49: The Past and Future with Dr. Charles Moser

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

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

You have helped build my marketing mind to a whole new level.

You have this natural talent, this unique ability. Hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott, and today I've got a special guest for you. Dr. Charles Moser, VP in charge of community management at DEO. Dr. Moser, thank you so much for being on with me today.

Well, it's my pleasure, Emmett, but I gotta tell you, I'm a little disappointed

right out of the gate. Like, I haven't even got into the content.

Yeah, well, you know, when my assistant made this arrangement to be on this podcast, she told me I was gonna be on Emmett Smith's podcast.

Oh, man, that is a disappointment.

Yeah. But no, in all seriousness, Emmett, it's great to be here. You are absolutely the real deal. Sandwich with double meat on it.

Oh, thank you, man. Yeah. Emmett Scott is just way too close. So I get that often. And I often tell people it's like Emmett Smith, but without the talent,

without the bruises.

Yeah, yeah. Athleticism, Dance moves. Of course, dance moves. I mean, we have to talk a little bit about that. Like, we tore it up at the last DEO summit. For those who didn't get to see it, you're lucky. But we did a few synchronized dance moves at Dr. Moser's last presentation. I was the emcee.

So that was in front of 600 people. So we are not shy.

That's right. Well, thank you so much for taking the time and being on here. Why don't we just start with a little bit of your background and kind of what got you to this place?

Sure. Yeah. So, like most people, I would assume I went to dental school thinking that I was going to be a private practice dentist, you know, for 40 years or so, and then get a gold watch and sell my practice and retire. And I was on my way to making that dream a reality. And then as life goes, I had an event where I injured my hand, which ultimately made it impossible to sit at the chair for six, seven, Hours a day. I was lucky enough to have the good fortune of knowing some people that were building a very successful group practice in Houston, Texas. And they had asked me a while back, which ultimately came to fruition, that I became the dental director for 16 locations in this large group. And so I did that for eight years. And the interesting part about it was in 2009, that group sold out to a private equity group, which was really one of the first public sales of a dental group to private equity. We kind of were on the forefront of putting the letters DSO together. Our attorneys were figuring that out. And then about eight years later, that private equity group sold us again to a large insurance company out of California with some cultural shifts that moved me out of that position. In all full transparency, they eliminated my position, which was fine. Then at that point, I actually just found out about the DEO through word of mouth, connected with some of the executives in the DEO and lo and behold, March of 2018, I became a full time employee with the DEO. So I've been there about a little over a year and a half now.

That's awesome. Okay, I want to dig into that because I really enjoy history a little bit. And though I'm not going to put you in the same group as our founding fathers or anything, but you're welcome. But you mentioned this concept of dso. It's really easy, especially for maybe people just getting out of school or entering the space, to think that this has some really long history. Maybe they're looking at some of the bigger DSOs and think that that conceptual and all the organization that you see today and the attorneys and maybe how organized they are, that's kind of always existed. And I think you hinted at the fact that it did. In fact, it really had a very rough. And it's still a consolidating industry, figuring quite a few things out, but kind of going back and being part of that group practice. How did that, you know, you started off with the concept that you said most people do, which is, I'm going to build a successful practice, and then at some point I'll have an exit from that. How did being part of a group change you change how you thought about the industry, some of the positives, some of the negatives, et cetera. I'd really like to dig into that because I think it's helpful context. And I think too, when you get global context, your situation now also has more information and meaning to be successful.

So, yeah, I think one of the things I would like people to understand Is when I was in private practice, some of my friends were starting to get into capitation programs. The DHMO product came out kind of in the early 90s, if you will. And of course, my mentors absolutely just said this was not the way dentistry should go because it is going to promote bad dentistry. And I posed that thought to one of my peers who had gotten really heavy into the HMO side of dentistry. And I kind of said to him, I go, you know, you know, you're doing bad dentistry, right, because you're taking HMOs. And he said one of the smartest things to me that a person that's not that smart ever said to me. What he said to me is, he said, you know, Charles, there's been bad dentistry a lot longer than there was DMOs interesting. And it's absolutely true, right? And so I've never forgotten that. And I took that into the DSO world too. When people would say to me, not to mention dso, we were in the Medicaid game in the state of Texas.

You were really bottom of the barrel.

