163: Unique Solutions for the Labor Shortage

Welcome to DSO Secrets. I know what it's like to be an entrepreneur in the dental industry. I've had my ups and downs, just like you. There's so much opportunity to be excited about, but so few resources to get answers. From here on DSO Secrets, we get you those answers so you can change the lives you're meant to bless and achieve your personal success.

When I was working as an associate right out of school, I never imagined I could own these many practices with this amount of support. So thank you.

You have helped build my marketing mind

to a whole new level.

You have this natural talent, this unique ability. All right, hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott. And you know, something I've been thinking about is leadership during such difficult times. But I wanted to simplify it down, and I thought, there's four principles that I get wrong, and I bet you get wrong when it comes to leadership. And we really, we could break out when we go, man, why is my leadership not working? We could break it out into these four principles. Number one, have we clearly defined the problem? You know, how many times have you been in a meeting? And then everyone's like, wait, what problem are we actually trying to solve? But you have all these really cool solutions, but you're not clear on the problem, so have you clearly defined the problem? Number two, man, this one's tough. Deciding who should solve the problem. You know, sometimes we get what I call the Steve Jobs syndrome, where we think that it's, I'm supposed to do everything. Then we do the other opposite, which we abdicate to our team with no clarity on what resources they have. So as leaders, we're constantly battling who should solve this, what resources we should provide, et cetera. Then we get to number three that we all focus on, which is what's the actual solution? Which that by itself is hard enough, right? Is this really the best? And none of us are as good as we think we are. And none of us are definitely as good as our team thinks we are, but we still take a shot at the solution. Now, if it was just those three, that would be hard enough. But I've been thinking about this number four, and that is how do you deliver the message of the solution in a way that creates the change management that gets the buy in, et cetera. So, anyway, I. I'd love your thoughts and comments and, you know, come over to DSO secret Facebook page, DEO growth Facebook page, and I'd love to get your feedback on these four principles. And I might post a little bit more on that. Well, one of the problems that I think we're all pretty clear on is this labor shortage and inflationary environment. And those who are watching some of these statistics, or even if you're not, you are. Now, the birth rate in America is the lowest since its founding, which in some ways people say, who cares except those for us who are entrepreneurs, is the labor market for us to pull from later. And when you have that, which has been going down for a while, combining with your baby boomers leaving the marketplace much quicker than we projected, and then you have the inability for people to migrate to America, to have immigration here like we did before, for various reasons, you really get into this labor shortage crunch. And no matter where you are politically, financially, we're all in the same boat together, which is how do we solve this, especially when there's still demand out there that we, that we want to solve. So my guest today, J.W. oliver, who's managing partner, and Brenda McNulty, who's dental group director, or as I like to refer to her, queen of the universe. Right? There you go. She said she liked that title better with Support dds and many of you know, support dds. But Brenda and jw, first of all, welcome on the show and congratulations on your new place in Costa Rica. So which you guys are there now and I'm, I'm curious, you know, why Costa Rica? We all kind of know you associated with the great work you're doing in Zimbabwe and the app in Africa, but now you've set up another shop in Costa Rica. Where did that come from?

Yeah, I think it, well, it really evolved out of convenience. My wife and I have moved our full time residents to Costa Rica and realizing that we had just amazing people that the level of education, the focus on education in Costa Rica was high. There was a lot of similarities between this and Zimbabwe were like, well, it's not as high as an unemployment rate, but there is a high unemployment rate. But this would be considered near shore versus offshore. You know, it's much closer to the US same time zones. And so we really then started seeing an uptick the last couple of years and people requesting Spanish speaking team members, bilingual team members, and so, you know, coming down here frequently, staying long periods of time, I said, oh wow, this might be the perfect solution. So we spent a couple years looking into it and Brenda's here now and we actually launch. It wasn't timing. We didn't time this podcast to be on this day. But Brenda happens to be as well in Costa Rica training. And so it was just a perfect match and solved a couple of problems as well.

Yeah, it's awesome. Brenda, what's the difference you're seeing between Zimbabwe and Costa Rica as you've done training in both?

