Grit, Leadership, Culture, and Acquisitions with Dr. Landon Libby and his Wife Nichole.

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.

Welcome everybody, to another podcast of the Associates on Fire program. We are thrilled today to have two of my most favorite people and two people who have seen incredible success over the past five or six years as they've owned practices and yes, I'm saying practices because they have bought multiple practices, folded them into one office. It's been an absolute journey. And I'm really excited for you associates who are listening to this because I really believe you're going to, you're going to get some, some knowledge out of this that's going to help you as you buy your own, your own practice. Some of the themes we're going to cover today are leadership, a lot on the concepts of leadership and team management, overcoming fear and addressing risk. And it's also going to cover what it means to be a spirit spouse who's highly involved in the growth of the practice, in the mission of the practice, the culture, and also managing the operations. So this is actually quite an honor that we have the spouse here. So let me introduce you to Dr. Landon Libby and Dr. Not doctor, but Nicole Libby, you can call her doctor. I give you both as doctors here, you guys are definitely running this show together. So, so welcome, guys. Really happy to have you on the program. And we've got a solid hour here. We'll probably use all of that. And we. This is, this is just, this is going to be fantastic. What I want to do is start off by asking, asking you, Landon, you've owned since I think 2015, 2016, and I've got your financial statements right here. And I'm looking at Libby Dental Corporation. December 2016 was your first, first full year. And at that time you had bought a small practice, very small practice, and you increased the revenues dramatically that first year. But you're right, your collections were 913,000 that first year. 913. Fast forward a few years. The end of 2019, you did 1.845 million. And this year you were on track to do somewhere around two and a half million. And the unique thing about that is this is 2020, the year of COVID and we're still seeing remarkable growth. I mean, I'm looking at your numbers these past few months and three months ago. And I think in June, four months ago, you did over 300,000 in collections. Then you did 193 and then 225. And it sounds like this most recent month you did about 275. So really incredible things are happening. We want to know how you do it, how you both do it. So here's a quick timeline. 2015, Dr. Libby buys a very small practice here in San Diego, is almost like a modified startup, we call it almost like a modified startup, old building. I mean, we did, basically built this thing, you built this thing up almost from the ground up and had some interactions with the seller, dentists that were a little bit at odds on a few things. Fast forward a year or two later and you buy a GP practice that was formerly a prosthodontic practice that was just sort of languishing, really languishing. Great location, great suite, a lot of ops, seven ops, but just languishing. And then fast forward another year or two and you buy a dentist down the street, you bring that dentist in your office, you bring all the patient records in your office. So you've been through, when I say a journey, I mean in five years, you've probably been through more sort of transition experiences than most dentists go through their entire lifetime. So I want to, I want to hear about that. Let's start off by telling me about this journey a little bit and start from the beginning. What are some of the things that just, you know, that, that you learn from, that you think would be helpful for associates who are listening and who are at the start of their own journey.

I'll start out on this one. So I, graduating from school, it was, I think what the difference is, and I'd love to just share with people, is defining what is it that I want? And if you can define that, if you can define where you're going and what turns you on and what inspires you and you can kind of put that into a definition, it's going to tremendously propel you into, into taking advantage and noticing opportunities that are in front of you. So I graduated. My number one goal was to find a fantastic, the best mentor I could find to learn the business of dentistry, clinical dentistry mastery. And I found that and worked as an associate for three years. And it was basically allowed me to work in a, in a culture and an office where I could see what was working and what maybe wasn't working. And I was able to mentally fine tune, like how I would want to set my stuff up in that time frame, I also.

Started flirting with the front office administrator, and she was on her way to dental hygiene school. And that's Nicole, my wife over here. So I was so attracted to Nicole and her power of being able to be a leader and just be a powerful woman and a powerful force in a dental office. And we've talked a lot about, you know, team output and like, the success of a dental practice is being a leader and inspiring your team to be more than they ever thought they could be. And I was just so attracted to Nicole when we first met and. And we kind of. We got to know each other and then she left that office about four months later after I started at that office and started hygiene. And that's when we started dating and ultimately got married. And I can say that that is the number that's the best thing that I've ever done was to marry a woman who is. Totally compliments me. Like, I. I've called her my ball and chain. So several times.

Yes, several times.

Because she holds back my dreams. But it's not that at all. It's. It's. She's able to bring a perspective. I'm. I'm a very big picture visionary. Here's where we're going. And it's always big and grandiose, and she is. Is nuts and bolts paying attention to the details. And it just is the best thing for me and I feel like the best partnership to have.

We work together, we run the business together, we live together. Obviously, we have three beautiful little girls. Five, three and one that we've been raising. So we.

I left my associateship job and I was. We could have spent a bunch of money on a shiny practice. And how I put it was, as I was going through this process, I was like, I could either buy a practice that had. That was kind of a painting. Let's. Let's think of a canvas on the pedestal. Buy a practice that had a little bit of white space up in the corner where I could make it who I am. And that's great, but you pay, you pay a lot of money for a practice, and you often inherit the culture, the patient perception, the team.

The team mindset, and also the kind of the ways of the selling doctor. And those may or may not work for you. I'm a very. I'm a strong personality. And so I realized that, like, I could. I would much rather have a whole white canvas of something that I can make my own. So when we were looking for a practice, it was. We were having our first Baby.

She was eight months pregnant.