Holy moly. Yeah, Right. And that was when the ortho thing was going. There was some really bad press going on with DSOs. But I always kept that statement in the back of my mind that bad dentistry knows no boundaries. There are plenty of private practice individuals charging a whole lot of money for their work. That is not the same quality that some of my associates were putting out in this large group practice. So I really think it goes back to leadership. I'll use the C word. That's culture. And it's all about what the owners want to project. And the owners of the practice that I worked for were probably, and I don't even need to say probably, the most ethical practice that I have ever been associated with. We did not play around with trying to backdoor insurance companies to get paid more. We did not over diagnose our product was. And our culture was that you treat the patient like individuals. You do as good a dentistry as your two hands can possibly do, run a good solid business. I'm not gonna say that we ignored expenses in the business side. We did not do that. And it became a wildly successful organization. So I think the first thing I would like to do is dispel the myth that the model is the decision maker of the quality of the dentistry. That is not the case.

Man, that is just like such a powerful concept. We could just let people just po right there, just sit there because it's an interesting human nature thing. And I Don't think this is limited to dentistry. In fact, none of what we deal with, whether it's in our practice or globally, strategically, or even as a whole industry, you know, stones that are throwing is unique to us because this is all human nature stuff that's just getting exposed through the lens of this industry. But I think it's a fascinating thought that when change happens and when people feel for some reason, some level of threatening and danger from that change, that they attack it as a character flaw, as an ethical component, like how can a compensation structure or a business model change a human character? And I don't think that that's 99% of the time that's true.

Well, and your statement to me, or your question to me was, I guess what did I learn? Or how did things change or what changed in me? And look, I was as guilty as anybody else when I was in private practice and I was watching my friends build this organization, making a lot of money. I will completely admit and be transparent that I figured they had to be cheating somehow. There was no way that anybody could be that successful, especially in the Medicaid game. Right? They had to be cheating. And then of course, as fate would have it, I end up working for them. But interestingly enough, like I said in there, I was like, holy cow, these guys are doing it right? They're doing exactly what I would have done if I would have built the company. And that is treat people right, run a good business and let the chips fall where they may. So I constantly said thank you to my friends that took me on because I loved my job as dental director.

A dentist recently told me that if you practice, let's say in the 80s and 90s or even today, and were not part of some kind of group, that the chance that you saw five other people's work was very limited. Right? Like you only knew your world. And so that was fascinating to me because of the ethical claims that I saw coming into this industry. And not being a dentist, I didn't know quite how to measure them. But I thought for as aggressive as people made comments, like to you around HMOs or whatever it might be, you would think that they have a very global view of what's going on. But the reality is someone that's been practicing for 30 years has probably seen their work and maybe one or two other dentists. So out of, I don't know, a quarter million dollar dentists or a quarter million dentists, that seems like a pretty small segment you've had exposure to, to make statements like that, but that never keeps people from making their opinion. So it sounds like you said one of the biggest things that opened up was models are not the same thing as ethic around dentistry.

Absolutely. Well said. That is absolutely correct.

And I would say, if I was going to argue anyway, that a group practice feels more exposure towards standardization and probably has more pressures to figure out how to do ethical dentistry and create culture. Not that they all do, but you can hear it.

I mean, I know you have, but for your listeners, anybody that's followed the Medicaid market from the 90s on with some of the changes that took place and some of the fraud, waste and abuse. That was the tagline, right? Medicaid dentistry, fraud, waste and abuse. If you followed that, then you know that if we were gonna change our name to Target Dentistry, because we knew we had a target on our backs, we knew that the community was watching, the state board was watching, Medicaid was watching, Health and Human Services was watching. And that good old reporter from Dallas, Texas, was definitely watching. And there was also a lawyer that was watching. And ironically, that lawyer was a patient of mine in private practice, but he was also on the news many times being an advocate for the patient, which we have no problem with. I think patients rights are very important and they do need an advocate. But the point of the matter was, is that you said it. We had to cross our T's and dot our I's way, way better than anybody else in private practice who was practicing, you know, doing $80,000 a month of dentistry, which is a nice little private practice. But ain't nobody watching those guys. There's nothing, you know, nobody really is concerned about what's going on there. But when you're doing $200,000 a month in Medicaid, people start watching. So we knew we had to be better than everybody else when it came to compliance, when it came to patient care, and when it came time to taking care of people.

