Building a Holistic Dental Marketing Plan for your Practice

Hey, dental associates and new practice owners. Welcome to the Associates on Fire podcast, powered by Practice cfo. This is the podcast that teaches you what you never learned in dental school, the financial side of dentistry. We cover topics from planning for ownership, buying a practice, to student loans, taxes, and all things financial for the hungry to learn dental associate. So let's light it up.

All right, welcome, everybody. I would like to jump right into this and welcome Josh Summers to our Associates on Fire podcast. I've known Josh Summers for some time now, and he runs a dental marketing business called Dental Game Plan. And one thing that I've learned in working with dentists is the need to have a strategy around your effort to reach the marketplace. It doesn't just happen. You could sign up for a lot of PPOs and have the PPOs put patients in your chair, but I don't think that's the style of practice that a hungry, eager associate should be targeting. Sometimes we fall back on that, but I don't think it's the ideal practice, which means.

We have to find patients to get them in the chair. And marketing is one of the most important elements of a business that I think any business has, and this is particularly true of dentists. So welcome, Josh. I'm really happy to have you on this webinar. I want to start off by talking about the industry from a high level. You have been in the industry for how long? About 10 years?

Yeah, about a little over 12. By the way. Thank you for having me, Wes. I really appreciate it. I'm glad to be on the show, and hopefully I can provide some helpful insight.

Yeah, I think you will know, knowing you and knowing how our conversations have evolved over time, I think you and I have been in dentistry for about the same amount of time. I got in dentistry about 2008, 2009 exclusively. You've been working exclusively in dental as well. And so we've been able to observe changes in the industry and that they're happening and they're happening somewhat quickly, and there are challenges in the industry, but there are also tremendous opportunities in the industry as well. And so. So let me ask you, I've shared a lot with associates through our Associates on Fire program or some of our videos and other podcasts, some of the changes that we're seeing and. And what our recommendations are. But from a marketing vantage point, what are you seeing in the industry, and how can dentists address these changes, particularly young associates?

Well, I think the changes that you're referring to are a lot of consolidation that's happening. In the, in the world of dentistry, the DSO type of practice. And I think the individual dentists, the associates that are getting out there to, to get into the marketplace, you know, they're going to have to be smart about their marketing. They're going to have to really.

Start hit the ground running and really focus on what their objectives are and who they want to bring into their practice. Right. You talked a little bit about PPO and having a PPO agreement or having a HMO agreement and waiting for those companies to put patients in your chair is a really slow way to build your practice. So if you're not really thinking about how your marketing is going to affect your practice, or if you're not thinking about the strategies, then I think that puts you in a poor position in the marketplace to adapt with the changes that are happening with the consolidations.

Totally agree with that. And one, it's important that dentists understand the financial implications of taking PPO. And PPOs know that they have the upper hand in many ways and so they sort of dictate future fees. And associates, most associates probably know what going UCR rates are for, let's say a standard crown. It might be around 1300, $1400, sometimes a little bit higher, sometimes a little bit lower. But if you're with a Delta PPO plan, you're getting around $600 for that crown. And guess what, your overhead costs are virtually identical. And so you're getting almost half the payment for that treatment and you still have the same overhead cost. It's a very, very difficult battle to face as a dentist as these rates, these reimbursement rates keep lowering and lowering. And so if dentists could replace, even if they lost 40% of their patients and they maintained 60%, now the stats are, it's even higher if they do it right when they convert to more of a fee for service practice. But if they can do that, they can work less and they can earn more, or they can continue working as much and earn a lot more and just have the ability to get ahead financially. That's hard for dentists these days with the amount of student loans that they have and all of the debt they have to buy their practice to finance equipment, equipment, maybe do some build outs, you buy a home, etc. It's a mountain of debt. And so marketing is one way to go through that conversion process. The way that I look at it now, I think that marketing should be looked at holistically. Can you tell me what does a holistic marketing plan look like? Because there's so many ways you can sort of campaign out there on social media or you do pay per clicks, or you do you know your website or you do mailers, you have all these different ways to market. What would you consider to be a comprehensive, integrated approach to marketing?

