256: What It Really Takes to Scale a Dental Practice

You can't take a system that you want and try and wedge it into something, or vice versa. You can't take a system and then you go to the trade show and you find something shiny and fun and you are sold on something and you try and take that and wedge it into a system. It does not work.

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 dent 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.

Hey everyone and welcome back to DEO Growth Secrets podcast where we go deep with the leader shaping the future of dentistry and organizations. I, I am your host, Kendall Hussain. And today's episode is going to resonate with anybody that is out there thinking bigger. I want you to think about scale, think about systems and the future of multilocation dentistry. And so if you've ever struggled with facility bottlenecks, expansion delays, operational chaos during growth, my friends, this one is for you. We are talking with someone who's been building scalable Systems for over 20 years. And these are systems that have help grow and really be a strong power behind hundreds of practices. And so our guest today is Ted Wegman and he is the co founder and chief development officer at Axis DSO Solutions. And Ted has helped more than 250 unique dental clients scale smarter and not harder, which is my favorite thing to do. And so we're going to dig into the blueprints behind that success. And so welcome Ted to the show. We are thrilled to have you here.

Thank you very much, Kendall. I appreciate it.

You have had such a rich journey, my friend. You founded Symmetry Dental Direct and you've been building out Axis DSO alongside with Bob Foss. For those that are new to your work, can you give us the why behind Axis DSO and what the company is all about and what makes your approach so different?

Yeah, you bet. Basically, Axis, we are the scalable solution developer for the dental industry. We've been involved in many different markets, including hospitality areas, veterinary, different things. But we want to really focus on the dental industry because we're seeing the enormous amount of growth with the group practices. What we do is we as Access have developed, we apply and we implement all kinds of unique solutions and systems to create a comprehensive group expansion, practice, playbook for you. And our focus is on the facility. With all these different tools that we have developed, we're able to comprehensively approach the design, build, equipping, outfitting, funding and operations side and tie it all together to simplify the expansion process.

So fun. So is this specifically for a dentist that is looking to expand and start a de novo, or is this for a dentist that would be looking to take over an existing practice and maybe retrofit it, you know, enhance it, build new ops, things like that. Do you work in both fields or does it specific to one?

We actually work in both fields. The best way to put it is every one of our clients has some existing offices. So we're starting work them. Say they have two offices, say they have 15 offices. They may, those existing offices may be profitable, they may be a very lovely office, but they are not positioned properly to get them into where the private in the future at their liquidity event that the private equity groups really find them meaningful. So what we do is we sit down with our clients, we develop a comprehensive solution for them so that their future offices, many of their future offices are de novo. However, we can actually apply a lot of what we develop with them to the existing facilities. And we do have some clients that once it's applied, their business model is rolling up existing offices or acquiring more and more offices. And we have to approach them differently because their needs are different. And the series of solutions that we've developed works for all of them.

Okay, I love this. So you're really changing the way that DSOs are growing in the nation, probably Canada, where I'm from, and some great other places like that as well. And so what pain points are you seeing when groups come to you and how do your systems help them solve it?

I'll do it. Would it be possible for me to share my screen?

Sure. Listeners will not be able to see your screen, however. So will you be able to walk

us through in that case? There's no need to see the screen. I'll walk you through it on. You're asking how we work with the clients? Essentially, yeah.

How is access DSO helping the group? What pain points are these people coming to you?

I apologize, I was missing the question. The pain points that we see almost every time with new projects, or as I always call it, the traditional method of expanding is that you get so much compartmentalized data that there's so much overlap and there's so many details missing that. Here's the biggest pain point I see over and over is the owner of the group practice has to become highly involved in the new facility. Our models, our approach minimizes that tremendously. You need to be focusing on your business, not going out there and saying, hey, we should have a outlet here, or we need this here. The way that we approach it, literally every decision is made before the construction process even starts. And it's an enormous amount of upfront work that pays big dividends in the end. One of the projects, this is actually one of my favorite projects. Our clients of 2025 is. We were asked by a client to. It's. He's on a second dso. He's already sold his first one. He did very, very well with that. And he goes, ted, I like the concept of creating a systemized solution. And the reason is because I can get any operatory up to 300,000 in revenue. How can we get it to where? And he gave me a list, just a big list of once. And he goes, how can we accommodate all this? And he goes, if we can, then I can make this grow in a very rapid rate. His goal in the end is to have a strategic partner come in over the operations. And he sits back and actually has all of the mailbox money because he now all owns all the facilities and collects the rents. Well, we approached it in a fashion that was extremely unique. It allowed us to create what we had as quad pods. Instead of looking at each new location as its own entity, we looked at each locations. How many of these quad pods can we actually fit in? Each one designed for 1.2 million in revenue, Literally almost its own standalone office inside of each facility. And each one of those quad pods, you'd have a doctor, you'd have an assistant and two hygienists. They're basically in that one location, that area all day long, producing, producing, producing. Everything else is being brought to them. Every. They're almost being served by other people in the facility so that they're getting an incredible experience. And it's positioning their. Anybody who's actually paid on account, compensated on productivity, they are able to produce. And it was very fun to develop. And it's actually turned from how many facilities does he want to. How many of these quad pods does he need to get opened up to make it to attain his liquidity event? It's kind of how we work is we always focus on the extra, the liquidity event first. And the one thing that all these private equity groups, if you want to maximize that, you have to focus on two major elements and that is your EBITDA and Your scalability and the big pain point that we see these doctors hitting over and over is like I said, they can have a wonderful office, but if it's not scalable, they're not really meaningful to who's going to be acquiring them in the future. And that's where we position them nicely.

