthodontic care and do it in a scalable way where we're delivering really good clinical outcomes.

Yeah, I found that the dentists really put, you know, as they're putting in new specialties, kind of thinking through two categories. Number one is, hey, is this a level of clinical care that I can be proud of, that I can put my name on? So when we're looking at aligner therapy, you know, that's definitely one element. And then how in the world do you actually integrate this specialty? Whether you're doing, you know, oral surgery or you're doing orthodontics, you're. You're having to merge in different capabilities within your current team and there's a lot of change management that happens there. So curious your thoughts? I guess number one is what was the work you all did for the motto product to ensure that the clinicians, you know, would, would feel proud of it?

Yeah, I think there's a number of things. So when you think about integrating orthodontics into a GP led organization, there's certainly challenges. Most general dentists leave school and have had virtually no orthodontic training. And so naturally, getting them to feel comfortable, to feel clinically confident and have that confidence when they present to consumers is really key. So for us as an organization, we're really thoughtful around what our training program is, what our mentorship program is. And much like we do in all other categories that we invest in and lean into, we're really focused on removing friction for the doctor. So we really think about it as we're not necessarily trying to turn our general dentist into orthodontists, but we're trying to come up with centralized, scalable clinical systems and processes to make delivering care really simple. So we do everything from centralizing the treatment planning approach. We have orthodontists on the team who really focus on supporting the doctors. So for the doctors who really want to engage at a high and are really looking to spend more time and sort of build that orthodontic muscle, they have the proper resources and support internally. But for other doctors who maybe their interest isn't there quite as much as it might be in other places, we've streamlined things to keep them in the shallow end to produce efficient, predictable, profitable results and really make sure that every step of the way they know they're supported and they have a lot of resource behind them. When we thought more specifically about rolling out motto, I think all the things I just mentioned were really the foundation to launching a clear aligner program within the organization. But when we thought about how we would really white label a product and develop this, it Wasn't just about the product. It was really about on the doctor and how do you remove friction, how do you make the clinical systems and processes really, really easy? And certainly at scale, that always becomes a little bit more challenging. And then the other piece was when we think about consumers, how do we deliver them a differentiated consumer experience? And I sort of highlight that concept of experience because a lot of the insights in the category are around those consumers not really wanting your traditional dental or orthodontic visit, but they're really wanting something that's a little bit more experiential. So we've gone as far as actually rebranding space within each of our offices. We think of it a little bit as a store and store type of concept, but if you come through our practices, we actually have a dedicated room to the motto clairliner experience. It feels a little bit more like a, you know, going to a medical aesthetics location or, you know, less dental visit, more experience. And I think everything we're doing where we touch the consumer with this category is really meant to feel more experiential, easier, simple versus what you typically think of as a dental visit.

Yeah, I think one thing we can all give credit to is Aspen and the leadership from Bob Fontana has very much been a streamlined, support the dentist type process. I think Aspen was one of the first to really do on scale. If we're going to do dentures, we're going to have the lab right here within the facility. It sounds like the same level of detail was thought through with this motto product. What were some of the friction points that you saw early on? Maybe you were expecting, maybe you weren't expecting that you're like, okay, to really make this work. Because I know there's a lot of thoughtfulness. And I think this is one of the secrets to take away is you can't just create a brilliant product, hand it over to your team and say, all right, now make sure the patients get this right. Because they have a thousand other things going on and they've got a thousand other things that that patient needs on top of this product. So I'm curious some of the roadblocks and how you overcame those.

Yeah, I'd say the biggest thing is sort of that change management piece in terms of rolling this out across the organization. So when you have over 900 locations and you're right, you have practices where Ortho is not the only thing they're doing. They're super busy, they're seeing a lot of new patients on a daily basis. They weren't originally trained on it. It's not their primary focus and they are running a core business. I think that aspect in terms of training really makes a difference. We have a pretty large field support team, both operationally and from a hygiene support team. And so I think all of those teams have really leaned in to support the practices. And we've taken on very much of a train the trainer approach. So leveraging those field resources. So it's sort of a combined approach of, you know, virtual learning, of course, because we're still in a pandemic, but also leveraging, you know, that knee to knee training in office support. I'd say that's probably one of the biggest challenges we've had. And so we've been pretty thoughtful about how we go about it. And we're still learning and we're still certainly optimizing the program. But I think that's really where it begins and making sure that our doctors and teams feel supported, feel like there's resources and feel like the entire organization is behind them as they sort of go down this new path.

