171: Large Practice Sales Trends with Chip Fichtner

It never hurts to understand what's going on in your market and what the potential value of your practice might be in one of these transactions.

Hi, I'm Emmett Scott, and just like you, I've had my ups and downs in the dental industry, but times are changing. The DEO has built a map of how to succeed in one of the most challenging industries to navigate. On this show, we talk to dental industry leaders, solve problems, and get you the answers you need to face these challenging times and thrive. Welcome to DEO's Growth Secrets podcast for dental organizations. Now let's get started. Hello, everyone, and welcome to another episode of DEO Growth Secrets. I'm your fearless host, Emmett Scott, and today I've got Chip Fichner here. He's the principal of large practice sales, and we're going to talk about a couple things. One, the difference between a DSO and what he calls an idso, and then also what's happening in the marketplace right now if you're thinking about a transaction. So, Chip, thank you so much for being on. You've been in the dental space for over 11 years now, but it looks from your bio that you've been in a lot of different industries and so business is definitely your expertise. And last year completed over 600 million of practice transactions in 2022. So that's huge.

Yeah, it's, it's, it's been an exciting time.

Yeah. Good to have you on. Well, I think the first thing we want to do is define how you think of large practice sales. There's a lot of ways to think of that really big or kind of big or medium big. So when you think of large practice sales, what does that mean for you and who's most of the time your ideal customer that you've been able to bring value for?

Sure, Absolutely. So thank you for having me today, Emmett. I appreciate it. I'm glad you're in Dallas. My favorite place to eat Mexican food. Yeah, it's the size practices that we work with are typically those that are generating an operating income or EBITDA, of at least $500,000 after compensating the doctor. And so what that typically results in is that our smallest clients in specialty have about a million five in collections, and our smallest clients in GP are usually at least a million Aitken collections or higher. You know, our average transaction's about $10 million, and we've done transactions as large as 80 and really nothing smaller than 3 million.

Now, in those size practices, I'm curious, is the transactions typically as a multiple of ebitda or is it some kind of multiple or percentage of revenue?

No, in our transactions it's always based on ebitda. The revenue, frankly, is irrelevant to the buyers. They're, they're buying profits, not revenues. Yeah.

I've looked at practices doing 2 million that are losing money. Right. So it doesn't really matter if, if the profit's not there, that's really what you're, you're buying. So I love what you said too, because especially practices, those single successful practices or two or three, sometimes they exclude the doctor compensation. Try to sneak that into net income. So it sounds like you always make sure that, hey doc, even if you're the owner, you know, and you're getting paid through net income, if you were gone tomorrow, we got to pay an associate. Right. So you got to have a fair value of really what net profit is. Yeah.

And when calculating doctor compensation, that's, that's always a question and basically it's negotiable within a range. But go forward. Dr. Compensation Post A transaction is a really important element in the value that you achieve up front for the practice. And generally the way doctor compensation will be factored in is based on replacement cost. If your area says that you have to pay a GP 33% of collections, that's what they're going to plug in as replacement cost for you. And it varies based, it varies widely based on specialty and geography. Where you see some groups that are demanding in perio, for instance, that the minimum compensation rate be 40% of collections. And in other areas you can do transactions at 30% of collections. And honestly, once doctors under understand the math and the tax implications in these transactions, they beg to work for a dollar a year. They want lower future compensation because it generates higher upfront value at 20% tax rates instead of 40 or more percent tax rates.

Sure, sure. But as the buyer, they're always calculating, okay, but if you're gone tomorrow, I've got to pay somebody a fair wage. Right. You're not going to hand over your transaction over to them. So you still have to know what the go forward business is. And that sounds like something that you help these doctors navigate through. Now one of the things I'm hearing in the marketplace, and I think you and I talked a little bit before the show about this is, you know, kind of a pausing in transactions. But I'd probably put a caveat on that. It's more around that above 7,8 million of EBITDA range and below that, it seems like the activity is still really High. Is that what you're seeing?