Well, you know what both of them are, everybody is so eager to learn. I just absolutely love that occasionally I'll throw a word out there or you know me, it was a joke that I wasn't getting laughs for and I was like, oh, don't quite understand that one here. So there's been a few things like that. But the overall, the team members, they're both just very eager to get a new career path under their belt. I love that they are taking notes like nobody's business, you know, and being in consulting for so long, I've had people that just sit there with their arms crossed and don't even take any notes. And these people have 30, 50 pages of notes when we're done with the course. So I'm, I'm excited. I feel like both of them are going to be an asset. The difference is by having bilingual team members. I'm almost training twice English and how do you say it in Spanish or what would be the best word for this to have the greatest effect. But man, it's nice to have them

trained up that way.

Oh, they're going to be amazing. I think that sometimes in our offices we forget or we neglect the Spanish speaking population or there's one dental assistant that has to run up to the front and catch the phone every single time. So this is going to be very convenient for all of our offices. It's been amazing, a blessing. These team members are like family already.

Well, if there's something I've heard consistently about support DDS is the team members that you all recruit in and train up are always eager. And I'll be honest, being where we are now the last couple years, having high level paying jobs that I put out there and people no show on the interview, no show after accepting ask for more money on the day they accept the job. You know, all of those things when you have someone who's, you know, out, outsourced, in, sourced through you all and they're like, thank you so much. This is awesome. What do I, it's like, oh, wow, that's right. This could be the labor market too. So yeah, it's, it's refreshing to hear that. You know, I mentioned in my opening about the immigration challenges that we have. And again, no matter where you are politically, the Pressure that puts on not just dental, but every labor market, which means that they increase their prices in order to attract what's left. And then that puts. And it starts this domino effect. It's interesting, but in a lot of ways I was thinking about it. Support DDS gets us back out to the global markets again, but without having to overcome a bunch of immigration laws to get there and, and to bring them in. There's, I think, a theme in everyone's strategy right now, which is what can be centralized, what can be outsourced, and what can be automated and kind of in those orders. Obviously, if you can just get your technology to do it, that's the least expensive, most predictable solution. But it's a heavy lift and you have to be very, very clear on your systems and processes because the automation just, if it's crappy, it just automates crappy. Right. But it feels like an easier lift is thinking through what can be centralized and then how do I get that outsourced at a, at a lower cost? And I'm curious on this. You know, early on, let's say three, four years ago, and definitely before that, whenever you talked about efficiencies as a business owner, you could kind of see team members get a little bit anxious, right? Is this going to replace my job? Is this going to have things changed? Because now I see team members like, well, I don't want to do that anyway, or I'm already overwhelmed. Could you get some help in here? Is that true, what you see kind of globally, that most people now are like, yeah, any help that you can afford or get, I'm interested in.

Well, I think personally, I'm not sure about jw, but when we talk about adding on a remote team member, we talk about adding a value there for your existing team members that you love and respect and you want to stay. There is a stress level today beyond where there's ever been a stress level when it comes to this patient's walking in the door. Do you know their insurance benefits? And staying on hold for Aetna for 45 minutes is nobody's favorite thing to do. So if we can take away the tasks that they don't like to do, we're going to increase team morale on that side. Now, is it possible to take away positions? Of course. I mean, that is possible. You can automate just about anything, you can outsource just about anything. But the main focus that we have is you need to have adequate number of team members to fulfill your mission and your vision every single day. To your patients, whatever that looks like, Is that making sure your phones get answered or greeting them when they walk in the door? And instead of giving them. I saw an advertisement, I loved it the other day. It said, quit giving your patients the finger where they're on the phone going, one more second. Allow those phone calls to be answered remotely. And then when they walk in, you can greet them like they're at the four season. That's really what.

