The DSO Dilemma: The 3 Things Every Dentist Should Know Before Partnering With a DSO

Hello, everybody, and welcome to DE Solutions Lab. I'm Dr. Pam Miragliano Muniz, chief editor for Dental Economics. Tonight we have such a great topic that I think just kind of hurts everybody a little bit, whether you're going into practice in practice for a while, or you kind of have the end game in sight. It's called the DSO dilemma. Three things every practice owner should know about DSOs. With us tonight is dental industry expert and advocate Katy Perry. I mean, Gary, Katie. Gary's the CEO and founder of Next Level Practice. I'm so happy to have Gary with me tonight. He's with me every single month, and I look forward to it every month. Gary, welcome.

Pam, you just made my night. Oh, my gosh, that is so funny. You know, look, I'll miss Yankee games to hang out with you for an hour. This is a big deal, right? And for you to honor me as Katy Perry. You know what my favorite quote is about Katy Perry? It's my favorite quote. She said, when you stand for nothing, you fall for everything.

I love that.

That is why we're stressed out. So we're going to talk about should you stand for a dso? Should you not stand for a dso? Right? So tonight is going to be a special, special, special night. I'm so glad. I hear you had a great trip with the ladies. Having some fun.

I did. I went to Miami. You'll see. I'm a little tan for the first time in the century. And it was so much fun to do that and to kind of sit back. I was with two periodontists, and we got to talk about our practices and teaching and all the things that we're doing. And inevitably the concept and the. And the topic of DSOs had to come up, which is crazy because, let's face it, it is one of the hottest topics in dentistry today, and for good reason. In Roughly the last 20 years, there has been a 15% decline in the United States dentists who run a solo practice. While steady growth in DSOs has been seen in almost every state. And this is a topic that comes up in social media. It comes in my inbox at DE all the time. And so we need to talk about what exactly is a dso. And for those of us that are maybe entering practice, or for those of us that are ready to pass our along the baton, is a DSO the right move for that? And I've even gotten the question, does Elon Musk own a dso? So, I mean, I could go on and on, but I think I got to turn this over to you, Gary, because I need to get these questions answered. So I know our audience can't wait much longer. So let's do it.

You bet. You bet. I love the Elon Musk piece because, like, he's just buying everything, right? You know, he's an innovator. And we're going to really unfold and unpack why this is all happening. See if you understand what it is and you understand why it's happening and then you can then make better choices. And that's what we're going to unfold tonight. I have a lot of insight in this area, a lot that I become an accidental expert in this area because, you know, I've had clients that were independent, they went to DSOs, we have our own roll up of practices. So I really, I've really learned a lot. I've done a lot of research. So, uh, I'm gonna, I'm gonna give everything that I got today about what a DSO is and really you're gonna be able to look and say, is it right for me? And I love the Elon Musk piece because like, you know, he'll buy Twitter and say, I'm out again. You know, but ultimately he is, you know, one of the innovators. And DSO is an innovation, but you have to look, not all innovations are right for everybody, right? So we're gonna look at that. So the first thing I wanna do is I wanna really talk about why they've become so popular. And the first thing to do is really understand what the heck is a dso, you know, because usually DSO word association is no dsno, right? Especially from a private practitioner. And it's really like turned our industry upside down. But there is some places where DSOs really, really work. So this isn't like a pro or con, this is an information dump. And making it simple for our listeners tonight to be able to really make good decisions for their future. You know, so the first thing is a DSO is defined as a dental service organization. And it's in our industry as an independent business buys a group of practices and becomes a support service for those individual practices, largely in the United States. I was just in France and I was in Italy. They're just getting wind of this and doing it over in France and Italy. But it's really, it's still, it's still not even on the radar yet. Right. The key thing here is they provide business management and support services, including non clinical operations. So that's the basic definition to what it is, a dental service organization. It's a separate entity usually owned by private equity firm or venture capital firm, and they, they own it as a business entity and they buy these independent practices and roll them all up together, and it becomes an entity in and of itself. So, you know, there's a big consolidation going on, right. And there's a big future. There's like a big sell off. Right. Of practices that are happening in there. You know, originally it was Aspen, and it was like, you know, your Aspens and your Heartlands and things like that. But then there's like over 9,000 small DSOs as well. Here's the thing to know about the, the industry, because I was, when I first started out, like, it's funny because, you know, I'm the last year of a baby boomer, Pam. Right. You know, I got the gray hair, I got the wisdom. But I do have a millennial card, which is cool, right? So I learned, you know, I learned all the rap music. I've. I'm a tech guy, you know, like, so I gotta be cool with the millennials because I, if I lose my millennial card, they're not gonna listen to me. Cause that's all we deal with is millennial team members. Come on. That was a funny dad boomer joke, right? Come on.