Well, I kind of look at the dental marketing space in two different avenues. I look at your internal marketing resource or your internal marketing sources, which are your recalls, your treatment acceptance, those types of things, and then I look at your external marketing sources. So I think the biggest problem anybody in dentistry, not just new associates buying practices, but any dental office, the biggest problem that they have is they underestimate the amount of manpower it takes to run a successful marketing campaign, right? So if we want to talk about recall, for example, right. If you have a practice that has 2 or 3,000 patients in it and your recall is being done haphazardly and you. And you're making like 20 to 30 phone calls a day on that recall program, you're losing hundreds of patients a year that are going out your back door. And you're getting maybe hundreds of patients through your front door with new marketing, which is why you see all these plateaus that happen in dentistry, right? Practices that hit a certain amount of money and they don't go above that amount and doesn't fluctuate or change much more than 3 to 4% either direction is because they're losing as many patients as they're getting. And so they underestimate the amount of manpower that it takes to continue to keep those patients active and coming into the practice and then also add more patients on top of that. Because if you think about it, your hygiene should always be expanding, right? Your hygiene days, the amount of hygienists that you have, the longer you're in practice, if you're not expanding your hygiene program, then you stagnated your business, right? So looking at it from both of those angles, you really have to take into consideration, like, how do I create a marketing strategy or program that keeps my existing patients coming into my practice and through my doors and then also adds new patients on top of that? So that's kind of the way that I approach the dental marketplace is by balancing those two sides of the equation.

That's a good point. And I've always felt like there's a lot of internal marketing, which is the less costly. Correct. The less costly marketing is getting people who have already been in your practice back into your practice. And that's a lot of times overlooked. Now, what specific. Let's Talk about external marketing. What are the most effective ways to reach new patients?

Well, I mean, it depends on what kind of business you have or what kind of business you want to run.

I think the order of patient quality is your referral patient is always going to be your best patient. Right. Then next to that's going to be organic search results. Then it's going to be Google PPC or paid click if you're looking online. And then it's going to be social media is kind of going to be the last one. Right. So depending on how you want to grow your practice, you may want to use one or two or all four of those ways to get patients into your practice. And when I'm looking at.

The types of marketing, I usually start with what's the most profitable ones that I can bring in right now into the practice. That's where we start. So Google ppc, more specifically, emergency patients. Because you get an emergency patient in the door, they're very highly motivated to do treatment because they're probably in pain. So that gives you a pretty quick ROI on your practice. Whereas if you target the general patient that's looking for a cleaning, you may spend more money to bring that patient into the, into the door than what you're collecting on a cleaning standpoint. Now, if you're really good at treatment, looking at the treatment and getting that treatment to convert from a cleaning patient, then that patient could be worth a lot of money to your practice as well. But I basically look at the situation and then when you start growing and you start adding practices, obviously you look at regional marketing approaches like radio or TV or different Internet radios or podcasts that you can use that can regionalize. So there's a lot of really cool things in the marketing space that you can do right now to get patients to come through your doors.

Speaking of ROI or return on investment, that's the way I look at marketing in a practice is, it is an investment. Dentist, please don't look at your marketing and as a phone bill or even as your rent, it's not a fixed administrative cost to keep your doors open. This is how you sustain your business by getting new patients in the door. And new patients are typically the ones who have the most treatment that's needed and then to bring them back time and time again, that is a, that, that is marketing and that's, that's the life of your practice.

And that is what marketing is. And so I think the perspective on marketing is very important. A lot of times I find dentists will view Marketing as another expense on the profit and loss statement. How can I keep that expense low? And don't get me wrong, we don't want to throw money in the wind. And marketing is sometimes a, in my experience. Josh, you can, you can correct me on this, but my experience with dentists is it's a little bit of trial and error experience because as you mentioned, some strategies work in different regions that don't work in other regions. And I've had people tell me this marketing approach worked fantastic, and somebody else said it fell flat for their practice. So, but, but on that subject of roi, what do you, Josh, believe should be the return on investment? So if they place a dollar into a marketing effort, what do you think should be the return on that dollar by way of collections?