Yeah, let's tease that out a little bit, because I don't know that that's inherently understood if you haven't been in that world. But first thing is, if you put, you said 16 practices. So let's say there was 20 dentists or. So you put 20 dentists who can see each other's data. By the nature of that, you've now shattered What I just mentioned, 80s and 90s was go 30 years and never see anybody else or only one or two. Well, now you've got 20 guys watching each other in real time. If that doesn't open up conversations, I don't know what will. So everyone trying to work towards the mean, trying to understand one another's approaches, et cetera, you get a standardization and you get, I think the word that I'm hearing more and more is evidence based dentistry start to develop out just because you finally have a mastermind group that's built out from there. But then like you said, if I'm an attorney, it's much easier in my business model to go after a group than to try to target individual practices. It's, it's just so much more work to go after individuals. And if I'm a regulator or government, it's a lot easier on my spreadsheet to sort by names or owners of practices and so forth and say, okay, where's the largest dollar amount?

Right.

If I can get 10% from them, that's more than trying to get three of these guys all together. So there's some economic components that we forget. These other business models regulators and attorneys also use. Right?

Yeah, I would think everybody would understand the concept of deep pockets. And yeah, when you're a 30 practice group, there's some deep pockets there. And then when you also throw into the mix that dentistry is a little different in every dentist's hands. You know, we all kind of do it just a little bit differently then as an attorney that would open up a lot of opportunity for inconsistency. You know, if I was an attorney, I would say, oh well, if they're all doing it differently, then the result has to be different. It would make sense that way, but it's really not. And dentistry is very much evidence based and the ends does justify the means a lot of times. But yeah, I mean it was a real eye opener to go to work every day knowing that we had to be better than everybody else because we were being watched quite a bit different

than what your friend told you. Yeah, yeah, but that's a shift, that's a big shift of going from, hey, this might be the unethical approach to going, not only do we need to be ethical, but like the world is watching.

The world was watching. And Medicaid practices in the 90s were on the news every day. And you know, I think again, the other thing that people certainly, I don't think dentists lose sight of this, but the public loses sight of this. There are some bad outcomes that happen in pediatric dentistry and they happen for reasons that many times are beyond people's control. If a three or four year old is in the dental chair. There is very little medical history that can be taken on a three or four year old. And it is extremely unfortunate when there is a bad outcome. But I think what the public loses sight of is when there's a bad outcome, the dentist feels terrible. I mean, imagine if you were the provider for that child that had the bad outcome. It's pretty hard to get up and go to work the next day. And I think that oftentimes the public loses a little sight of that. The tragedy that happens obviously affects the family the most. No one would ever disagree with that. And because I don't want to use a. But there, I'll use an. And there's the other end of that line too, where the provider goes to sleep at night, wakes up in the morning and has to figure out how to go to work and still continue doing what they're supposed to be doing. So, you know, it's a big deal. It's a really big deal.

It's interesting. I wasn't thinking about going down this path, but just talking to this a little bit. One of the things I've watched happen in a lot of the dental practices we support is the dentists have also felt more and more pressure to use more and more drugs to make sure that the patients are calm and happy. And there's no crying, because the last thing they want is some Facebook post of my child went to the dentist and they cried. Now they cry when they get their hair cut, too. Yeah, there's these interesting pressures. I've always said dentistry is one of the hardest health cares to provide because it's the only one where you have to drill on the patient's bones while they're awake, but still make it a good experience.

And they're long appointments. You know, we typically keep people in the chair for a long period of time. So I have. Dentistry is extremely unique for the things that you mentioned. And I think I want to bring up one more point that kind of puts a target on dentists back in general, especially in the group space, is this whole. Dentists are paid on a production or on collection, which makes it appear that they're incentivized to do more work. I'll even go so far as to say, yeah, we are incentivized to do more work by the fact that that's how we make money. But I would ask people to look at the rest of the world out there. Every salesman out there is incentivized to sell more stuff. So the reality of it is, look, it's culture. It's ethics, it's your morals, it's your core values. You gotta make a sale. But sell the things that are the right thing to sell, and you really won't find yourself getting into too much trouble that way. Yeah.

Yeah. Well, we could have the whole argument that if dentists are supposed to be salesmen, they really suck at it. Cause if you look at any practices, unscheduled triple treatment, you can say we got a long ways to go to. We're probably still under. Treating most patients because it's a hard thing to sell.

It's not a cell phone, you know, or a new pair of shoes.

No. Yeah. People aren't lining up for the new upgrade of. The new upgrade of root canal coming out, version 10.2.

