228: The Mistakes That Nearly Broke This $10M Dental Group

Growing your top line is not the way to become more profitable. If you understand where your expenses are off, you know where you can make changes, you can really focus in on where the opportunities are. You can be much more effective.

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 challeng 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 Grow Secrets. I'm your fearless host, Emmett Scott, and Today we have Dr. Alex Reznikoff, owner and founder of Dental Group of Chicago, on with us today. He's a dentist, He's a tech entrepreneur. Alex, just great to have you on. I appreciate it, my friend. There's something special about entrepreneurs and the dental space, and you've been with DEO now for six years, and I'm just curious if we can do a little bit of looking backwards. Tell me about Alex six years ago.

Sure. So six years ago, I had just acquired my second practice and actually joined a deal. I mean, my first seminar with the DEO was right before COVID Okay. Which was instrumental because there's so much I learned from you guys during COVID How to handle all. You know, at that point, we, again, two locations, we had roughly 20 some people, we were. We had about 2.5 to $3 million revenue.

And how was that broken out? Because it's usually not like half and half. It's like one's doing great and one's. Okay, so that's interesting.

You asked. So my story is I. I acquired my first practice that was doing around 600,000. And in the first year, I grew it to over a million. So I thought I was hot. I was hot. I thought I knew everything. And then I went and acquired a bigger practice, and this one was doing about 1.8. So when I say 2.5, that's because the 1.81 started to go tanky when I. When I acquired it. That was not a good deal.

Looking back on that, what do you. What do you know now that you would tell yourself then?

Well, a couple things. One is don't fall in love with every deal, whether it's a merger or an acquisition. You know, at that point, I thought I was ready to go for the second one. So I found something, and it looked shiny. And rather than going through the process and being diligent about thinking about what, about this might be dangerous, I was making excuses for everything that I could fix. And there were a lot of. A lot of red flags that I didn't pay attention to.

Okay, so the old adage, how do you make a million dollar dental practice start with a $2 million dental practice kind of thing, right? Yeah, exactly.

I was really good at, you know, the other thing was when I was at my first location, you know, I learned some systems and before, when I was working as an associate, and I brought them to the new practice, and that's how we were able to grow. But basically I was the system. I was the one driver of this practice. I had a great team, but I was the one driving the growth. When I acquired the second one, you know, I. I assumed that systems are systems and they're just going to work, and that's not the way it happens. So I didn't have a team. I. It was just me. And then, like, we had some office managers. There's no organization. Me jumping in between two locations, and

you can't do that. Started getting burned out.

Well, you get burned out, but you, you can't oversee everything. You really have to then build. The first thing that really helped me climb out of that mess was putting together a team.

What was kind of the first part, because that can seem a little bit daunting. People are looking at their cash flow, you know, trying to manage that. So what was like the first team member that was meaningful to you?

Well, at that point, I had two really great leaders. In our first practice, I had the office manager and her right hand, if you will. I called them my R and R team, my Rolls Royce team, Renee and Robin.

Okay.

And they helped quite a bit. And at some point, when I just saw the second practice burning, I went to Renee at that point, and I'm like, I need your help. I need you to come start overseeing things at the second. And that's when we just started building a little bit of organization. And we started having quasi meetings that we didn't. We fumbled through, started really kind of developing SOPs. That took a while. It took a while. You know, there's two ways of looking at that. One way is it set me back, because it, it was, it was tanking. That's the way I used to look at it. Now I look at it differently. I had a very expensive education, but no education is free. So through that process, I kind of started learning these are the things that we need to do to run an organization, not just be the one workhorse, you know?

Yeah. Was there a specific. Was it more the RCM stuff? Was it just an overall culture? Like, sometimes SOPs can feel like, okay, I got to build a, you know, 10 manual book. But, like, what was the cheat sheet thing like? Okay, getting. It sounds like getting someone who knew your system and leadership over there was helpful.

Just from the patient flow. Everything starts from patient flow in the practice. You know, how you take a phone call, how you greet the patient, how they move through the office from.

And was R and R. Were they really good at that? Is that kind of where you leaned on them?