Yeah, it's really surprising because we get questions about that all the time. But as a real world example for you, we had two practices, both of them in Orlando, Florida. Bids were due the end of March. So after the Silicon Valley bank crash, which has rattled everybody across the country, and First Republic going down this week didn't help. But even at the end of March, the oral surgery client had 18 qualified bidders to choose from, with the high bid being at a new record for oral surgery in our world. And the other one was a pediatric practice, about 2.9 million in collections, and that practice had 13 bidders. So there has been absolutely no reduction in the number of bidders eager to find great partners. And the values are still at record highs. In fact, the highest value transaction we've ever done of a normal practice, let's call it, we closed a couple of weeks ago at over 12 times EBITDA, and this was a 2ish million in EBITDA practice. So, no, there's so much capital that has flowed into dental consolidation just in the last six months that the number of bidders are up. They have fresh capital, they have fresh credit facilities, and they're eagerly trying to participate in the frenzy because, frankly, it is consolidating very rapidly. To put it in perspective, I think we did about 300 million in transactions in 18, and we did over 600 million last year. And based on the new clients that we've signed year to date, we will probably break a billion dollars in transactions this year.

And really, congratulations.

Thank you. And it's, you know, it's not thanks to me, it's thanks to our great doctor clients. But the interesting thing that's happened is the age levels of doctors. So five years ago, we probably did one transaction for a doctor under 40, and yet last year, 102 million of our transactions were for. For Doctors in their 30s, almost 20%. Yeah, it's. Excuse me. We're seeing a dramatic increase in the interest of younger doctors in these, what we call invisible DSO partnerships. And probably a good time to talk about the difference between a DSO and what we call an invisible dso.

Great. Yeah, please.

So the, you know, the traditional DSO model has generally been based on groups that will buy 100% of a practice. The doctor will continue to work for one, two or three years, and the group will take control of the practice. The doctor will focus on patients only, and the DSO will functionally manage the practice. And the doctor has a relatively short time horizon, and the group is going to micromanage the practice and they're going to homogenize it to fit their corporate standard. And the doctor will lose autonomy in an invisible DSO transaction. Their basic bedrock philosophy is we want owner doctors as our partners because owner doctors run better practices than employee doctors do. And they have skin in the game and they share a common goal. When you're an owner in the practice, you operate as an owner. When you're an employee, you have different motivations. So the bedrock philosophy of an invisible DSO is they want owner doctors. Those with the longer the time horizon the doctor is going to practice, the better, which is why the interest and values for younger doctors are higher than they are for older Doctors. And I'm 63, so I hate to pick on us old guys, but the reality is today that a young doctor practice in an invisible DSO partnership is going to have a higher value than a doctor with a six in front of his age. And that trend is accelerating.

Yeah, let's talk about value knobs. Okay, so let's say the range is. What do you think's a fair range? So you said 12 being the high side here. What would be a typical, you know, not lowest side, but kind of median low side of a transaction?

Right now, you know, with the invisible DSOs, they are paying more than the DSOs, because in the invisible DSO model, they're partnering with a doctor who's going to stick around for 5, 10, or 20 years. And in those transactions, they are not trying to micromanage or homogenize the practice because they believe the practice is running well, otherwise they would not have invested. There are millions of dollars in it. And the doctor retains full autonomy. He's making the decisions, the hiring, the firing, when to be open and not when to take a vacation, what payers to take or not take. These doctors truly are gaining a silent partner and benefiting from that silent partner's resources. And therefore the values in an invisible DSO transaction are typically higher than in a ds. In an invisible DSO transaction, the values are higher than in a DSO transaction. And then what is the values that. I'm sorry, go ahead.

Yeah, yeah, I was going to say. So what is that range then to think about? Because my next question is I want to know what the knobs are. But yeah, what would you say if I'm kind of a. Let's say okay, but not great practice, what should I expect as far as a multiple?

As long as you have at least a half a million dollars in ebitda, you're going to have at least A half a dozen qualified bidders. And when you have multiple bidders, it drives up value. And the lowest value transaction we did last year was about seven times ebitda. And the key today to values is growth. Practices that are declining or flat have lower value than doctors that are continuing to deliver growth. And obviously the faster the growth, the better. And so we're seeing initial EBITDA multiples starting at 7x for a half a million dollars in EBITDA and then going up from there as EBITDA increases and as the growth rate increases. So it's, it's not unusual for us for a GP practice today to see eight or more times ebitda. And in the specialty practices it can be significantly higher than that, depending on the location, the growth rate, the age of the doctor, et cetera.

If your son had a practice today and he wanted to do a transaction in the next year or so, what would you say? You know, hey, son or daughter, here's the three things you need to have going well. Or, you know, maybe they have the option of either being a specialist or not a specialist too. So go ahead and put that in there as a, as a variable. But here's the three things going well to really maximize value. And maybe here's three things that if they aren't going well, just plan on a little bit of a discount.