Oh, it totally is. In fact, I think I was trying to earn my millennial card, and then I said on fleek last week, and I think I got it swiped away. So I'm now at a lower rank.

I've got more work to do. Yeah, it's like losing your license on that. That's hard. That really is heavy. I'm sorry about your loss. But we'll, you know, I have ways. I have people. I know people. We'll talk about that in our future here. But ultimately, it's like I resisted millennial thinking. I thought it was entitlement. I thought it was like, you know, their resume had so many jobs on it. But if, you know, the proper care and feeding of millennials, like we talked about last month, and the only way I could do and understand proper care and feeding of millennials is really understand what they're looking for and how to serve them. And that was a game changer. Right now we have teams that are motivated, driven, retained team members, things like that. The same thing happened to me in the last five years with DSOs. I was, I was a stand, you know, going back to the Katy Perry quote, I was such a stand for, you know, the private practitioner, because, you know, I believe that, you know, it's not A. It's not a turn, you know, drill, fill and bill PPO mill a dental practice. It's a art and a science. It's a. It's a place where local communities connect with the local individual entrepreneur. You know, that's the only thing I've known. And that's the way it should be. Right? Would you agree? Like, that's, like, you know, that's the way it was and that's the way it should be. Right?

Well, there's something comfortable about that, but the world is changing, the economy is changing, and this practice model has become just more popular. And so not only for us as practice owners, but for those that are coming in. So there's a lot of going on in this realm.

Well, here's the thing. You know, you can either fight them or you can join them like millennials. Like I did with millennials. I joined them. Now my wife thinks I'm younger, sexier and super cool. Right. My son thinks I'm cool, too. So we'll get past that. Now let's move to the dso. I stopped fighting the DSO and really design something that works and really work with the ones that truly work. But here's. We can't stop this train. This train has left the building. Let me give you some stats. In 2017, 7.4 of all practicing dentists were affiliated with the DSO in 20, 20. 10.4. Now, I'm going to give you. There's no real stats for what happened post pandemic, but I, in my estimation, this is anecdotal, is somewhere around 25 to 30%. 25 post pandemic. We are now at 25 to 30%. How do I know that? Talking to attorneys, talking to brokers, talking to DSOs, talking to, talking to the people that are in the know, the biggest people that do these collaborations. So when you get that and then why did that happen? Well, here's why. Student debts out of control. We have rising fee structures. We have insurance challenges. And then the external threat or circumstance of the pandemic. See, the pandemic wasn't done to us. It was done for us. So people that were on the fence that didn't really want to play, that didn't want to put the energy in, they. They took the easy way and dropped out. And that's fine. There was a lot of people, but unfortunately, those, Pam, those people who just sold out without having the knowledge that we're talking about tonight are really in. Like, imagine if you're 50 years old. You got, you got to Stay on for another five years. You've been stripped of your philosophy, and you have to follow a methodology that. And a philosophy that you don't believe in. And you have to work there for five years in order to realize what your agreement was. And that's really. There's a lot of people in that place. Sadly, sadly, that. That's going on right now. So the other thing that's happening is there's changing demographics. So unlike, you know, people, Dennis, doctors of today, the millennials of today want different life experiences. They don't live to work, they work to live. And then the other thing about demographics that really shifted in our industry is that more than 50% of graduates are women, which is awesome because, you know, female dentists are just, like, amazing. Here's the thing about that, though. Let's. Hello, hello.