Well, I think that also depends a little bit on your marketplace. But I did want to bring up something, I thought of something when you were talking just now. And I also, I also think that people that get into marketing, they expect that the first month they're going to see that roi. And that typically doesn't happen because in dentistry, we see patients, we treat patients, or we schedule treatment, patients for treatment the next visit around. So what we end up seeing a lot of times. And when I take on dentists, I tell them this all the time. I say, hey, look, the first month, look to break even, you know, look to push your marketing, push your marketing however you want to do it, look to break even. But by the third month, you should be seeing 3, 4, 5 to 1 ROIs. If you're, if you're getting those patients in, you're getting them to accept treatment, then those should be your return on investment. Some people see way higher than that, some people see a little bit lower than that. But ultimately, it depends on the marketplace that you're in, the quality of patient that walks through your door, which is a big challenge in marketing. Anytime you put your marketing message out there, you're going to get the people that don't have two pennies to rub together, and you're going to get the guy that, that wants to spend $10,000 on treatment today because he'll do it in cash. So there's a lot of variety that you're going to get walking through the doors anytime you start putting a promotion out there into the world.

You know, one of the struggles dentists have as they go and start to invest more money into marketing is how to track whether that money is being used. So I'm going back a little bit more to this term. Return on investment.

And some doctors will say, okay, well If I get $2 in collections for every $1 I spend, then that's a good thing. Well, you have to remember that that dollar of collections is going to come with all of the overhead related or those $2 of collections, all of the overhead related to it. So, so you're probably looking, tell me if I'm wrong, but probably looking for somewhere around four to six as a return on your marketing dollar. Is that reasonable?

Yeah, I totally think that's reasonable. And the longer that you're doing your marketing programs, for example, right, Organic search results are not going to kick in in the first month. But the longer that you're doing it, the higher your ROI is going to get on that. Because it's pretty, it's pretty inexpensive. If you look at how you spend your money, it's pretty inexpensive to spend your money on organic marketing. So your ROI is going to get higher and higher and higher. The longer you're doing that and the more keyword terms you're picking up that's actually generating traffic to your website, the other ones have a little bit less. But as you, as you compile them together, you should see that four or five, six to one roi. But the thing that you also need to remember is that if you're good at retaining patients, you're going to see a much longer term ROI and also patient referrals from that patient that make marketing even much higher than that four or five or six to one ROI that you're talking about. You know, you get one patient that brings their family in and now you're seeing huge amounts of ROI from that one marketing spend. And then if you get one patient that stays with you for five years, let's say you spent two to three hundred dollars on that patient. Well, the average value of a patient's 5,700 over five years, right? So now you have $300 that you spent 50, $700 that you made, what is that, 20, 26, 22 to one ROI, you know, on that patient. So there's, there's a lot of ways of looking at this and you know the numbers as well as anybody. So you can, you can attest to some of that. You know, when you keep patients for a long time, the value of that patient's pretty good.

That is true. It's not just a function of, okay, over 12 months I returned X on my marketing dollar. It is a function of time. I mean, if you have a patient who stays for 20 years and maybe they have Family that they bring in during that period of time. It's almost incalculable what that return is on that patient. And, and sometimes you just have to see it in a longer timeline to understand the value of what a marketing dollar can do if it's spent. Right now, a lot of dentists are well known as people like me, CPAs. We're well known for being DIYers, the do it yourselfers. Why? Because, well, I got some extra time. I can go ahead and do my own website on Square, or I can do, you know, my own, you know, my own marketing or whatever that is. And, and there's a. There's a strong inclination for, for associates because the fact that they have mountains of student loan and they're just sort of trying to get buying, really get started. Where can I save a dollar? Is really top of mind. And then they step into a practice and they have all these expenses already and, and they're worried about. They're worried about spending money. To what extent should dentists plan on using their own time? Do you believe, in other words, how involved does the dentist need to be if they were to hire you or a marketing company, how involved or engaged do they have to be in the process of marketing? Or can they simply delegate virtually all of it?

I think that the dentist can either be pretty involved or not involved at all. It depends on what kind of person they are if they want to just see patients and be active in their craft and sitting in front of patients every month. For example, I just started a practice in Houston. We saw 67 new patients in the first month. So basically, there are a lot of things that you can do in your marketing space or you can hand that over to somebody and you can say, hey, do this for me and plan in your budget. Hey, I need three to six months. When I'm taking out that loan, I'm looking at how much money do I need for marketing. And let's put that in the loan and make sure that there's enough. Because again, coming back to my point earlier is that far too often dentists underestimate the amount of time, effort and energy that is needed towards a campaign to get it to work right? How much manpower do I need? So I'll take this example just because fresh in my mind, we had probably 800 leads in that first month for that dentist. And we. And we had six. We booked 200 patients. We had 67 that came into the office. Out of that six, out of that 67 patients, we had to call those patients over and over and over and over again to get them on the phone out of, out of all those leads. So it's a lot of work to do that. And if you're going to be one of those guys that says, hey, I'm going to do that myself, well, you better get, you better get real comfortable on the phone because there's a lot of things that need to happen in a follow up process. And the way that you look at how your follow up process is, well, do I call, do I email, do I text, what do I do? And in which order to have the best success with my communication cycle.

