Build the Perfect Compensation Plan: Dental Economics Solutions Lab October 2021

Hey, everyone. I'm Dr. Pam Maragliano Muniz, chief editor of Dental Economics. And welcome to DE Solution Lab. Tonight's topic, building the perfect compensation. How to attract and retain top talent with an irresistible offer. This is something that I think all of us need right now. Now, before we get started, couple of housekeeping tips. Questions are not only welcomed, they're encouraged. So get in the chat, ask your questions. The sooner you ask your question, the more likely it is that we'll get to it. I know that with this guest in particular, questions tend to go on forever. And unfortunately, we don't have all that time together. So please get your questions in and we will address them. With us tonight is dental industry expert and advocate Gary Kady. Gary is the CEO and founder of Next Level Practice. For years, I've watched Gary champion dentists and their teams through struggles, embracing and implementing change and succeeding to getting doctors to enjoy practicing again. Dare to dream, right? I am super excited to have him on tonight. Gary, welcome.

Oh, Dr. Pam, I am so crazy excited about being here. I even broke out my new Brooks Brothers. I got the control pace dialed out. I mean, to be with you, the chief editor of de. I mean, what a privilege to be here. And, you know, the thing that I'm so excited about is the group of people that are going to be watching tonight. And I'm recording, you know, operate at a different level. So we're going to be able to work fast. We're going to give good content and good solutions so we can get past this tightrope that we're dealing with in dentistry right now.

It most certainly is a tightrope. And I couldn't be happier to have you here because you just like everybody else, I'm going to be here. If you see me looking away, I'm taking notes myself. So I can't tell you how many times over the last year I've been asked about the hiring crisis in dentistry. It's definitely one of the top challenges in the industry right now. You have an innovative approach to solving it, which really stands out for me. But before we get into the nuts and bolts of this discussion, I want you to get your take on why is it so hard to find the right team members.

Yeah, well, right now it's just the supply and demand issue. You know, number one is we've lost about 10% of the dental workforce just because people are just not coming back and they're not going back inside the office. They might, you know, picking up sales jobs or other positions. It's just like, it was a time, I believe that, that the pandemic was done for us, not to us. And people looked in the mirror and said, look, I need to make new choices. I want to have a different lifestyle. This is the time to do it. I have the time and space. Let's go do it right now. And then some people were just forced out of being chairside, whether having to be home with their kids or just made choices, new choices as well. People have moved, so there's that component as well. And then there's a divide that I see going on, Pam. I see the struggling doctor that hasn't pivoted yet, hasn't really reinvented, hasn't. You know, during the pandemic, whenever you go through a crisis, I went, I walked doctors through 9, 11. I walked them through 2006, the Great Recession, and then, you know, 1800 practices, through furloughing people and getting to the other side and reopening. And, you know, some, you know, practices really pivoted during that period. Some really stayed the same. But what happens is, during our crisis, Pam, is that it unveils your weakness. So going into the pandemic, if you didn't have a good recruiting, hiring, and onboarding system, you know, you were, you were going to get unveiled during this process, or if you didn't have good leadership, management, a good culture, a way to retain millennials, because millennials and baby boomers are two different. You know, the care and feeding of a millennial is different than a baby boomer. All, all those elements. If you didn't reinvent and strengthen those areas, you know, you'd have fallout and you wouldn't retain some of your team members. We've had, I would say, 50% of our practices lost more than three people. Some have just reinvented and lost their entire teams and shifted. So it is really a compressed, a compression that happened during the pandemic, a compression of time, people looking in the mirror, a transition of people moving in and out of dentistry. And it's really, really a fine time right now to get this handled so that you can really get on the trajectory of really where the successful dental practices are. We have a huge group of people having bigger demands for team members. And that's the other thing. It's a supply and demand issue. And these thriving practices that pivoted are really taking those patients, I mean, the team members. So it's really a time to look at this. If wherever you are, starting from today, I agree.

And I have to say, with most challenging times, there's opportunity here. And so even though it is frustrating and I think recruiting and getting the right person that fits into the practice at a reasonable, with a reasonable package, let's put it that way, is really difficult right now. It's an opportunity and when you find that right person, it's going to be nothing short of magic.

Yeah. And the great part about what we're going to share about tonight and if anyone wants to connect in the future after this session with me, like the opportunity to really reinvent how you offer packages so that you don't disrespect and dishonor the existing team that's been there at maybe a lesser dollar amount. And you know, just like supply and demand for team members and talent, it's not just in dentistry, it's everywhere. And it's not, you know, it's, you can see it like even in the housing market, supply and demand and people are getting 10 offers on their house. So it's, it's, it's no different than any of that. But you have to know how to navigate the current times and we're going to unfold that today.

So excited. So for those of you that are stuck in this crisis and need a helping hand, which is many of us, Gary has such a good opportun for you to get some help. So I encourage you to stick around until the end because you definitely do not want to miss that. Also, as I mentioned, we are going to be fielding questions at the end so please feel free to ask them. Enter them into the chat on the right hand side of your, of your screen and we are going to get to it. So first things first, I have a few questions about how to pull yourself and your practice out of this crisis. The first one being what would you say is key to attracting top level talent?

