74: CEO of a DSO with Dr. AJ Acierno of DecisionOne Dental

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Hello everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott, and I'm here today with Dr. A.J. acerno, CEO of Decision One Dental. And man Doc, you were talking to me just before this about your morning. So thank you so much for being here and being willing to share and let me ask you a bunch of questions, but I mean, just to start off like the day in the life of a doctor running multiple locations, a dso. Yeah. Tell us about what your morning was there in Chicago.

Yeah, I mean, it's been a tough weekend for us, you know, emotionally and actually physically. I mean, a lot of. We had our riots this weekend and one of our offices got pretty badly, you know, damaged in the situation. But in saying that we, you know, I have patients also this morning, so you can't miss out on the patients. So, you know, start seeing patients at 7:30 in the morning. So, you know, it started around 5am Trying to figure out how do I, how do I deal with this issue now we just got done with the pandemic economic crisis and now we're sitting here, all of a sudden we got the National Guard who are shutting down the city because of protests and riots and you know, having an office affected by that while we're seeing patients during the day today. So it's, it's been, it's been one of those days, you know, I don't

even know if it's like, if it's one of those days, you know, your new normal reached an ultimate level here because. Yeah, I don't think we could have written this and I, as we would often say in things less dramatic than this, you know, where was this in the business plan?

Right. Yeah, yeah, that's, you know, I had a, I actually one of my patients today, he came in last week and he was in emergency and I saw him today to help him out, but he's a professor at the University of Chicago. And he does this business course, and he's kind of. He's 83 years old, and he's been this guru business course guy at the University of Chicago and actually has helped me out a lot during my career of learning some business. But, you know, he came in and told me, he goes, you know, that you need to go into. And become a professor when you're all done, right? He's like, because they're gonna write books about what's going on right now that you guys don't even know. You can't even imagine this because there's no way to teach it. You're the only people that can teach it, you know, and that's. That is. It is a true story. I mean, it's. I guess you don't understand it, but again, I can always understand. I always thought of myself as running the company through an economic crisis. I mean, it comes and goes. And you're going to do it. I mean, if you run a company long enough, you're going to have an economic crisis. But to run it through a pandemic. And then now running it through, you know, one of the worst riots and, you know, protests that we've ever seen in the history of Chicago here. I mean, and that's coming from, you know, police and, you know, the National Guard. I was out there yesterday, even the ones that have been here, you know, during the riots of the Democratic National Convention riots in Chicago. I mean, it was. It got pretty heated this weekend. So it is crazy. It's. It's an emotional roller coaster. I think it's an emotional roller coaster for our team members. I really feel bad for them. You got to remember that, you know, because you're going through all the emotional rollercoaster as a leader. But as a leader, the team members don't really care what you're thinking, Right? They care about what they're thinking. And that's what you gotta. You gotta remember that. You gotta put your hat on and just go, everybody's going through something. And our Chicago offices, I would probably say about 30% of our team members have somebody in law enforcement or something that's on the front lines, you know, dealing with some of these violent protests and stuff. So. And then you have the other side where, you know, some of these people are going through. They. All they want to do is some of our team members want a peaceful protest, you know, and so you're. You're really, You're. You're. You're navigating through all that stuff. So I Somebody asked me today, like, well, you must be used to this because of the COVID issue. And I said, this is way different. This is. This is like, deep emotional stuff. You know, the COVID stuff was more strategic. And it is strategic still. I mean, it's not over. So it's not even close to being over. But that's strategic. This is emotional, and this is. This is tougher. Yeah, yeah.

And, you know, you brought up right there, like, out of the gate, probably the principle of leadership that has really served you, which is. It sounds like having empathy for everybody. That's. That's going, you know, of everything that's going on and how are they feeling through this, et cetera. There's a lot of things to have empathy for. You know, how do you. How do you balance that against, you know, the quote, unquote, strategic plan and the business?