So yeah, I become a believer in using technology to automate some of that now. Gosh, there's still a lot of work in marketing. Technology sure does help the process be more efficient. These automated client communication systems, there's a lot of them out there, automated text reminders, automated reviews have really helped. I personally believe that doctors, as much as they delegate the marketing, I think when they're dealing with patients directly, particularly if they want to move to more of a fee for service style practice, they have to build strong relationships with their patients. If they don't, and as soon as they switch from PPO to fee for service or go out of network, they're going to lose a lot of patience. But if they know them by name and they know a little bit about their life and their context, maybe their family, and if they were to give a personal phone call to that patient at the time of moving to fee for service, there is a high likelihood that that patient is going to stay. But I also think with case acceptance, which is a, which is a huge area of opportunity in dental, is that there's a lot of treatment that is presented and unaccepted that is just sitting on the books. And I feel dentists as a part of their comprehensive marketing plan is, which isn't just getting people in the door, it's also closing on case acceptance. Getting patients to say yes. The full funnel from finding, bringing them in, getting them treated and getting them to say yes and then doing the treatment and collecting on it. All of that to me is sort of one big business strategy. Marketing flows all throughout it, but is that they should contact those patients and ask them about the treatment they presented or text them. Just a personal touch, especially those bigger cases I think is really important. I want to go back though and touch on that.

By the way, if I can get a dentist to do that, just so, you know, like, if I can get a dentist like post treatment is amazing for new patients. Calling the patient for post treatment, sending a little text message yourself. I think all of those things are really great. The personal touch from the dentist is a huge valuable thing, for sure. I know.

And if I would just budget into your time dentists that after, at the end of the day, you just plan on staying for another 15 minutes and you make a few phone calls and you have a list. It can be a manual list in your office or on an Excel spreadsheet. Just track people that you want to contact. Those personal connections will dramatically increase the probability that they will say yes to whatever you recommend for them clinically. All right, let's go over to reviews for a sec. Josh. We're here in Southern California and Yelp is a. Is a dominant player in the review space for dentists. And there are what are called micro review sites, which you can sort of automate these through a marketing company or an automated client communication system like Revenuewell or Lighthouse360. There's a number of these demand force. The microsites don't really, from my understanding, increase your. The search results, how searchable you are when somebody searches dentists in your area. But the Google reviews do, if I'm correct, and even Yelp reviews will. Now, Yelp has always been a challenge for dentists, and I don't mean to badmouth Yelp. However, Yelp will hide so many really good reviews, and then they will contact you and ask you to pay for their advertising fees. And they claim that by paying, it doesn't affect their algorithm that displays the reviews.

Yeah.

And so a lot of dentists will have great. I mean, even for my own company practice CFO, we have like 30 five star reviews and only seven of them are showing. Most of those weren't solicited. I think I had one or two or asked for a review, but pretty much all of them were just natural. And yet Yelp hides all of those. And then they asked me, of course, to sign up and pay for their monthly service of 500 bucks a month or a thousand bucks a month. And a lot of patients here in California, in certain parts of the country really use Yelp. In other parts of the country I found they don't, but here they do. How important is Yelp and review sites in general and what can dentists do to approach those effectively?

I think, I think they're extremely important, even though some, in some ways you feel like you're being held by the mafia right against the wall. But. But they are super important because people use them and they trust them. You know, Yelp is a very trusted review platform that, that, that basically has dominated this space. So you have to play their game. It's like Google, right? If you want to be visible to people who are searching for a dentist, you have to play Google's game. Well, you also have to play Yelp's game in this particular scenario. And the way that you do that is, yeah, you only have six or seven showing, Right. But you have to continually ask patients to post reviews, because the only way those reviews show is if somebody's a Yelper. Right? So if they're active on Yelp, they're doing things on Yelp, and you don't know that from a practice standpoint. So you got to keep encouraging patients to post reviews on Yelp. Put signs up in the office just like you do. At the end of an appointment, you always say, right at the end of the appointment, you say, goodness, Wes, you know, you are. You're such a great patient. We love to have more patients just like you. So one of the best compliments you can give is if you send, you know, a friend or a family member our way. Right? So that's a constant thing that we always say at the end of a. At the end of a. At the end of a treatment. But the one thing that we have to add to that now these days is say, hey, you know, we would love to hear what your feedback was. Please, you know, feel free to jump on Yelp, look us up, and post a review. There's ways to nudge that along even further. Send it in a text message, use these various different programs that you're talking about. But Yelp really doesn't want you to solicit reviews, Right. If you end up soliciting reviews, they'll block your account. So you have to be. You have to be pretty strategic about the way that you go out there and you get people and patients to post reviews on Yelp. But I do think it's really important. For sure.