Yeah, great, great start and great question. Top level talent is available. The first thing is to get out of fear and scarcity that they're not available because if you have that mindset, no matter what you do, it's not going to work. Right. So I can have, you know, a person who says I'm never going to find any good people because I can and my friends can and all the people at study club can. So therefore I can't. So the, the mindset going into this is the difference between scarcity and abundance. Scarcity means there's not enough and abundance means there's more than enough. Now if you. Now this isn't woo stuff. Pam, I want to be clear here It's a mindset that will allow this to turn out. So first is you got to stand in that there's more than enough people. There's more than enough people for you. You just haven't put out the right message yet and offered the right package. And that's the key. So mindset move from scarcity not enough to more than enough because we're having just to paint a picture of what's possible here. The practices that have deployed this thinking and this strategy actually have wait lists for doctors and hygienists. Now I know that that might sound like absolutely insane during these times, but it really does work and here's why. Another thing that you said, Pam, I want to highlight, you said top level talent. If you're interested in B players and C players, you know those people are interested in J O B. They just, they just put their resumes out to a thousand people. They may show up for your, you know, appointment with them, they may not. They're looking for a job. They'll give you their time and you give them money. A career person maybe is the step up from that. They care a little bit more. They want to know how you know what your vision is. A little bit of that. But they're really not where we want. We want people that have a calling. There are so many hygienists and we call them hygieniuses. We elevate every position. So hygieniuses. And by the way, we have that trademark, Pam. It's awesome you guys can use it. It's so good. What happens is it immediately speaks to you. Relate to your hygienist as a hero. When you acknowledge people as heroes, those men and women that work around you and you honor them, they feel that because they don't always get that respect. And the number one thing a person wants is honor and respect. When they know that and you go, look, we don't just hire hygienists here, we hire hygienistes. And the third level of a hire is job, career and calling. When you can speak to the emotional purpose of why a man or woman became a hygienist and speak to that and say, we have a practice that will give you the opportunity to fully express your purpose inside of our practice. Now you're going to attract top tier because you're going after the people that have a calling to do their work from a place of purpose, not exchanging time for money. Does that make sense?

I think fully express your purpose. Sounds so powerful and I want to come work for you. I'm listening to this, and I'm thinking, this is. It's incredible. I mean, I think it's incredibly powerful. And it's such a different way to present the opportunity to a candidate.

Yeah. And it starts with, see, most people want to check a box and they go, can you give me the ad that will attract the right person? You have to do a little work to package your practice, Pam. And here's what I mean by that. You know, especially millennials, because the other thing that comes up in 2021 is 60% of the workforce for dentistry are millennials. Awesome. And I wrote a book called Dentistry for Millennials, and I have gray hair, so I'm the oldest millennial. I have my millennial card. I know Drake, I know Quinn. Cool stuff. Pam. What? Yes. I am so hip. I know gonna. I know Dababy. I am, like, so. And I work not to lose my millennial card. But here's the thing. I was gonna pull my hair out because I used to think millennials were entitled. They didn't want to work hard. You know, they thought that a resume of 30 different businesses in the last two years was a success, and they just come from a different place. So if you're going to attract the type of people that are like. And by the way, once you speak to what's important to the millennial team member, oh, my gosh. Like, they are. You've met my team. They're insane. Like, Ava Ryan, these. These men and women care deeply about the work we do that you're taking care of. Our work comes out great. Like, it's amazing. But if you look at them and, you know, a lot of business owners are baby boomers, and they're going, ah, they just don't care. They're just that, you know, and that, again, goes back to the mindset. You know, if you have a scarcity mindset and then you have, like, they're entitled, you're going to miss the game. Does that make sense?

Completely.

Yeah. Two different universes. And so one of the key things here is putting purpose into your practice. So, you know, like, I buy. I love. I went up to Maine, up to L.L. bean, and there was L.L. bean. There was Patagonia, there was. There was North Face, there was Eddie Bauer. They were all there. And there are outlets. I walked past all of them. I went to Patagonia. Why? Because what that company stands for is open spaces. Now, look at this. They have the donation board. We gave 10,000 to this trail and 20,000 to this trail they're donating to. Keeping spaces open and usable to the to public and not getting them constructed and built over. Now, I buy Patagonia. It's probably that, you know, the pillow jacket with the lines in it and it says Patagonia. You know, they're probably all made in the same place in China. But because of what Patagonia stands for is why I buy their products. And so the same is true when you're selling your practice as a product to a person who's buying it. I want you all to be thinking that your team is your internal customer. They buy your practice as a product every day. What's the experience that they have? That's the other thing Millennials buy experiences. If the experience is in your face, like, you know, micromanaging. If it has all that to it, they sniff that out and they don't want to run there. You know, it's the same thing as a real estate buyer. If it's not quite right, they're going to go on to the next house and buy the one they want. So why don't you make it so that it's desirable as a package? And when you put a vision, purpose, and values, like, I'll give you an example how simple it is. On a good day, we save smiles. On a great day, we change lives. We're in the business of enhancing the quality of people's lives. Our values are integrity, honesty, transformation, accountability, and fun. We have fun here. And so you package it like that. And then when you. You put out the ads, then we're not going to be running ads. Ads are for jobs. Like job posts are for jobs marketing. Ads are ones that have enrollment in it on the top on what you stand for. Like, do you want to help us, you know, enhance the quality of people's lives? Would you like to, on a good day, save a smile. On a great day, save a life. Would you like to be honored? This is hygiene heaven over here. Would you like to be honored as a hygienist, where you can actually express your purpose fully and make a profound difference in the lives of our patients and have a collaborative dentist who supports you and honors you as a practitioner? That is a very different ad that says hygiene 9 to 5, Monday through Thursday, Dentrix, etc. That's a job post. Do you see that?