Right. But yet, if you bought a new car last year, if you bought a new car last year, I guarantee you, as soon as the new model comes out, you're getting a brochure and a call from the salesman that sold you that new car to tell you that the car you bought last year is like, are you kidding me? You're still driving that old hag crazy.

That's awesome. Okay, so you went through several stages, it sounds like, early on with private equity. And did you end up interfacing with them much? And what was your experience there? You know, people have a lot of mixed experiences, and again, those who have no experience have the biggest opinion.

Yeah, right, right.

What would be the pros and cons?

Yeah, so.

Well, I mean, you were at the provider level. You were clinical director and so forth. But, yeah, I'm real curious, like, what did you feel? What did you not feel?

Yeah, I would say that I wasn't quite inside the circle, but I was definitely on the border of the circle. I certainly interfaced with our CEO and our CFO quite a bit, and I found it to be. Maybe it even put me in a better position because I got to watch the partners and the owners interface with the CEO, and I got to watch that conflict, basically. And what I learned from it was conflict is not a bad thing, especially if you have an alignment of values, which I believe they did. I really felt that the business guys did want us to treat people well, and that was their underlying core value. Now, do they want to make a lot of money? Sure. I mean, I want to make a lot of money. I don't think that's the devil. Right. I mean, we live in a capitalistic society. That's what we're supposed to be doing. If we lived in a different society, I would play within those rules, too. I don't have a problem with that. So I thought what was interesting was that we created, or they created at this company, a really nice yin and yang. It was definitely a kite and a string type of relationship. And both are extremely important. Right. One is no good without the other. So I did not feel pressured to. To do anything that was outside of my comfort zone. But I also enjoyed the ability to have someone to learn from that had an education that I didn't have. And so it would have been very naive of anybody on the clinical side to put up roadblocks or to put up walls and say, I'm not going to listen to you. You know, I'm going to do it my way. This is the way we became successful, and this is the way we'll be successful. And that wasn't the case. I mean, there was plenty of conflict and great heated discussion. But at the end of the day, I think what came out of it was another version of a really good model. And I think it just kept evolving that way. And I think our profitability showed that it's awesome.

I think in the best scenarios. And tell me if this was some version of this you were. You are experiencing is a lot of times the biggest tool the business guys have is some series of data and spreadsheets, and we often make fun of them for that.

I've never argued with a spreadsheet, though. Who said that? Who said that first? Right.

Well, my business analyst will often joke with me and say, well, I did the hard part. Now you guys just have to execute. And spreadsheets never talk back about the changes you make.

That's right.

But what's interesting about that outside perspective in the spreadsheet is that often it's wrong about what could be executed on. Like you said, it is somewhat of a kite. It's somewhat of an ideal. Hey, if we could trim this much, hey, if we could do more of this. But if taken in the right context and with the right respect on a team, it can push the mindset to say, are there areas of care we're not providing? Are there efficiencies in our flow or in our cost models that when we were smaller, we just didn't worry about and didn't care. But now we look at this, and this could actually create a better patient experience, better outcomes and more profitability, which at the end of the day, what more profitability really allows is for us to access more patients. Right. Because now we can do another practice. We can hire More people, et cetera. So anyway, is that somewhat. What you're talking about? Was there was this push of, here's what we're seeing now. How does that translate into actual clinical work and can that work?

So, yeah, that's a good part of it. And I think, look, every. No, I don't want to speak for everyone. A lot of dentists nightmares, especially in the group practice, is someone coming them and trying to suggest how they can do more. Because, you know, we're already doing what we can do. And if. If there was a way to do more, we would know how to do more. And I would challenge every dentist out there that we really don't know how to do more. We know how to do dentistry, but we don't know how to do more. We're really not experts in efficiency and we're really not experts in scaling and we're not experts in profit loss statements. What I found was that if we could just check the ego at the door and come in and listen to the experts about what they're experts about and if they would do the same thing, check their egos at the door and allow us to be experts where we are experts. It's a tremendous marriage. It is really. It's flammable.

Comes back to your culture word again, though, if you get that right. That trust and that safety zone it creates can get exponential results that neither party by themselves can achieve.

Yeah, we were absolutely. The definition of the sum was greater than the total, was greater than the parts. The sum of the parts. Yeah, no doubt about it. Now, moving on, when private equity sold us to that next investor, if you will, that insurance company out of California,

which I'll just set some context here, Right. If I'm going from private equity to an insurer that's very large, that's been in the dental space for a long period of time, I just have to tell you, my mindset would be this is moving from someone who doesn't know what they're doing to someone who really understands because they see these claims, they interact with providers. I would kind of feel like I was upgrading a little bit. So I'm setting the stage for a year.