That's a great question. Because our three values are altruism is the number one value that we have. Teamwork and excellence. Right. And altruism is a really tough one because it's, you know, you treat others better than yourself. And so whenever you have to let somebody go or you. You have to write somebody up or something like that, you know, that can always get thrown back in your face because you're like, wait, hold on a second. You're not treating me as you would treat yourself. You'd never write yourself up or you'd never fire yourself. So therefore you're not altruistic, you know, but that's. That's a tough one. But that's why we picked it, you know, because we do believe that, you know, servant leadership and making sure that you have empathy with people. We teach this. We teach lead in our offices. So we listen, empathize, ask questions, deliver, you know, so that empathy is really important in the values that we have at decision one, whether we're dealing with patients or whether we're dealing with our team members. Because, you know, if somebody comes to you and says, I'm not coming into work today, I'm fearful. You know, as a leader and sometimes as an owner, I should say your first reaction is, I mean, I'm going. You should be. You know, so. And you have to check yourself, you know, and you have to empathize, and you don't know what they're going through. And you got to start asking those questions of, okay, why are they going through this? How can I help them? You know, that's. Sometimes that's really tough. You know, that's. That's, you know, when Covid's going on, and you're trying to ramp offices back up, and you have this strategic plan. Then all of a sudden, somebody just busts it open and says to you, hey, Doc, I just don't feel safe coming in.

I don't. I don't feel comfortable. Right. You're like, the amount of mental power you did just to. And we were probably giving us too much credit to even call it a strategic plan. It's more just a rejectionary emergency plan. Right. And then someone's like, well, I don't feel comfortable with that, you know? Yeah, you have to step all the way back and remember the human component. Huh?

Wait a second. That was a part of the plan. Yeah, that's exactly right. You know, but I have three kids, so I'm used to that. So that happens when you're a dad. But the other thing, too, is, I mean, when you're dealing with all these people and you're dealing with some of these really tough issues that are occurring, especially with the COVID you know, coming out of the COVID when you set up a strategic plan, great leaders understand that it's the beginning of a plan, you know? And believe me, I'm the first to always raise my hand that says, like, hey, man, I fail as a leader a lot of times, you know, but sometimes you go into there and you go, okay, I just spent three days working on this plan. This is what we're gonna do. You know? And then all of a sudden, you find out, wait a second. They don't agree with it. The people that are implementing the plan don't agree with it. And sometimes we've. That's our biggest mistake, you know, is we just don't listen to the front lines. We don't listen to what's going on. And then you got to stop and say, wait, there must be something, you know, and let's try to figure that out to correct the situation. And we've had to deal with that, believe me, in the last two weeks, we really had to deal with that a lot, you know?

So tell me a little bit about that. I mean, maybe we should start a little bit at the beginning. You know, you're a clinician. You come out of school, you know, you start a practice or you work as an associate for a period of time.

Yeah. So, by the way, I apologize for being outside. So I saw patients all day, and then I had to go to the practice that was affected by the riots, and I am not allowed in that house unless I, like, disrobe and shower immediately after seeing patients all day. So that's why I'm stuck outside. So there's like a big X on the door.

So good for you. And we're glad we're not doing the podcast, you know, after the disrobing. So we kind of free or after. So.

Yeah, so I apologize for that, but. So go ahead. The question was, yeah, so I mean,

just from the beginning a little bit, you can shorten it down. But, you know, when. When you talk about kind of where you are today, I mean, you started off, you know, a clinician. Did you do it as associate, or did you go right into owning a practice or.

Yeah, I'll give you. I'll give you kind of the story, but I'll give you kind of the short version. You know, worked for a large DSO coming out of school, learned a heck of a lot, but also was just kind of like, oh, man, there's just something else, you know, there's a burning desire inside, you know, for something else. And. And I didn't, at that time, I didn't really know what it was. I thought it was, okay, I want to own my own private practice. And I started my own private, you know, bought a private practice. I got lucky. I bought it in a building that had four other dentists that were older than, you know, dirt. And so we ended up buying those other doctors practices and moved them into ours. And I started figuring out, wait a second, I have a burning desire. I like the business of the practice. You know, I enjoy it. I enjoy, like, the leadership side, the aspect to it. And then my brother, who's a dentist, we decided to start up, you know, kind of our own dso. And that's really how it started. So we bootstrapped it around seven practices. We got a angel investor in, and that helped us get us off all the personal guarantees and all that stuff which end up, you know, that stuff that kind of keep you up at night, you know, when you have a small group and you're just starting. So we were able to do that and give up very little of the company in order to do that. So we were still majority, major, majority owners. And then it was just in 2018, I started figuring out, wait a second, I'm 20 practices, 25 practices, and I need support now how do we support ourselves? Because, you know, what ends up costing a lot of money is the support, you know, the support system that you have. And all of a sudden you. You look back and you go, holy cow, I got this. I got this. Call center. And I got this insurance department, I got all this stuff. And they keep asking for more people and what do you mean you need more people? And you know, and it's really that the growing the support center and growing your acquisitions, because we're acquisitional based is. It's a stepwise process. So we were talking, I was talking with a lot of people at the Adso about it and struck up a friendship with Steve Bilt. And Steve is a great mentor and a great person in the whole entire DSO world.

