3 Ways to Combat Inflation in Your Dental Practice

Hello everybody and welcome to DE Solutions Lab. I'm Pam Maragliano Muniz chief editor for Dental Economics. And Gary, we're back another year.

I am so crazy excited. Pam, thank you for inviting us back for another year of residency at DE. What a great year 2022 was. Now 2023, Pam, we are kicking it off with a hot, hot topic. And I'm so excited, so excited for the industry this year, our practitioners, the patients they serve and the families that they have. So this is a great way to kick the year off.

I could not agree more. So everybody, tonight's topic, weathering the storm three ways successful doctors are recession proofing their practices for 2023. I know you know him and he needs no introduction, but with me tonight is industry expert and advocate Gabriel Gary. Katie. Gary is the CEO and founder of Next Level Practice. Gary, I'm so excited to kick off this year with you.

Pam. I got a bobblehead for a gift this year from somebody in the community. So I want to thank, thank the person who sent me this. I mean, come on, that was one of my best gifts last year. So now let's give out gifts this year and really deal with this issue that's really top of mind for everybody right now.

It really is. And I think that it's kind of a little sad because many times we go into the new year excited and re energized and with all of this hope and optimism. But there's this looming feeling of the economy and so let's just hit it head on. So there's differing opinions on whether the United States economy will enter a recession in 2023 or if we're currently in a recession. And nobody can argue that we are in an economic downturn and, and the outlook doesn't look so great. Unfortunately, dentistry is not immune to the impact of a cloudy economic forecast. Between rising overhead costs, increased labor costs and lower insurance reimbursements, we know that dentistry could end up in the eye of the storm. In fact, the latest consumer Price Index data shows that the 12 month change in the CPI for dental services has reached 5.3%, a new 14 year high. Now, I know the looming thought of the recession has been on every practice owner's mind, but now is not the time to hit the panic button just yet. So don't worry. In fact, it's quite the opposite. It's actually time to start taking a proactive approach so that you can fight this recession head on. Tonight we're going to take a deep dive into the 2023 Economic Outlook for dentistry. And Gary's going to share several ways how to combat the recession without compromising your morals or putting your practice in jeopardy. Whether you're a new practice owner or you've been at it for a few years, you do not want to miss tonight. Gary, I think a great place to start is getting your thoughts on the current economic forecast and what it means for our audience tonight.

Yeah, you know, just to keep it simple. Like, you know, I'm not an economist, but, you know, I study this stuff just because I need to know how it's going to affect everything. And, you know, you mentioned the perfect storm earlier and, and it's really about, it's not just measured by one factor. Like, if we really look at the facts here, right. If we're looking at the facts and we're looking at the labor market, consumer and business spending, industrial production, GDP factors, incomes, the value of the dollar abroad, all those things. Very simply, a recession is defined as 2/4, a reduction in over 2/4 of the gross domestic product. What does that mean to all of us? There's a fallout. My best way of defining a recession, and I've, I've been through 3, and I've been through 9, 11, I've been through 2008, I've been through the pandemic. And our clients came out better. And I want to say that again, better when they had this looming thing. Because, Pam, it creates an intention. You know, the things we're going to share tonight as solutions for this are just common business, simple common business practices that unfortunately in dentistry, most dental practices don't do. And so we're just going to highlight them now. When there's a, you know, looming recession, the conversation at the chair is like, oh, my gosh, I don't have the money. And by the way, I just want to let you know, patients are always going to say they don't have money for dentistry. Even in the rich years when everybody had big numbers, people still said they don't have money for dentistry. You know, that you're sitting chairside and it's because we haven't known how to create the value for dentistry. And something that I want to introduce tonight, you know, and I told you, I've been through the main three over the last 20 some years. But there, you know, we've, we have practices in Puerto Rico, they had a recession when, when the rest of the US did not. And we created something called creating your own personal economy. Creating your own personal economy. Yeah. What do you hear When I say.

That, Pam, it sounds to me like there's obviously what's going on on a global scale, what's going on on a national and even a regional scale, but we do live in our own little practice bubble. And I think that my economy and my practice could be completely different than the guy down the street. And I think that you still do have to kind of look within, look at your practice, look at your patients, so that you can get ahead. Is that kind of along the same lines?