It's interesting the way you framed it too, and I want to make sure that I've got this clear is you've set up a separate experience, which I love that word by the way, because if you don't have experience, then you have a transaction. Right. So, and what consumers, what patients really remember is how they felt, which is what the experience was like. So you've established this separate experience. It sounds like it's almost somewhat of a blend or a hybrid of some of the direct to consumer, but it's there in the dental practice. Can you kind of talk through that? I mean, sounds like the dentist still has their hands in it, but that the patient can do a lot of the driving as well.

Yeah, absolutely. So when you look at the clear aligner category, you've got two ends of the spectrum. So on one end you have the traditional clear aligner companies that are distributed through doctors practices. And of course there's a number of those popping up left and right and they offer a great quality outcome. You've got a doctor involved, but there's some challenges with that in that it's, you know, an average of $5,000 per patient. You know, not every practice is online scheduling. Not every practice has, you know, evening and weekend appointments. Not every practice is able to deliver, you know, a same day starter tray or care that day. And so there's a lot of friction for the consumer who, you know, if they have that moment of truth where Today is the day after 45 years or so that they want their teeth straightened. There's a lot of.

And I want it on prime shipping, right? Because we've all been Amazon a lot

of roadblocks that get them that day. And so you have, you know, all of these new direct to consumer, you know, sort of do it yourself organizations that have come in and have improved that process, right? It's more affordable. You can get treatment for around $2,000. It's convenient, right? There's a number of scan shops with a consistent experience. You, in theory, could take impressions from your home. And then of course, it's experiential versus a traditional dental practice. But there's no doctor involved. And so a lot of the insights are that a high percentage of consumers who don't go forward with treatment through that channel cite the lack of Dr. Involvement as being sort of a key factor in that decision. And so we really think we're uniquely positioned to sit between the two ends of the spectrum where we, based on our scale, have the ability to deliver care at a far more affordable rate, which is really a big part of our brand promise and who we are, but much more affordable than most private practices and certainly other DSOs out there on the market. With more than 900 locations, I think we have a number of access points and try to make ourselves as convenient as possible. We've got the online schedule and we've got evening and weekend hours. So we really feel from a convenience and affordability standpoint, we're really uniquely positioned to deliver on those core pillars. And then the nice thing is we have doctor involvement. So we're hoping to come to market with really an option that makes it so consumers don't have to really choose between affordability and doctor expertise. And then consistent with who we are as a brand. And I think you mentioned it earlier, we've got labs on site, labs in every one of our locations, so that when a patient comes in, we are able to deliver that sort of Amazon experience and really get them started that exact day. And so I think one of the things we're really excited about in Clear Aligners is our ability to leverage 3D printing capabilities in the practices. So when a consumer does come in, they're able to leave with that starter tray, they're able to start whitening. And that's a key differentiator that I think a lot of practices and organizations really aren't able to deliver on today just based on who we are as a core business and what we've Set up.

I love it. If somebody's listening and they're thinking, forget about it, I'm not doing aligners anyway. I think they would be missing the point here of the really juicy principles that Aspen's figuring out, which is how do we take care of our two customers, both the patients who want this very convenient experience. Right. And as I was saying, like, Amazon's ruined all of us. We're just entitled about everything. So we have to lean into that, accept that, and figure out, okay, how do we create that level of convenience for that customer? And then of course, our doctor customer who wants to be involved. And frankly, as you said, the patient wants the doctor more hands on, more involved. So how do you make these two things work together as convenience for both customers? And it seems like you're really striking that balance there. And that's the goal with motto.