And by the way, he's for next week, so is he really?

All right. So, you know, and then Steve and I were. Steve was actually, he was, he was coaching me through how to go to private equity and how to do all that stuff. And then I was just like, man, I just, I've interviewed like 15 private equities. I just, I don't like it. You know, it's not, not my cup of tea, you know. And that's not knocking anything. That's not knocking any of that stuff. I actually like private equity. It's just no one came to me and said, hey, listen, I got this problem in it. And they were like, I can fix that. They were all like, well, I can hire somebody to fix that. And so I was like, man, I

don't something AJ that I almost want to go back to just for a second because it was like so valuable. But you made the connection right there at the beginning of what drives a lot of dentists to want to go multi group. And then dso, because you said at first the word business. And then you said, I just felt like I could have, you know, bigger impact and I enjoyed the leadership part. Now, you know, you're getting really neck deep in leadership right now, right? Global pandemic, riots, et cetera. But I think for a lot of people, when they connect to dso, they immediately think P and L, right? That most people get attracted to this because of, you know, a profit loss statement, the financial outcome, etc. And you know, I don't think anyone in America shows up and, you know, wakes up in the morning and doesn't think, hey, you know, can I put my financial self in a better situation? But you can't do what you're doing if that was the only reason. You know, I mean, a big part, I think as I've talked to different leaders and CEOs is part of their compensation package is the development of their personal leadership capability.

Yeah, yeah, I. Okay, so I'm still a wet fingered dentist, right? And I have been. I. It was just three years ago, not even two and a half years ago, that I stopped working five days a week at the chair. And everybody always thought, well, that's crazy and this and that. And the answer is, when you're. When you're building a company, if you take all the money out in order to pay yourself, I mean, we, as Dennis, we get paid very well. If I decided to pay for what I was doing, I was running a 3.4 million dollar practice in my own practice. So when you're at 3.4 million dollars and you're. You're the dentist, you're making some good money, right?

Yeah.

There was no company that could afford to pay me when I was making as a dentist. So the fact is, I didn't want to just pillage my company in order to pay myself. So I'm just out of. Out of dentistry. The other fact is, I enjoy it, right? I'm on the front lines every single time I'm in the chair. I mean, the rules that I'm putting in place isn't because I think they're gonna be pretty good. It's because I'm actually testing them out and I'm figuring it out. You know, especially during this pandemic, you know, there was some sorry for the wind. There are some of these times that people are like, well, I don't like this PPE and I don't like this, well, okay, I'm wearing was pretty good for me, it wasn't the most comfortable thing in the world, but let's work on this. So. So yeah, I learned really early on in my career that I know very little. Right. As soon as you start to realize that you learn that you know very little and you surround yourself with really good people that know more than you and the areas that you're deficient, it works really well. Right? And that's. I just been lucky that way. I was lucky that way. I was. My dad was a cpa, so my dad came on as our cfo, right? In my dental chair. I happen to, what I believe is probably one of the most brilliant people that I know, started E Trade Financial as one of my patients and then came on as one of my board members, right? So, boom, I'm learning there. We had one of the VPs of McDonald's that it was a patient of mine. Boom, he's on my board. So all of a sudden, now I knew I had to surround myself with people that knew what they were doing. So I'm not one to ever Profess. Wait a second. I know exactly what it is, you know.

Well, now, A.J. you're getting on. You know, one of our core principles, which, number one is humility, right? Because it opens up. I don't think people realize how much opportunity humility opens up because as soon as I kind of tell the world or tell the, you know, give the impression that I already know everything, people tend to not want to talk to you too much about stuff. Right. So, I mean, you, yes, you've got some incredible people on your board, but you had to put yourself in the mindset too, of like, hey, universe, I'm open for feedback and I don't know everything. And then, wow, it sounds like you've gotten some amazing support.