And.

Oh, and chief editor of the best magazine on the planet for dentist.

Hello, hello, hello. Hello. Ding, ding.

Go figure. Thank you. For your corporate office to identify that, we need a voice that's. That's a woman. Because women are visionary. Here's the difference about private practitioners, though. Women. This is really cool. Interesting. Most males. And this. I'm going to give you the stat first. 13.3% of women coming out of school reported to be working in DSOs in 2019, compared to 8.7 of male dentists. Here's the reason why. Male dentists have more identity, ego in their work. Right? That's what we see more of. They need their name on the door. Women don't have that when they work because they have, like, you guys, this is, this is the honor that I, you know, the number one job is being a mom if you're, if you're a mother of children. But, like, you know, looking, having to look good, having to manage a family, you know, having to be up on all the latest, Having, being an entrepreneur, like, to do all those things is a lot. Right? I mean, I shouldn't be talking. This is what the female dentists that I work with report to me. You tell me, like, what's your experience of, you know, living in a world that we're talking about here?

Well, to be honest with you, I feel like in some ways I identify with men in it because I don't have children. I have pets. And so, I mean, that's enough for me, believe it or not. So I think, you know, I know when I got married, it was sort of like, I got married at 35, so it was like, we're going to have kids. We need to have them right now and we need to decide what we're going to give up. And at that moment it just seemed like to me not to get too personal, but it just seemed like to me that, you know, things were getting really great in my career and I didn't really want to give anything up and my husband felt the same way. So we just decided to put our heads down and work hard and not have that added responsibility. But hats off to those who do, because to watch mothers, my hygienist has seven kids to watch. I know to watch people multitask and be there for your patients wholeheartedly, be there for the industry and be there for your family. It is no joke. And to be honest, I don't have the energy for it.

Yeah, my wife went down, we have one child and we were like, we wanna put our heads down, we'll take one, we'll strap on our back and take em everywhere. So we did the wash and wear version of being parents. But oh my gosh, it's like my wife went down with back surgery. I had to be working day to day. Energy is different when you're working in the office and to go home and have compassion and patience and all those things that you need to turn on when you're being parent and doing homework and all that stuff. It's like I really have a lot of compassion, but also a lot of honor for those that do that. And there's males that manage kids too. So there's that piece and then the big piece is the money. So Dennis, success rate is 99.7% of all the SIC codes in the world. Dentistry has the least amount of failure in it. So you know, the average billionaire invests 19% of their money into PE firms. So there's so much money in this space to buy practices and it just flooding in because it's a very low risk, highly diversified game that allows the big money people to make even more money. And but here's the thing, people that are selling practices don't know all these things. So I really want to highlight some of this. You know, they would rather like the people like for banks and PE firms, they would rather group up practices because it's only like 0.3 of a crash. That's next to nothing. They'll bet on that all day. So these are all the elements that have gotten us here.

I think also, you know, just when you kind of you, you're looking globally, but then when you look at students coming right out of dental school looking to join a Practice or somebody fresh out of residency without any real experience. There's almost this, this thought that, well, go join a DSO because they'll take a new student. And I'm not sure if that's 100% the case. Yes, they most definitely will. But I also think there's opportunities for those in private practice should they want to do that.

There's no doubt. I mean, I have a lot of young people, I do a lot of talks at schools and there's a lot of entrepreneurial young dentists. Yes, they need to get their speed up right. That's going to be key. Because if you don't have your speed up and a little bit of confidence in, that's when I would use a dso. Maybe do it for a year if you are going to do it. But if you have a dream of really creating your own world. And by the way, when you own a business, you have three ways to make money. You know, when you're associate, you only make money on salary. Maybe, maybe some of you are making money on commission. But when you can have an equity position and I'm going to show you how to buy practices, I'm going to show you the One thing that DSOs don't want people to know because there's so much untapped. The reason why dentist dental practices don't crash is because there's so much untapped potential there. But most people don't go after the money at the ethically, the ethical dollars that are hidden in plain sight. There's so much money in a dental practice hidden in plain sight that most practitioners are looking in the wrong places. So I'm going to unveil that coming up next. And when our new doctors understand this like, I'm going to give you a quick story about Nick and Kristen up in Grand Rapids, Michigan. They came to me again. They got their speed up. Nick's a dentist, his wife Kristen is a hygienist. They came to me and they said, look, we want to be entrepreneurs. We don't want to work for anybody else. We don't want to work for a dso. They were actually working in a group, small group that we were, that we were coaching. And they go, I want to buy my own practice. Can you help me? So we found this practice and I'm going to show you this equation. I did this equation with them. The practice was doing 690. They bought it for 500. It had 3,000 patients in it. One year later, they did $1.8 million.