You know, I've talked to some of these bigger CEO DSOs, and they have some really good models around what they're thinking about labor. And number one model, of course, is we need to make sure we have dentists. And then we need the people who are directly supporting them on sites, right? Because they're thinking through, from a cost perspective, if I can only afford, who, who do I need? And as it starts getting farther away from the dentist, the reality is we live in a world where if you're requiring someone to come to a location, right. This is crazy because three years ago we wouldn't have talked about this, but if you're requiring someone to come to an office, which a practice inherently requires, it is much more difficult, it's much more expensive because we're competing against somebody out there saying, do you want to work from home? You know, do you want to just be on a zoom and not have to drive into an office? So if we do get those team members, those are going to be the precious amount that we want to be able to spend that money on as we get farther out from that. To pay someone to come in, I'm just putting this out there, but to pay someone to come into a practice, to answer a phone that could be answered virtually seems inefficient today. Again, I wouldn't have argued with it three years ago. I would have argued maybe exactly what you said. The reason you want to centralize is you want your front desk people to be managing patients, not on the phone, et cetera. But today, now there's a labor cost component where people. I'm hearing things, even from dentists that are saying things like, are you going to reimburse me because I have to drive 20 miles to my practice? Or whatever. You know, I mean, there's just this new barrier to that, that, okay, great, if I'm going to have to do those kind of things, then I better make sure this other stuff is outsourced. The other thing I'm seeing from the labor market is there's just tasks that feel unchallenging enough that they don't want to do them. Being on the phone on hold is like, it's just not meaningful enough in their life.

Mm.

For the U.S. market. And so they're very open to having those delegated out.

Well, Emmett, imagine this. Imagine if you hired somebody for your business team and they're really good and you're hiring them at let's say $25 an hour and they're on hold for 45 minutes. How much did that cost you? That it's absolutely ridiculous to think of what you're paying somebody to be doing.

Yeah, yeah.

J.W.

yeah, I was going to add. Yeah, I was just going to add to that. It's funny, I think, you know, it's like even the number of people that couldn't use zoom to, you know, three years ago. Right. I mean, it's just amazing that people are like, zoom. What is zoom? And everybody got up to speed on that. So I would say even pre Covid there was this thought, okay, yeah, we can do insurance verification and we can do these data related task in the background. But you know, Emmett, that's changed tremendously. One of our most popular Brenda can speak on is like this director of first impressions. The, the scheduling, the answering of the phone, which if you, if you think about that, that was always thought of. Oh no, that's got to happen right here in our office. But with technology and with automation, now you're realizing that that's another test. So what I've noticed is the number of, of roles that can be performed remotely, virtually that we can insource, as we like to call it, that are different. And Brennan, you might speak on that because that director of first impressions role has become a really big option. And as Emmett said, this makes it where somebody doesn't have to come into the office and take up space in your office or make the travel commute time and they're able to do that job just as efficient.

Well, now you're expanding it with a Spanish language speaker too. So, you know, for those of us, especially in a Texas Medicaid market or some of these other markets, I mean, that's huge. Yeah, Brenda, I'm curious too. Like, you got that $25 hour person will go with your analogy here. They're sitting on hold. There's a domino effect to that. Right. So there's the domino effect of what's happening with the patient in front of them and whether they're able to address that. But what about all the other phone calls coming in too?

That's exactly right. Just Like JW had mentioned, this director of first impressions role really came about out of desperation from one of our dentists. He said, my team is not able to answer the phone but I am paying a ton of money for my marketing. So it's not a problem with the phone ringing. It's a matter of somebody answering that call and giving them the time of day that they need. The times of these two minute new patient phone calls I think are over. People want to connect to the office, they really want to hear about the office and they want to be educated about the office and that's going to take a little bit of a time. If your in office team is on the telephone, they can't service the patient in front of them. If they're servicing the patient in front of them, those calls are going unanswered. So I advise anyone that has the methods to track those calls, see when they're missing them. Because it very well could be after hours, maybe an hour or two after your office closes. You get to design the hours for our team members. So maybe they come in a bit earlier than your team or they work a bit later. But the whole point is don't let that phone go unanswered. The statistics are alarming. When you see how many phone calls are missed and then give that person the time to make the caller feel the trust like and confidence from your practice.

Well, can we talk about that for a second? Because I think the biggest fear and probably the model and understanding that most dentists and owners have is when they think of after hours, they think of all that crappy service they've had for after hour phone. Right. Which is doctor's not here. Let me get your information. They'll get back to you tomorrow. I mean you're talking about someone who would understand the culture of the practice, be able to answer questions a little more deep like what I would expect any front desk person or maybe my ideal desk person, front desk person to be. Is that the expectation I could have with a support DDS person is that this is more than we just take your information and throw you on the schedule and then somebody else has to handle the real work later. Are they actually doing the heavy lifting?