Yeah. Because of that mindset, Emmett, if you're going to be a good dentist, you better be willing to hit some feedback. Right? And dentistry taught me a lot because, you know, we're really big into in our group teaching the personalities. You know, we use this profile system, we teach personalities. And I tell everybody, I said, listen, I see a lot of dental practices per month, 20, 25 dental practices when we're searching for acquisitions. And I always walk into a dental practice and the doctor will be like, oh, man, my team members are awesome. My patients are awesome. They're just like me, you know? Yeah, because you've offended everybody else, right? So you basically have a seven hundred to a thousand person patient base and you've, you've had 12,000 people run through here. Well, you've offended everybody. You know, people don't. So the best of the chameleons, if you're a chameleon and you can be every single personality type, or at least learn to hit on every single personality type, those are the dentists that are very successful. So when, when we're looking at dentists and we're interviewing them, we're trying to figure out like, what their personality type is. But not only that, what personality types do they relate with? And if we have somebody that's just like, I just relate with my own personality, they're not going to be successful. You can tell that right away, you know, and that's really the number one. That's the number one thing when you.

So now we're kind of moving into associate recruiting. Is that, is that a big part of what you look for in those associates?

It is, it is. It's hard. It's, you know, I mean, you could put them through like all the personality testing and do all that stuff. But I always look at dentists you don't really get to know a dentist until you put them actually into an office and get them starting to work. Right. And putting them in stressful environments and putting them into a. You know, when you're running behind and all that stuff, and you got to go do a hygiene check in with a new patient and you're stressed out, you know, that's, that's when I start to see things come about, you know, and do your team members really love you and are they going to follow you, or do they just not like you? I, you know, you get into leadership, and there's a lot of doctor leadership, right? And I do believe that you could teach anybody good leadership, but you can't teach people that aren't open for good leadership, you know, and that's, that's the part that I see a lot of us, my colleagues, unfortunately, they're just not open to leadership. They're not open to learning how to get other people around you to follow you, because everybody.

Interesting. That's an interesting one, because I had someone tell me now, Emmett, do you know what a leader is? You know, and I give all these lists of characteristics and so forth. And he said, actually, let's just simplify it down. It's someone that someone else is following. He says, otherwise you're just a loser. And I was like, that's really great way to just get directly to results, which is how many people are willing to follow you could be a direct relationship to your leadership skills and to the degree you want to impact more people. And I think that's the example you gave, right? Some dentists are able to impact a few people. Some can impact more. And obviously you've worked to expand your leadership skills to impact a lot of. I mean, if you look at the total patients that you impact through other clinicians, it's. It's dramatic, right?

Yeah. No, that's all. That's all true. That's all true story. I mean, it's, you know. You know, it's a billion. It's a. I think it was. I saw like a $3 billion industry leadership, right? And then you start reading all the books and it's kind of like they're all saying the same thing, just something different, you know, just a different way. It's. It's because everybody takes on leadership a little bit different. You know, you take the information and you siphon it through yourself a little bit different. So that's at least what we've. What we've seen with our docs and stuff. And we try to teach that we hands on stuff and I try to, you know, teach them through my, through actually watching in my office. You know, I'm not afraid.

Let's sit on one of the questions that DSOs usually get hit with, which is how are you balancing the autonomy versus the mentorship component? Right. Because you'll have an associate say, listen, I need to know one thing. You're a dso, right? Am I going to have my autonomy? And then the next thing is now am I going to get mentorship too? How do you balance that and you know, being a clinician? What's your concerns today around DSOs controlling the outcome of clinicians?