Whoa.

Pam. I'm talking like $1.1 million more. All ethically done. It was done inside the practice and that's one of the key things to start thinking about here. The untapped potential in the practice is your existing patient base.

Isn't it an interesting coincidence that you mentioned that and all of a sudden questions just start popping up.

There you go.

Clearly we see that there's people who have questions and need a helping hand. Don't worry. Gary has great opportunity for you, but you have to stick around because I know you will share that with us at the end. But we also try so hard every time to field questions. So please ask your questions, enter them in the question box on the right hand side of your screen and we will most definitely get to them. So let's get right down to it. There's so much to know with DSOs. And you have to be so careful to make sure if your practice and your situation is really conducive to that specific DSO. Because let's face it, there's DSOs that are just a couple of handful of a practice versus DSOs that have hundreds of practices. And there's obviously different nuances there. What is the first thing we need to know before joining a dso?

Yeah, and it's almost like I always like to say, this is what DSOs don't want private practitioners to know. This is also I want the new dentist who is considering to look at this just like Nick and Kristen did. You want to really look at this from this perspective. So I'm going to give you an insight that's going to open your eyes to understand how to really understand what your true practice value is. All right, so let's take a look at it. I'm going to actually share my screen and I'm going to actually walk through. You know me, I love my Madden teleprompter. So we'll bring that up right now. And I want to draw out, there's, see the, the, the one of the reasons why practices get stuck. And by the way, if you're just looking to build your practice, this is also a great tool and a great, you know, awareness piece for you to really understand what the true value is and where to go strategically to build your practice. Because, Pam, when I'm, when I'm delivering a program and there's a hundred dentists in there and I say, how do you build your practice? 99 of them will say, I need new patients. See, this is the gap that we're dealing with. The dentists think it's new patient acquisition. The private equity firm or the person DSO knows this information. So there's actually three ways to grow your practice. One is case acceptance. Okay. And one is retention. Patient retention. Now, by the way, this is the number one reason why practices don't fail, because the demand is always there. The patient knows that they need to go to the dentist twice a year, and 50% of us does that. And, but here's the thing, only 18% of people come back twice. So it's an inefficient model because nobody's focused in on creating a retention system and a case acceptance system in the practice. And by the way, this is for gps. If you're a specialist, all you need to do is case acceptance, obviously, is what are the type of cases do you want your referral doctor to send you? And retention is retaining your referral doctor. So the difference between a specialist and a GP, I speak to this for the majority of GPs, but you just take what we do in hygiene and replace that with your referral doctor referring doctors. That's how you'll be able to apply the same methodology. And then the last way is the acquisition. Sorry, retention. And then the last way is acquisition. Am I spelling that right? Acquisition of new patients. New patients. This is how you fill in, but this is where you focus. So I want to do a quick equation, if I may, just to give you what your potential is, so you can take out a piece of paper and a pen. And it's very simple math. The first way, case acceptance. So case acceptance, okay, the average case acceptance, and we're going to use PPO fees here is the average adult will invest in the value of a crown in a buildup annually with a good case acceptance system. So I'm not saying we're going to be selling crowns, I'm saying the value, it gives us the value of, you know, let's say that, you know, some will buy no crown, some will buy three fillings, some will need nothing but the average adult in their mouth. The average case acceptance annually is about a crown and a buildup. Let's do PPO fees, Pam. Let's call it $900 for a crown and build up. Right? That seems fair, right? For a crown and build up.