Yeah, I mean, that's kind of how we grew our initial practice. Right. Those systems did not exist in the other practice. There were a lot of other things or refuting partners that I brought it from one, bought a practice, and started swiping patients. It was a mess. But when I saw that we were just bleeding money, I brought in my first advisor, and he asked me, what are your core values? And I'm thinking, man, what are you talking about? Core values? I'm bleeding money, and you're asking me about core values? And now looking back, there's so much that you build from core values besides your team culture. You get tools, how we hire people, how we promote people based on your core values. And just the cadence of meetings, which we didn't have before. Right. Just some type of organization. So what's going on? Just give me a pulse. It's when I joined the DEO and you guys talked about traction. I read this, the book, and I'm like, all right, this is how we're going to run. And I went to my advisor, I'm like, help me implement this. And that's, you know, when we figuratively started getting some traction.

Yeah, it's awesome. Yeah. Getting that meeting structure in place. Right. It's. It's not as overly complicated. I think you hit on two things that I see at that early stage. That's super helpful. Some kind of, you know, set of values is helpful because we're running a human business here, and they really have one thing they need to understand, which is how are they supposed to behave? And you would think, like, it's just common sense, but people come from different family backgrounds, different cultural backgrounds, different work experiences. Corporate, non. Corporate family. And so that, you know, as fluffy as it can feel like having values, it actually gives you something to be like, oh, this is how we behave here, you know, so that's, that's really cool.

The other I think that really important part, what I learned in that experience with the first practice I was in, I was in every, everywhere, anything that went through me. Right. But as you scale, you just can't be everywhere growing besides selecting your team leaders. Growing your team leaders is so important. And to do that, giving them trust and I think allowing them to fail forward is so important. Crucial. Right. You know, from a clinical perspective, I was very fortunate when I was starting off to work with some great mentors. And I saw these guys, you know, while they're prepping crowns, they have an assistant adjusting a crown for a crown seat. Pretty practices like that. But I train my doctors now to do that and when I tell my doctors to do that, at first they're flabbergasted, like, oh my God, we're going to let a assistant adjust the crown. What if they open up a contact? Response to them is, well, have you ever opened up a contact? Yes, anybody that's done crowns at one point or another has opened up a contact. And what happens, you learn. Right. And that's the clinical perspective. But then if you look at the, from the business perspective, there are plenty of things that we do in, in, in business, day to day business that we can make mistakes in. And no matter if it's your assistant opening up a contact or your team making a mistake that they learn from, you know, you can't reprimand them, you can't get angry with them, but help them through that, and as they grow, they become more competent and become a huge help, a huge asset to you. So you can't be involved in everything. You got to give trust and, you know, that's how you multiply.

Yeah. If you want someone to be responsible, you have to give them responsibility. How did you overcome the anxiety that every entrepreneur feels as a perfectionist? And also maybe, you know, cash flow being tight and so forth, thinking, I can't afford to make mistakes. Right. How did you kind of overcome that in yourself to be able to, to step into, await. If there's no mistakes, there's no development, you know?

Yeah. You know, I'll, I'll be honest. Before this year, there were a couple years that we had a tough time. You guys called it a dark tunnel. Five to ten million. And I felt it, it was dark. All those issues that you were talking about, cash flow issues. You know, your top line is growing, but your margins are not there. And what I discovered is you can get into a dark place, but it's so important to be a leader. Mindset is so important. And I spent a lot of time, you know, following people like Tony Robbins, reading books like Dan Sullivan's the Gap in the Gain. Right. We all have this, all of us on this call, we have this desire to be better. Right. And it's healthy. I think it's healthy. You know, I feel like you're either growing or you're dying. But Dan Solomon wrote a book, the Gap in the Gain. And, you know, the concept is you could always set your goals ahead of you and keep setting those goals ahead of you, but compare yourself to the past. Every one of us here, a year ago was in a totally different place, and we've all grown. I could have, I would bet anything on that. Right. It's great to reflect on that and builds strength. I also, you know, what I, what I started to do is implement goals where I could just get quick wins. Right. You and I, Emmett, we went through a health journey recently.

Yeah, we got the hair health journey

going, but no but like, but we lost quite a bit of weight.

Oh, yeah, we got that one too.