Well, I think we, yeah, we have less than 5% turnover over the last eight years with our doctors and we have less than 11% turnover with our team members. So I think autonomy is the reason why, to be honest with you. But we do freedom within a framework. So we put systems in place in an office and we show them the systems and the why behind the systems and then we go ahead and that's your framework. Now there's freedom within the framework of what we allow them to do. When it comes to being a clinician, I always find it odd, you know, because every DSO has a CMO or has a chief dental officer, chief medical officer. And you know, dentistry, we learn how to do dentistry in dental school. I help out at the dental schools, right. So I know how you're taught, I know how you're not taught and what the wrong way is. Okay? So the fact of the matter is this is the argument that I always have with some people from dental associations. I won't name any, but dental associations that always talk about DSOs, man, you know, the autonomy. And I'm like, well, I don't know if you know, but the problem that you guys have is the non autonomy or the autonomy that you have in your, in your private practices. And they kind of look at me and I say, come with me to 20 dental practices this month. You will be shocked and appalled by what you see in a lot of these dental practices. And the fact is there's, there's a right way and there's a wrong way. I think where some DSOs get mixed up in right is when you have. And then there's. So that there's right way and wrong way in dentistry. Okay? Right.

And that's kind of, that's agnostic of the business platform.

Right?

I mean, so now clinicians, right?

So now you get this is where we get in trouble. Real productive Dentists and kind of productive dentists. Right. The kind of productive dentist we try to push to be real productive dentists like this. And that's not good. You know, that's not a good situation because these people fight you. They don't like it. They think that it's, you're trying to do something wrong to me. And so that's where you have an issue. So when you take a medium dentist and try to push them here and they fight you, you either accept them for what kind of productive dentists they are or not. And that's what you get. You get the conservative, real conservative dentist, you get the aggressive dentist. Right. They're both sitting in the right spectrum. You get too conservative, wrong spectrum, too productive, wrong spectrum. You got to get them right here. But this person and this person look really different.

Yeah. It's interesting because you bring up maybe a physics problem or a law problem that exists in dentistry today, which is standard of care isn't very standard. You know, let's eliminate DSOs for a second here.

Yeah.

Just sampling across individual practices. In some ways, the DSOs are looking for a standard to follow. I mean, you, as you called it a framework. And then you're basically allowing clinicians to either opt into that framework or decide that there's another framework that they're more, more interested in. Right. Or feel better.

I would, I would agree. I would agree to that. Yeah. And it's. Hopefully we can, hopefully we're learning a little bit more about that. You know, I think it's a, again, I think there's a, there's a world in dentistry for everybody, you know, and we really educate doctors on the business of the practice. Because if you're a low producing doc or a medium producing doc and your office isn't profitable, then it's just not going to work.

Right. It doesn't matter whether you're on your

own or doesn't matter. Yeah.

How have you, as you've gone through these different stages, you know, can you kind of break out for us which stages you felt were difficult or, you know, just kind of in general terms was. Was going to 2 or 3 difficult, was it at 10, 5 to 8

was really difficult, you know, 12. So it was like during those, like you add 4, you add 5 on those became really difficult. So, you know, 5, 5 was 5 to 6, 8 was difficult, 12 to 15 was difficult. And then 22 to like 27 was, you know, difficult. And it's all about your ramping the amount of stuff in your support center because you start to stretch everybody's capacity like crazy. I mean, we're only 18 people in our support center, right. With 31 locations. And you start to, like, we're feeling it right now. There is no doubt about it. We're at a stretch location, you know, stretch. Thank God for Smile Brands and our partnership and. But that's the reason why I did it. You know, I did that. I did that with Smile Brands because I wanted to be able to still have our autonomy of decision one and our culture. Right. But have a partner like Smile Brands to be able to say, this, man, somebody's got to help us out with the financials. Somebody's got to help us out with supplies. Thank God for them during this pandemic, Right? I mean, because I'm a medium group. If I go to my. My supplier and I ask them for something, they're giving it to the big boys first, before myself, Right. And so thank goodness we were hooked up with a larger organization. Thank goodness, our insurer, you know, with insurance carriers that were. With a larger organization. So those were the pain points that we were in.

Yeah. And how about navigating this? COVID 19. I think everyone's interested on how kind of the DSOs navigated. It sounds like, you know, you're sitting outside your home right now, so definitely you've taken it seriously. And for your team members, you know, I've heard one extreme where someone said, I heard DSOs are only giving them level one masks or whatever. Tell us a little bit about your experience. How's it been? You know, you're in Illinois, so there's been a lot going on there with dentistry and ppe.

We have a lot going on here. It was tough for us, you know, I mean, we're at 15%, 14% of productivity. You know, during the heart of. During the heart of the pandemic. And then two weeks ago, we were able to, you know, fully open up.