Yeah. And really, I'm going to show you a visual here, Pam, that I think will really help share this. And I know our guy Brian, who is our quarterback for us working together. I know he loves the Madden teleprompter, so, you know, I got to break it out every time for my guy, Brian. So I just wait till it comes up here. So the first thing I want to do is like, where do you put your focus? Right? So, you know, there is, you know, a situation out in the world, and this is the circle of concern. And this, you know, this came from, I think it's seven Habits of Highly Effective People. You know, where you look at, like, I could be concerned about the recession, and that's important, right? But if you only spend your time in focusing on what's happening circumstantially around you, it's where your focus is, you know? You know, my. My son's got me into Formula one racing. It's awesome. Like, watching it, it's really cool. And one of the things he told me was, it's like, dad, you know, when they teach these racers, you know, they have this thing called dry to drive to survive, which he's turned me onto, which is really fun. And it's like they. They teach them not to look at the wall when they're going into a turn. It's like looking into the turn, because that turns. And for. For a horse riding people, I just started doing barrels. And it's like the horse turns. Like, you don't turn the horse, you turn your body toward the barrel that you're racing toward. So the circle of concern is like, yes, there is a situation going on in the economy, but we want to look inside of the circle of concern, and that's the circle of influence. So influence. The circle of influence is like, what can you cause in the face of circumstances, right? So, by the way, this is a mindset thing, right? Part of walking through a recession, Pam, is shifting your focus and your mindset. So if I start going, okay, that's A that's happening. People are responding to it. Our patients are responding to it, Our team's responding to it. I need to respond to it. But where am I going to put my attention on what I can influence things? Influence things, like, are. Like, I can influence my team to have a positive attitude. I could put in systems and processes. Right. And then it's like, what can I control? See, you know, there's a. I'm, as you know, I'm coming up on 15 years sober this year, man, which I'm super excited about. Yeah. And one of the things. One of the first things I learned was this prayer. It's like, God, grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference. And so, you know, as an alcoholic, I was like looking at my circumstances and they were bleak. And how did I walk through that? I. I focused on the things that I could change. And that's going intrinsically looking inside the self, looking inside the business, not really looking at gdp, because I can't do that. And if I'm listening to newspam and it's feeding me negative thoughts, please don't watch it. Start breaking yourself from that. Because when you create your own economy, you're focused on what you can control and what you can influence.

That makes a lot of sense. And I think that, you know, I know you talked about abundance last year and you talked about going into it with that mindset. And I think that, yeah, there is a lot of negativity floating around us, but you certainly can focus on what's positive, focus on what's going on in your practice so that you can harness that positive energy and kind of move forward with it.

Exactly. And what I'm saying here, we're going to get really down to one or two things that if you focus in on by the end of this and you've just focused in on one or two things for the entire year, you will walk through this. You know, I think somebody said, when you're going through hell, keep going this. You're going to actually get ahead of yourself. Because here's the thing that most businesses that have explosive growth started in an economic downturn, they start there because that's a really good time. So blank slate, your practice. That's what I'm going to suggest for 20, 23. Blank Slate, how you go into your strategy. And today we're just going to unpack this thing so that we can get people to focus on what needs to focused in on. And what it is is creating value in the mind of your customer. That's the ultimate thing. You have to go do that with your team first. And I'm going to show you all the numbers on how it's going to manifest itself today. But oh my gosh, this is a gift, right? So it's not like, oh darn, there's a recession. It's going to be a crappy 2023. It's like, thank you for giving us that. Now we're going to create the best year ever.

And it's absolutely possible. And New Year's resolutions don't have to be made on, you know, December 31st. You can make them right now and you can change your practice today and tonight. So having Gary on your team is certainly, you know, it's like hiring a big gun. So there's many of you that might need a helping hand. And so the wonderful thing is that Gary is such a great opportunity for you. So stick around until the end. You definitely don't want to miss that. And we're also going to field questions, so please feel free to ask questions by entering them in the question box on the your right hand side. So Gary, let's get right down to it. What's the first way to recession proof your practice?