No, that hurts.

But, yeah, it does hurt, but I'm going to go low because, you know, I know Boston and Massachusetts, the reimbursement's higher and just because all the insurance companies are there and they don't want to be picketed, you know, you know, a lot of Them are there and Hartford and Connecticut and Massachusetts. Anyway, $900. And the retention is two profis, two exam a set of bitewings, let's call it 300, you know, dollars. If you, if they come back twice the average value. The average annual value AAV of a patient in a PPO practice is $1,200. Clear so far?

Yes.

Now, the average practice from DE, because, you know, we, we have an offer where I meet with people after our sessions and when I ask them this question. The average dentist has 2,000 patients. The people at DE, that's about a good average. So this practice potential is $2.4 million. Clear?

Clear. But I will also argue that that's a conservative number. How so that 900 plus 300 conservative. Depending on where you are in the country. I think that's a solid number.

Absolutely. But watch this. There's no new patients in this conversation. Zero. Now, are we going to get everybody to come back twice? No. Is everybody going to build, buy a crown of buildup? No. But this practice, because I talk to people, when we offer the half hour at the end of our session, they'll tell me they're averaging about 750. The average practice averages 650 to 750. And this practice will sell to a DSO. Completely. Completely. Pam. Undervalued. Completely undervalued. Because the doc goes, I'm going to compare myself against last year. I don't want to do this anymore. And they'll go out and sell this thing for a ridiculous number. The PE firm comes in, not only do they bolster up the top line, they reduce the expenses. And now they have a highly profitable practice. Nine out of 10 practices fit inside of this model. This is also beneficial for the new doctor who thinks they can't buy a practice out of the box. Yes, you can. And by the way, the ideal person for a new doctor to buy, they don't want to sell to a dso. They want to leave a legacy. So you young doctors coming out of residency or you're sitting in a DSO and you're sick and tired of being in a dso. Here's what I'm telling you. You can find doctors because they have high levels of integrity of who they want to leave their patients to, they do not want to leave it to a McDonald's, a dentistry. And they will sell to an individual. And by the way, you also get a built in mentor. You also get a built in person who is committed that you continue on to be successful. You see, you can look right now if you're a new doctor, you know, wondering whether you can do this or not, this is actually a better time because the doctors who are committed to leaving a legacy and, and leaving their dentistry off to an, a great, a great doctor, you have a champion there. Where in the past it wasn't as big of a, like a stand and a fight for, you know, their patient base and their legacy. So it's, it's actually, Pam, this is it. This is all circumstantial. But if you start looking for the leverage points of the new circumstances, we're actually in a better position to do all the things we did before in this period of time, which is really cool.

I think it's a really promising option for a new dentist. And I think that you're right that you shouldn't just kind of think that this is your only option, especially when there's certainly more out there for you. Now, I also want to kind of talk a little bit more about joining a dso. And we're going to get to the second thing that we need to know. But I also know that there's this misnomer that you mentioned. Your practice is making 650 to 750. And a lot of practice owners think that a DSO is going to pay the multiples of that 65750 when that's clearly not the case. So tell us more about what we need to know about joining a dso.