Yeah, I've ended up just telling dentists it's a numbers game. And you just gotta plan that 50%, possibly more of your reviews are going to be hidden on Yelp. And. But I would be targeting a couple hundred reviews on Yelp over time. And if you've only got 80 of them showing, well, 80, let's say four and a half to five star reviews, that's pretty dang good. And most people accept the fact that there's going to be a bad apple in there. There's just Always going to be somebody who gives a sour review.

For some reason. And maybe there's a legitimate purpose behind that. Maybe there's a mistake made and. Or maybe it was just that person. But if you can dilute it out by having a lot of great reviews, then the outcome is really beneficial. For my clients, my big clients here in San Diego and Southern California, they all have a ton of Yelp reviews. They just do. How important are Google reviews for a dental practice?

I think that you can talk about reviews just in general, across the spectrum, as being really important. Obviously, Google and Yelp are gonna sit at the top, but Facebook reviews are also super important. And they're important because they show some social proof that helps. That's part of Google's algorithm for SEO results. Right. So even those smaller micro sites, basically, those micro sites are still important to have reviews on, even though they're not as important as Yelp or Google. Because what Google does is they give what's called a page rank, which means how important is this site to the rest of the world? Well, of course, Yelp and Google are more important than those micro sites are, but they still are a factor to your overall social representation on the web, if that makes sense. So Google uses it as a factor for your ranking. So any type of reviews that you can get that are positive out there and the number of stars that you can get, those are all important. I would focus on those top three, though. If it were me, it would be Google, Facebook, and Yelp.

Good content. Let me ask about the website.

Yeah.

And all of those review sites and Google searches and pay per clicks, that's all to drive them then to the website, which eventually drives them to call you, which then you have to have a plan around the scripting or on how your front office answers that phone call. There's something that I think is often neglected. Every doctor should know, I believe, exactly how that phone is answered and what is said. And there should be rehearsals on that. And then, of course, they get in the patient. Now, how do you talk to them in the chair? And how do you get them to accept treatment that they need? And then how do you bill and collect? You got that whole funnel. The website is one important aspect, because my belief is that's where you're starting to build credibility before ever having met them.

Yeah.

And some of my favorite websites are from clients where they'll have a video on the homepage, and it will almost be like a short bio of the doctor, and it'll be the doctor maybe. Maybe a minute, 30 seconds on their background. Maybe their mother or father was a dentist and how they've really grown up in dentistry and how they love to practice dentistry and oral health matters. And then they transition into their office and they might interview them in front of some patients and some nice music in the background, but just something really personal like that. And then a website that's just obviously clear and explains the treatments and all of that. What constitutes, or my question for you, Josh, is what constitutes a really good dental website and how important is video on that website?

I think video is crucial. Like these days, video is really important to a website. It's really important to getting out the message, like you said, getting to know that person. Stories sell, right? So if you're, if you're telling somebody a story, they're probably going to listen to it and they're probably going to have some affinity for you by listening to that story. So it's really important. But I want to take it a little bit deeper because it's not just about a website these days. It's very, very technical to get a website set up that will actually rank. Google just changed their algorithm to what's called Mobile first. So speed is like the. One of them, one of the most important factors to a website these days. And most people don't even know, like, what's speed, right? What's speed factor? Well, you can look up Google Page Insights, right? Or Speed Test, Google Speed Test. And it will pull up a tool for you to look at. You put your URL in there and then Google tells you how well it loads on their platform. And it's really important that the speed of your site is good for mobile devices because 80% of their search results are done on mobile. That's why they went with a mobile first algorithm. So, yeah, websites are important, but for most people, they're just brochures. They're just sitting up there waiting for somebody to type it in. But if you really want to, if you really want to use it as part of your marketing strategy, then you've got to consider the technical parts of what a website is. That's why Squarespace, you brought up Squarespace earlier. Squarespace uses a ton of extra code because it's a builder, right? It's a code builder. So it uses a bunch of code so that you can build your own website, but that code is then dumped into the website and it takes really long to load because there's extra code there. So definitely need to have somebody that knows what they're doing when they build that website so that you can have it set up for then SEO or search engine results.