They're doing the heavy lifting. The example that I use for a director of first impressions, first of all, they're going to be dedicated to your office, in your office only. So it's not a call service for after hours. They're. Their success depends on your success as an office. So they're going to take the Call. Some of the first questions that they ask is, what inspired you to contact us? What are your expectations of us as your new dental home? They gather all of the right information. They educate them. By the time they get off that phone call, they would have sent a link to the new patient paperwork, and they set up an exact time to confirm the appointment two days prior to them coming in. That way, they can go over the new patient paperwork with them, give them a basic overview of their insurance benefits, and answer any questions that they have. Then, after they have that new patient appointment, they call the patient back and they say, so, Emmett, you said that the expectations that you had for our dental practice was that we were going to run on time, that we provide you multiple options for your dentistry, and that we would have affordable payment plans. How'd we do? And if you said it was fantastic, we say, oh, that's great, Emmett, if I sent you a link, would you be so kind as to write a review? Our doctor reads those reviews every morning in the morning huddle. So not only do we personally ask for it, but we also make it time sensitive. And if they had a bad visit, we hear them out. We use active listening. If I hear you correctly, you were in the reception area for 45 minutes longer than what you felt you should have been. Let me have our patient concierge reach out to you, because that's not who we are, and we want to make this right. Let me have our patient concierge reach out before they write a bad review. What we're looking for here is while

you guys are doing Ritz Carlton, talk about ideal, right? I don't know a lot of dental practices who've reached this level, and not because their intention isn't to. And not because they haven't mapped that out. But the problem becomes. Back to our first part is, let's say that my front desk person had that entire model. The problem is somebody walks in the door and the model goes out the window, right? Or the phone rings a ton and they've got other things, or somebody's out in the practice and they got to go do sterilization. You know, I mean, whatever it is, it kills the model so quickly. What's always been a benefit of centralizing and now taking it to that next level is that they don't have those distractions, right? They can follow a full, full cycle of customer service. So, yeah, this is way beyond after our, you know, take a message.

You know, Emmy, your. Your example was interesting about an answering service. I literally just had A call with a, with a COO from one of the DSOs. And they were saying, talking about the different services and they were looking at a few specific. And I said, you know, even after hours they go, oh no, we have that covered with our answering service. And I said, oh, okay. How many appointments, new patient appointments, did your answering service make after 5pm and they were like, oh, well, none. I said, yeah, because what happens is the next morning somebody has to call all those people back. You know, all they did was take a name and a number, right? And she went, oh, yeah, yeah, we could probably do that from like five to seven. I went, exactly. And so it was the understanding of. And that's a common thing, right? Oh, well, we have all that covered, right? Oh, Susie at the front desk does that. That's all good. It's like, is it really good? So you probably use the best terminology. It's a deeper understanding of what the role is.

There's an interesting dichotomy that's happening too, is we as consumers and we as laborers have totally different expectations, but we need both to interact at the same level. So what I mean by this is I don't want to work as a laborer beyond 5 o'. Clock. Let's say, guess when I make all my phone calls to dental appointments and any other healthcare appointment after 5 o', clock, right? So there's this weird thing where I want everybody else to be available when I'm available. And how do you do that? It's one thing if there's a few of us that feel that way. It's another thing when you have a total culture change and people are like, hey, I'm really prioritizing family and I need to be at my kids things by this time. And like, I think from a spiritual and social perspective, we all say that's really positive. From a business owner perspective, we say, this really sucks, you know, because everybody who's saying that to their employer is calling your dental office once they get out. And you don't have anybody there because you're trying to do the same thing they're doing so that you can keep them. Right? So this really starts to fill that gap. And again, going back to my principles, defining the problem, right? The problem here is that we've got this social difference that's happening for us as consumers versus laborers. And how are we going to bridge that gap? And really if we can reach outside of our little circle into different global markets where they say, hey, we don't care about 5 o' clock what we care about is having a great job and income. You know, good for you guys. But we would like this. And then we get them trained up from a resource like you. It feels like a cool solution to explore. What are some areas, I mean, this is a big one that I think will be enough to, to consume. But if you're just going to hit, I don't know, top three to five places you're seeing dental practices usual, you know, state some of the obvious and. But then maybe some that aren't as obvious.

