229: Why 1,600+ Location DSOs Still Face Your Same Dental Practice Problems

Most businesses are sitting on another million dollars of revenue or profitability that's limited by a conversation they're scared to have.

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 Solutions 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 I'm here with JW from Support dds. And we just finished kind of a different environment than usual for the podcast, but we just finished a cool event called Destination DSO that you've been doing for a few years now. We got to sponsor for the first time.

And yeah, yeah, we started that. We felt that there was a void for leaders, especially in the DSO world, to get together out of a kind of a convention setting where you got to spend some time. It wasn't salesy, it wasn't trying to explain your product, but really getting to know people. And I think the. Well, Buck Davis spoke today and he talked about something that's missing in today's world is the social connection. And so to me, this was destination DSO was a way to bring together 25 or so people that. That could really connect.

Yeah. And he spoke about resilience, which I thought was really good, just knowing what's happening. At the end of the day, we are a service business through people, and how well can we really continue to upgrade and support those people? Which leads right into a lot of what Support DDS does. But one thing I thought was interesting is we had DSOs of different sizes but fairly emerging to large. And one of the emerging groups of 17 to 20 talking to a group with 1600 locations. And his comment was, they have the same problems I have. And I think it was just a good reminder that no matter what your size is, at the end of the day, it's going to come down to the practice level and your office managers and your team connections, your systems and processes. And all that happens as you scale is there's more of that going on. It's not like somehow once you reach a certain size, I don't know that you eliminate all the people you know, like the patients aren't there or you have less patients or you have less Team members. And so just a good reminder too, as I was talking with him, that you just need to lean into the growth and skill set because it's not going to get lighter. You're going to have more crucial conversations. You're going to have more issues that you hadn't even thought of with team. And so I think that could sound a little bit negative and discouraging. Like, man, it scales and gets worse. But I think it also really means don't avoid the conversations you need to be having today because you're just going to have to have more and more as you grow.

Yeah, it was interesting. We were at the first night at dinner and one of our clients here, one of the people here, participants was, I think they had about 16 or 18 offices, was speaking to someone who had 100 plus offices. And he goes, oh, I just thought when I was. When I get to be you, that all these problems go away. He actually was like, no, there's just a bunch more of them. Yeah, but you have levels of people that can. Can kind of help you. But it was interesting to be able to understand you're probably going through the same struggles that other people is. To me, Emmett, it's a little bit like you see somebody in their marriage on social media, you know, oh, they're always so happy that husband and wife, they get along all the time. I wish my marriage well. Guess what, they're struggling with the exact same things you are. So that's a good analogy for me to always remember that we're working together and you have to be a little bit some humility as Buck talked about, because if you'll be open to that, then other people can say, hey, here's some ideas that I've used in my life as well.

I recently posted. We have a new DEO app and all the members are in there. And so, you know, I'm posting different things as I'm coaching people or our coaches are coaching some kind of ahas that we're having. And one of the ahas that I've realized is that most businesses are sitting on another million dollars of revenue or profitability that's limited by a conversation they're scared to have.

Wow.

And it's just, you know, as you scale, that number gets bigger and the conversations get a little bit more difficult or require some more sophistication. You know, you think about what it means to be a CEO of an organization as you grow. It means you have an office manager, you have a regional, you have executives. So you just get Purely filtered bad stuff that ends up coming up to you as you scale. And so the question is, is what are you doing to develop out as we learned, you know, your resilience and ability to kind of stand as those things happen, but also just your skill sets and communicating with people, leading people, clearly fight and flight isn't going to work for you to be a good leader, you're going to have to be able to reason with all different types of personalities.

Yeah. You know, I think it's interesting to also, you said something that struck a nerve with me. I think I've been an entrepreneur now for 35 plus years and I always thought I could do it all right. And. And so I thought, oh yeah, I'd be a great cfo. And I'm a horrible cfo. Right. We're going to go broke if I'm the cfo. So it's like finding people that can help you as you scale and build. And really a lot what DEO is doing now with finding those, those coaches or finding that CEO that can come help you to reorganize. And that's what we do. I mean, with support dds, we're trying to help them scale without breaking the bank on the labor charges and some scarcity of labor is there. So you're right. It's about learning to leverage what you're not very good at.