Very much so. And it's funny that you mentioned this, because anywhere in social media it says, great office, great team, great opportunity, and literally nobody even wastes their time liking the Post No.

And it's interesting I said about vision, purpose and values. And a lot of doctors get scrambled when I give them this distinction. I all it is is wrapping your practice in a meaningful purpose. So if you think of your practice as a living, breathing entity, is it one that nurtures and transforms and adds value or is it a place where it's hard to work? It's frustrating. You know, look, breakdowns happen, but if you don't have a good culture, that's going to. When, when the person goes in. And even if they make it to your space, a lot of times there's this grapevine. I don't know if you know this, but I used to travel a lot with Benko Patterson, Henry Schein reps. And they would get two to three calls a day and go, hey, I'm looking for a new job. Who should I go go work for? You know, is this guy good? Is this gal good? And it's that going on and they actually have that kind of influence. By the way, that's another. I like fishing. So when I fish, I like to have a few poles out. One poll would be like, you know, you're indeed your zip recruiter. Your, you know that, that group of, that group of people. Then you have dental, post specific for dental. And then you have your influencers that you pay money to that you want to turn on to as recruiters. And if you write these ads up and you let them know what you want and why you want it and the type of person they actually help you become, you know, you know, somebody that they know might be looking, they may make that recommendation.

I think that's extremely helpful. And the tips that you've given are so different from what I think the average dentist is doing to recruit. So say we do this, we cast out our polls and we get a bite. What's the next step?

Well, in the age we used to do this before the pandemic, but what we like to do is first do a cursory phone calls. So, you know, it's harder. It was harder to set up a zoom call or a Skype call at the time. So we would say paint your ideal position. So this is a key question because, you know, you might be able to adjust if you answer that question. And let's say it's an hour off or an hour here, an hour there, according to their schedule, they'll say, no, I'm not interested. But if you say paint your ideal position, you know, give me your hours, give me your ideal income, give me you know, your ideal scenario to work because then what you can do is gather that information and see if it, if you can make it work because, you know, you have to have a little bit more flexibility. We can't be as rigid as we were before. So you can adjust. And sometimes, you know, we've been able to place two hygienists because, you know, they wanted to both work part time. It's not my ideal scenario, but we go out of the box to solve problems during this narrow time. And it's not going to be forever. It's, you know, really for the next, I would say for the next four months we're going to see this and then I think it's going to start correcting itself. You know, that was the other thing they were getting, you know, making some positions, were making more money staying at home or almost the same amount. So that was, you know, another key issue. And then we have state, you know, issues in California and such that also cause more constraints. So you know, there's things like that. But phone call, ask the ideal. Then I like to do a zoom call. A zoom call, usually with a team leader. I like a zoom call because I know a lot about you. Just seeing your back background Pam, like I know that you care about the way you present yourself. You have really cool. I, I mean I can't stop looking at your backdrop. I mean it looks awesome and it's like you're well put together and it's like she's professional. You know, do you show up on time? You know, before we had everybody plugged into Zoom, they, they, you know, we're, we're high tech company. So if you can't get a Skype call set up, like I can't tell you how many times people couldn't set up a Skype call. They're not a candidate for a very high tech company that we are. So they would, it wouldn't work or they would show up late like, or my, my dog locked me out of my house. Like it's interesting to see this. And by the way, you asked this question. The mindset of abundance, knowing that there's more than enough. If you don't take this recruiting approach and the interviewing approach, you're going to get turnover too fast. So the key here as I give you this system which is phone call, what's your ideal scene? Zoom call which has, it starts going deeper into the vision, purpose and values and then you ask them how they can contribute to it. Now what you're doing is you're establishing that you're not hiring just like everybody else. You know, we've taken up to three months to hire people. Now, if I said that to you in a hard environment to hire, you might go, there's no way. No, I'm not telling dental teams to do that. But we'll put people and they actually have to work through. Like, they have to do book reports, like my first book. They'll read it. We ask them to write a book report because we want to see how do they cognitively take information and apply it. So there's like, so many tools that you can do. But for specific, for the dental practice, the phone call, that's the qualifier. Then there's, you know, the zoom call. Then we do a second team interview. This is where we have them come on site so you can see how they present themselves. Do they show up on time? Now you got a third time to show up on time. Now you're going to get their vibe. Do they come in? Are they complaining? Are they smiling? Are they presenting themselves well? So now you're getting the visual check, right, and you're having that conversation. The other thing is we have them interview with four people on the team, and each of them take a question as to the values of the practice. So let's say fun is a value. One person's going to say, what do you do outside of work that's fun? Because we like to have fun around here. And so what happens is you can't train values, but you can train skillset. So we make sure that there's a value fit, and then with that value fit, anything's possible. So that happens on that. Then we definitely do a book report. And that's crazy. Like, we'll have them read like a white paper on the philosophy of the practice. Maybe it's a short one. Sometimes we have them read my book, depending on the who we're interviewing and et cetera. And then we asked them, can you just write a paragraph on what you took away and just notice they're now investing time for two reasons. One, to learn more about you. But they're also noticing the level of impeccability and care. Because in this conversation, you're going, we're protecting you against making the wrong decision to come on board and vice versa. So when you start having that position, the opposite happens. Then you think from taking all this time, people actually honor and respect that you do things really, really well, and you do them differently, and you do them because you care and you're looking for long term relationships. So then, then we have an on the court session for four hours depending on the position and they actually go execute. And then you can do it one of two ways. Either they can shadow you and you can say what was your experience there? What did you see? So like somebody could shadow another assistant or you can put them on the court and see how they roll if they're willing to do that. So and then, then last is the offer, the offer letter and so on. And we have a templated version of really a written offer letter that outlines all the specific details and make sure you make good agreements on the front side. So that's, that's how you attract and get talent engaged and enrolled and have them be the right fit. Pam. Because what we don't want to do is get them in there and have them quit a week later or you know, whatever. So you invest time in the front end for a long time relationship on the back end.