Sure. Again, number, number one driver is going to be region. These groups are very excited about certain regions and less excited about others. So that's something unfortunately you can't really control. But, but it does dictate the number of bidders and the number and the values that we can achieve.

What regions would I want to be opening up in?

You want to be opening up in areas that have high growth rate of population. So that gives you Florida and thus the high number of bidders that I talked about for my two Orlando clients. You want to be in Tennessee, preferably Nashville. You want to be in Dallas, Austin, Houston, Phoenix, Denver, Atlanta. The sort of, the key states are those in the Sun Belt which are generating extraordinary growth. And then that, that continues on up into Utah, Nevada, Idaho. Idaho has become a hotbed just because of its population growth. So the investors in the invisible DSOs are following the population trends. And therefore a town that is growing is going to have a higher value than one that is not. Again, nothing you can control. But it's important. You know, the next element is the doctor's age. A single doctor practice who has got a six in front of his age is going to attract far fewer bidders than a single doctor practice who has a three or a four in front of his age. Again, something you cannot control, but it's something that impacts value. The next items really are based on growth rates. Practices that are growing top line and bottom line are becoming rarer and rarer. Certainly plenty of practices are growing their top line. But because of increases in cost thanks to inflation, particularly labor costs, you were seeing practices experience margin compression where while their top line may be growing, their bottom line is not because they're absorbing additional cost. So a growth in top line and bottom line is important. Not always possible, but it's very important. And then the next thing you got to look at is the doctor's personality. What I tell doctors early on in our process is you're in the business at the moment of selling yourself. And so your goal is to project a vision of activity, positive attitude and a willingness to accept suggestions. While these groups are only going to be interested in, in partnering with practices that have been successful for whatever unique reasons, they are always going to believe that they have certain resources that can help that practice grow bigger, better, faster, more profitably. And those resources will vary from. Some of these groups have great recruiting departments so they can solve your recruiting problems, which everybody seems to be having. Other groups are exceptionally good at marketing. There's one particular group that we've done probably a dozen transactions with in the last two years. And their average practice, once they partnered with this particular group saw an average increase in production of about 28% in the first 12 months just because they're exceptionally good at driving new patients into the door. So the key for a doctor who's entered one of these transactions is what I call have a personality and a plan. They're looking for doctors who believe that growth is possible and they believe that they want to grow. And the ability to project that personality and plan is critical to the values that doctors receive. And everybody thinks this is just a numbers based business and it's really not. Doctors with a positive outlook and clean financials, and we'll talk about that in more detail in a minute, are going to achieve more bidders and get higher values than the doctors without a personality and who don't have a growth plan

with a. This is super helpful. With a doctor who maybe has three locations, four or even up to 10. Is there a, is there a diminishing return on that for you or is there a sweet spot that you think is a better place for a transaction?

You know, it differs. We, we've done, we did a transaction recently for two office practice that had over 40 million in collections. The number of offices is necessarily relevant unless they are productive offices. One of the things I see happen is that doctors open multiple offices, which divides their focus. And so you end up with three, four or five practices or five offices that are marginal performers. So that doesn't necessarily add value for you because again, the baseline measurement is going to be based on EBITDA. And whether you have one practice or 10 practices, having multiple practices does not necessarily add value. In some cases it can, but not necessarily.

Got it. So there's not necessarily a negative or a positive. It really comes down to some of the numbers on that piece.

Yeah, it does. And so to give you a recent example, we did a transaction for a nine office group recently. They were very underutilized offices, meaning there was a whole lot of capacity there that was not being utilized. And we got them a very high multiple of EBITDA because the new partner believed they could double the collections in that group of practices over the next two years with better management and better marketing. And I actually saw the doctor a couple of weeks ago and said, how's your partnership going? He said, it's great. They're actually finally utilizing what I built because I never could figure out how to do it. And so the doctors need to be open to suggestions. These groups will not give you commands. And we think it's important that any doctor has a very in depth discussion with all of their potential bidders about what their plan might be. And to agree on a plan long before you get married, as we call it. And that's a really important part of the process. Is everybody being on the same page as what the future is going to look like?

One of the questions I get a lot is how are these deals getting structured now? It seems like early on maybe the purchaser wanted 80% or minimum 75%, 90%, and now they're going much lower, maybe even 50% or 60% or 40% and they want the doctor to roll in the rest. Is that a lot of how the IDSOs are starting to structure that to keep the doctor as part of the group?