Because you're at that 14, because you're just emergency care, right?

That's correct. Yeah. And I always. My same rules that I started the company is the same rules that I did during the pandemic. You know, I listened to people, I empathized with them. If they were nervous about coming in, don't come in. You know, like, I could totally understand that. And then we listened to everybody of what they wanted, you know, okay, okay, you want to. You want an N95 and you're just scaling teeth. Yes. Have an N95. You know, use it, preserve it, don't use it. Like crazy. But go ahead and use it. What do you need to feel comfortable? Well, we want a shield at the front desk. Then we'll get you a shield. You know, like, we'll have you with a face shield. You know, you listen to it, but then you also, you have to speak about it and talk about it and go through it. Now, one thing that we did during the pandemic and we started the first day that it all happened, was we met with our teams. We met with the entire company every morning at 8am so we had 180 to 230 people every single day at 8am we would invite congressman. We had a congressman on, we had the VP of Disney on. We just, we brought in people to talk through it, you know, because we didn't know, you know, you don't know what's going on. So. But I think I got a lot of feedback from our team that they were just happy that they had something to do in the morning and they had, they had. They had somebody that was talking to them about something that was going to help them in their future, you know, and so that's what we did. That's what we did. And I think we gained a lot of capital with our team members during that part, you know, because then we can have these discussions about PPE without them thinking that we were just putting them in this horrible environment and stuff like that. I mean, I'm getting, you know, we just had a hygienist that we had to hire for. And I mean, we have a ton of resumes coming in because of what's going on with private dentists, you know, and a lot of dentists office is closing, unfortunately. And that's sad. That's horrible to see. You know, we just put on decision one, we just put on our Facebook page and everywhere else on social media. Our entire playbook, everything that we have, we put it out there. We can help anybody in this. I mean, this is a time for collaboration, not competition. That's what I keep saying. I think that's the most important part.

Well, it sounds like you're paying forward. It sounds like Steve Bildt was really helpful to you, willing to support you, try to figure out, you know, if you needed financing or capital or whatever. Obviously that created a partnership and now you're pushing that out to others. I mean, I think that's a part that maybe not everyone in the community really understands is they think of it as such a competitive. And would you say, you know, there's just kind of a scarcity mindset there. Right? And as you get into leadership, maybe you realize that the biggest constraint is simply yourself and the more you can share and learn and so forth. You know, we keep coming back to this component that 65% of people aren't going to the dentist regularly, you know, And I posted on DSO Secrets, I said, man, the cell phone market has 125% of the market, you know. Now I don't know how we get 125% because they can't have to dental works, so to speak. But man, I think we could do better than 35%, you know, penetration. So I'm curious your thoughts around that though. Of, you know, is the issue the competition or is the issue maybe ourselves get just getting better?

It's ourselves. I mean, this isn't. It's competitive. It's a business competitive, right? Like, okay, who's. Whose company could be the biggest company, you know, and stuff. Some people have that aspect. I know Steve doesn't. I know, you know, I think it's the quality that's better than the quantity, you know, But I do think there's a competitive view, but there's not a competitive view of I want to be the only DSO in the space that just does not exist. I mean, the amount of collaboration and talking with the other DSOs, you know, from the Adso during this time has been unbelievable. Nobody has shut their doors and said, no, let's not talk. Everybody has brought in and said, let's, let's talk. I'm one of the DSO. I'm a small DSO, but I am one of the CEOs that believe that you're going to always have private practice, you're going to always have. And I'm happy with that. Listen, I think competition drives quality, right? The better the competition, the better the quality that you're going to have going forward. And I enjoy my colleagues that are private dentists. I love them, you know, they're great. It is. We're all in this as a, as an organization, you know, And I always wanted to walk away from the organization, from dentistry, saying that I bettered my field. There's nobody, not one person in medicine that is involved in the business of medicine and trying to grow something could walk away and honestly say, man, that was awesome. I bettered my profession. Think about that. In the last 25 years, anybody, any physician that was involved in the business aspects of anything cannot walk away and say that because their field has gotten worse. You know, I don't want to do that. I really Don't. And I see it getting better. We're just, man, we're deep rooted. You know, dentistry is deep rooted. We have some, some deep roots that are taught in dental schools to say like, this is good and this is bad and if they own any more than two practices, all they care about is money.