Yeah, we got healthier. Right. And I'm assuming you, like, I wanted to do it because we just want to look better at first. Right. Tell me, what did that do to your mental psyche?

Yeah, just the, the ability to have had that discipline. Right. It just bled over to everywhere else, the confidence.

You know, I, I know. I don't know if you ever have days like this, but I try to go to the gym five times a. A week now in the morning. And there are times when I get to the gym in the morning, I'm looking at the gym, I'm sitting in my car, I'm thinking, I don't want to do this. But then I force myself and I get through it, and that's a win. And now I feel better. And now I could take that energy and let it spill into the rest of my day. And I think setting up those types of wins makes you mentally stronger. And it helps you because I'll tell you about my day today. I had closed all my practice, all my practices. We had 60 some people that were supposed to show up for a training. We flew in a coach yesterday for a full day training. And today in the morning, 6:30, I get a text. First time in her history, she's got. She has to cancel the meeting. She got stomach flu four years ago. That would destroy me. I would be angry. And when I'm angry, I make bad decisions, I can't think straight today. I, I look at things like, why am I going to worry about things that are out of my control? There's so many other things I could, I could worry about. Why worry about that? And if I can keep a clear mind, I make better decisions. Right. So cash flow issues keep your mind clean and you could get, work yourself out of it. It doesn't happen overnight, but at least you could work yourself out of it.

It's its own muscle to build, though. There's a good saying that the leader is the calmest one in the room. And so what it tells me is that when I'm not that person, I'm also not the leader at that point. Right. And so being able to build up that muscle to look at the P and L, look at the bank account, hear the squabbling, whatever it might be, you know, get the resignation and be able to be bigger than the instance that is happening. Right. It's because there's kind of also this concept of if you feel smaller than the environment, then that's anxiety. If you feel bigger than the environment, then that's confidence. And so being able to feel bigger than, than what's happening. But it's not like you said, it's not something you're like, oh, okay, I'll start doing that. It's any more than, you know, to lose 60 pounds that I gained over 30 years, you know, happened on a Monday. It took some time.

Right, right. And, and fixing the cash flow takes time too. But if your mind set correct, you see solutions, you find solutions. And that doesn't happen overnight too. But you keep going at it and going at it and you start making, you know, healthy changes, I believe.

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Now back to the episode. So what ended up happening? You got these two practices, obviously Going, you learned a ton that second practice. Really, one kind of humbled you. We'll just call it as it is, right. And taught you like, oh, this is a big boys game. This isn't just I show up, do good clinical, and somehow it all works out. Like there's a lot more capabilities I'm going to have to learn here. You know, it always reminds me of like CrossFit, like, oh, you can do an overhead press, try a handstand pushup. Now you're like, oh, you know. So that second, third location, you know, takes it to a whole nother level. So what happened as you work through that? Where did you go next?

So today we have three locations, but we've actually expanded two of ours. So they're larger facilities, they're open eight. We have over 60 team members, remote workers as well. And we're headed to cross that. You know, I see that light now. I mean, I see that light at the end of the tunnel because we're projecting to cross that 10 million mark this year.

Yeah, it's incredible. And you're following the principle that we talk about at deo, that two doctors makes more money than two locations. Right. So you're optimizing.

Yeah, at one point I was kind of stuck. I'm like, well, I was hoping to get four offices at this point, but we made one facility into two, possibly three facilities in the future.

But I actually think locations is a pretty poor KPI actually. You know, it's not an indicator of profitability. That's one thing you kind of mature into because locations are just multiple sets of overhead, like another rent, another office manager another. And if you think about the core of business, it's establish some set of overhead, then cram as much income through it as possible. So those who kind of use cation as a KPI, I think they find themselves spread very thin rather than those who kind of ground themselves in profitability find themselves, you know, flush with cash, which is a lot funner.

And that was an issue for a long time for us as well.

Where was that bleeding out now? Looking backwards.

So, you know, one thing that I think was key in growth was really understanding, really knowing your numbers. And a couple lessons I took from that. You have to know your numbers because if you don't know your numbers, you don't know where your opportunities are. You don't know where you're making mistakes.