Oh, man. Pam, my docs now, docs don't cringe. I'm going to ask you a question right now. And we did this at a big live event. And I said, doctors, how many of you have read your P and L in the last 90 days? And one hand goes up, right? So the first thing that has to happen, like, I wanted to lose weight last year, right? And I go, you know, how much weight do I want to lose? How much do I weigh? I didn't even look at a darn scale, Pam. I didn't have a scale because, you know, numbers tell the story. Don't tell the story about your numbers. Let your numbers do the talking about how you're performing and where your attention is. You see the difference there. It's powerful. So again, I'm going to go telestrate right now. I think it's a really, really great visual for people. This is, I want you to identify one of the four areas that you are starting from as it relates to your numbers. So the first is like, I'll use weight. I was in denial. I was like, I was like, I'll tell you the number. It was 228. I'm like, 2 28. Oh my gosh. I never weigh 228, so I was in denial. I'm like, I'm feeling a little fat. My stuff is feeling a little. Little. You know, little tight. But I was, like, in denial. I'm like, fine. I kind of, like, suck in my belly and suck in my cheeks, and hopefully that's like, gonna, you know, deal with my loss. No, that doesn't. Denial is the first place that most people start from. The next is committee, honey. Man, I'm really feeling fat. Committee is like, you're talking to people about being overweight. Knowing your numbers is. I finally bought a scale. I saw 228. You talk about motivation. Oh, my gosh. I'm like, I don't. I have never weighed 228. So now I know my numbers. But knowing doesn't matter. It's owning the numbers. Then I go. I went to my doctor. I go, what do I do? How do I do it? He's like, keto is the best. It reduces inflammation.

I.

And then I had to get my wife on board because she was. You know, we had cabinets full of carbohydrates and no keto, you know, to. To be seen. So I really took ownership of it. I share with the. Sat down with my wife and said, I need to lose weight. And now all of a sudden, she is, too. We're having fun. I'm down to 204, you know, and it's not difficult, and I love my life, so you can really design a life, but you got to know where you're starting from. Pam, here, what comes up for you as I share this first point?

Oh, well, as soon as you talk about numbers, my first thing is I want to hide under the table thinking about the scale. So there's always that. But even I just, you know, I meet with my office manager all the time, and we were talking about different strategies for the upcoming year, and she, you know, just flat out said it, and it's so true. Numbers don't lie. You can feel how you want to feel about certain things or your team or whatever, but at the end of the day, you have to kind of always respect the numbers, because those tell the story.

Yeah. And 9, 99. If you're listening out there and you're a practice owner, 99% of your peers are not looking at PNLs. That's why you don't. And by the way, you don't have to. You can hand it off to somebody, outsource that, and have them focus in on that, or hand it off to Somebody internally and they can focus on that. That's, you know, that's what I'm going to be talking about at the end. The opportunity to really get this right for yourself. And we'll share with you because, like, if, you know, like, no matter what, you're not going to look at a PNL because you just fall asleep when you're looking at it or you don't know how to look at it, you can delegate that. We'll show you how to do that at the end of our session today. So that'll be awesome. Yeah. And then I think we go right into Pam, this guy right here, this is. Do you see my screen here where there's four. It's where you're starting from. So this is additional. So the first is your mindset about your relationship to numbers in your practice. By the way, you cannot get through the recession if you don't turn this dial up and keep your attention on it. You know, if you're relying on your CPA once a year, it just doesn't work. So I want to show you on the left side here, this is the effort that you have to put in. All right, so this is the effort, and down here are the results. Okay, so if it's easy to put your head in the sand and hopefully that the. This recession goes away, your numbers get better and. But your head's in the sand. It's easy to do that. But how are your results or, right, your results are poor now go down. You could be a juggler. It's hard to juggle because how much time do you have? Plus, you hate doing this stuff. The results are hard, usually poor, because you're not an expert in this particular area. You know, if we learn one thing, Pam, in the end, through the pandemic, is raising your hand for help and outsourcing and leveraging the people you have that love this stuff. That's the gift of the, of the pandemic. If you haven't learned that because you couldn't get through the pandemic alone, that's a transformational thing for a lot of dentists that I have noticed. Now, if you're an air traffic controller, so you're like, you know, pointing people in the right direction, you're good like that, but, you know, you got it handled, but you're still at the center of it. It's still hard, but your results are a lot better because now you've delegated that. That's another level to get to. And then really delegating to an advisor delegating to a person that has structure and accountability, a person that's going to sit there once a month with you and go, here's what I see. You know, you don't have. You don't have to read the book. It's sort of like, what do you call those things that are, like, shortening the book? Like, in 10 minutes, you can get the whole book. I don't know what they're called, but, like, that's what I'm talking about here. Well, Cliff Notes. But you just lost half the millennials. I said that once, and I lost my millennial card, and I did retain it. There's a new thing called Cliff Notes that replaced that, and I forgot it right now, my millennials, you'll get with it. It's basically a fast pass, an HOV lane to getting this done. And you don't have to own the responsibility of it. You're delegating that out. So, yeah, I want you to also identify, like, now you're on the court, and you're. Now you have to own your numbers. This is how people do it. What comes up for you here, Pam, as I share this with you?

Gosh. Well, I think first things first, we have to kind of acknowledge what went down last year and at the end of 2020, what is it?