Absolutely. I'm going back to the days of my organization expanding and man, that was painful. That was no fun. You know, you mentioned, oh, where are we going to put the outlets? And I can't tell you how many times I walked around that practice, you know, thinking the same thing. Where are we going to put the outlets? Where does the X ray sensor go? You know, where are we, what are we going to do with that? And man, oh man, it would have been such a blessing to have somebody come in and be like, okay, what, what is your future goals? What are you trying to achieve here? Is it that you're trying to scale and expand and sell to a dental service organization or do you just want to convert one off into a hygiene off because it has such a different avenue that you're trying to get, get to from, like I said, you know, converting an operatory until scaling a business so that it becomes attractive for a DSO and a partner and somebody to come in and ultimately, you know, acquire your practice or become a partner with you. And so I'm just reminiscing or maybe I'm having nightmares of those days where I did that through my organization.

One of the neat things with it, I love that what you're talking about because you can actually apply this to your past. That one client that I was Talking about from 2025, obviously we don't give out people's names. But once developed the system that he needed, what was even more interesting was he is now able to repeat, repeat, repeat. And we literally redesigned an. A fully integrated concept that ties together his full operations. Whether it's. And what it is, we worked with, we worked very tightly with the company, with Zerk, with Nicole Campion and her team over at Zerk. Fantastic group. And we built a system that tied together all of the operatories in a fashion that Zerk can help him repeat, repeat, repeat, so they don't lose the systemization as they expand. The larger you get, the less communication you have with the individual people and the more they want to say, hey, this is how I do it. This is how we do it. So we want to keep this way. This allows a systemized approach that is data driven, is trainable, and if, if you want to move an employee from one location to the next. It's very, very simplistic. And what was very. The big thing was, is after we designed up each of these operatories, his cost for weird. Actually the standard is about what we're focusing on for him is 12 operatories, three quad pods in each one. Just the equipment in the operatories and sterilization alone reduced by over $150,000. That's the startup cost.

That's fantastic.

And what's big is though, when you tie that together with the construction, there's a lot of other efficiencies that we're able to build in. In fact, we're working with him now to take him to the next level and that is that we are going to be doing off site construction for his facilities. So they literally benefit from every efficiency of off site construction. Literally producing these offices in a factory and rolling them down the road. They'll be arriving as three separate 85 foot by 20 foot or I can't remember what exactly the dimensions were. Sections that go together and build the complete facility. And this, that's one other area that we bring to the table that is actually going to be reducing his cost of construction. We don't know the exact number for that, but it's estimated right now that it's probably going to be between 12 and 15% per facility.

Fabulous access. DSo, as you sit there, explain it is the definition of scalability that rinse and repeat, having good, good systems that we can replicate and just rinse and repeat over and over and over again till we get to the point that again, it is a scalable business. And so I love how you're speaking to that because at DEO that is what we are all about, is helping our practices scale and get to a point where they then, you know, get to live their best life. Whether that's taking time out of the chair or maybe, you know, starting up a new practice, whatever that looks for them. And so as we start to think about, you know, some of the inefficiencies that maybe I had to go through when I was expanding, you know, my practices, can you maybe share some of the inefficiencies that you've seen and what you've been able to build upon so that these clients that you're working with perhaps don't even realize that they need this?

The biggest inefficiency I see over and over is trying to think of how to say it, but it would be overlapping of duties at a job site or cross trade interference if you will. We see so many of these job sites that are or we see so many of these projects that are developed in the traditional model. And it's a very linear path. That linear path means that a lot of the information that needs to be shared is compartmentalized. And you get there and you see somebody cutting, you might see a cabinet person cutting out holes for electric, whereas that could have actually been developed together so that everything slides in. And think about that every time you have that you have an installer out there spending an extra hour making a lot of mess. These installers don't come cheap. It's. And if you have that times 12 each operatory that might you just add in a couple thousand dollars just for that one little inefficiency which we can actually develop as a comprehensive solution that even attaches with the full chase systems that we want to have in the facility. We realize that in 10 years, whether you still own it or not, there's going to be new equipment and you are going to need those, you're going to want those efficiencies pre built so that adjustments can be implemented, that you can have some flexibility built in. That's what we, that's what we do is we develop all of that.