Real quick, I'm going to pause you before you go there. Before you knew that was true, what did you believe was true?

I'll take that back. I knew that that was true. I just didn't have the right numbers and I also didn't know how to study them and apply changes to it. You know, previous to dental school, I got an mba. I, I had some business background. So I knew the, the significance of numbers. I just know how to get them appropriately and get the correct.

And so, so it matured in what, you know, you knew you need numbers now, you know how they need to be formatted. And the reason I asked is because I think a very common thing for any entrepreneur in any industry is if I do my trade well, my profession well, the rest will work itself out. And it's just not true. You know, for some dentists, they get very fascinated with being very strong clinically. And then what happens is revenue continues to climb because of their capability, but right behind them is these expenses catching up. And pretty soon they're not even making associate level of pay anymore because that's not getting managed. So. But it sounds like you knew that. Oh, that is important. But maybe like, but I don't know how to get it where I need it to be or how to read it.

And you know, I, when I got my third location, I also created a dso, so that added a little complexity to financials. And I hired a bookkeeper that I kept for a little too long, explained to him what I wanted to get but just didn't get done and didn't get done. And I just kept thinking, oh, he's going to figure out, he's going to figure it out, he's going to figure it out. And unfortunately he didn't. And it, you know, the problem kept persisting. And then I heard another one that didn't work. Couldn't figure out for quite a while. I finally hired our fractional cfo. Is it okay if I mention his name? Yeah, Kevin Arnold. He's actually on the call right now.

Awesome.

He was. I love this guy. He really helped clean things up for me and show me where our opportunities were. And we made huge changes. And I mean like this, our margins changed.

You know, it's interesting because if you're listening to this and you're feeling a lot of anxiety and you're like, man, I just feel so dumb. What I found is anxiety comes from a lack of information. And so you're, you're not dumb, you don't have the information necessary. And for many dentists out there, they're running a million multimillion dollar business and yet you, you know, if you asked them so how's it going? Or what's happening other than their bank account and maybe a report they're getting from their accountant, you know, once a year or so forth, they really don't have the information they need. And so they're perplexed how someone else can scale so much. Well, that person's sitting on very clear information. It's much easier when they're just doing the math versus having to go off their gut of can I do this? Can I? I appreciate you calling that out.

One, the importance of clear financials and getting good numbers, which you still sometimes have to question because sometimes the data that gets put in is not accurate. You have to be really, really mindful of what goes in that comes out. And two, you sometimes, you know when to move on from team members. Something that I still struggle with. You know, I feel like any team member that joins our team, they put a certain level of trust in me and our organization to provide them a career growth, provide food for their, you know, put food on their table. And I, I feel obligated to give them all I can to help them succeed. And I think we still should do that. But at some point, you know, you have to know when it's. If it's not working, you'd have to make some changes for the health of your organization and for the. All the other people that you're. You provide a job for. Right?

Yeah. I was just talking to a member around this as well. And it takes time to kind of get the pattern recognition. I know it's a common saying like higher, slow, fire fast. But the reality is, is it's way more complicated than that. Typically, you're. You're really trying to navigate your own understanding of like, is it me? Is it them? Is it me? Is it them? And you're developing the skills too, around what you should toler and what you shouldn't tolerate. And over time, I think you get better at knowing what you shouldn't tolerate. But also you're learning what you should tolerate and where you have unrealistic expectations. So it's a tough skill set to learn. I'm curious on your leadership as you look back, how has your leadership style evolved? If I had Alex six years ago versus today, what's the difference between the two of them?

One thing that I, again, I just, I picked this up from you guys. When I was more of a clinical doctor, my customer was my patients were my patients. Right. I would be calling everybody that I injected. I would be calling new patients that are coming in because Those were my customers, and I cared about my customers as we scaled, as we have more, more people, more patients that were, you know, providing healthcare for. And I look at our customer as being the team. If I could provide or my team opportunity to grow and make a living and a great environment, then the downstream effect is good healthcare is good dentistry. Right. So that's one thing that has changed. I really look at how are we as an organization doing for our team members. Are we providing everything that we can for them to be successful to do, you know, the, the that we want to do for our communities?