I think that's really smart. And I also like to mention that this process that you go through, it also empowers your team. I know I've historically done something a little bit different, but I think we're going to be adopting your approach. But my office manager and sometimes my assistant or my hygienist will sort of pre interview and meet the candidate first before they come to me. And I can't tell you how many candidates don't make their way to me because my team says not just anybody can work here. They need to come here for the interview, they have to come on time, they have to do these things and they're so protective of their space that I'm so proud of them to see them doing that because I really want that extra team member and they know that we really need to pick the right one. And I think that it's definitely worth the wait. But this brings me to another point and I think this is really important, especially because many of us are dealing with this now. So you mentioned earlier supplier demand and I get it, I'm totally into it. However, what if you have those loyal team members that you've had for a long time and they're making X amount of money and you just love them and you know you're paying them fairly, but it's now all of a sudden so much lower than this new person is coming in asking for. How do we properly compensate a new candidate without completely disrespecting the person that's been loyal to us for so long?

Yeah, this is a quandary that Exists almost in every single practice I talk to. I, you know, as you had mentioned, I offer a half hour for 10 people at, you know, after this session. And 10 of those people are dealing with this issue right here. So let's, let's unpack it a bit. Okay? So the first thing is, is that you have to understand a few things. Number one, not everyone's currency is money. Not everyone's currency is money. So if you make that assumption, then, you know, and that everybody's going to be asking for more. That's that why on that first call, you ask for what's your ideal? So if it is higher, there's a way to come in but not give it as a hard fixed expense. So, like I'll give you an example. We have, we have a practice in Reno that got a call. There's a lot of people moving now. A ton of people moving now. Right. So the example is this woman was from Alaska, and in Alaska, the supply and demand has been an issue forever. And they get $50 an hour, and the existing hygienists were making 35 to $40 an hour. So the first thing you want to do is you put a bonus system into your existing practice. And we have a bonus system that works beautifully for this. And I'll give you a quick just overview of it so you can see the picture of it. See, you want to make new money. If you're making new money, you're willing to share it if it's above your fixed cost, because the variable cost above what your fixed costs are. There's a. There's 70% profit in that versus 30% profit, ideally at the threshold that you've been at. So the minute you can consistently get above the number you're doing, you can share more money because it's two different types of profitability structures. Right. But you can't, you can't get blood out of a stone if you're not growing. So the way we design this is a bonus system. So, Pam, what I would do is sit down with you and say, look, how much money do you want to make? Okay, you want to make 2 million. How many days a week do you want to work? Three days a week. Great. How many weeks vacation do you want? Six weeks vacation. How many hygienists do you have? We get the number of provider dates. Then what we do is about the average of 1500 a day for hygiene. We multiply that out and we get, let's say that number is, let's call it 750,000. So that means that the doctor needs to do 1.25 million. And so we divide that by the number of days and that's how much you need to do per day as a provider. So let's just say it's, I don't know, 10,000 a day, working three days a week, and it's 1500 a day for the hygienist. We mapped that out over each team member. And now you put accountability by the team member. So the appointment coordinator, when they fill the schedule to 1500 a day and the doctor schedule to a 10,000 a day, you pay them a daily dollar amount to do that. Right? So that's number one. Number two, I'm sorry, just one thing came up here. So number two, I'm sorry, I lost my train of thought because I just got an alert that somebody was in my Apple id, Full transparency. That's what just happened. So anyway, we're good security everywhere. So that's being taken care of. So when you map this out over your team now, you turn them into the mindset of growth and high performance rather than trading time for money that will give more money shared with your existing team. Now here's the nice thing that happens. That gal who was at $50 an hour, we started her at a competitive rate and we showed her how in hygiene, if you recommend treatment, you're going to get 1% of the treatment. You do $10,000. I mean, you do $100,000 from your chair and we have hygienists doing that. Your number is 1,000 bucks. So you're making more than $50. But here's the thing, the compensation package is on new money, performance versus just saying here's $50. Because what that does is that just swipes money from the existing cofers that will just basically now you can't be as profitable as you were. So it's the triple win. The patient wins, they get the care they need, the team member wins. Because now they're measured by a daily outcome and, and only paid when you collect 167,000. So, you know, 10,000 a day for the doctor, 1500 a day for the hygienist. And in my book, Million Dollar Dentistry, it outlines this whole thing. So I'm not going to go down that road. But I wanted to give you what there is to do. And that is an incentive plan, reverse engineered from how much time and money you want to make as a practitioner mapped out over the team that becomes their measure. Now they're, now they're Looking at their role as an outcome per day rather than being busy all day. Because what happens is they get busy all day and they do the most non confrontational things that don't move the needle on the top line, which is fill the schedule, overcome broken and canceled appointments, handling objections of why they can't afford it. Those things usually go to the background. Now they go to the foreground. Because your team has skin in the game for what you need them to do to produce the initial dollars that you can share with them.