Yeah, that's a completely logical way to look at it. That absolutely didn't happen.

Yeah, yeah.

Theory and execution just totally went awry. And I mean, I'm probably. I'm not going to say the name of the company that bought us, but it rhymes with Lardian and it does. You know, look, I mean, there was a lot of discussion about Conflict of interest. Why should an insurance company have the insurance policy, have the patients, and have the provider? Again, I really don't think it matters. What matters is the alignment of the people that are providing the service with the alignment of the people that are running the business. That's what got wonky in this next transaction. When we talk about the C word, it changed dramatically. The. The organizational chart changed dramatically. And it went for me personally. It went from the best job I've ever had in my life to the worst job I've ever had in my life.

Yeah, that's fascinating. And on a tactical basis, we said, hey, if the business guys come with some new insights, they respect the clinical feedback and the clinical pushes back, but they push back with open mind. That's what creates the synergy. So what would have been different than from your perspective? Where did that go sideways?

Well, their model was to remove, I'll say 90% of clinical leadership, and they inserted operations people into those clinical leadership positions in an attempt to raise the ebitda. Right? Lower expenses, raise the ebitda. I think that if you're a clinician listening to this call, I think you would probably agree that you want to be taught, you want to be mentored, you want to be educated, you want to be led by another clinician, not an operations person. So that in itself changed the culture dramatically. Then in my opinion, there were some very bad decisions made from a treatment standpoint, from a care standpoint, that just were not congruent with the genre of patients that we were seeing. And then ego got in the way. There was a lot of ego at the top of the food chain in that organization. And because they had had success in another area, they immediately assumed that they would be successful in this area. I would really like to make this statement, Emmett. And this is a little bit of a write down for people. And that is that success and failure are really both the same imposters. And what I mean by that is timing is so important for whatever you're doing in life. And success sometimes can make you think you're smarter than you are, and failure can make you think you're stupider than you are. But really the only thing that happened was timing was wrong. Yeah.

Well, when I was in financial planning, there was a shirt that was going around that I absolutely loved. It said, don't confuse brains for a bull market.

Yeah, there you go.

This is about 2000. That's right, 2001. Everyone proved they weren't quite as smart as they thought they were.

You could Throw a dartboard at the stock market.

And what I love about what you're saying is it reinforces what we were talking about in the beginning, which is this isn't a unique issue to dentistry of, hey, I've been successful in single practice ownership. Therefore anything different than that is wrong and evil. And I'm brilliant and I know what I'm doing. And hey, I've been successful in these other industries. So how you're doing it is wrong and evil, or you're not as efficient or you could be better. Like just arrogance and ego just doesn't work well. Right. I mean, it's just, it's where we're at in the world. And I don't know enough to know if maybe at some point it worked. Okay, maybe in a factory industrial age setting you could get away with a bigger portion of it. But from what I've read about, you know, Carnegie and others, I don't think that's true either. I think their differentiating thing too is the way they built trust and connection with people.

I think ego and volume work well in the military. You know, the beatings will continue until morale improves.

Yeah, well, I just read Extreme Ownership with Jocko and he's like, that's not true, it's not true. But you're right, they probably can get away with a little bit more. But even there, I think, you know, they're starting to find, they can find another level of efficiency through trust and connection.

Right, right.

So I agree. So, I mean, that's huge. Just maybe as a warning out for everyone, could you give us like one scenario where they really gummed it up? Because, you know, I'm always interested in kind of protecting myself from myself. Is there a scenario that kind of concisely you could say they thought they saw an opportunity, they did it this way and they didn't listen to anybody. And then it just fell on his face.

So, yeah, I mean, this was amazing to me. So again, set a little context. We were the largest Medicaid provider in the state of Texas. Okay. I believe we had anywhere from 9 to 11% of the entire Medicaid market in Texas. It represented, depending on which office you walked in, anywhere from 65 to 80% of the patients that walked through the door. The insurance company that bought us thought it would be a good idea to train every. They were looking at a top line possibility here and they thought it would be a good idea to train every clinician in a 55 office group practice. They closed down all the offices, rented huge Ballrooms at expensive hotels, and trained every clinician to be an Invisalign provider. So we were gonna start providing Invisalign care to Medicaid patients.