Yeah. There's interesting study you've seen around. Like some of the top CEOs are all like, dyslexic, ADD, et cetera. And I have a son who's dyslexic. And as I've watched him, I realize what skillset he has that some of us who maybe school came a little bit easier, we're high performers. We've been able to accomplish a lot, especially in like, solving problems is, you know, your weakness is the overuse of your strengths. And so it's like, well, I can do it all myself. He's grown up in an environment where he's always relied on some level of support. Hey, could you read that for me? Hey, could you do this part? And so his delegation skills are insane. They're fabulous. And so he scales very quickly on things because he doesn't have. It's not a big deal for him to ask for help. And he knows what good support for himself looks like. And he'll communicate like, hey, you gave me too many tasks at once. If you could write those down for me, organize them this way, then I can go. And I'm like, yeah, that's what we're trying to teach every CEO how to do.

Slow down. Yeah.

Use the IDO system, you know, all of those things. And so, you know, speaking of add, where was I going with that?

I think, oh, I'm jw. You're him.

Yeah. Thank you. Um, I think that the critical skill that you learn is what am I good at and what am I not on scale.

Right.

And if you're feeling a lot of anxiety, I think a big part of anxiety comes from trying to do too many things, trying to believe, well, I could do that better, et cetera. And the reality is that you're just not gonna scale. Like, it's not a bad thing, but your influence is going to be limited to this level to get to that next level.

I think for me, too, as we. We've grown, that I used to have touch points with a lot of departments and a lot of leaders and a lot of our. And I knew everybody. And, you know, we're at now 1500, and you can't know everybody. You can't know. You really can only know your upper leadership team. And so that's a problem for me because I wanted a lot of times to micromanage all the way down. Right. And really get in deep. And I've really learned this acronym. I've stolen some of it. Some of it's mine is I take this idea of evaluate what you're doing. So usually on a Sunday or Sunday, Sunday night or Monday morning, I'll really evaluate my week, and then I'll try to eliminate things like, I don't know why I'm in this meeting on Thursday. So let me eliminate that. And then I look at some things that are on my to do list and say some of those can be delegated, which is kind of our business model. What could be delegated? So for me, it's evaluate, then really eliminate. Especially meetings where you like, I don't need to be in that. I've got good people already in that meeting. Then delegate a lot of the stuff you do. And then my last one is focus. So I think if you can evaluate what you're doing, eliminate what you don't, delegate what you should. Don't need to do. And then really, you can focus. You know, one of the. One of the talks today was about came in and said, what are our top priorities? And he said there was 78 of them.

Right.

At a group with 70 plus locations. And he said, we narrowed it down to three. And so I think as leaders, too, we think. We believe we have the skill set to multitask, which I don't even know if it's a real thing anymore. But you need to focus. You really have to be focused and honed in on what you're doing.

The word that I've started switching around focus and priority is if you're a strategic leader. I think we've always thought of strategic as innovative. So it's like, hey, we need to do a strategic plan. It's like, what's the new ideas? But what I find the best CEOs do is their strategic plan is exactly what we heard, which is what is the prioritizations that will have the highest return on investment.

Yeah.

And I think bringing this frankly back to support DDS type things is as you look at your team, every team member is operating, let's, let's say that they have a salary that's, you know, $30 an hour. They're doing some things that Might be worth $40 an hour, $50 an hour. They're doing things that are at $30 an hour. They're doing Things that are $10 an hour. Right. And the question is, I think one of the first places when you think about scaling isn't go by 20 locations. But getting good at helping team members work at the highest level of their skill sets and their compensation, because that creates a career path for them, can also be very disconcerting for them because you're delegating and teaching them how to delegate. But if you can get support and get activity, it's a return on investment. If I'm going to pay 30, can I get a $70 return or am I paying 30 and I'm getting a $12 return? And then I wonder why I feel stuck.

Well, and some of the best, worst managers, office managers, you know, practice managers, et cetera, are the ones that either the, you know, somebody in the executive team or maybe at the local practice level. Oh, they can do everything.

Yeah.

And so they let them. And then that person begins to take pride in, oh, I can do it all.

Well, they become the bottleneck of it.