I love it. So I'm a dentist. I decide I want to scale my practice. I'm ready to expand. I'm thinking about future growth of potentially partnering with the DSO at one point in time. How do you begin working with that client and what does the onboarding look like with your company?

It's very simple, the startup process. Let's Talk for about 20 minutes on Zoom and see if our two companies are right to work together. It's. We're not right for everybody. We are the type of clients that we onboard are ones that have a defined goal in mind. Doesn't mean that they know that they want to retire in five years or in 20 years, that's irrelevant. But they want to take the time to do the upfront work that allows them to expand easier, more simplified, more economical and basically call, text, email us and let's set up a zoom call. That is the best process because each of our. We're not trying to bring on everybody onboard everybody. We want to onboard the right people and we want to basically make sure that we have the right clients that we're able to bring the benefit to that client. So yeah, just give us a call, have a 20 minute Zoom call, go from there.

I love it. All right, so now we're partnered up. We're ready to go. I'm excited. What happens from there? What's the next step? Do we sit down and create a plan? Do you talk to us about, like what the inefficiencies are and what do you think some of the problems are? Walk me through what that next step would look like before we start breaking down walls.

The next step is we don't want to be at the we. We are not at the point where someone says, hey, can you bid out this equipment? Can you bid this out? That's not where we want to be. That's not our client. What we want is to sit down with them. We want to analyze the staff experience that you want, the patient experience that you want. We need to know the EBITDA that you're trying to attain per facility. We want to understand, do you have a niche that you're trying to fulfill, like a concierge dentistry or you want to be a multi specialty facility? We need to understand that up front so that we can actually determine what the actual needs are. That is where we will actually come out. We'll sit down with you at your location, anywhere in North America. Sit down with you and analyze that. That usually takes a couple hours. And then we can actually from there we're able to put what I'll call the pitch. We'll be able to put together an idea of how we want to, how we want to approach it. And everybody's slightly different. And we have some, because we have some clients that want to put up four offices this year and some that want to put up one every 18 months. That's okay. We just need to know how to approach it to maximize the efficiencies. We literally some of the people, if you've been to the DEO meetings, if you come by our booth, you've seen these 17 inch by 11 inch blue books that I probably have displayed on our table. That is the playbook that we're developing for each of our onboarded clients. And that is the goal is to completely develop that before we even create and build the first office for you.

Amazing. So how does access DSO measure success? Is it the speed, is it the cost reduction, team alignment that gets excited about this? How do you, how do you measure that?

First off, everything that you mentioned right there is part of what we, how we measure that. We have to. When we understand someone's goal, our goal changes with that. I have one client, I had to tell her the other day, and it was, I know her well enough that she was able to laugh at me. But she goes, what do you want me to do? And I said, go home and play with your family. It is. Let us get this facility up, because every time you come in, you have a different adjustment to it. It's adding a lot of cost when in reality you're not going to get any value out of it. And as we always call it, how much juice are you getting with the squeeze? And I was like, you're doing a lot of squeeze, not a lot of juices coming out of it. Let's get these, all of these offices up and running in a comprehensive fashion, and you'll enjoy your life a lot more. Seeing people enjoy the life a lot more is one of my favorite things. I'm. I'm 50 years old. I have three daughters. This last month has been chaos because two in college are both home. And it's fun. I look at that as one of the biggest aspects of seeing the success. And that means actually taking a lot off their plate and systemizing it. You know as well as I do that you're going to have pushback from people. There's no way you could implement a system without pushback. And we've seen it many, many times. When you implement a new system, you're only going to see it for the first time. We know what to expect from that, and we want to sit down with you and say, okay, let's talk about that, so that we can implement it from the beginning properly, knowing there will still be a little pushback. But then how do we handle, how do we overcome that? Because we've worked with you to not only get the facility up, but to also make sure that your team is using it effectively so that you can maximize your ebitda.