Well, the thing about it is, if you're an existing dentist, the first thing I want to make sure that you know, and I want to be specific about the numbers, you can spend a year and build the heck out of your practice. By the way, you saw Nick and Kristin. They didn't work any harder. They didn't work any more hours. They just focus in on patient retention and case acceptance. That was it. That's all they did. And they got their team on board with the new thinking and just spoke to their patients in a certain way and they, the patients got a chance to choose. No selling none of that stuff. And you're selling at a different number if you're sitting at 6:90 that you want to sell it at when the practice is doing 1.8. Is everybody going to do that? No. Nick and Kristen are very special individuals. They've been around the methodology, so I'm using them as an example. But it's an extreme example. But increasing 500,000 for someone who has 2,000 patients is not. It's very typical in our world. It might not be for you you might be sitting there going, really? Yeah. It's no kidding. That's what's available to you. Now, I want to talk about the downsides now. Now that we know about that, I want to talk about the downside. So you, if you sell, you are going to lose autonomy. I. That. You got to put that in. Now, the key thing here is to really identify and mitigate what are you willing to give up in autonomy, right? What part of your, your world are you willing to give up? Now, the first thing I want to really talk about, and I want to big. A big blinking yellow light, red light, because I've had many of these happen. Someone who is presenting to you the invisible dso. If they are telling you that they are going to be an invisible DSO and they're going to let you have business as usual, it is not true. It is a myth, okay? Because here's why. You're either going to lose autonomy on the business side or the clinical side, or both. Because the way the economies of scale work and the strategy, in order to get the return on investment for the PE firm, they have to have economies of scale where they'll bring together like all the HR or they'll bring together a call center and you're not going to answer the phone, or they're going to bring, you know, insurance or expenses or buying equipment, or there's going to be some loss. Now, if you're a, you know, nine out of 10 of my dentists are control freaks because you have to be a control freak to control the environment in the mouth. Now, if you're an obsessed control freak when it comes to your business and you're a driver in the personality type, you're going to have a hard time for this because you're going to, you're going to hate going to work every day because one little loss of control is like, you know, exponential for, for a good handful. But if you're, you know, the type of dentist that, you know is like more methodical, more humanist, and you're willing to, you know, you're actually like, oh, man, that, that feels like, you know, it's like being a pinch runner. Like in baseball when you're a veteran, it's like, oh, man, I just hit a double and I'm exhausted and tired. You know, you run, you know, you run the bases today. You know, you might, it might be like what you're looking for, right? But just know that if, you know, there's two types of DSOs here, good actors and bad actors. You know, there's good ones that, that are all up front and they, and by the way, the more you can get in writing in some of the specifics. Pam, this is big. Most doctors don't know what they don't know to put in the agreements. So I want to make sure that you, you really are, are educated here. Like if you have a certain philosophy, you know, let's say you do pinhole, you know, therapy or you have certain therapies like be specific about the clinical side of your work, be specific about your systems that you're willing to do and not to do and put those in the agreement. If they're not willing to agree, you can pretty much get that there are going to, you know, they might be saying one thing and doing something else. And I'm telling you, Pam, that is. I hope this message gets out to you, please. It's. They're going to paint a picture. That's great. And most of them, and again, this is not a knock on DSOs. Most of them do what they say they're going to do. But I want you to really look at this. The new ones, if you're the, if you're number one, two or three, be careful of that because they don't know what they don't know. We have a lot of small PR. Small DSOs right now that are upside down financially and they also, they have good intentions by the way. These are not bad people. They have good hearted people. They have good intentions. But then if you're number one, two or three, they're going to go to school on you and they're going to make changes because they have to. If you're, you know, 8001, 8002, 8003, you know, let me, let me give you this. I mean I'm going to pull up the teleprompter again. This is a good visual for everybody. Let me see how my, my artwork. I, I've been practicing artwork, Pam. One of the things I did on vacation was I got pencils and I started drawing and I'm like, my son's like, dad, you have like, you got a talent here. I'm not going to get that crazy here. But this is what I'm talking about. Let's see if this comes up. Let's see if I can draw. Like I do have some perspective. I do want to take a class. Pam too. This is cool. If anybody knows a good art class, let me know. There's that and then there's this. Let's see if I can do this. So it's like square peg, round hole. So if you have, if you're a doctor over here and the DSO is over here, be very careful about, you know, you fitting into them, you know, really see if they'll fit into your world and or at least have some form of balance here. You know, that's why I don't like, if you're, you know, numbers 1, 2 or 3 or 8,000. You know, the thing about 8,000, 1, 2, 3, if you like you're a Heartland fan or whatever like that, you know what you're going to get. So they're going to, they've made so many mistakes that they're going to tell you exactly, you know, how it works, what you have to do, and then you have to be the square peg to fit in their world. You know, what I like to do is square peg, round hole, match it up business wise and clinical and be clear about that in your agreements.