Now, a lot of dentists will opt for these stock sites and there's some dental companies out there who will do your dental website and they basically will have a portfolio of sites and you can choose from it. Then they sort of make the theme consistent with your color theme and put your name on there. And I've seen a lot of dental sites where it's this. I immediately know when I see it that it's from this particular company.

Because it looks exactly the same. And a lot of the wording is even the same on there as well. Now those are typically less expensive. They might be around 3,000, $3,500 or so to get those. And you can go live within minutes, it feels like.

Should dentists avoid those more off the shelf sites or do you believe they should invest more into a custom site? And if they do, will that custom site be more.

Conforming to Google's mobile one? Did you call it Mobile First Algorithm?

Mobile First Algorithm, yeah. So basically that's a really tough question because the websites have gotten so complicated. Google has made SEO more complicated over the years. It used to be really easy to get your site to rank, right? Just throw some backlinks out there and your site's gonna pop up there. But what's happened over the years is Google has made this extremely complicated because they want you to spend money on their paid platform, right? So their strategy is let's make this really complicated so nobody wants to do it and then they'll just spend money with us, right? That's kind of been their strategy and it's worked probably fairly well. But if you're going to do a website, there are several factors that you need to look look into. And sometimes those templated sites can work, you know, I mean, depending on which one you're looking at. But I look at the conversion factors, right? Does it support live chat? Does it have video content on it? Is there calls to action throughout the site? Do you have landing page options? Those are the types of things that I'm looking for from a conversion standpoint. And then you have to look at it from a technical standpoint. Does it load fast? How many words are on each page? Does it have the meta tags and meta titles and the meta descriptions in there? So there's a lot of things that go into building a website properly so that will actually pay benefits to your practice through organic search results. So while I think that if you're just getting Started out, and you need something quick and fast and dirty. Okay, fine, just go get the brochure. Right. But if you really want to use it as part of your marketing strategy, which I think is a good idea, again, an organic traffic patient is your second best type of patient next to a referral. Just is. So if you want to use it as part of your strategy, then you need to dig deeper in terms of what you need to do and how it functions.

Yeah, you know, I think.

Gosh, I just can't. When I think of marketing, I sometimes being a cpa, go back to the P and L and I. Our P and L is a practice CFO for our clients have a specific section for marketing. And under marketing, we have different methods of marketing, from online marketing to mailers to some website investments, things like that. So we can see where's the dollar going in marketing. And in the past, I've never really had a good budget. What's the budget that a dentist should set up for marketing? Sometimes I hear it depends on your capacity. If your chairs are open, well, then it might be 6 or 7%. Heck, it could be 10%.

Yeah.

If you think of big companies, big companies spend large amounts of their budget in marketing.

Huge.

A lot. I mean, they'll easily spend 10, 15%. In fact.

We have a client who does a lot of all on fours. It's a very, very, very large practice. And this client spends $250,000 a month in marketing. But it's also a business that's doing 12, $13 million a year. And I would rather have a practice that has a profit margin of 25% that is doing $3 million a year than a practice that's doing $600,000 a year with a 50% profit margin. And of course, a lot of that is a personal preference, the style and size of a practice that you want to be into. But what's your answer to that question, and forgive me for asking it, as, you know, as the accountant, as the cpa, but what budget, what percentage of collections should doctors plan on allocating for their marketing expenses?

Now, I've had this discussion so many times, so it's a great question, though, and it really depends on where you're sitting. Like, obviously a new practice, they don't have any collections. Right. So their expenses are going to be pretty large. It's going to be way over what their profits probably collecting, or it's going to be about the same what they're collecting, at least in that first month. So I think that if you're looking at it from an established practice. The larger practices, the larger DSOs will be around like 7, 8% of their, of their budget. Some, some of the ones that I work with want to stay around 8%, but they're okay going up to 9 or 10% as long as they're expanding the, the collections. And then there are other people that are that, that are, you know, going up to 15%. But I'd say between 8 and 10% is probably pretty standard. If you're looking to grow, if you're looking to kind of maintain where you're at and just hey, I'm happy with what, where life is at, then you can probably dip down into the 5, 4, 5% range. But overall, I think if you're trying to push it and looking to grow, then I think it's probably more like 8 to 10%.