That's right. They become the problem. And although they seem like they're the solution, and you're right. And so when you back that out, do you want that office manager, that front desk manager, or your coordinator, whatever you call them, to be working on those 7,500, maybe $150 an hour returns? Or do you want them making those outbound calls or handling new patient calls, things they probably should not be doing?

Yeah, it's a Good call out. Like the way you move up, if you're a team member right now and you're listening to this, the way you move up in an organization is you see a problem, you fix a problem. Just be proactive, right? And your boss will be like, oh my gosh, saw a problem, fix the problem. Those people get promoted because it's so nice to not have, you know, the individual that you have to tell them everything to do. And half the time they do it, half the time they don't. So if you're in that top 5% where you see a problem, you fix a problem, you work proactively, which by the way, you can judge if you're that person. Because if sometimes your boss is like, hey, slow down or hey, you kind of stepped on so and so's toe, you're doing a good job, you're on the right track. Yeah, I always like individuals. I have to say, whoa, rather than giddy up, you know, and, but, but the problem is to move to the next level. You have to see a problem, document, organize, prioritize, and then figure out if you should work on it or if someone else should or if it's the most important thing to work on. Right now that's a totally different skill set because see a problem, fix a problem is like a great dopamine hit. You get to be the hero everybody loves. But see a problem, organize it, prioritize it, delegate it, give credit to somebody else for getting it done. That's leadership.

You encourage that person more than anything. Right?

Yeah.

Yeah. That's interesting because you kind of coming back to, if you're not delegating these tasks, and usually it is that office manager, that's kind of the bottleneck, right? Somebody at the front desk, it could be the bottleneck. Then when you think about that next role, you know what, we're needing a regional director or we're needing somebody at the next level, that's a pay increase, promotion, et cetera. Oh, we, we can't move Emmett because if we move him, the whole world falls apart. Right. That's very self limiting to yourself. So you need to be, in some respects, I've said, you need to be the Maytag man. You know, you're, you've got everything running so well, you're kind of twiddling your thumbs like, I don't know what I'm doing next. Everything's running real smooth. And that gives you the ability to move up to the next roll too.

So AI is very popular right now. And I'll kind of use this analogy because it's so popular, sometimes you almost get frozen. I'm like, how could I use this? So DEO created an AI workbook with prompts for front desk, back office, how an HR person could use it. All these different things I'd love for you to kind of walk through. We talk about outsourcing, insourcing solutions, but I think it's just good to review. You now have almost 1500 people that you know, within dental and other industries have been outsourced and in source to you guys. What are different ways? Like if you were sitting with someone who's never heard of this concept before and they're thinking about bringing a team member in and you know, they're starting to understand like, oh, I could get a lower cost, high functioning individual, take somebody who's at that $30 an hour and continue to move them up while having a lower cost solution. Do some of this work. What are some ideas that from single practice owner and then just kind of scale up, if you would.

Yeah, I think first of all, don't think it's magic. Right. And don't you and I had this conversation. Don't think you're gonna set somebody in there and two or three weeks later it's just all running smooth. Cause that's not reality. It does take training. We find the offices that have really good SOPs in place, they have a training plan and they kind of know what they want. Nina, our director of rcm, we were talking today about the number of times people have come on and we haven't set expectations right. We didn't level set and say, well, we expect them to do this. And so now you know that going in. So I believe when you're considering this, the first thing I would do is probably go to your staff and say, what's holding you back? What are the things? And you're gonna get the traditional thing. Oh, this insurance verification or you know what, we bought this new AI technology that's given us this great dashboard, but we don't know what to do with it. Right. We don't have time to call all these back, the missed calls or the recare or whatever it is. So I think I would initially kind of that evaluate piece, go into your team and say, hey, what's holding you back from getting to the next level? Or what's holding us getting back?

By the way I love about that is that's way better than like I grabbed this person now office manager, go figure out what to do with them. Yeah, but so much better to be like, hey, I want to get some support and resources under you. Where should we start?

Yeah, yeah. We say, look, go to your team and say, hey, I want to elevate you, which may enable me to pay you more because you're doing those higher ROI jobs. And now they're bought into the idea of the old traditional, you know, and I, I've heard you say it a couple times. Outsourcing, insourcing. We don't like outsourcing. Only because there sometimes is a bad connotation. There's going to be a language barrier. They're going to be in another time zone. They don't know what they're doing. There's all this.