That is an evolution for sure. It takes a lot of maturity because it's kind of easy to see customers as customers because they're paying you money and you want the money and so you want to take care of them. It's weird because your team, you're paying them money, but they are helping you generate that, you know, and take care of the customer. So to be able to pay them money and treat them as a customer is really a hack that once you get into that mindset, and this is why I love the term DSO actually, because the better you get as a dental support organization supporting the team, the better you get at understanding to take care of your doctors and that your doctors are really your customer and the patient is the customer of your customer. Those kind of things just take you to the next level. Right.

So one thing that I would add to the doctors being the customer, it's also our every team member because if we can give our assistants, our hygienists, our admins, all the skill sets, then they can provide for the doctors, right?

Yep.

Like to look at every team member as a customer that we're really trying to affect.

If you could go back on the financial side real quick. And then I want to talk a little bit about technology because you have some passion around that. Would you, even if you were just a single practice, would you at least get your P. Ls organized kind of the DEOA? What, you know, when you think about fractional CFO, you kind of think really big. But what would that look like for you at each step, do you think?

I mean, 100%. When I was one location, I was, I was the one doing my own QuickBooks. And you know, that kind of move put us into this unstable position as we grew. Because, you know, I'm good with teeth creating financials. Right. So growing your top line is not the way to become more profitable. Just throwing more on it and is not the only way to become More profitable, you know, if you understand like where your expenses are off, you know, where you can make changes and you don't have, you don't have to have all these wheels spinning so quickly and out of control. If you can really focus in on where the opportunities are, you can be much more effective and it'll be a lot easier. But you can't do that unless you have the right data. And the P. L is. That's where it starts.

There's a good entrepreneur saying if, if you're doing it right, it gets easier as you scale. Right. And that's why, because you're bringing in the clarity. All right, let's talk tech. So what are you excited about right now, man?

I am. The last thing that we latest thing that we implement was an AI agent. So any of our overflow calls that don't get picked up, get picked up by an AI agent that sounds like a human being, answers all the questions, schedules the appointment. We don't have missed calls now. And it's 24 7. Brittany, that's her name, I think, is our hardest working employee.

She can answer every call instantly, anytime. And. And you're feeling good because, I mean, obviously this is still emerging technology at this point. There's, you know, there are issues that happen.

Not foolproof, but it's definitely, you know, I, I have a lot of excitement in what can happen with that. You know, the next avenue for that is outreach. I don't think it's quite there yet, but. But right now it's just capable of sending out text messages and having text communications with. With patients to get them scheduled. But I can't wait for it to be able to make a call. And if it doesn't get the call, doesn't get a. A person on the phone, send a text and an email and work, you know, your reactivation campaign the way we should be doing it in house.

But step one, if you got the inbound taken care of, that means you got freed up team for outbound. Right. So that's. That one's huge. Do you want to kind of talk through some of the ones you tried and where you settled on right now? Not, not that you're endorsing it, but that this where you're at today.

I've been happy with it. I've been using neurality.

Neurality. Okay. Yeah.

You know, here's the thing also about technology. I like toys, I like tech and something shiny like, let's do it, let's do it. It's not like you could just Say, okay, we're signing up with this technology and tomorrow it's running. Implementation of technology takes time. And my team always lets me know, hey doc, slow down. You know, like throwing so much at us, right? Because I think okay, we could just go, we just go. But somebody actually has to be the one picking up the call, making sure that everything's working and it takes time. So I would just caution with technology, find your pain points and whatever the pain point is. If you could implement technology, cool, do that. But don't spread yourself thin going after everything.

Well, and I think just like when you hire an employee or a team member, it's not a set it and forget it, like, okay, I hired you, good luck, you know, that's something to be nurtured, developed, onboarded, et cetera. Sometimes when we hire a vendor or we use a technology, we apply kind of this very much abdication approach and then we're like, it didn't work or they didn't work, et cetera. But if we actually treated them like we would onboard employee and had some kind of weekly follow up or whatever that might cadence might be. That's where I see people really scale is you kind of get past the immaturity of like, oh yeah, I can just throw dollars at this and it works. It's more of I'm going to throw dollars at it and then I'm going to utilize it as a tool, I'm going to monitor it, I'm going to give feedback to the company. You know, I'm going to figure out where it works, where it doesn't, et cetera.