Gary, this is amazing. So far, I'm not sure what's more amazing, your artistic abilities or the information that you're sharing. And I mean, I'm not kidding. I think that your trip to Europe has really been inspiring for you and I'm highly impressed.

Thank you.

So I can't wait to hear the rest of this. But we need to really acknowledge the questions that are coming in and we will certainly try to get to them shortly. But a lot of these questions are about how can you help them directly. Can you share a little bit about that?

Yeah. One of the things that we do, we took up this residency because, you know, first because of you and your voice and your vision for what's possible and we want to work with the best in the world. And then the second reason is because the community that reads dental economics are like a step ahead of the average dentist and that's the type of people we work with. So one of the things that we believe in is dentists are bombarded with like, you should do this and you should work with this person and that person. And you know, we believe, you know, I've been in this business for, you know, almost going on 30 years and 6,000 practices in Canada, North America. We have, oh, we just have Bermuda, the Bahamas and Puerto Rico too. Just added, for some reason this must have gone out to them and we've, we've secured practices in those markets as well. It's really interesting. So cool, right? You know, to be like, it is awesome.

Congratulations. Although I think they need in person help. I would, you know, just saying, well.

And we just Got Key west yesterday, in fact, so that's a pretty cool place too. But what happens is, is that you want to work with somebody right now who really has wisdom like that, who you don't want to just work with somebody who's just come out of, you know, and started out. It's really tough time to do that because there's so much nuance. And every practice, Pam has different nuances going on. And so what we do, we offer five hours and. And they're half hour increments. And we do a zoom call like this. It would be a zoom call. You just click there and you register. You get on my schedule or my team schedule, we figure out who's appropriate for you to talk to. It's a really safe space to really share what you have going on, where you're at now. You might need. There's so many questions here tonight. It's really interesting. This topic's hot, right? And there's like, specific questions, even down to, hey, I want to talk about this person or that person. And they want to really get that kind of nuanced, individualized care. So all you have to do is click, you'll get on the calendar, and we'll just. It's no obligation. It's easy access, and we have a nice dialogue, and it's really powerful. And people leave there, you know, clear, confident, and certain, where they're like, you know, all this noise in her head really calms down and they leave calm. So that's what I love most about, you know, the work that we get to do. I get to talk to the people that watch us. And by the way, you know, there's some people that, you know, have been watching us month after month after month, Pam. And they finally go, you know, I'm just gonna. I'm just gonna jump on and talk. And I always like that. Or somebody who just saw this for the first time, and it's a topic for them, they jump in and, you know, they might be in the middle of a negotiation or might be in the middle of thinking about it. Wherever you are right now, you could just jump on the calendar and get in. And we have 10 slots every month.

That is such an amazing offer. And I think it's worth mentioning that it's really never too early or never too late to get some advice when it comes to your business. So if you're thinking dso, you think down the road, that might be where you're going or, you know, you're just not sure. I think it's really great to get some really sound coaching advice. So Gary, thank you so much for that.

Yeah, you bet.

Let's get into the last thing you need to know before joining a dso.