It also kind of has a disconnect feel to it. I just throw it over the fence and hope it gets done. This is a team member you're bringing into the fold. You're going to have them up, you're going to include them in trainings, you're going to include them in huddles, whatever else, like you would any other virtual team member.

Yeah, we, we, we do a training, we've got a training program for a dental coordinator, we call it, and they do learn all the functions and have a really good background. If it goes into something deeper like the rcm, we'll give them some deeper training, but they're going to have that. You, you need to have that 90 day plan of, of how you want to slowly integrate them. And again, don't throw all the tasks on day one. They're not going to figure that out. Right. Start small, think big, start small. I would say if it's, you know, something simple like, hey, just taking in our overflow calls, we could start there. Probably the most popular is new patient calls. And the reason that really works is your front office typically doesn't have enough time to spend with a new patient. Oh, Mr. Scott, hang on, let me put you on hold and I'll be right back with you. And you know, now you're like, I'm not going on hold, rather than you get the call. And if you need to spend. I think the average time is around seven minutes for a new patient. If you need to spend seven, eight minutes with them, you can allocate that. So we've had a good starting point is getting new patient calls. Now that scares people to death.

They're like, it's like my lifeblood.

What are you talking about? Yeah, but we encourage record phone calls, listen to phone calls, definitely do a lot of training in advance and pretty soon you'll learn that our teams can do that better than your teams can do it because they're dedicated to it and they get used to it. They're taking a lot of calls and it's uninterrupted. So you can take that 50% conversion rate. We've seen it go to 80% for new patient calls. So that can be monumental.

You're getting an individual who's not getting distracted by the realities inside the practice of having to take care of patients and just 100% taking those calls in. You talked about the 90 day plan. I think whether you're hiring someone in the US or insourcing someone, you should have a plan for how you. And part of the reason you may be having the turnover is people just not being able to feel successful, etc, so it's a good place to start. Which, you know, DEO can help with that too. Of like, what should I be training, how should I do these job descriptions, et cetera, when they first come on, how should I think about that? I mean, if I'm going to have to train them, what's the benefit of using a support dds? I mean, I, I think one thing is you actually have resumes of people. If you're in that town where you're like, I can't get anybody to do these tasks, you're going to get people who can do those tasks, right? And then you can take the people on site and move them.

And probably where we differ a lot is we've got these trained dental coordinators now, some of them with as many as 1, 2, 3, 4, 5 years of experience, right. That we can bring to the table. The really, really the first part that's important is you get to interview, you interview them, you talk about their background.

The office manager interview, have the office

manager do a joint phone call, spend 15, 20 minutes and say, yeah, that person fits. We just have a connection there. So then you can, you can select them. But you're right, I think you need to have a plan and then you need to have expectations if you are expecting them to do recare and you're saying, look, I need you to make 80 calls a day, then that's the marker and use that going in. So there's no misconstrued expectations when you do that as well. So to me that's the biggest thing, is just understanding what the expectations are. But I think you might have been about to ask, I'm going to put words in your mouth is how much time do you need to spend with them. And, and I would say the first week you probably need to spend an hour with them each morning just like you would somebody in your office. You're going to spend more than that if they're sitting in your office. Right. And then you can slowly over that 90 day period say, you know what we can do Monday, Wednesday, Friday, okay, we can go two days a week. And then probably by the time 90 days is up, it's one day a week for 30 minutes.

You know, if you do find that man, I hired someone, they didn't work out. Yeah. I just didn't take the time with them. You probably just have a generally bigger problem and that that's how you're onboarding people in your organization. So being thoughtful about that. For those who might feel a little bit overwhelmed around like getting these positions, you know, this is a place I would encourage you to do AI. There's just so much you can utilize to say, here's the problem, here's the thing. My office manager doesn't want to have to do anymore. Here's the thing, my front desk are feeling overwhelmed, whatever it might be. If I had the perfect person, they'd look like this. Help me write a job description for that. Then you can say, okay, that's a great job description. Add this, delete that, come up with questions that I should ask somebody. What would be their ideal answers for these? And so you can just keep using it as kind of your HR consultant because I think some people feel a little bit overwhelmed by just getting started. And that can be a great place to start. And then you can always feed that into I need to put together a 90 day plan for my office manager and this new front desk insurance coordinator, whatever, to work together. Could you go ahead and build that out for us? So you know the old adage, you don't have to know the whole textbook, just be one chapter ahead of the student. You know, just when you do onboard them, as long as they're kind of a chapter ahead as far as that cadence and best practices, then you're good to go. All right, what are some other areas? So insurance verification. Not having to be on the phone for the insurance is a great one. Those new patient calls or some kind of overflow calls, most people are at 60% of phone answer rate. So they're basically spending double on their marketing. Other places that are popular.