That's really interesting, but I'm going to ask you this question because I think that this is a problem that we're facing. So I love what you're saying, but you're also putting almost more responsibility on that team member. You're looking at the schedule and there's an aspect of the schedule that they're responsible for. And what happens if somebody leaves now it just seems like a chunk of your schedule sort of fell apart. How do you eliminate or at least minimize significantly team turnover?

Yeah, well, team turnover is like a whole nother world here that I want to step into. So we were just talking about attracting. The first thing we talked about was attracting them and we now know how to do that. Then overcoming the issue around like the difference in compensation pay, honoring the existing and then really setting the new person up. The team turnover piece, Pam, is key. And we had to invent two systems and I mentioned one before, one is the vision, purpose and values. See, my team is like, they bleed this work. And I'm literally moved to tears because there was days that I hated working in my own company. I did not want to go to work in my own company. I hated everything about it. It became something, you know, I was an individual guy running around. Then I had consultants, then I had, you know, so many team members. And I hated working under those conditions. So I had to step back and get my arms around it and say, why are we doing this? And then we created a vision, purpose and values to get. We're here to get a billion people healthier through dentistry. And so we're making a global impact and reinventing how dentistry is related to by the patient and the team members, right? By reinventing how we approach it. And when you do that, people feel like they have a contribution and they're going to leave a legacy behind. And so I started really like getting congruent with why I do what I do, which is my ultimate purpose is to provide freedom. Freedom to be, freedom to do, freedom to have the things you Want people be, do and have anything that you want. So that's like what I stand for. And I happen to do it in dental practice development, specifically for GPS pedo perio. Right. So that's really what we do. So once I got connected to my purpose and I'm using myself as an example because I think we've all dreaded going into our own businesses. You don't have to live that way. I always say, Pam, pain is necessary. In dentistry, suffering is optional. Like pain tells you to make a change. If you are avoiding change, hoping it goes away, shoving it under the rug, waiting for the day life is going to get better, like that's suffering. You are in the suffering. Don't suffer. If you do one thing from our session today, make the unacceptable unacceptable and take one new action that you wouldn't take, right? Do that today and I promise you your life is going to be different. You are going to start looking at why you don't like your practice and why we're not retaining. By the way, my turnover was ridiculous. Look, on Glassdoor there was people pissed off at me, Pam, and it was because they just weren't doing what I needed them to do. And I was going, you know, face to face. That's the other thing. As a business owner, I had to step out of the management people. If you're a business owner and you're managing people, even though you're the kindest, I'm a kind, loving person. But when I got to get things done and I got to make payroll and I got to handle business and it's not going right, you know, I'm going to come to you and you know, it's just heavy handed when the business owner does it. So I have the best management team on the planet and I only talk to them. I don't talk to my team. The only time I talk to my team is just what I call sprinkle, you know, dust on them and tell them how much I love them and send them love and acknowledgement and do nice touches. So that all of a sudden transformed our retention. Now we retain people. And then when you get people inside their calling and they're doing what they love to do and they get like so jacked up about like making an impact. Like there's probably six team members that organize this. They're so proud right now and I'm so proud of them. Like they don't get recognized. You know, you and I have this discussion and we're the outward face, but I want to pull them in here right now and give them a big hug and show them. And like that wasn't always the way, Pam. I was angry and frustrated and, and resentful for how things are going. So once you start coming face to face, then building your bonus system, then I'm going to give you one more little tool that we invented. We apply here and it's life changing and it's called our dream program. So you appoint a dream manager, you fill out 100 dreams and it's not easy to fill out 100 dreams. The first time we fill out and we've done this thousands of times, people go, I want to weigh this, I want cholesterol, that those are goals dreams are. And I've done these, so I'm going to share those with you. Go fishing in Canada in a private boat, catch a salmon and cook it while the sun's setting in in Vancouver, Canada. Did that, you know, and I'm sharing with my son. I go, son, this is one of my dreams. He's like, God, dad, what other dreams are we going to do? And by the way, when you have this dream program set up, it's meant to go into your family life because when you hire somebody, you're not only hiring that person, you're hiring their family because how much you're getting paid, how you come home at night, are you complaining? Are you not like those types of things? When we put this bonus system in the home life of people got better. Because what do you think the number one dream is of dental team members? Take a guess. What do you think the number one dream is?

Vacation.