1.

Gary, all the information that you share with us is like a continuum, you know? And so what's coming up for me is you talked about decentralizing yourself, and that was something that resonated with me when you mentioned it a year ago. And, you know, it makes your life better. It makes your life more effective and more efficient and your practice run the same way. And so if you are one of those people, which I feel like I, you know, we all are. We're dentists. It's our practice. It's our baby. We want to be in the middle of everything we might be getting in our own way. And so what you're describing sounds to me like decentralizing yourself, but also putting the right people in place so that it will allow your practice to thrive.

Absolutely. And you should go back to our library of monthly calls, because each one, you can get your individual value out of each one, but one, like you said, builds on the other. And, you know, we're leading up to this situation. I mean, I'm going to give you what needs to be done from a business standpoint. And there's deeper solutions, whether you want to do a coaching call at the end of the session or you want to go back and watch the videos or you know, the video recordings. Yeah, for sure.

So, all right, let's go to it. Number two, what is the second way to recession proof your practice?

Yeah. And so now that you have a new relationship to mindset where you're going to focus your attention this year and now you understand decentralizing yourself from having to do everything you got that you want to have an advisor or a person that's going to own that for you. Now what you have to look at is, I can't tell you this, this is so fun. And I know all my, all my Henry Schein reps, all my, all my Patterson reps, all my Benko reps are going to love this one. Stop stepping over dollars to get to pennies. And you know what happens is when people, when a recession hits, the first place they look is how do I strip my expenses? You can't shrink your way to growth. You can't shrink your way to producing more profits. It doesn't work. So you do the opposite. This is called the Costanza, I call it. You know, if you ever saw Seinfeld, Costanza had that thing where he did the opposite of everything and things turned out better, you build your top line to be more profitable. So the reason why DSOs are buying up practices like crazy is because they're all undervalued. All of them. Every. I haven't seen a practice that hasn't been undervalued in like all the valuations that I've been doing. And it's because people don't look at the top line growth potential that people have. So let's take a real hop at it. Let's first look at Pam. I want to look at the numbers of what happens when you look at your top line. So let's get to that right now.

Awesome.

So this is a real practice, 750,000. You know, this is like the, the, the mean practice in the middle of, you know, this is the average practice. And if you really look at it here, you know, right here, 762,000 in top line income for 20, 21. And then you can see, you know, it's about 21% profit. This is like a very average practice, you know, 169,000. Now take the strategy of number one to build your top line. That means your income. Look at this right here. I just went up 400,000. But look at, look at my profitability. It went from 169 to 407. Massive growth. And look at the profitability went up to 35 from 21. Okay, so this is an important aspect of walking through a recession, getting through to the other side. So here's where I want you to look. How do you. What's your potential to build your top line? Now, this is a very low remuneration for. And by the way, yes, you can eliminate your PPOs, but let's say you don't want to do that first. Let's say you want to strengthen before you drop PPOs and your insurances. You got to strengthen this, what I'm showing you here and what this is, is I'm giving you the lowest of low. These are like Western Pennsylvania. This is. This is West Virginia. These are like lowest reimbursement areas that I found across the us. So I wanted to make it ridiculous. The average adult, when you put a good case acceptance system in and you need a system, the system is not. What did you come in for today? Is anything hurting? Anything bothering you? If you're doing that, I'm talking to you, right? That means you're giving your power away and you're not being an advisor to your patient. The average adult will invest in the value of a crown and a buildup. 854. Now, also, patient retention here, Pam. Two profis, two exams, set of bitewings, GP practice, right? $207. So when I add them both, we're now looking at the average annual value of an adult patient. That's how I want you to be thinking about this to build your top line. Now, let's multiply that times the last 18 months. We're taking 18 months because of the pandemic, so people are lagging. Still 2178 patients, the potential for this practice is 2.3 million bucks. When you see this, when you see this potential capacity, what comes up for you, Pam?

It looks like so much potential. And honestly, you're so concerned, like to say conservative, it's like beyond an understatement on the numbers that you shared here. So I think even if you know, I recommend that you look at this slide, take your numbers, multiply it by your number of patients to figure out exactly what your potential is. And that's, again, really conservative.