Yeah, I would say when you look at the, the front office, what we call director of first impressions, that can be the new patient calls that are coming, could Be the overflow calls. Definitely. When you look at the recare unscheduled treatment plans, you know that's an area you can go back in and spend the next six months on just making follow up to those unscheduled treatment plans. A lot of times they'll do the fast fills for hygiene. If you have a hygiene appointment that gets canceled, what 50% of. I think it's 50% of all hygiene appointments are canceled within 24 hours of the appointment. So we recommend 48 hours. Make that phone call. Hey Emmett. Just letting you know, doctor's got an hour scheduled with you for the. Or the hygienist has an hour scheduled with you. That reminder sometimes just oh yeah, I need to, I need to be there. And then if they do cancel having a way in which to fill that seat because that's, that's non revenue. You can't get back if that seat's empty. So utilizing it for that accounting functions can be very simple. Whether it's just some simple bookkeeping functions to get some of that off of your teams. Larger groups, larger DSO groups are using us for kind of an HR specialist, HR generalist, helping with those SOPs, helping with the paperwork, the documentation that needs to be required, et cetera.

So for onboarding other people.

Onboarding other people. Yeah, Even internally. Right. Some of our bigger groups are using it for doctor compensation just to doing the payroll, doing the payroll calculations, sending it over to the provider and saying hey, does this look right for last month? And so that's taken a lot of time off of it as well.

So I mean kind of if you can imagine it and it doesn't happen, have to be in the practice, which ironically a lot doesn't.

Yeah.

Then it can be insourced. All right, so if somebody wants to get a hold of you, what's the best way to do that?

Call EMT. You can go to support DDS.com you can email me JW. It's pretty hard J@A W support DDS.com and or you can go to the website, schedule a discovery call. I highly recommend doing. The discovery call takes about 30 minutes. We can explain it. We can. Well, first thing we'll say is what are your pain points? You know, we want to understand what you're struggling with and then we'll talk about some solutions. We do usually have one of our team members on in our Africa office so you can hear them speak and understand if this can be a right fit for you as well.

And you just wrote a book, right?

Oh, I did had it with me. Yeah, Global Talent Local results. And we if you're interested, we'll send you one. We'd love to get those out to you at no charge. We know that it really is just a pamphlet or a kind of an outline of how you can in source outsource better. And look, I want to say this, you may be using a current company to do this now you may be already in the process of about to hire another company. That's fine. The book and what I like to do is help people to understand what they need to know before they try it. For instance, how do I keep my attrition rate low? What do I do for training? How do I integrate them into my culture? How do I make them a better part of my team?

And it's really got the best practices.

Yeah, some best practices. And no matter if you're again use us, ask these questions of the companies you're considering. So you know our assistant. Oh look at mine. My lovely assistant.

For those who are watching this on YouTube, you're able to see this beautiful.

And look at there, our lovely assistant, our lovely Vanna or Michael Irvin got his for us. Yeah, Global Talent Local results. It is a plane ride read and I really think it's just helpful to understand the best practices and how you can get started.

So awesome. You can also connect with JW at most EEO events, I think all of them at this point. So if you're going to be In Phoenix here June 12th through the 14th, we'll be there. We're going to be talking about labor costs actually and what are the exact labor costs that you need at each scale of your practice. And then within those, how much front desk versus back office. And within that, double click down, you know what is a level one, level two, level three, front desk, back office, et cetera. So we're really just giving you the entire labor blueprint. We'll also have our mastermind breakouts with our tribes, et cetera. So it'll be awesome. If you're interested in that, that is for DO members only. Hopefully this has been helpful for those listening. Great to be with you all 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.