Yeah, absolutely. I mean, I think again, a big part of who we are as an organization, you said it really well, is removing friction for consumers to get the care that they need and make it affordable, make it convenient, make it a great experience, and doing the same for our doctors that they can deliver great care and have it be pretty simple to do. So I think we're pretty excited about it and feel really good. And it's interesting, as I talk to a lot of other doctors and organizations, I think there's a lot of concern around the clear aligner space and it potentially being a race to the bottom with all these new entrants to the market. And I think in a lot of ways we feel really good about it. It's creating a tremendous amount of interest and awareness amongst consumers out there. And so to us, it's really just about being thoughtful, how you lean in, where you lean in, and despite the change, how do you sort of leverage that change to create an even better experience for the consumers and doctors involved?

Yeah, one of the realities we all have to deal with is dentistry is not iPhones and this really fun product, except when it comes to orthodontics. That is a place where a lot of consumers, maybe in some of the denture market as well, but aligners, orthodontics people see that as something a little bit more exciting. And so to your point, to the extent that we can actually expand that marketplace, we all know that creates a domino effect of, hey, before you can do these aligners, you got to get this perio under control, et cetera, and really leads into a lot of the other general dentistry that maybe dentists have more passion around. So I think all the work that's being done around the marketing for aligners, for ortho, I think it does nothing but just lift the entire industry. Do you see that at the Aspen level as well?

We absolutely do. And really we're hyper focused on access to care. And so I think this is yet just another opportunity to drive that access to care and to get people in the door. And when you think about the number of patients out there who don't come consistently see a dentist, there's just a tremendous, tremendous opportunity.

So I think this could be that hook, right?

Absolutely. Well, I mean, this is the thing that people get excited about. I think there's also a really nice referral opportunity around it. It's non invasive, it's aesthetic, it helps improve self confidence, self esteem. So I think it's something that consumers get really excited about. And also they come in and there certainly is the halo effect that you're talking about. And when patients start their clear aligner treatment, it definitely increases their dental IQ and sort of encourages them to do all the other things that they really should be doing to improve their oral hygiene and get consistent care.

Now, within all of this, I'm going to kind of pivot a little bit, but, you know, Aspen's a big organization. You're in different parts. One of the things that a lot of dentists struggle with is, you know, you're developing out your own vendor, if you will. There's vendor change and selection, so this might feel a little bit out of left field, but I know a lot of dentists who are constantly interacting, of course, with vendors. How does Aspen think about vendors? Is it lowest cost provider? Un. Is it a little bit more sophisticated than that? And of course, with your experience, just curious as another secret, if you're willing to share it.

Yeah, absolutely. So it's actually really interesting that you asked that because having been on the manufacturer sales side for more than a decade and now being on the customer side, I've certainly seen both. I think as an organization, we really. We actually sometimes stray from the word vendor because we really try to look at this as partnerships with different companies. And, you know, certainly when goals are aligned, everybody wins. As we start to evaluate different services, products, I think we. The misconceptions at times is that it's solely focused on price. And while that's certainly a key determining factor on what vendor you go with and how you partner, I think there's also a lot of other things that we think through. Certainly one is scale. Right. You know, can this other organization Scale with us. Can they move as quickly as we're looking to move? What is their level of investment as it relates to innovation? In R and D, we want to be cutting edge. We always want to be forward thinking. Are we selecting a partner that is going to help us with that and sort of shares the same goals? Certainly the relationship plays a role. When you think about signing up for a partnership, you're going to be interacting sometimes daily with this partner. So how do the two organizations mesh? How's communication? I think that's important. And then also as a large organization, it's all about integration. So when we think about making things easy for the doctors, the more we can integrate things both from an IT perspective, from a marketing perspective, that only helps to deliver that care and to do it in a pretty efficient, consistent manner. So always looking to lean in with organizations that sort of share that same sentiment and that same vision for what partnership means.

Yeah, I love that list. So those listening, you could just kind of make notes of those lists. And I think if you put a plus sign amongst those, those all add up to can I provide better patient care the way they want it. Right. Because the reality is if we have friction with those partnerships with those vendors, the patient's the one that ends up feeling that. Right. They're the ones frustrated on, why does this cost as much, why does it take that long, why isn't this happening, et cetera. And then we're just kind of the bearers of bad news based on the relationships we've developed. So I love what you're saying, that the cost, I guess, needs to be looked at holistically. Right. Not just the cost on dollars, but the cost of patient relationships. We're probably not as sophisticated sometimes around that because that takes a different level of thinking.