You know, the structures really haven't changed much in the last, let's call it two years. The only big change that's happened to structures in the last three years has been the implementation of what we call a Covid earnout where these groups are providing the doctors with, in essence, a purchase price increase after closing. If the doctor hits certain growth metrics in the one, two and sometimes three years after closing. And those growth metrics can be based on top line growth, they can be based on bottom line growth, they can be based on growth in patient visits. But the COVID earnouts are really gold for doctors who have a growing practice today and say, you know what, I'm not ready to do a partnership because I want to harvest the growth. The seeds that I have planted in the last two years, whether it's a new associate or new offices, but transactions today pretty much are all going to have a Covid earnout that pays for performance after closing. And the way we structure those is those are created such that future payments that these doctors will get based on their future growth will be taxed at long term capital gains tax rates. It's not a bonus which is ordinary income. So the structures from a percentage of cash versus equity really have not changed that much. Last year we did one deal. It was about a $52 million transaction for a group of young doctors, all under 40. And in their transaction they were big believers in the equity upside because they had a 20 to 30 year time horizon. Therefore they could see the value of that equity multiply over time. So in that transaction they took 26 million in cash and 25 million in equity. 5149 dol. That worked out really well because their partner recapitalized six months later and the value of their equity doubled. And on the other end of the spectrum, last year we did a transaction for a 59 year old doctor who was very clear up front that he wanted as much cash as possible because his time horizon was only three years and therefore he would not be around to see the value of his equity increase over time. And in that transaction, which was a $42 million transaction, the doctor got 95% in cash and 5% in equity. One of the things that doctors need to be aware of in these transactions is that equity that you are getting, whether you're getting the equity at the practice level, the parent level, or combination of both, you've got to fully understand what that equity is and where it sits in what they call the capital stack. Because a lot of doctors who are doing deals directly without an advisor are finding out that the, what I call the magic paper that they got from their new partner is worthless. Because unless you understand where that piece of equity sits in the big picture, you may have little to no upside in that equity. The other thing we're seeing some of the, we'll call them lesser quality invisible DSOs attempt to do right now is to give the doctors notes or a preferred, what they call a preferred stock. But that preferred stock has no upside in it. It has a coupon or a yield or a dividend, but it has no upside whatsoever. So understanding not just the percentage cash versus percentage equity that you're getting, but actually understanding what the equity is and what its features and risks are is really critical today. Because we're now with the, with the boom in consolidation, it brings all kinds. There are some great invisible DSOs that have been started out there by exceptionally talented investors. And there are a number of them that are not as on the up and up as they should be. And some of them will fail.

Well, yeah, talk to me a little bit about that. What do you think are going to be the core variables that are going to determine if Some of these IDSOs or DSOs fail in the coming years?