Is this because the dentists were kind of crying for that and said, hey, absolutely not. All right. So this was a total push campaign. And if I know anything about when these go wrong, there was a spreadsheet involved, and they said, look how many patients we have. If we could just do this many Invisalign cases across this many. And all we have to do is get all these people to learn a new procedure, get all the staff to do it, get the financing to work. And we're not going to beta test it. I understand. We're just going to pull everyone in at once and roll it all out as one big push. Or did they have five? They had already beta tested and were extremely successful.

So their beta test was some offices that they owned in California and Utah. But the difference was the concentration of Medicaid or Medi Cal patients in California. They were really more of a 50, 50 mix with Medicaid and fee for service patients there. And I don't believe every clinician in those offices was trained. They had a few that wanted to do Invisalign that were good at Invisalign, but again, they had some real issues there. They had a guy that had started something like 75 cases and then decided he wanted to leave the business. So he left that office holding the bag for over 50 Invisalign cases that weren't complete. So now you have the issue of trying. How do you transfer an Invisalign case to another doctor in that environment? It's not a private practice where there's only two or three docs there. Even that beta test really didn't go swimmingly. Well, then, yes, against the advice of the clinical team of my group, we were like, I really don't think this is a great. What we should have tried. So they. They got the order backwards. They trained everybody in Invisalign in hopes that they were going to increase the number of fee for service and cash patients. What probably would have made better sense was to try to first raise the percentage of fee for service and cash patients first. And when you saw that that experiment was working, then you should have trained a couple of key. Some of your better clinicians that wanted to do Invisalign on Invisalign. Now, my new metric as a dental provider was, how many Invisalign starts did you do last month, Charles?

The answer was out of everything going on, all the revenue potential, that was the one thing.

Consistently, that number was zero.

Interesting. I'm going to push on us a little bit here because you made a couple of comments about things they did poorly, and I'm going to just pressure test it. You know, one was putting more operations and less clinical. And two, the way they. They rolled this out, you know, because there's somebody listening who said, I've done both of them, been very successful.

Right.

There might be even someone who says, I have 100% Medicaid, I've rolled out Invisalign and it's gone well. And I believe that that could be possible on both scenarios. I think the underlying thing that's the real takeaway is how they did it and how they aligned with the clinical team for execution. Because in human nature, if those dentists all said, I get this, I want it. We've worked through all the issues, and I can see why this would be so much value to my patients. I've got the support around me that now these are a lot of hills to climb. But if that time had been taken and those guys said, this is the best thing for our patients and we're going to make this happen, that organization could have done it. I believe it could have been executed on, or they would have gotten to a place where they said, this just isn't the right fit. And you just kill the project early on and move over to say, but what our patients could use that we're not doing more of is this. Like, that's the power of a really great culture and conversation is you probably could have found something that would have moved that top line right in the right direction by increasing value in the right area.

Yeah. Again, I think you said it best when you said, how do you beta test it? And I think that you're absolutely right. Somebody out there is probably shaking their head wildly. No. And saying that everything that I'm saying is wrong. And they'd be absolutely right. I would say congratulations to them. I would also suspect that if we got them on the call, they would say, well, we did it a little bit different. And that little bit of difference would be like, oh, okay, you put salt instead of sugar in your pasta sauce. And it did make a big difference. Right. Yeah. There's a way to do it. I'm sure there's a way to do it.

Now you're at an interesting place that I really have a lot of respect for, which is being at the deo. I have a lot of respect One for the organization, but I've been at a place where, in consulting and other positions where I get to see what's happening in the industry. And so I'm just thrilled to have you on because you get to talk to dentists at all different levels. Like that's your job every day, right? So talk about a swing from being in a private practice only kind of knowing your work to now you get to talk through every problem that's happening in the industry. So what, what got you there and what was kind of intriguing about this position you now have?