Yeah, I want to talk about the different types. I want to dig in a little bit because you know I mentioned a little bit about like you know, the brand new DSO that's just starting out and then the more mature ones. But I want to really talk about next something called roll up groups. And a roll up group is a group of like minded practices. Right. They have the same philosophies, they have similar operating positions. Like what we did is, you know, let me draw a picture and I'll share this with you. This will help, helps show you what I'm talking about, what a roll up is because there's a couple of people that are doing this nationwide. We're one of them and I want to introduce another concept, another way to do this. So Pam, most people I'm going to draw, this is called my iceberg drawing. Most people come to us for practice management, go in, take care of team systems, process and the typical practice management, coaching, consulting and training. Right. And that really is only 10% of what we do. Underneath the surface, what people really want is they want career advice, they want to know and business advice. And the first thing they want is financial freedom. So most people are up here doing the do but they haven't figured out like how to get out of debt, how to manage all the wealth and money. The next thing is they want to have time freedom, they don't want to work more hours. So you know, a lot of times there's this misnomer of I got to work harder or work more to have more. And that's a, that's just a myth and a misnomer because if you go inside your practice like I showed you, you're and you just run efficiency and focus in on that. You can remove all the noise and, and just get focused on case acceptance, retention and new patients and then clean up the stuff that they're dealing with which is recruiting, hiring, training, team motivation and systems training and development. The last thing is frustration freedom and frustration freedom. Frustration is different than problems. You're always going to have problems but frustration freedom is doing the same thing, thinking you're going to get a different result and you're just frustrated going to work every day because nothing's changing. And when nothing changes, Pam, nothing changes. And you want to work with somebody who's going to actually understand your unique situation. Put a plan together and actually walk you down that plan and get it implemented. Because, you know, if it doesn't get implemented, it doesn't matter. But ultimately, what people want, if they get those three things, is clarity, simplicity, and certainty. This concept of clarity, simplicity, and certainty, you know, life has become so complicated and so overwhelming that when somebody can take and make your life simple, your practice simple, teams made simple, systems made simple. And I'm not. I'm not like, over exaggerating this. What I'm saying is, is that you can absolutely simplify your life and take the chaos out of it and take the reoccurring hassles out of it. You do not have to live this way. See, what happens is I have this saying called make the unacceptable unacceptable. It's not until you make the unacceptable unacceptable that this changes. That's the key here. Right? So I know. I can see you have something that you want to add here. Pam, is there something you want to say about this?

It just seems to me that it's so individual, you know, it's just depending on how many practices you own or if you're a solo practitioner, depending on where you are in your career. There's just a lot to unpack here. And I don't think that we can just, you know, give like an umbrella answer for everybody. And I think that's. I feel like this time I'm like, wow, there's just so much. But I'm really sad because we're kind of approaching the end here.

What? Are you kidding me? Pam, we're done already. I just want to get one more thing in, if I may, before you. Can I just. Can we extend a little bit?

We have to. Yes.

All right. Thank you. This concept of roll up is we go in and we build up the practice like we talked about, and then you have an opportunity to roll up with people that you're crystal clear with, aligned with, have you understand what your. Where your loss of autonomy is. And then you plug in, so you get your number, you build it up, and then you can roll in. So it's a. It's a whole career, you know, process. Right. But one thing I wanted to do is, I talked about that, that. That equation earlier, and I want to actually. I wanted to let people have an opportunity to actually do it. So I'm going to bring it up here. We have this. We have this link here. So it'll take you right here. You'll be able to go in here, and this will give you your true potential of your practice. So how many locations you have? I have one location. I don't have any associates yet, but I do want one. I have four to eight chairs. This. This tells you your capacity. I've been practicing. Let's do 20. 20 years. Let's see. We're currently doing. Let's do 750. 7, 50. We're currently doing 750. We actually have 2,000 patients. Good. Let's put that right in. And then you put your name in so you get your. Your information sent to you. Oh, look at that. Unpopulated and everything. This is nice. And then you'll get a report immediately and buy. Our calculations, your practice could be making 3 million a year. 3 million a year. You're operating at 25% capacity. This is the automated system to really look at and identify where, in fact, you know, your practice is today. So you could just jump right in. I just didn't want to jump off without, you know, having our guests, you know, have the opportunity to jump in and use that. That. Thanks, Ryan, for putting that in. And I apologize, Pam, for extending us long today.

No, that's okay. But I think that that's such an important point and something to think about. So that popped up so quickly, so easily. And this is why DSOs want to gobble up your practice, because look at the potential that we aren't realizing. And so I think that, you know, before you maybe necessarily jump off and hand off all of your profits to somebody else, maybe you take a minute and use some of this insight for yourself. So, Gary, now we're out of time. So I know everybody. We couldn't get to all of the questions. But don't you worry. I will make sure that they all make their way to Gary, and he's more than happy to answer them. So, Gary, thank you so much for your time and your expertise today.

It's my pleasure, Pam. Thank you. Good night, everybody.

All right, everybody. For DE Solutions Lab, I'm Dr. Pam Maragliano Muniz. And can't wait to see you next month.