I love that. And we all know struggles with building, whether anybody's ever built a home or, you know, expanded a practice, built another practice. It all sounds fun to begin with until you're, you know, in, in the knee deep and in the thick of it. And so to be able to have a company like Access dso make sure that there's a systemized plan and that we're following it and we're moving through, being able to accomplish, you know, the builds and the structure and putting things in the right areas, and also, you know, reconfiguring the office so that it has a good workflow and that we're able to maximize on the potential revenue in there, which, of course maximize that revenue, cut expenses, we're going to have a good ebitda. It sounds like a really Smart place for anybody that's looking to expand to at least explore 100% just in the terms of stress reduction and time reduction. And that's what I'm all about as a coach is, you know, trying to figure out how do we get people more time so that they can spend it with their family and do things like that. And, and how do we, you know, create a, a world where we're already not stressed out even more because life is stressful. Dentistry can, can be stressful at times. And so taking this off of, off of our dentist plate just sounds absolutely amazing. And there's so much innovation that's happening in the DSO world. What advancements are access DSO working on so that our listeners can maybe have this on their radar as they're starting to think about growing and expanding and being attractive and lucrative to the DSO world.

Well, there's, there is one thing that we are going to be releasing at the DEO meeting. I believe it's the end of April and we have taken all the efficiencies that we've developed over the years and put together a standardized approach that I can't tell you exactly what it does, I can't tell you a lot about it yet because we don't want to give away too much. But it's going to put these offices that have three, four, five facilities now and they struggle to compete with the big enterprise groups. We have a solution that's going to come out and it's going to help level the playing field and we're going to release it at the DEO meeting in end of April.

So. Amazing. I'll be there listening, that's for sure. In terms of those DSOs, those smaller DSOs that have five, six, seven practices that aren't, you know, enterprise size over here. Where do you believe these smaller DSOs are under investing when it comes to their long term infrastructure systems?

It's always systems. It's 100% that we see so much people running around like a cat chasing their tail because they might have this concept in their head that they really want, but how do you apply that? And how do you get, now that you have 50, 60, 100 employees, how do you get them all on the same page? And we have some clients that are amazing at that, at getting them all on the same page and they have that culture developed. I think that that's the biggest part, that if you get that structured and you tie together the culture with the productivity, it leads to the scalability very, very nicely.

So good. You've been in this space for a long time, my friend.

This building, not gray in this space.

What's one core principle that. That's really stood the test of time for you in scaling systems?

I would have to say, start from the very beginning. You can't take a system that you want and try and wedge it into something, or vice versa. You can't take a system and then you go to the trade show and you find something shiny and fun and you are sold on something, and you try and take that and wedge it into a system. It does not work. You have to. In fact, it was actually about 20 some years ago I was meeting with one of the guys who built one of the largest. It's one of the largest DSOs in the world. And he told me a very good point. And he goes, I don't care if this product is $5 or $500,000. I need to understand how it works with the entire company. Kind of like, makes complete sense. And yeah, don't be wedging stuff into your systems. You can always add stuff to it, but you have to think it through of how it's going to affect every element.

I'm so happy that you mentioned that, because as entrepreneurs, we sometimes get that shiny thing syndrome. I'm sure you've heard of it, right? Where it's like, I call it prey

to myself many times same. I'm.

I'm probably the worst offender over here, but I'm learning over time, right? Making sure I've got my financials right, so I can make some really good decisions. But we see that shiny thing, and we're like, ooh, I want that. Yeah, this. This is definitely gonna be the game changer I need. Right? And then all it ends up doing is, you know, disrupting the system, slowing us down, making it the wheel move, you know, slower and more clunkier instead of getting it to. To really move faster and be more efficient. And so, yeah, I think keeping. Keeping us aligned and focused on, you know, what is the goal? What are we trying to achieve? How do we scale this practice so that we can get to a place where we're rinse and repeating, rinse and repeating, and ultimately taking it and making it something fun and exciting and, you know, profitable at the end of the day. So I love that. This has been incredible. Ted, I'm so glad that I was able to chat with you today.

Appreciate it, Kendall, thank you very much.

For sure. As I start to wrap up, I do have another question here for you, though, because I want to know if you have any advice or anything that you would share with our listeners today that are growing fast that they, you know, should be thinking of as they start to scale, any last words of wisdom here that would be call us.

We put the system together, there's a good chance we can help you out.

I love it. To our listeners, you just got a front row look at how infrastructure, systems and leadership ultimately intersect in one of the most critical aspects of DSO growth. And so, Ted, I thank you again for being here and I thank all of our listeners from tuning in. If you're scaling, planning or just dreaming of bigger, put this episode in your playbook. Make sure you get in contact with Access DSO Solutions. Ted, what is the email address or website that they can get in touch with you at?

Call me directly or email me directly. T wegmanccessdso.com and that is W E

G M A N yes.

314-497-0403 that is my direct cell phone number. And our team will take very good

care of you listeners. You've got the phone number to the man himself and so don't delay. Make sure you reach out, especially if you're thinking about dreaming bigger, scaling, planning. What does that look like for you in the next evolution of your DSOs? And so, listeners, until next time, keep learning, keep building, and always 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.