Well, obviously the first one. Director of First Impressions. We're answering phone calls, recare, you know, the basic phone skills. What I love now is a huge onset of people that want RCM support because over in Zimbabwe we are very blessed to have a bunch of accountants, people with financial backgrounds and people who understand how to enter a payment, what the correct adjustment would be and have that type of personality. So our RCM requests have, have been huge. I would. So Director first impressions, RCM support and then of course, always insurance support, whether that's verification, claims, follow up. But really it all comes down to what the office needs at that time. Sometimes we get that call and they're desperate because nobody's answering the phones. Other times it is that they can't get anyone to post their payments or follow up on their claims.

Yeah. So you can really kind of meet them where they're at. Since most, you know, dentists maybe haven't used. You don't really understand this outsourcing, insourcing solution. You are doing this, you know, all the time. Do you have a way that you almost train us as customers on the right way to do this? Because it's, it is different than another vendor, you know, where you say, all right, take care of that. I mean, we're hiring a team member through you. All right. It's almost more of like a PEO relationship than anything else.

Yeah. We take great pride in the fact that it is your systems, your way. But let's say you don't have a system. We can say many other offices similar to yours or similar to your size. This is the way they do it. It's always going to be your systems your way. But if you don't have it, we can help. What is wonderful is our training. We teach them the standard way to do it that we know is successful, but then they're also adaptable to whatever it is that the office wants to do. And we found that many times the office will reach out to us and go, can you teach us to do it the way that our team member is doing it because, man, they're good at.

Yeah. I mean, when you were walking through the process, that's what I would imagine everyone starts to say is, okay, now we want to upgrade our internal, you know, now that we freed up their time, how do we create better customer service internally as well? There's something else that you hit on that we're going to be talking about Wednesday, actually. We're having a meeting with Ken Kaufman and cla and several others around the accounting process. But we're going in a different direction than you usually think, which is where are the constraints in the financial model where people are pouring money in and not getting results out? And there's several places in dental that this happens. And one you just hit on, I see this all the time, is like, hey, this pay per click company wasn't working well, so we moved over to this other pay per click company and now we're doing this Instagram and now we're doing the social media. And so they're doing all top of the funnel marketing. What they're not addressing is 40% of their calls aren't getting answered right. So it's like if you just kind of got rid of that expense and just looked at, you know, the actual conversion rate and online marketers look at conversion rates of funnels. Dentistry, we don't have that sophistication yet, but we're starting to bring it through DEO anyway. You just touched on that. But it's one that I think every marketing company out there would say, man, I really wish dentists would fix this first because it would make me look better as I'm feeding things into their funnel.

Yeah, that's interesting. I just had a conversation with one of the marketing companies and they're saying there's such a level of frustration that they're saying, well, we're thinking about stopping services with you. We really haven't seen the results that we would like. And he said, we looked at the data and literally he said they were answering less than 60% of their calls. It was like 58%. He said, you know, we can pour all the marketing into new patients that we want, but if you're not going to pick up the phone, if you're not going to get them on the schedule, what difference does it make? Right? You can. You're really kind of spinning your wheel. So you're right. I think there's, you know, if you looked at the top of that, that funnel, it's more of what are you doing in the middle with it and how are you handling those callers? And if, and we've, we've got some proven statistics where we can take this answer rate from 60% to 95% and then we can take this new patient conversion from 50% or I said 60% to 95. And then take the new patient conversion from 50% maybe to 80%. And just those differences is a big turn in the needle.

Yeah, huge. Way more than you'll get out of changing marketing firms.

Absolutely. Yeah. Start with the basics.

Yeah.

Yep.

Hey, let me put a plug out there because you guys are going to be there. But DEO Growth Summit, for those who don't know, for this year is June 8th through the 10th in San Diego, California, which, you know, I'll argue is probably as pretty as Costa Rica in

a lot of ways. Absolutely. I would agree. Yeah.