Well, what got me there was that I needed a job. You know, I mean, after I separated from my group practice, I was fortunate enough to, you know, make some money there. And that was nice. And I did take some time off, but you can only stay at home for so long with your wife and your two dogs. And so, yeah, I wanted to stay in dentistry. I couldn't go back into private practice. That wasn't an option. And I saw this, you know, look, this group practice thing, this DSO thing, is a train moving down the track. If you want to be superman and get on that track and put your arm out in front of it, then God love you. I hope you've got good insurance. But it's really one of those either, you know, get out of the way or get on board, so to speak. I'm not saying that group practice DSOs are going to take the lion's share of, of the patients out there. I don't think that will happen. I think private practice will always be the dominant player in dentistry. But DSO and group practice is growing. So my why for this whole thing was pretty much the same. Why when I became dental director is my history, my roots. My decision to go into dentistry was to help people. And if the group space is going to increase and grow, then if I have any opportunity to keep the quality of care high so that the patients are as confident and as comfortable going to the dentist as they were in the 50s and the 60s and the 70s when it was one of the most ethical businesses in the world, then that's what I want to do. So when I joined the deo, my why was is that I wanted to make sure that I got to talk to group practices to say to them, look, treating people well is still a really good recipe. That hasn't changed. Now you want to look at KPIs, marketing is way different now than it was in the 80s and 90s. And all of that is very important. I mean, we there's only two ways to make money in dentistry. You need a combination of two things. You need somebody that has a need and somebody has a way to pay for it. If you don't have that, then you're just taking a walk. But I wanted to make sure that people understood that whether it's group space, whether it's private practice, small groups, DSOs, not DSOs, whatever it is, quality of care is still the way to be successful.

That's awesome. Well, that and I think that aligns with the culture of deo. What's kind of your role like day to day? And

I'm back to having the greatest job in the world. I mean, and we talk about knowing a lot of people and seeing a lot of dentists work. I mean, I went from private practice to working closely with 45 associates. That's closely. I interviewed hundreds of clinicians over an eight year period. So the amount of dentists that I know, the amount of work that I've seen, I never. This was not what. This was not on my five year plan when I wrote it coming out of dental school. And now I get to play in a sandbox with I think the DEO. We're at about 140 members and those are groups. I think we're close to representing a billion dollars of revenue per year, which is crazy.

It's about having an impact on the industry. Right, right.

And I get to work with people that have 25 groups and 100 associates and guys and girls that have two practices and three associates and they're just trying to figure it out. And I get to put those people together and watch the magic happen there. At the deo, our model is that we believe that connection is what makes the world go round. And so to be able to put those people together and have people say, how did you do this? What did you find when you did that? And people actually taking things away from it, making things happen. It's a great job. And I get to dance on stage with you every once in a while.

Yeah, that's right. That's right.

How much better.

It sounds like culture fits good too.

Culture fits very well. But I will tell you, I have a business guy for a boss that is, you know, we are kite and string for sure. But it works just beautifully. We really, we really, the whole team, the whole DEO team just really makes things happen.

What's the biggest question that you're getting from members since you have dentists at different levels, where do you see kind of things going to based on those questions? So, first of all, where are people struggling? That's probably where you're getting questions from. What challenges are they trying to overcome?

So the biggest just nuts and bolts question that I get from the dentists are, how do we recruit associates? How do we retain associates? I'm in New York, New York, so the density is huge. How do I find a dentist there versus I'm in rural Virginia. How do I find a dentist there? And the answer is really the same. It is different. And it changed when I was in group practice, too. I mean, we had a situation for the first three or four years when I was there, dentists fell off the tree. You know, I mean, we just shook the tree and dentists fell into our organization. And over the course of my eight years there, that changed significantly too. With more opportunity for the young dentist coming out of dental school, which is great for them. They did have more opportunity. That opportunity was still in the group space, but nevertheless, they were starting to have more options. They were starting to be able to negotiate. But really the biggest question for the small groups or the groups nowadays is, where do I find associates and how do I retain associates?

It's a fundamental shift that happens when you're, and I've said this in previous podcasts, the moment you hire one associate, you're a dso, right? Because your customer just switched from being the patient. Now the patient is the customer of your customer. Your primary customer now is, how do I take care of an associate? And that sounds like a dental support organization from a culture and a mindset perspective. So I could see why that would be a primary question, because that's a big shift to go, hey, this used to be my customer. And sometimes people argue, well, no, they're an employee. And I would say there's nothing about that relationship that you can just say, it's an employee relationship. There's just too much that seems like, no, this is a customer that ends up making the organization a lot of money. They're actually a big customer, and we need to support them and help them to be successful.

Yeah. Branson says the most important person in your organization is your employee. Take care of your employee, they'll take care of your customers. I totally agree with that.

People are a little shortsighted on that. I sometimes get the questions like, so what's the bonus program you use to get to hire people? Or just some kind of tactical component which is part of it, but not really hits at the heart.