Yeah. A Disney cruise. A Disney cruise was number one. I want to be Walt Disney and get commission on this because we are sending people to Disney cruises like I've never seen. And they use the bonus system to have something emotionally fulfilling not only for themselves, but their entire family. And it wasn't going to happen. And, and you actually keep, now you might be sitting there going, I never had to do anything like this. Like, what are you talking about? Why do we have all this? Look, you don't have to do anything. You could just keep doing what you are doing, but you are not going to get top talent and you are not going to retain them. This is lower, no cost. You talk about morale boosting and joy and like in lounges, we have unfulfilled dreams. And when one gets filled, it gets moved to the other side of the room. Fulfilled dreams. It creates momentum and awareness. And then here's what we noticed about our bonus system. Do you know, most people, they're not driven by money. So if I put a bonus system in, half, the team is not driven by money. But when they have a Disney cruise at stake and they figured out how much money they need to make and then they have the ability to make it, they're going in five or six months, paid, done.

That's a big deal. I have to also say a couple things, too. I think about I was you when you said you were miserable. I can tell you that I bought my practice a little over seven years ago, and I've told people this story, and it's just true. I'm Italian. It's not really my way to kick people out. So when I bought my practice, I retained the staff, and they were people that were going through the motions with the previous owner. I'd bring in a new idea, and it would be out the window before it was even out of my mouth. And it was something that I became comfortable with kind of being a little unhappy. And for me, it took the pandemic to just have that minute to take a deep breath, look around me, and realize that I am not even remotely happy with my practice. My vision that I had when I bought this practice and what it was in reality were two totally different things. And I felt really stuck. And I can tell you, in the middle of the pandemic, I replaced my entire clinical team. And it was kind of a nightmare for a minute. But I can't tell you how much I love my team now. And so when you were talking about Ryan and Ava and all of the people behind the scenes that make you look good and make you able to do the things that you do, I feel like I am there, and I feel like because I have that team, I don't hate the idea of having a dream manager, because if this was the team I had two years ago, I would be like, I can't make it. You know, Like, I can't even. I'm having nightmares. I can't have a dream. It wasn't really my thing. And I feel like now I love them individually, I love them collectively, and I would love to support their dreams coming true, and I would love to be part of that. And I think that when you have the right team in place and you attract the right people, then all of this is a reality. It's not just, you know, you're not just throwing rainbows around. And this is true. And I think that this is something that's extremely powerful. Trust me, if I can do it, you can do it. And I think that if there's anything you get from this, I agree with you, Gary. If, if you don't have the team in place, just take a deep breath and get the right team in place, because it will change. I mean, my dentistry is better, I believe. Like, I feel like I'm a better dentist because I get to come to work happy and I'm not mad at my assistant all day long. Like, I just. Everything's better. And I think that what you're saying is so valuable and so achievable.

Yeah, I just wrote an article. I love the title. I'll just bring it in here. Lost half your team after the pandemic. Good for you. Because some people have been holding on for people for 25 years that are actually not allowing you to retire financially free, not allowing you to take your time off. And not bad people, they're just stuck in the old way and they want to hold everything together. And so, you know, one of the things that also brought up is for a new doctor who's taking over, we have a five step process, very simple. I want to share it here because this will also facilitate turnover so that you can get rid of people that are not aligned to your values. It's called our line in the sand system and we do this for doctors that are taking over new practice. And step number one is acknowledge your team. Team. Thank you for allowing me to be here. This has been your family. I now own it. I'm the new person here. Thank you for warmly welcoming me. Step two is I'm taking a level of leadership that might have not been the same as the past. I really want to do it collaboratively. I want to be of service to you. I see you as my internal customer. What got us here, Step three, what got us here isn't going to be where we're going. I have a clear vision for what the practice is going to look like. It's going to honor old values and old principles and it's going to integrate a new vision so that we can be relevant in the future and so that we can continue to grow and do well. I am asking you to join me. I am asking you to join me because I don't expect you just because I purchased the practice to be a participant in this because you didn't sign up for it. You signed up for Dr. Rosenfanger's practice. I'm Pamela and I'm Italian. I'm not Rosenfanger, I'm the Italian gap doctor. So we just have A different world, but we want to honor existing people. So are you on the bus? Leslie, Brittany, Betty, Jessica. And then here's the thing. The reason why there's turnover is because of this one quote. Let me give it to you. She convinced against her will, is of the same opinion still. I'll say that again because it's a little, a little deep. She convinced against her will, is of the same opinion still. So if somebody has like this is, we should be doing drilling, filling and billing dentistry. And you're saying we're going to bring in whole body health and we're going to bring in sleep dentistry and we're going to be, we're going to take care of the whole person, not just a surface filling, you know, and you're going to have this new conversation. If they're dedicated to that and they don't aren't willing to relook at how they. Their belief systems, if you try to train that person, it's going to go nowhere and they're going to be defiant and they're not going to line up with you. That's why you invite them to participate in your new vision. Now you have a starting point in agreement that if they are defined in resistance, saying that you made the choice to come into the new journey, the new chapter of our practice. So there's, yeah, there's a lot of people working in places that they have misalignment with and they actually need to go in an adult way and transition out. And we do that in a healthy, powerful way and we handle that. Now here's the other thing about team turnover. Ritz Carlton, I Learned this about 20 years from Ritz Carlton. I'm like, how do you get these people? We were in Cancun, Mexico. I'm like, how do you get these people? So the guy was like the expert in, in having world class customer service. How do you get them to do what you need them to do? And they live in little villages, you know, 50 miles from here. And they don't understand Ritz Carlton. He goes, because, Gary, they know that there's 13 people behind them. If they don't do their job, someone else is going to take it, goes back to package your business as an irresistible place to buy with bonuses, with dream programs, with a great culture, with some flexibility. I'm not saying a ton, but like some flexibility. Like, you know, we offer now Friday, you know, Fall Friday. It's like, you know, you know, once in a while, if you're not busy, send somebody home. You can't do it in a dental office like we can in a consulting firm. But like people, like when you give them some time and some flexibility, like, again, we're a little bit out of the box given where we are. But ultimately, when you do this and you package all of this, people will stay. And not only will they stay, they will, they will line up and wait for a position there. So this is what the other piece that I wanted to highlight about team turnover. Recruit on board on an ongoing basis. So I have like people that have small DSOs, like four practices, you know, five practices, three practices. And we have a dedicated person. They do nothing but recruit, even though we don't need them. So what happens is we always have redundancy and leverage and a wait list of people to come on board when we're ready. And then, you know, with 40 or 50 team members, when you have this ongoing thing, there's people that go on vacation and then they become a floater to the three practices. So I don't want to go down too far, but the idea of investing, if your practice is large enough, a dedicated person to do nothing but recruit and continually have that coming in those two things, you're not on your heels. If somebody leaves and the existing team members go, there's tons of people. If they exist, There's a natural subconscious that if all the team hears is I can't find somebody, the subconscious goes, I could just be lazy and reduce down my intention and not play at a, at a type A, because I don't know about you, I just got it. I like tennis now. I got into pickleball. I'm a little older. Like, I play up or down to the person I'm playing, like you just do. And so you got to keep that level of leverage on going and up. And that's, that's what this strategy does.