And now let's look at mindsets. So when I do this exercise, there's one of two places people landed and this. You guys, you want to check the truth about this? When I do this, they go, there's two camps and there's only two camps. My patients aren't going to buy a crown. A year. There's no way that my practice is going to do that. All my patients are clean. I've cleaned them all up. They've been coming through here. They're all 100% healthy. They're, um, so. And then the other camp is. And you want to check your mindset in reaction to this, the other camp is, how do I do that? Oh, let me look, Let me look further. You're curious, you're like, you're, you're, you're, you're interested in finding out more. If you, if you are, if you're. And I call these ants, these are ants. Ants is an acronym of automatic negative thoughts. We all have ants. They click in and they run wild. And if they're red ants and they're killing off the possibility that I just showed, that's what's going to change. That's what has to change. Not the recession having to change, not your team not not being able to hire people, not the lower reimbursements, not all those things that, like, are circumstantial, that are circles of concern. You look inside intrinsically and, and shift that mindset.

Gosh, I've got so many things on this topic. You know, I think that, you know, you say these things and, I mean, the energy from you is, like, amazing. So I feel like, yeah, I want to. Yeah, I want to do that. Yes. But then all of a sudden, when it comes time to implementation, you might be maybe a little fearful or unsure or how you're, you know, or maybe not even sure how your team will get on board with this approach. But if you think about even some of the statistics of periodontal disease, you know, and look at even your numbers of how many patients are prophy patients versus what are considered perio patients, if, if that number isn't upwards of 35% of your practice, chances are that there's an opportunity there for you. And I can tell you that I changed everything during the pandemic. I just kind of, I mean, we could go on and on about that, but I changed everything and I decided to just be brave and be myself. And if patients didn't like it, then they're just not my people. And this isn't, you know, my practice will morph based on what, you know, my vision is, and people embraced it. And my practice has never been better. And so I really encourage you to feel brave and feel confident and feel, you know, optimistic that making these changes will definitely benefit your practice without, you know, beyond a shadow of a doubt. So, I mean, As a dentist who has implemented some, you know, brand new total practice changing things, not only is it a change for the practice but you'll be amazed especially when you have a relationship with your patients already. Now all of a sudden, you know, you're giving them better care. So Gary, I mean this is awesome and I can't wait to hear about the, you know, the last wage to recession proof our practices. But first I have to acknowledge all of the questions that are coming in and we will certainly do our best to get to them. Now a lot of these questions are about how you can help them directly. Can you tell us a little bit about how you can do this?

Yeah. One of the things that I have really taken on over the last couple of years in our relationship here because of who the de community is. I mean this is a group of people that understand the economics of dentistry. They may not have implemented the changes but there interested here because they really want to make a difference. And you know, we do this as a customer service value creation, introducing who we are obviously. But it's like every person, Pam has an individual need or nuance or concern. Right. That comes up as we share these things. Right. So we found I block off five hours which allows 10, 30 minute coaching sessions. And in this case we, I have Ava Tallman who is extraordinary and she is my recession proofer. I mean this gal is obsessed with all the content that I'm talking about and she will meet with you for a half hour and walk you through some of the things and answer your concerns or questions that you might have from a nuanced standpoint and it will be fantastic. People leave, they're like their shoulders come down, their uncertainty turns to certainty and now all of a sudden they go, okay, now I can go do this right? There's something about like, you know, I can do a group class and hide out but there's something like when, like this is the difference between the girls and the ladies. This is like I'm going to step in and like put it on and go for it this year. I'm not going to sit back and wait and look back on December of 2023 and have it be the December of 2022. So this would be your next logical step and you can just click here and get on Ava's calendar and she'll freakin. She's safe, she's loving, compassionate, non judgmental and powerhouse, will take you by the hand and walk you across the bridge.

That is so generous of you and of Ava to give away Your time like that Ava is amazing. So, yeah, get on her calendar and you will not be sorry. This might be the first best thing you do for yourself this year. So, Gary, let's get to the final way to reception proof your practice.