Yeah, yeah. Well, I like what you said about the individual practices because people ask me often, is this world just going to be all DSOs. And the thing I can tell you is that this world will continue to improve towards better and better patient care because if it doesn't, then the patients will simply step away from it. Right?

That's exactly right.

And so even if, you know, everybody was capitalistic minded, their capitalism is still in a framework of what does the patient want? And if we don't meet that need, frankly, that's what gets us at 35% of, you know, penetration. So that's where I see a lot of opportunity for us out there to go to the next level to make things more convenient to, to really meet the patients, you know, where they're at. And frankly, we're competing against, if anything, not one another, but all the other places they can spend their time and money. And if we don't step it up, then, you know, they, they're at Disneyland instead of getting dental work done or something like that.

100%. You're, you're exactly right. This is a relationship based business. Right? I mean, listen, we are, we are inches away from somebody's face with our hands in their mouth. And if you don't have a relationship with somebody, that's why I'm telling you, Emmett, if anybody ever asked me like, where do, where do we screw up? Where do my colleagues and everybody screw up? I'm telling you, we. 65% of the nation doesn't go to the dentist because we haven't connected with these people. We have not taken the time. There is so much low hanging fruit that we don't have time to connect with the other 65% or the other 20% that maybe came in to try us out and was like, yeah, this is not what I like. We didn't find out what their dominant buying motive was. We didn't find out what their emotional treasure was. Why are they sitting in our office, you know, and that is, that is realistic. And I do believe that when I'm older and you know, I'm looking at all the young people starting up DSOs or running DSOs that they're gonna go, hey, AJ, you had it freaking easy. When you were running your DSO, right, like you had it easy. Now we have 60% of the nation that is going to the dentist, and now it's harder to get patients. You know, that's. I believe that will come and I hope that does come because I want more people to get to care. And that's what we're in.

This means everybody up their game and actually connected better. Right?

That's right. That's exactly right. But in order to connect, in order to connect though, you, you have to, it's, that's, that's a learned process, you know, I mean, that's a, that's true altruism right there when you care about what others feel before yourself. Because usually a dentist goes into an examination feeling like, well, wait a second, okay, what am I going to find on this person and what's on the X rays? And man, can I get him in for same day treatment. And the aspect is you got to go in there with just what do they want? You know, and that's tough. That's a tough thing.

You bring up a good point too. And I don't think we always make that connection, but when I see kind of an outsider looking in, the amount of, we'll call it civil war and you know, just negativity towards one another that sometimes dentists bring to the game, to think that that doesn't spill over into their patient interactions would be ignorant. Right. And so it's so important, I think, all of us learn over time that like, who we are is who we are. So if we're showing up, whether it be on social media or whether it be with our teams or, you know, wherever it might be, how we're showing up, people are picking up on, and we just have to be careful that we're going to attract, you know, those type of individuals around us.

Yeah.

All right, so on a tactical basis, I just get you a couple questions that have come through on the Facebook feed here. What do you think is a couple proven steps to enhance the patient experience? If you got to go into any practice today, wave a magic wand, you know, you said you get to look at a lot of practices. Yeah. What would you do?

Well, I mean, customer service is the first and foremost thing. I mean, it's amazing. We in our support center, I have people from the salon industry and the restaurant industry, and I specifically hired from those industries because they have come to us and looked at dentistry as 1970s and customer service comparatively to where they are in 2017. So I really like that aspect. But I would say training people on treating people how they want to be treated, not how they want to be, how we want to be treated. And that's really difficult in the post Covid environment, because now we're very regimen. Right? You're very regimen. We have, okay, we're checking you in here, we're walking you through here, and we're putting you in here, and we got to rinse here. And like, it's very regimented. So I'm telling my team, you have to ask them how they're doing. Right. What's amazing is you have those.

Everybody's got masks now, so no one knows who's smiling, who's angry.

That's right. That's right. Emmett, if I. If I tell. If I ask anybody. Why are you in dentistry? Oh, I'm in dentistry because I love patients and I love to help people. And then you ask them, you go, okay. Have you told anybody that today? No. I'm like, you should probably tell the patient that you're really happy that they're here and I'm here to care about you, you know, so if you ask me, really strategically what it is, you could have the best dentist in the world, and their practice is on a suck if they don't have good customer service and good patient relationships.