I agree with you. I think another thing that we might not always think about is if we are always, you know, we need somebody, we can't find anybody. Well, guess what? When it's time for some, somebody to, say, have their annual review, they can ask you for a crazy raise. I mean, you could almost get internal extortion in your office because it's like, you can't find anybody. I'm the best that it gets. You better be paying me top tier, whether I'm top tier or not. And so I think that the idea of continually recruiting is great from an unspoken cultural type thing, but it's also, you're going to ultimately find the right team, especially if you don't have the right team in place right now, and if you do have the right team in place right now, they don't care that you're recruiting, they want the help and they're part of the growth. And so I think that there's so many reasons that that's beneficial. So here's the thing. I could go on and on with you for days. I love listening to you speak and I know that when this, you know, when basically I'm going to be sharing this with my office manager and everybody because the points that you came across are so important and we have tons of questions coming in and we will get to them. But a lot of those questions are talking about their own specific office situations and how you can help them directly. So I know you're busy, but you're actually offering your own time to meet with doctors personally free of charge, is that so?

Yes, I have this affinity to the community at Dental Economics and when I talk to doctors that are readers and participants on the labs here, you know, the conversations are fantastic. So I book out. One of the things I've dedicated to is to give back to this industry that's given me so much. So I just dedicate, I do give five hours of my time, so that's 10 slots and I do that once a month and that's my give back time. So it is like nothing's off limits. You ask me any questions, put me on the hot seat, give me your nuances, what I find. Pam, Doctors really love to tell me their story, their journey and I love to hear it. Just like you've been so gracious as a listener today and a leader in this and a host. Thank you for just being so incredible. There's something about having somebody have a listening that are a champion for you and that had been down the road. You know, I've done this for 27 years. 6,000 practices directly, you know, I mean all across the world, you know, hundreds of thousands of people in our workshops. And you know what I find is I love the intimate zoom calls because I really get to hear what's really going on and I'm a very safe space. You know, I've been through a lot of personal stuff, like I'm 13 years sober. I've been through alcoholism, autism and, and workaholism, those three isms. My son's now, you know, 17 and off the autism spectrum. I'm 13 years sober and I worked Tuesday, Wednesday, Thursday and that wasn't going to happen. So like you said, you Know if you can do it, anybody can do it. And so that's why I just have this purpose of providing that level of freedom for people. And so that's why I donate my time. So, you know, all you have to do is click on my, on the, the item to the right. You can get on my calendar, we'll confirm everything and we'll have a nice dialogue. It'll be fantastic. So I'm looking forward to talking to people this month.

All right, we'll get on it. So there's nine available spots because I'm going to take one. So make sure you get on Gary's calendar, because I can tell you right now, I'm, gosh, Gary, we've known each other for a while, and I, I will tell you, I'm never sorry. So I think that you'd really be beneficial if you do that.

So.

Okay, let's get to some audience questions because we're going to get cut off at an hour and there's so many people that want to hear something first. Question 1. How do I know if I'm paying my team too much?

Yeah. Well, we have like a whole schedule for profitability, So I like 22 to 28%, depending on the type of practice you have. That's usually my, my staff salary position. And, you know, as long as you're fitting inside of that 22 to 28%, you're good. Most of the time, it's not what you spend, it's the return on investment you get for your team. So when you put that bonus system in, you're going to get, you're going to turn your payroll into a profit center. So how do you get that to happen? You have not 20% of your team producing 80% of your revenue. You get 100% of your team producing 100% of your revenue. And that really changes that equation really fast. See, most people are trying to nickel and dime and cut expenses, but when you raise your top line, Pam, your percentages go down unless you're ridiculously out of line. But 22 to 28% is a nice range for payroll.