Yeah. You know, this is an important thing to know is, is really looking at your numbers, right? So there's two groups of numbers I want to look at. One is the performance. So what we've done so far is we've looked at your mindset. We've then set you up so that you can have control over your numbers, whether you do it or somebody else does it. Then we really looked at what, you know, building your top line and then how much do you really have? Like, that should really give you comfort. Like, man, if I'm doing 7:50 and I see 2.3, I'm like, oh, that's good news because I can go inside my business and I can control that. Once you have to go to marketing, it's unpredictable. Unpredictable and expensive. Right. You don't know how it's going to go. So that's getting through a recession is going. Looking from the inside, looking to the inside of yourself and looking to the inside of your practice. That's how you create that economy, that personal economy. It's based upon what you cause and create, not all these peripheral, extra, extra things. So the next thing I want to really look at are two quick things to finish us off. And one is going to be your daily primary outcomes. A lot of doctors, Pam, I find, don't like setting numbers, setting specific outcomes. Like, they think their team, you know, they don't want to like, share metrics because it might be negative, or they don't want to share numbers because they think like, oh, the team's going to think they have all the, all these numbers and then, oh, you know, they're going to want me to buy them a car or like a boat or. I don't know, it's crazy. Like, you know, like, if I show them all these numbers, they're not going to do that. The opposite is actually true. We do culture surveys of thousands of dental practices a year, and the number one thing that they ask for is, I want to know what my measure is. I want to know how I can get there because I want to help grow the practice. It's the opposite. But these are things that are in some of our docs that don't want to share their numbers. So here's a very simple way to break your numbers down and set goals. And we're in January. So you want to really set goals. And how do you eat an elephant? One bite at a time. So this is the way you do it. So the first thing is if your goal is, if you got to set a goal, if it's 1.2 to collect, and let's say you're writing 25%, the average person writes 25% of their fees off, you have to produce 1.5 to do 1.2. So now if doctors want to take time off, this is where you do it. So by the way, you should have, for every doctor, you should have two hygienists. That's how you know you're retaining your patients in a healthy manner. Two full time hygienists. So, and by the way, this doctor time, this is four days a week with four weeks vacation, that's 192 days. If you want to take more, if you want to take six weeks off, less doctor days, higher revenue per day. This is where you do it right here in the configuration of this algorithm. So if you want to do that, first thing we do is we take hygiene days. So two hygienists working four days a week at a, at $1200 a day, $460,000 in hygiene revenue. Okay, so we subtract 460 from the 1.5. Oh, my numbers are wrong here. I did, I did the wrong numbers. Just bear with me, Pam, real quick here. So If I take 1 million 5, minus 460, 800, that number is a million 39. So this number right here is a million 39, not 1.6. And if this number is correct, the doctor needs to do 5500 a day. The hygienist needs to do 1200 a day. And this is a key number right here. You got to present 8,000 a day and close 5,500 a day. That's a 67% conversion rate. These are all the benchmarks for dentistry nationwide that we put in place. Now if we look at presented dollars, Pam, and accepted dollars monthly, it needs to look at 128,000 presented and 88,000 accepted. So when we look here, look at this practice, this is a real life practice. The same practice that's doing 750, look at this. They're presenting enough treatment per month, but they're not getting the treatment accepted per month. 99% of people, Pam, do not track treatment presented and treatment accepted. Got that?

What's a great efficient way to do that? Because I think that that's kind of an Obstacle for people that they sort of just stop right there.

Yeah. So we have a spreadsheet, and so we have a whole spreadsheet built out. This is an analytic dashboard. There's three or four of them available. We happen to use dental intelligence, but that's still not 100% exact. That's why we use. So when you get on a calendar with Ava, she'll just share that with you and she'll give you. Give you the treatment tracker that we use manually. And by the way, you know, Pam, I have so many songs in here that I love, but I don't know I have them. So if you're tracking using a dashboard, it's like having Apple music and not remembering the good songs you have. When this is we. You know, obviously most people don't want to do manual, but when you do manual, you know your pipeline and you can call patients back and people are having to put information in. It's the only way to get 100% accuracy. Okay, so this is a big deal. So if. If you really. Look, we just boiled where you need to put your attention down for the whole year. Treatment plan, case acceptance. If you just increase this number by 70,000, you're. You blew your recession numbers out of the water. Blew them out of the water, Pam. Okay, and then this is the second number I want you to look at. Most people only look at the patients coming into their practice. Oh, we had a good month. 37. 37 new patients. What they didn't look at is now they've recaptured old. So 37 minus 17. But they're not looking at lost patients. What we track is monthly, how many patients didn't come back after 18 months. So if I take 37 plus 17 minus 60. This patient base is shrinking by six patients a month. Now, watch this. People buy what they want. They want hygiene, and then you can give them what they need. That's the treatment plan presentation and case acceptance in your hygiene department. That's how you build your practice during a recessionary time.

Once again, you mentioned earlier how numbers not lying and how numbers are really where it's at. And I think if you ask most dentists where they. How successful is their case acceptance? I think many of us say pretty good. Oh, yeah.