So the book. Someone would pick up something around emotional intelligence or. I mean, has there been a book out?

Customer Service? Yeah. So I have a Lee Cockrell. Lee Cockrell is a VP of Disney. He's retired, and he has a. He has a couple of books. One is Customer Service and one is Creating Magic. And believe me, you can learn a lot from that book. That book is an amazing book.

Yeah, that's huge gold right there. That's huge. Okay, what about from a tactical basis? What have you been surprised? Is a lot harder to solve. I mean, customer service, anything like tactically, software, accounting, practice management software. I don't know. Is there anything tactically, medical equipment, anything. There been difficult.

Nothing's harder than patient or team member. Team member relations. Honestly, that's it. I would tell you anything in dentistry is anything in our field running as a DSO and a leader. If I can get rid of team member issues, everything else falls into place,

you know, with your two statements on customer experience and team. I've once had an entrepreneur that said, you know, my. My business would be easy if I could get rid of the customers and get rid of the employee. And it's the human component. Right. Is what we're really signing up for when we Decide we want to serve more people.

Yeah, you're exactly right. And it's not, you know, the team members, they're all good people. Nobody. I always said this, okay, and a little vulgar, but I do say this to everybody. I said, nobody comes to work to be a shithead today. You know, nobody comes to work and says, I want to make sure that I screw up this entire office today. Nobody does. You know, people come to work, they want to do well. They're just. They got other things going on in life. And if we can. If we can show everybody, to give everybody grace and to allow them to understand what they're. What they're going through in life, believe me, it's way, way easier for Everybody. Much easier.

A.J. you've been very generous. I know you've been sitting outside your home doing this.

No, no, you're fine.

Thank you so much. I don't know if there's any, like, parting concepts or anything else you would, you know, hope to give to our listeners. Like, what you've given is, like, very meaty. I don't think you've given anything that says, okay, great, now this is easy. So I think all of us, if anything, it's that sobering reality that you've really tied the dots on, which is, you're not going to get a better result than, one, how humble and willing you are to give to everyone. Number two, you're not going to get a better result than how well you can recruit great clinicians and defining that greatness as ones who can connect and have emotional intelligence. You're not going to get anything better than your ability to lead and direct your team. Right. And so it feels like, as you've been talking, you can just kind of connect all the dots back to your philosophy, A.J. which has been, if I improve myself as a leader, everything else tends to be working out.

If you. When you went in the morning. Emmett. Me? Emmett.

Yeah, I can hear you.

When you. When you wake up in the morning and you look that person in the mirror, that's the only person that you have to worry about. Right? That's. That's the first person that you have to worry about, I should say. And then start there, and then move it from. Move it from there. And so if the person in the mirror. If you have a problem in your company, the person in the mirror is the problem. Start there, then work it backwards.

It's so painfully true. The business is a caricature of ourselves. Right.

Believe me. Believe me. I've had a look at the guy in the mirror a lot and say, hey man, you got a problem? Yeah. Yeah.

And then for some weird reason, we love it, right? That personal development. We show up and we are like, let's do it again. Well, aj, thank you so much. I really appreciate it. If there's any clinicians or others who just wanted to maybe check out your company, is there a good website they could go to?

DecisionOneDental.com or my Facebook page. AJ Serno, listen, anything that anybody ever needs, I hope somebody you know. I've met so many people that have formed great DSOs and I take pleasure in any which way that I can learn from them. I mean I learn from everybody. Every single dental office that I acquire, I learn a little something. And every single DSO that I affiliate with and help out or talk to, man, I learned something from them. So they can reach out anytime and be my pleasure.

Awesome. Thank you again. I really appreciate it. Listeners man, tons here to take notes on a few books also to read. If you have any additional questions for aj, come over to DSO Secrets Facebook page will make sure those get filtered up to him. And until next time, keep smiling.

Thank you for listening to DSO Secrets. Join our community on Facebook at DSO Secrets and get answers and resources to some of your most challenging questions. If you want to get a copy of the seven secrets of any DSO, go to our website at DSO secrets.com and we will get that emailed to you. Remember, don't go at this alone. Let us be your team while you build your team.