Well, really the most important thing to understand when selecting an invisible dso, and there are a lot of elements in those choices, but the first one, before we let anybody bid on our clients, we understand who the financial sponsor is behind the invisible dso. Because as I like to say, the money is stuck. Management may come and go and they may be forced to go, but money is always there. Right? The money is stuck. And so the first thing anybody needs to understand is who's the money behind this transaction? What is their track record either in dental consolidation? Because there are a number of investors that have created invisible DSOs, built them and monetized them, and returned billions of dollars to their doctors and investors. And there are other groups out there today that think this looks easy and they have plenty of money, but they have no strategy. So you've got to understand they have no experience in either health care roll ups or dental consolidation. So the first thing you have to understand to understand the potential value of your upside in your equity is who are the investors? Because it really matters. And so that's the first thing we do before letting somebody bid on our practices. We understand who the investors are, how much capital they have access to, what kind of credit lines do they have access to, and are they growing. So when looking at the investor and the invisible dso, the entire business model is assemble a group of practices, integrate them, operate them correctly, and then monetize the group with a larger investor. And this is not new. This is the basic play that's been going on not just in dental consolidation, but consolidation of any provider based business. And you can look at the MDs. You know, 78% of all medical doctors now work for a group or A hospital. So consolidation happens and it's been happening for decades. I mean, the invisible DSO concept is not new. It's been around for 35 years where doctors maintain their autonomy and their brand and their operating flexibility. But it's just become more popular lately. And when you look at the money flows into dental consolidation, there was about $6 billion put into invisible DSOs by big investors that had never invested in dental consolidation before, just in the last four months of 22. And these were not amateur investors. The investors included the third largest sovereign wealth fund in the world, the country of Abu Dhabi's wealth fund, which is interesting in that they're number three behind China and Norway and then Abu Dhabi, which is a tiny country, but lots of oil money. The other investors that invested a couple of billion dollars into invisible DSOs last year included BlackRock. BlackRock is the largest institutional money manager in the world with over $10 trillion under management. And they stepped into the U.S. dental consolidation gain with a gain with a little $2 billion investment in the fourth quarter. So you've got lots of money coming into this, but you need to understand who the money is and who the backers are. When choosing an invisible DSO partner, next step is to look at their growth rates. The way you create value in this business is through acquisitions, through smart acquisitions, and through internal growth, internal growth at the moment for many of these groups. And when I talk about internal growth, I'm talking about internal growth at the bottom line level. Certainly top line growth is important, but today, given inflation and expenses, bottom line growth is more important to creating value over time. So when you see a group that has not done a number of acquisitions in the last year, let's call it, that's a group that's having problems. So what you want to look at is, are the groups that are continuing to acquire great practices at reasonable prices and is growing. There were a number of groups last year that ran into credit line problems who made no acquisitions whatsoever. The year before the same thing. So one of the things you want to look at is are they growing? And then by looking at their capital structure, can they continue to grow? Because that's how you create the values. Where you have the stories of the doctors who made five times their money in 36 months, because that actually happens, we have had doctors do that. The other thing you look at is internal growth rates. Are these groups able to add resources to help the practices grow, both top and bottom line? And whether those resources are recruiting or marketing or higher payer reimbursement rates, which is a thing that independent dentists need to understand. The invisible DSOs. And the DSOs may be getting reimbursed at higher rates than you are because of their size and their leverage in negotiating. And I think that's one of the emotional things that's driving more and more dentists to consider these partnerships, because they see it as being unfair that the doctor down the street, who's still operating under his brand name, is getting reimbursed at higher rates. Everybody pretty well acknowledges that that doctor down the street is paying 20% or some number less for his supplies, his technology, and his benefits because he's part of a bigger group. But there's. There's sort of a new realization coming to doctors that's frustrating them, that the bigger groups are able to negotiate higher reimbursement rates than the independent dentists are. So a lot going on. I'm sorry for the long answer.

No, that's great. I mean, I think you're really speaking to the realities of consolidation and what being part of a bigger group is. And it sounds like these IDSOs are, frankly, a version of a DSO culture of how do we provide support to the dentist and what volume on the spectrum does the dentist want? And I bet you get to see a lot of different DSOs and IDSOs that you can really match up to. Right. Based on their culture and your own culture. And that's really where you help Chip. Right? It's about the money, but it's also about finding that right fit for the future.

Yeah, it really is. And it's. It's more about the fit than the money. And I'll give you a great story. The president of one of the three largest dental associations, state dental associations, came to us, and they had, I think, 9,000 members. And so when you have the president of a dental association, he's very attractive to an invisible DSO to become their partner, because he knows a lot of people, he knows the politics of the state and knows a lot of doctors. So this doctor was a client, and interestingly, he was an orthodontist, which is very rare. You have an orthodontist as the president of a state association. And so he was a very hot commodity. We had, I think, nine bidders for him, and he ultimately chose the under bidder, who was a million dollars less than the high bidder. And I asked him, I said, and the high bidder was a great group. I said, why did. Why did you choose this group? You left a million dollars on the table. He said, it's Real simple. He said they have 400 doctors. Their average doctor age is 44. I'm 62. If I'm hanging around with these guys, I'm gonna. I'm gonna stay younger. They're gonna allow me to practice another five years because they're going to keep me young, because they are young. So his, his decision point was, was made based on a culture because it was a relatively young doctor group. So everybody's going to have their own reasons why they.

Yeah, what a smart choice, though. That's. That's a smart. Right there.

Yeah, no, it was a great group and that. We did that a little over a year ago. And he's a very happy guy. So the really, what we emphasize to our doctors is you should look at all of your options that are at least qualified bidders. We're not going to bring the, what I call the garbage invisible DSOs, the ones who are going to offer notes and bags of marbles and have ridiculous promises of upside. We're not going to bring those guys to the table. But we want, you know, we won't take a client if we can't identify that they have at least six bidders that we know. And so what that does is it enables the doctor to choose the culture and the group that has the right support services that will help them the best. Because all of these groups are different. Every single one has a different personality, a different strategy, different resources. You know, there's one group out there that we've sold hundreds of millions of dollars of practice to, that today has 27 people full time in house in their recruiting department, and their sole job is to find front desk assistance, hygiene and associates for their partner practices. And so that's a solid resource. And we've done a number of deals where the doctor made their choice based on their belief that that partner could solve their recruiting problems. We see that a lot in oral surgery. Oral surgery is really the hardest thing to recruit for right now. And we did two big transactions, both of them over 50 million last year with oral surgery practices whose sole goal was to partner with someone who could recruit new oral surgeons for that?