So you know tech companies where they will set on ongoing calls with you and although it might seem like, well why do I need them going forward for so long? It keeps us accountable to like everything is working that check in with the company. It just. Is this software product working? Yes or no? Because like you said, if you just set it and forget it, sometimes you're just burning money and nothing. It's not being utilized.

Right. Like marketing or anything else. How long we've had some people use neurality or some of these other ones. How long did it take you to kind of work out some of the bugs and start feeling a little more confidence?

Couple months. I'm not at that point yet, you know, because neurality wants to go to being the first tier.

Ah, so you're using it for overflow.

I'm not using it for.

That's brilliant. That's where I see most people right now.

Yeah, it sounds awesome. You know I'm not that adventurous yet. Where I wanted to first year of picking up the phone calls.

Well, and what's the. What's the negative of it being overflow? Right. Those are literally calls you were going to miss. And so, and, and in some ways, it creates its own metric system, which is how many calls it answers is the number of calls you've been missing. Right. So it exposes that as well. So, yeah, that's really cool.

When I look at an appointment scheduled by neurality, I'm like, yes, money.

Yeah, that's just like straight dollars that you would have totally missed before. And it. It grabs. You know, a lot of times people are like, hey, what marketing firm? What marketing firm? And they want to do more on the top of the funnel, but the biggest dollar there at the bottom of the funnel, all the stuff we're missing, treatment coordination, not answering the phones, not having the right scripting to get them scheduled. And then you can pour the money into the top right after the leaky bucket's been solved. So it's awesome. Anything else you want to throw out there? As far as the tech, I mean, where do you see kind of dentistry going in the next few years here, and where's the biggest opportunities you're excited about?

Next thing that I'm really excited about is I want to see what happens with RCM in dentistry and tech. Right. We've had with our RCM department. We're fixing these issues right now. We're spending a lot of time trying to fix our RCM department. But I think, like, in the next couple years, it's all just going to be automated, and I can't wait for that. But, you know, we can't believe it took me so long to realize that I could automate my statements to go out. I mean, it took me a long time to figure that out, that I could automate that process. But even that, you know, I thought once I learned about it, I called Robin, our director of ops, and I'm like, hey, can we just get this going? And I thought, well, tomorrow it's going to roll out. But no, Robin's got other things to do, right? So it takes a little time, but when it rolls out, I think it's going to save us tremendous amount of time and open up capacities to do other things.

Yeah, it's awesome. Well, I think you've hit on that theory of constraints concept is, you know, you take on one thing at a time, do them well, continue to organize the best CEOs, prioritize those, return on investments. Alex, thank you so much. Thanks for being open and vulnerable. It's super helpful for people who are on this journey to be able to look around the corner. We're all kind of struggling with wherever our ceiling of mindset, our limiting belief is, you know, and what our. Our strengths have gotten us to this point. And the hard thing about a paradigm shift is we actually have to think differently than we currently do. I. That's what I always think of, man. Man, this is going to be tough because I just have to think a little bit differently. But when I hear somebody that, you know, is similar to me, that I trust, that I know has their best interest, my best interests at heart, and I hear how they had to make some of those changes, it accelerates this greatly for me. So really appreciate you giving your feedback.

That has been one of the reasons why I've been a member for six years. Because, you know, before I knew some people grew up organizations, I didn't have access to all these people. And being in this group, I see people, you know, when you see somebody else that's done it, I have this belief, well, why can't I? And find out how do they do it? And when I have an issue, I have a group of great friends that I've met that I could at any point message, and I have like a list of answers. It's. It's pretty incredible.

That's awesome. Thank you again, Alex. We really appreciate it. For those who have not signed up for the DEO summit coming up June 12th through the 14th out in Phoenix, Arizona, it is members only, but it's going to be epic. We're going to be hitting on a lot of things that Alex has talked about. We're going to have a whole AI pre conference, so make sure you're at that. See where the technology is going. We'll see some of the RCM stuff that's happening, those phone calls that are happening. So great having you all here. 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.