So how do you measure results then?

Yeah, like I'd mentioned, just to, just to pull back that reverse engineering. Two million, three days a week, six weeks vacation, ten thousand for the dentist, fifteen hundred for the hygienist. And then you map that out over each team member. So if you're an appointment coordinator, you would fill the schedule to those numbers. If you're an assistant, your partnership with the doctor to get 10,000 in your column, you're now not just turning rooms and sterilizing equipment and making people feel comfortable, which is important. If you have 9,500 in your schedule and you see that there's fillings that are not scheduled, you get them in and you get them same day. And now all of a sudden you helped get that, that number. And then, you know, the hygienist does a certain percentage of production and treatment coming out of his or her room. The treatment coordinator converts the care to a certain dollar amount. So everybody has measures by position, by day. And when you break it down like that, people aren't like, if you're bonusing on group, they're not looking on the 29th going, hey, are we going to make bonus this month? They're playing the game from hour one, day one, and they play the entire month. So it allows you to have controls and allows you to know how to put accountabilities in and measures in.

Well, I think with many things in this world, consistency is key. And so I think when you build in these systems and they're looking day by day as opposed to like you're saying the 29th at the end of the month, wishing they could kind of get it together and bring in this extra cash, that probably won't happen. I think that's it just instills really great habits. So the next question is actually kind of timely. Based on the discussion, how do I deal with existing team members who aren't following through?

Yeah, this is, you know, this is what drove me to drink. I always say I didn't have to drink alcohol at 5:01 every day because people didn't do what I wanted them to do, when I wanted them to do it, how I want them to do it. I'm a control freak. There's no hiding here. But I was like, how do I put controls in so I don't have to be a micromanager control freak? And it's this system that I invented. And then if they don't do it, there's two tools that we put inside of the culture tool. Number one is what we call management by agreement, who's going to do it? What are you going to do? By when will you get it done? So we take the emotion out of dentistry, make the action factual, have it managed by the team leader. Now, who, what and by when would be an example. Who are the hygienists? What do they need to do? Intro all pictures, every patient, every time before the dentist comes in. That's the by when this starts today. Now, do you agree? Yes, we agree. That handles the. She convinced against her will is of the same opinion. Still, they chose to agree. Now, if they're not doing it, you can then hold them accountable. That's the way that machine works beautifully. And then if they don't do it, you escalate it with the AID system. We like a lot of acronyms. PAM AID stands for. I asked you, I insist, I demand. We now have to enforce. We have to put you on a performance improvement plan. And if you don't make it past that performance improvement plan, we're going to suspend your position. So it's an escalation. I learned it in child psychology because I was reprimanding my son for not making his bed. But he needed the AID system. Son, I asked you. We had an agreement. You said you're going to make your bed every day. Oh, Dad, I forgot. Oh, I'm insisting now. Remember the agreement. Oh, now it's the third time, son. Now I got to really demand. And I want to let you know, it's, like, really getting frustrating over here because you've agreed to it and you're not doing it. So what do you need from me? And then I become a collaborative support person. Oh, I just. Can you. Can you. Can I set. Can I put a sign up? We put a sign up. All right. Now he remembers. Now he's. Now he makes his bed every day, and he puts the toilet seat down. Not bad. No, not bad.

But I think that's the other thing is we get tired, and we tend to enable people and just sort of let them do their thing. And you know what? It's your business, and you can't do that. And I feel like, believe me, I had correction fatigue years ago, and it was one of those things. And I looked back at my notes, and I was after some of my team members for specific things for five years. And so, I mean, don't let it take a pandemic like it took me. It doesn't have to be that way. And so, Gary, I hate to say this, but we're out of time. And I know that there's still some questions that have come in. Guys, get on Gary's calendar. I think that's really important. And make sure you get your questions answered, because nothing is more important than your business. I mean, obviously your family and other things. But I feel like for you to be happy in all aspects of your life, waking up in the morning and enjoying where you go and actually seeing the fruit of Your labor is incredibly important, and Gary will help you get there. And it seems obvious to me that the name of your business, next level practice, is not a mistake. And Gary, thank you so much for your time and your expertise and all of these little pearls you dropped on us today because, I mean, this information is so necessary right now, and I think that all of us are better for it. So with that, I thank you so much for your time.

Yeah, thank you, Pam. And I'm so grateful to work with someone who I see as the voice of our industry. You know, being the chief editor of dental economics is no small position, especially when you have a full time job during the day. And here you are really being the voice, getting good messaging out to the world of dentistry in the US and around the world to make a difference. And that's who you are. And I really think that dentistry is in good hands. I'm also, I'm a big fan. I'm so glad we have a woman in this position. I can't tell you how incredible it is because my grandmother, who's 104, she said, Gary, find a good woman, listen to what she says, and your life's going to be amazing. And so I'm just incredibly excited for the future of dentistry, the future of dental economics, and the future of the practices that we have had the privilege to impact tonight. So thank you, Pam, you're extraordinary.

Oh, my goodness. Well, thank you so much for saying that. I'm kind of speechless, so I'm going to end it here. So for DE Solutions Lab, I'm Dr. Pam Uragliano Muniz here with Gary Katie, and we will see you next time. I can't wait.