Well, I think that what I see is a lot of organizations that want to put all of their employees, all of their associates in the same box. Here's our bonus structure. Well, a bonus structure might not be what a newlywed really wants or a 59 year old dentist really might not be interested in the bonus structure. So I think what I'm finding and my recommendation to people is that you have to create a menu of different types of opportunities for your associates to choose from in order to retain them. It might be a cash bonus to somebody who's looking to buy a house. Right. They may want another $10,000 to put down as a down payment for their house. Well, $10,000, $15,000 might be just exactly what you need to get them to sign on for another three years. A little bit of a golden handcuff there. But the 59 year old guy or girl, of course, who they may want something completely different. And then the 40 year old person may want more CE, they may want to learn how to go do cirac or eat 4D or Invisalign, whatever it is. And so you really need a menu. And is that a real pain in the butt from an administrative standpoint? Heck yeah. And you know what, I'm really sorry, it's really tough to be a leader,

but you speak to something which is these stair steps that we think are incremental are typically, we're signing up for something exponentially harder now. Exponentially more rewarding, possibly, but exponentially harder. And so it's like, I think one of the things that the DEO has done a great job of is are you sure you really want to do this right? And you all are very open. You're not just taking people's money and selling them a dream towards, towards the future, which frankly, several of the industries are open to doing that and are motivated to do that. Yeah, let's open another office. And here, let me get you a bunch of equipment and everything else in there. I think you all are very thoughtful around. Hey, is this really the lifestyle? Is this really the challenge you want to take on? Because here's the list of things that you're going to have to start thinking and becoming.

And I would say out there, look, probably most of the people listening to this are not members of the deo. So a little bit of advice, and that is what we preach, is that make sure your organization is stable before you start to expand. Now there's all types of different ways to evaluate levels of stability. But just as a quick example, if you don't have good margins right now and good patient flow and good stability in your executive team or your employees, then it might not be the right time to buy another practice. You're just adding chaos to the organization. You're absolutely right. Our motto at the DEO is not buy more practices, build more practices at all. Our motto at the DEO is figure out what your vivid vision is. Figure out what it is that you really want. Bring it to us, because we probably had 25 to 30 people who have had that same vision and mission, and we'll hook you up with those people and we'll help you achieve what it is that you want.

It's awesome. That might be a good tagline to end this on because that was awesome. And what I really appreciate about this podcast, and I hope our listeners will draw from this, is what's made you successful. Dr. And I think what makes your insights valuable is you really understand that change is built into the system that you've given several examples where your mindset and paradigm had to shift, where you saw you got advice from people that was wrong. But you've also been in scenarios where the relationship and different perspectives worked amazingly well together and it accelerated not only your career, but their opportunity as well. And I think that's a huge takeaway from this conversation, is if you're going to be successful and if you're going to sign up to go to the next level, get ready for a little bit of an emotional butt kicking because there is some paradigms that you're going to have to rip down and, and some changes you're going to have to make to get to that next level. Is there anything you would add to that?

I would just echo that. I mean, if I had to give any young people any advice out there, it's echoing that in that look for change. You don't have to make the change, but look for change. Don't be fearful of it, don't be resentful of it, but look for it and study it and become an expert on it. Because it may end up being CEREC, which if you remember, CEREC 1, 2 and 3, not a great product and a lot of people just decided they were going to throw that in the trash can. But look where it is now. I mean, it is a viable player and a lot of people missed it because they just decided that they were not going to be a part of it because it wasn't working at version 1, 2 and 3. So the mind is a parachute. It works better when it's open. And just don't be afraid of change. You're going to have to change.

It's awesome. Hey doctor, thank you so much for taking the time today. If people wanted to get to know more information on deo, we've mentioned it a couple times. Can you just give websites and contact info so they could

I give the website? I should know the website for the deo? I think it's. I think it's. I don't know. Emmett, what is it? Deodentalgroup.com yes. Yeah, I know that if you Google deodental entrepreneurial organization, you'll find us. Yeah, I should know that.

Deodentalgroup.com you're exactly right there. I was able to fact check you.

I'll even throw out my email address if people want to contact me, which is.

I think that'd be helpful.

Cmoser which is c m o s e r@deodentalgroup.com.

perfect. Perfect. Hey doctor, thank you so much. And you're also part of our Facebook group @DSO Secrets. So if people have further questions they want to ask, they can bring them there. I really appreciate your time being with us today and to all our listeners, keep smiling.

Yeah, thanks, Emmett.

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