You know, they're going to say, yeah, my patients, they. Whenever I tell them, they buy it. They don't know what the facts are. I'll also say, what do you think your patient retention is? They go, 80%. I go, it's not even close. You're upside down, you're shrinking. They don't know those two numbers. And once you do, you're like, oh my gosh, that explains everything. Because by the way, that negative, you're not going to notice six patients shrinking. And you will in three to five years. You'll know it then. By the way, this is why DSOs are blowing it up. Because they plug these two holes really fast and they know they can blow up a practice. That's why if you're a private practitioner, do this now before you sell. You know, if you want to get through the recession. Let's just get to the second set of numbers, Pam, because I know we're tight on time, but I need to give you these numbers right here, okay? These are key numbers. So we've been looking at how to grow the top line. Let's look at how to manage the bottom line. So there's three types of expenses. Now I don't know about you, Pam, but you know, I was taught everything is a bad expense. Every, every expense, anytime I got to take out my wallet. By the way, that's why they have all inclusive vacation places. Because you're on vacation, you don't want to confront taking your wallet out every time you got to buy a drink, right? They don't, they, you want to take that pain out. So there's three types of expenses that I want you to really understand. Destructive expenses. That's where you have a person on your team that maybe be good in skill set, they're a good assistant or whatever and, or a team leader that like, you don't like really what they're doing. But you, you're not confrontational and you don't want to deal with it. You're paying that person $25 an hour and they're killing off all the new initiatives. You say white, they say black, you say left, they say right. Because they are the really controllers. Not, it's not the recession out there, it's the virus is inside your business. In a destructive expense. When you're paying somebody something and they don't line up and follow through on what you need them to follow through on, that's a destructive expense. A consumptive expense is you add like hot towels or water and it's a better experience, but it doesn't give you a dollar for dollar return on investment. A productive expense is when you invest in an advisor that guarantees a return on investment. And now you spend a dollar and you're getting five back and your peace of mind is better because you don't have to worry about being upside down. So those are the three types of expenses. Now what you want to do is you want to. This is the game changer in expense management. This is a proactive layout of how your expenses are going to grow. Or like you're going to manage your expenses on an. On a monthly basis so you can project how much money you're going to make at the end of the year. You project how much you want to make on the top each month. Okay. And you can see that there. What we do is we take what you did last year. Then what we do is we look at what we're going to project as growth. So the first number is history. The second row is what we're future casting. And then the expenses. That's. That's how we're going to control our expenses. So if you're just spending money out the door on, like, you have no budget set for an assistant that's going to manage your expenses or your supply budget, you know what that looks like is you get $10,000 a month or $15,000 a month, and once you spend the money on that, that person says, oh, my budget's up. That's going to go into next month. So I better really get better at really putting my arms around these types of things. And so you're not just making money decisions on the fly. Walking down the hallway from room one to three and you're going, somebody asks you, hey, can we do this that the other thing? Or a shine rep comes in and you're going to, hey, should I buy this piece of equipment? And you're geeked out on toys, but, like, you don't know the impact that it's going to have on your game throughout the year. So, by the way, that's why you want an advisor that's guiding you on. On your expenses. Should I do this? It shouldn't be reliant upon you during your day. It should be you step out of your day, you go into that monthly meeting on your expenses, and then you really look at, you know, should you make this decision? We make no big money decisions on the fly. 00. And we have control points on each of the areas that Dennis leak money. It's money with wings. They're just sending comes in the front door and it goes out the back.

Oh, yeah, mine definitely has wings. That's for sure. Well, you know, again, I know I mentioned this, but I feel like you gave us so many awesome pieces of advice last year that we talked about. You know, is Your advisor. An advisor. Do you have, say, for example, your accountant, Are they a bean counter or are they advisor? Like, who do you have on your team? Because, you know, I'm not an accountant. I would say most dentists are not. And, you know, most dentists are not financial planners or financial advisors or practice managers. And so having the right person on your team is only going to benefit you. And that's without a doubt. So, you know, what would you say is some of the hardest budget lines to keep in control?