The weather, the weather at least is awesome. So make sure you come over to the deodental group.com and get registered for that before the prices go up. Fact, prices are moving in the next 10 days here, so definitely something you want to get in because these are the kind of conversations that you have. And I always say, as a leader, I'm kind of tiptoeing because I don't know the correct answer until I have conversations like this or with other CEOs, other team members, which. One of the things DEO's really done well is expanding out the number of team members we're supporting. Guess what happens once I'm clear, man? I start running. Right. So then the results come faster than the tiptoeing. So I know you all will be there. This has been awesome. Just the feedback and thinking through, I mean, something as big as the labor market. I know with Adso and other associations I'm part of, you know, we're doing a ton to push forward more awareness about our industry, but I'll be honest, so is every other industry. Right. And so creative solutions like this could be the faster way to start going. Okay. How am I going to redesign this to possibly get actually a better patient experience? Lower cost, more availability, better conversion. You know, I, I, I think it's worth looking at. I think it's worth looking at. So anything else you guys want to say? Yeah, go ahead, jw.

I was going to add one thing. You know, there's, there's, there's this massive push towards automation. And I agree. I think in every business, right, you want to, if you can figure out a way to automate it by all means automate it. But you know, is that abdicating or relegating or delegating too much? Because most, most of the time we're finding that that solution is a combination of labor and a combination of automation. Right. And, and I think that, that we can help offer those because we integrate all kinds of various softwares and AI into people's practices that we can also help support. So I think it's important to, when you, you know, you mentioned to find the problem and then who to solve could be a combination of things. You need to solve it to get that solution.

Yeah. I think the magic word I hear in investment firms is they're looking for tech enabled companies. Right?

Yeah. Okay.

Right. Because you know, you outsource something, you're not writing down the appointment on a postcard and sitting out. You know, it's tech enabled to create that, that automation to make the workflows easier, to make the communication easier. So that's where you really get, I think the biggest bang for your buck versus, you know, today at least we're not able to just call into an AI system and it talks to us in beautiful way or something. But will this be anything else you guys want to add before we finish up this podcast?

Yeah, I would love to add the fact that when you are considering hiring more team members, whether in office or insourcing or a director of first impressions, a Spanish speaking team member, take a look at your wall, look at your mission and vision and think, is this going to get me closer to that or farther away? And I think that when you are looking at your mission and vision and it is patient centered and your patient's calls aren't being answered, it's a no brainer. The return on investment is there. Just the fact that if one of your team members gets overstressed, doesn't love their job anymore, they're going to leave. And it costs a lot of money to replace somebody if you can. So when you're thinking about it, when you want to learn more about it, look at the mission and vision and see if it matches having somebody insourced for you. And if it does, give us a call. You're not only helping out your office, but you're always helping out the world because we donate 51% of all of our profits and all of that tied together with a nice little bow is a gift. A gift for your team, a gift for you, and a gift to the people of the country that you're supporting.

It's awesome. Brenda, thank you both for being on. I really appreciate it. If someone wants to reach out to you, easiest ways.

Yeah. Go to supportdds.coms U-P-P p O-R-T dds.com and there's a place to schedule a call. You can schedule a call with Brenda. She's way better than me, so direct yourself to her. And, and if you want to, that's how you handle your, your, your labor issues. If you want to learn how to get skinny and look fantastic, you just call Emmett and ask whatever diet he got on and whatever program he's using because I'm signing up at about. Well, as soon as this podcast is over, I'll be signed up.

Well, thank you, brother. Yeah, it's been a, it's been a chore, but I'm finally getting there, so. Well, thank you all so much. Been a total pleasure. Appreciate you bringing real life solutions to, to our audience here. And if you want to have more conversations around this, come over to our DEO Growth Secrets Facebook page. Come to our summit and this is the type of stuff that, that we'll be solving. And until next time, keep smiling.

Thank you for listening to DSO Secrets. Join our community on Facebook at DSO Secrets and get answers and resources to some of your most challenging questions. If you want to get a copy of the seven secrets of any DSO, go to our website at DSO secrets.com and we will get that emailed to you. Remember, don't go at this alone. Let us be your team while you build your team.