Absolutely. And I think also the larger organization you become, the more emphasis we also put on learning and development and what mentorship looks like, what field coverage looks like. So organizations with large sales teams is, you know, we see as very valuable. Having come from that side myself, I see a tremendous amount of value and, you know, having sales reps going into practices, educating doctors, supporting them. And so I certainly think companies who are able to scale in that area as well are seen as, you know, extremely valuable.

All right, Another topic. The demographics and dentistry are changing, right? Dramatically. You mentioned your involvement with women in dso. I'm just curious your thoughts. Obviously, being a woman, being in the space for the last 15 years, you're really at a lot of the. In the change that's Happening. A lot of it has been in the last 15 years. We're seeing graduating classes that are more than 50% women. What's your thoughts on it? Just generally and where do you think that organizations will need to change? Women will need support, women will need training, whatever it might be. What would be your perspective?

Yeah, I think it's definitely starting to shift. I was really enthusiastic to be a part of the women in DSO group that just launched. I think as we start to see more female dentists graduating, both general dentistry and in specialty, I think there's an opportunity to think differently about how we interact differently about the programs we build, differently about how we recruit dentists and what young dentists out of school are looking for. We're really focused obviously on the supply side of things and how we can make our organization sort of the DSO of choice. And so we've made a lot of shifts as an organization to be more thoughtful about this new group of dentists graduating certain things. We're doing our four day work week and just trying to be a little bit more agile, being a little bit more creative. So I think thinking through that as an organization, whether you're a large DSO or small, really does make a huge difference. I also think when we think about just the space as a whole, there's so many really intelligent and thoughtful female leaders in this space. And so I think it's nice to start seeing groups like women in DSO or other females and executive leadership roles in the space is really exciting to me. And I think particularly the women in DSO group will be an opportunity for many of us to network, to share ideas, share successes, share areas where we've learned and how we've improved or optimized. So for anybody listening, I would certainly encourage people joining that group because we're excited to bring a lot of these really great women together in the coming year.

Yeah, it's awesome. Yeah. If you've come into dentistry in the last 10, 15 years, the main thing you signed up for was a lot of change. And if you're someone who's excited about change, this would be a great market to be in. Right. Because all the change that's happening, it's more consumer focused, it's more customer centric, it's more diverse centric than I think it's ever been. And for those who embrace that, I think there's a lot of opportunities. And it sounds like over at Aspen there's just a full culture of embracing this and willing to make the change. I think that's what's so hard is it does require though a rethinking. Rolling out a product like motto isn't just something you do in a day or hey, this would be a fun idea. It takes a lot of investment, a lot of thinking to get to that point. So anyway, kudos to the work you guys have done.

Thank you. Yeah. The other thing I would also say what's interesting is if you look at the percentage of hygienists that are female, it's a very, very high percentage. And so when you think about career mobility and opportun, you look at a large organization like ours and you have a lot of hygienists out there who believe that that's probably as far as they can go being chairside clinicians. And so when you think about how these organizations scale the support teams that get put in place and the opportunities for maybe a chairside hygienist to turn into a territory of manager of hygiene support or to grow into other roles, both still in a clinical role, but maybe not quite as chair side and maybe more focused on developing hygienists or developing leaders in that space. I as DSOs grow, I think the support teams will continue to grow and the opportunities of course for those that are in practices and clinicians will continue to evolve as well.

Man, that's a great secret that I think hasn't fully gotten out is the power of mobility that hygienists have within dss. Right. They just sit in such this beautiful place of clinical understanding and customer centric focus and that's what you need in the leadership of dso. So that's a great call out. Sarah. Sarah, if anyone wanted to reach out to you, you know, maybe had further questions, et cetera, what's the best way for them to contact you?

They're welcome to find me on LinkedIn or my email is Sarah, period. Sharfsteinpendental.com and I would certainly welcome connecting with anybody in the industry that wants to have further discussions.

Thank you so much for being on and being transparent about what's going on at Aspen and we wish you the best of luck for everyone who might be listening to this. If you do have further questions, feel free to follow up with Sarah or come over to our Facebook page. I'd love to hear your thoughts on this. What do you think is positive? What do you think is negative? Where do you feel like we need to go next as an industry? And until next time, keep smiling.

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