You know, for me, it's like it's always the number one and the biggest expense, Pam, which is payroll. And that is fixed by putting measures in by position, like I showed you, and then asking them if they commit to those. Those numbers and then having them take ownership. You know, most people go, oh, I gotta. I gotta save money on cotton rolls or gloves or. Look, you're stepping over dollars to get the pennies, the dollars that are leaking out the door. Is you not dealing with your team and giving them a business model and structure to take ownership of which 90% of team members want to take ownership of it, and then rewarding them on the incremental growth that the practice has. You know, I see a lot of doctors throwing $6 an hour, $5 an hour. That raises your fixed expenses. When you do that, versus this is the conversation that you want to have with your team. Team, I want to pay you more money. I want you to have benefits. I really want to take care of you. That's what my heart says, right. I can't get blood from a stone. There's a finite amount of money here that's available, finite right now. And what that allows me to do is take care of all of our expenditures. You're looking at one thing, usually, which is how much money's coming into the practice. What I have to do is know how much money is coming, how much money is going out. If you're willing to help me grow, I will set a bonus structure up on the incremental, and I'll share generously on that. But I can't take more money out of what I have because we have to take care of what I call the mothership. The mothership is the business, and that is a living, breathing entity. And we have to keep feeding it oxygen, and we have to keep feeding it. Nobody's greedy here. And I'm the type of doctor that loves to share, but I can't share from nothing. And the nothing is we're at capacity because of inflation. It's Just the same thing that you're dealing with. Do you want to help me get past this so I can help you get past these inflationary times, these recessionary times? Well, I'll set up a business program, I mean a business triple win business model that allows you to get more money. As we grow this company, I'll show you where we have to focus our attention. It's in two particular areas. Patient retention, getting our patients back in hygiene, filling two full time hygienists, and when we're there, having a conversion rate of 67% or around $80,000. We're at $16,000 right now. We have to get that number up. And with that 70,000, I'm going to share it with you guys in your area of accountability and I'm grateful to do that.

That's incredible advice. And I think that, you know, gosh, I mean, I know we could go on and on and on about this because I know, I just want to hear more of myself. But we're kind of out of time and I know we didn't get to all of the questions. But don't worry everybody, we will make sure that they get forwarded to Gary. But Gary, you still have a little bit more for us.

Yeah, yeah, I got, I got like, I got Encore. I'm throwing in Encore in the residency. You know, Brittany does it, Katy Perry does it, you know, so I want to really get in here and I want to share one thing because this is future casting for what I call like not having December 2023 end up like December, you know, December. I'm sorry, let me just pull this up here. I don't want December 2023 to end up where December 2022 did for people. And this is what's going to happen throughout the year. So you have your current situation, let's call it, you know, 112, you know, 23. Right. And what we know is you're going to have a financial future on 12, 31, 23, right here. And then throughout this time, you're going to have your ups and downs and stuff's going to be good in your favor, not in good in your favor. Now left your own devices. What's going to happen is you'll sit here, right? We know this for sure. And if you do nothing, you're going to go down to a drift. That's weird. That came up. You're going to drift and you're going to end up in a crisis because changing nothing, when nothing changes, nothing changes, right? And then maybe you'll run it a little bit better. You'll be like somewhere in here, you know, right here with some instability. But ultimately, where you want to go is up in the green areas. And this isn't bad for a colorblind guy, right? You want to get into security and abundance. And how do you do that? Well, it's really simple. If you wait till the end of the year like you might have waited till the end of last year, or you're coming into this year, you're in your furthest part right here. It's harder, it's riskier, it's costlier to go from crisis to abundance. But if you make a choice right now, you jump lines, you ride the curve because you're making good decisions and then you fast start. What I'm recommending is whether you do it with me and Ava or you do it with another company, interrupt the automaticity of what you know is going to happen and get a coaching call to interrupt that to get you on fast track to abundance. This is the prediction of how the year is going to go if you make a choice today to go, hey, it cost me nothing. Let me get on this call and just get in conversation with Ava to change the trajectory of, of where we're going, make choices and make decisions. Analysis, paralysis. 80% of our dentist want to analyze, you know, how last year went, change your trajectory this year by interrupting yourself and have a better chance at really crushing it.

I couldn't agree more. And I feel like, yeah, you're right. You know what? And if for nothing else, look at your numbers and make that call and let's see what the information lies. I mean, knowledge is power, right? So see what the possibility is and you can decide for yourself if it's time to jump in with both feet. But here we are, a new year. Let's make this the best year yet. And yes, there's a recession, whether it's looming or here, I think it's kind of here. But I would say that it's. We can do something about it and we can certainly get through this with, you know, pretty, I would say unscathed at worst. You know, we can certainly grow in this environment. So, Gary, this was awesome tonight.

Thank you, Pam. Thanks, everybody. And hey, this is your year. Make the unacceptable, unacceptable. I'm going to say that one more time. If the way you're living your life, with time, money, experience is unacceptable, make it unacceptable. And that's when change begins.

Thank you, Gary. This was so inspiring. So I know we're out of time. Everybody. I can't wait to see you next month. For De Solutions Lab, I'm Pam Maragliano. Muniz for Gary Katie. We will see you next month. Take care everybody.

Bye bye, Pam.