Yeah. And I think that doctors need to avoid this concept which I think about a lot called marginal thinking, which is the belief that it's okay to ignore a, ignore something because the effect of ignoring it feels harmless. Today, that might be a simple example would be if I don't go exercise today, it's in the, you know, in the bigger picture it's not going to hurt anything. But in the bigger picture you do that a lot and in the aggregate, it really, really hurts. Well, I think marketing is a little bit like that too. You could get to a point where you say, I'm doing plenty of dentistry. There's, this is about how busy I want to be. But every dentist loses some patience. And if you're doing a good job as a clinician, you're fixing a lot of teeth, you may not need or have as much clinical work to do down the road. And so if you wait, if you wait to then start marketing at that point when your chairs are starting to be empty, then as you mentioned in the beginning of the podcast, there's a time delay from the point of marketing to seeing that play itself out in your chairs.

Yeah.

So I feel like there should just be a constant attention to marketing, that it can't be neglected. Also too, if you're trying to convert to something that's more fee for service, maybe you're wanting to get more cosmetic work done or you're wanting to do more high, high dollar treatments and you may need to market aggressively for those types of things. And I would plan accordingly in, in the budget now, I would watch it because if it never really translates into people in the chair, then that's money that you could have been funding a 401k plan or, you know, buying a new house with or whatnot. So you do need to be mindful of it. And we can't just be totally hands off as business owners and as dentists, but I do think there needs to be a continual budget for that. Well, let me ask you one final question, Josh.

Yeah.

Which is, and we'll end on this, given all of these changes. We started off the podcast with this a little bit, that there's a lot of consolidation in the industry right now. And I think over the next 15 to 20 years that that'll continue. And you and I have talked about how the private practice needs to somehow get some of the benefits of scale that larger DSOs and larger practices have. And so we've talked about, you know, what, what can they outsource so that private practices can sort of get that aggregate value on different services and products?

And then, of course, the insurance companies and all the pressure they're putting with lowering their fees continually, particularly delta, and then the student loans that are mounting and associates seeing their balance going up because they're on an income driven repayment plan and they're paying less than that, the interest and the debt is mounting. Here's my question. Should dentists fear practice ownership today as they come out of dental school? And why or why not?

I would say no. I mean, the reality of the situation is that there's a lot of consolidation, but that kind of gives you an advantage, right? Because not a lot of people want to go to a dso. Let's just be honest, right? I'm not. I'm not the kind of guy that goes to a dso. Right. I don't want to go, even though I work for a lot of DSOs. And I know that there's a lot of great care in those practices. But I like seeing the same guy every time I go into my office. Right. My dental office. And I like the personal relationship that I have with my dentist. And I probably won't leave that dentist because of that relationship. So I think that there's a lot of opportunity as things consolidate. Private practice is going to have advantages to that. They can give personalized care better than a DSO can and they can do some things to stay up. Like, for example, I'm pushing all my single practice owners to externalize their call portion of their practice. And we're putting them in Vegas here, where I have my call center. We're putting them in Vegas and they're making all their recall calls, all their treatment calls and all their marketing calls. Because when somebody walks into the practice, they. The thing that I want to see out of my practices is that personal attention, right? Somebody walks into the doors, that person stands up, they greet them. They don't sit back down and get on a phone call and book a patient. They go over, they greet them, they work with them, they talk. Maybe they fill out their forms together with them for those new patients. But it's a really personalized care. And that's one of the things that I think is a huge advantage to these DSOs because they cannot provide that just by the model, by the structure. You can't provide that personalized care, that you can't provide that one on one care.

I think that dentists, private practice dentists are going to decide over time, sort of as a collective group, what business services they shouldn't focus on, that they should outsource, and what business services they should retain in house. And the ones in house are really the ones that are all about the patient experience and creating that connection with the patient. Great comments, Josh. I just want to say thank you for being on the show.

My pleasure. Yeah, thanks for having me, man.

I'm sure down the road we'll probably do another one as well. So thanks for being a part of our Associates on Fire podcast.

Awesome. Thank you very much. I appreciate it.