Yeah, it's awesome. Are you seeing any of these groups, IDSO or DSOs, where they're like, hey, we acquired these five practices or nine practices or whatever, and they're really just not the fit we thought, and they need a new home? Are you doing anything like that yet?

I think that you're going to see more consolidation within the invisible DSOs who have been unable to grow and unable to build businesses where their financial sponsors are going to be looking for an exit. One of the things that we try and do for our doctors is negotiate a trapdoor such that they have the ability to have their equity purchased, their retained equity purchased at a point in the future that will require some sort of notice. But we've done a lot of deals where the doctor has the right to give 18 months notice and their partner will buy their equity at a predetermined formula. And I call that the wife wins the lottery trapdoor. You know, if your wife wins 500 million in the lottery tomorrow and she doesn't want to live in Springfield, Illinois anymore, you need a way out of your practice. You need a way to monetize that equity. And the way many deals are structured is the doctor's equity is functionally illiquid until such time as the investor partner has decided to monetize the group. And so the doctor has no known exit. Whereas we like to negotiate in exit elements for doctors where that's an issue to them. So a lot of little twists and turns to how these deals get structured.

Yeah, no, that's excellent, Chip. Well, listen, your website is pretty straightforward largepracticesales.com so anyone who's interested, is that a good place for them to go? And you have a Facebook page also at large practice sales anyway, else that they should contact you if someone's listening and they're like, okay, I'm interested. I want to have, you know, some help around this.

Yeah. So basically what, what our offer is to doctors is let's have a conversation. I talk to every single doctor that calls in or emails or texts or whatever and we have a conversation about what's possible. And we just learn a little bit about their practice and I give them a little bit about what's possible in today's market. And after that call, some doctors are interested in pursuing the process, which is free and easy. They provide us with two years of P&L statements plus first quarter of 23. And then our analysts will contact them to ask some questions, figure out where the bodies are buried and add back the personal expenses. And then I'll have another conversation with the doctor and say, hey, we think your value is this. We think you'll have this many bidders and these are the structure options you'll have. So functioning, the doctor without cost or obligation can get a free practice valuation. And so you can go to our website and look that up there. But to me, this is all an education process. There are doctors that signed up as clients last month that I've been talking to for five years. You know, not everybody's ready to do anything now, but it never hurts to understand what's going on in your market and what the potential value of your practice might be in one of these transactions. So, yeah, we. We would love to talk to any doctors, and largepracticesales.com is a great place to start.

Awesome. Chip, thank you so much for being on the show today. Appreciate all of the information and kind of the breaking down of these pieces. There's so much opportunity for dentists, and that's one of the things I've said. Whether it's a DSO or idso, the dentists are going to win. Right? The underlying concept is dental support organizations. And this consolidation, this new support that's coming in, as you mentioned, whether it's lower supplies, negotiating with insurance companies, we are stronger together. And so I appreciate your work in the industry and helping some of these groups really maximize their value and being able to be part of bigger groups so that, you know, oftentimes the biggest competition is simply the internal friction points that they're trying to overcome. You know, it's less about other dentists or maybe how patients are spending money elsewhere, and they need a good marketing group with them. So, anyway, thank you for the work you're doing, and I appreciate you being on the show.

Hey, Emmett. Thank you. And thank you for your service to the adsl, a great organization. For those of you who don't know what the ADSO is, it is a group of invisible and visible DSOs out there, and they do great work for our industry. So thank you for your 3 years of service there.

Absolutely. Well, I appreciate that. And if you want to continue this conversation, come over to our Facebook page @deo Grow Secrets. Or even better, meet us in San Diego. It's beautiful there. June 8th through the 10th, we'll be having the largest summit of DEO there in San Diego. We'll be having these conversations and many, many more. And until next time, keep smiling. Thank you for listening to deo's Growth Secrets podcast for dental organizations. Continue the conversation on our Facebook group and meet other dental leaders, get questions answered and the strategies you need to succeed. Plus, we have some free resources for you right there on the Facebook page. Remember, you're not alone. Let's do this together. Join DEO's Growth Secrets Group on Facebook. And until next time, keep smiling.