She was due in April. And I was jobless because I had quit my associate job and, and we found this little practice that I wouldn't even call it a practice, but it was a little converted house, and it had four operatories of working equipment, and we paid $100,000 cash for that. And what I saw when we walked in there, and I had to kind of convince Nicole in what we were, what was there was. I saw just a space where we could create that white space where we could create. We could create a culture that was us. And her being a hygienist, her being an exceptional administrator in the front office, with her knowledge, it was like we started out, just the two of us with a new baby. She would assist me and answer the phone at the same time with Olivia in the front pack. And, you know, it was a true, like, family adventure starting out. So that was important to me. And I, and I, I, I, looking back on that, Wes, I, I really value the, the opportunity to, like, pay a little bit of cash.

And then I, we had the mindset of, like, hey, when we make some money, when we make some profits, then I can buy an electric handpiece, then I can buy a digital sensor, then I can, you know, then I can buy the things that are going to make me a better dentist. But I don't need to go out and spend dental, you know, 500,000, a million dollars just to get that in an office that's already set up so that startup. And we got a few patients from that practice because it was a dentist that was working about a day every two weeks or so, doing his own cleanings forever. And so the thing I realized about taking over somebody else's office is this, is that it's really important to find a. That you, as the doctor, resonate with the selling doctor, the doctor that's leaving there, that you're taking over his patients, that you. It even. I'll even go as far as to say, like, it helps that if you're a woman, go buy a woman's practice, or if you're a tall guy, like, find a tall guy. I mean, all those things. Because what happens is that patients are very, like, they're very accustomed to who they've been seeing for years and years. And if, if you come in and you create a bunch of differences right off the bat, it can be scary for people. And, and so if I was to buy a practice now, that is what I would be paying attention to is, is, is. Is there a team in place. What is the culture, what is the mindset of that team? I would get to know that team before I bought the practice. Practice and our is, is my mindset and how I see dentistry and the care that I want to give people. Is that in line with how the selling doctor has been doing dentistry? Because if you come in and you're a proactive dentist with a, with CAD cam technology and all this computers and you're taking over for a doctor that hasn't even looked at a digital X ray in his whole career and has been know watching things, it's going to be a. Those conversations are going to be tough to have.

You know, can we pause and talk about that for a sec? I see some associates buy a practice and, and they sort of take that to the full nine yards and they, you know, they, they don't change anything for a long time. And then I see some come in and they want to change everything on day one. And every office is going to be a little bit unique, I think in their tolerance for change. You've been able to create.

More change than perhaps I've seen in any other acquisition across all three of the acquisitions you've done from Dr. 1 to then Dr. 2 and then more recently the Dr. 3. A lot of change for the team members, a lot of change for perhaps the patients. And yet it worked and you didn't wait years to do the change. So how did you balance keeping things so it wasn't such a shock that people ran away, but then also it created that motivation for them to change. And some people didn't change. If I understand some people weren't willing to change and they're no longer a part of your team. That's one of the most difficult things to understand and juggle and balance as a new practice owner. When you have all these visions of greatness in your practice that hasn't, that haven't been there for a long time. How do you.

Well, let me go back to that question I asked of like defining what you want. And what I defined, what I wanted was I wanted to be a person that was so well rounded and equipped with my personal skills of dentistry that I could talk and perform comprehensive dentistry. And I spent the first three years as an associate spending more money every year than I did in a whole year of dental school. Doing the ce, doing the. Learning all my surgical techniques, learning sedation was the first thing I did out of school. And it's been the biggest tool that has led to our success up to this date. Was doing sedation dentistry every day. And the one thing that doesn't change is when you can hone in your ability to communicate with people, to communicate with the new team. If you do buy a practice to go in and define the vision of where you're going and you do it and you say it with excitement and the way that you're being is, I'm going to bring you guys along for the ride and I'm going to expect you guys to be more than you ever thought you could be so that we can all grow together. That is inspiring people to jump on board and to go somewhere. You can change everything as long as you, as long as people feel like they are, they are safe with you.

And that you include them in that you include them in that decision making, that you include them in the long term vision and you explain why you're going there and that you get them excited to be part of that vision too.

I can't tell you how much I believe in that right there. That you give your team a sense of reason to exist in that office. And it's not just to get a paycheck and it's hard to, to sort of bridge that gap from I'm going in because of a paycheck and I'm going in because it's like my second family and we're, we're doing something really, really cool together. And there's a lot of investing in that team and we've spoken about that in the past. You take your whole team every year to the crown.

Member of your team. Not just YouTube, but, but everybody. And that's, you know, that costs a little bit. You've had consulting over the years. You've eagerly sought out coaching beyond the clinical. So you first dealt with the clinical. That's what sort of what you had put on your canvas is I'm going to master this clinical, be able to do comprehensive dentistry. And you've got, yeah, you've got to get that down. And you invested in that. And part of the reason why you've been able to do that is because you have a wife who's been frugal on the home front and lived on a budget and you know, driving around the used minivan and, and your, your house.

Every idea of a, the best date is for me to take her to Red Lobster. And that right there is like so beautiful because she is, she is. No. And I, and along those lines with, with investing in your team. I have, I'm a part of that and I'm a Visionary and I can ex. I can, I can inspire and enroll my team in the vision. But Nicole is, is one of them. She is able to because she's a hygienist, she's a office manager. She. And she's been a team member before. Right. So she has this amazing ability to connect with the team on a personal level and have the knowledge of what an owner, an ownership mentality is. And it, and it just creates a perfect blend between her and I of how to, how to really take care of our team and make sure that they know how valuable they are.

Because I think that's one of my biggest things is that I was a team member before because I think a lot of doctors wives are not. They haven't been a team member before. And so you can have an idea of how you want to treat team members or what you think it would be like to be a team member. But since I was an actual team member who worked for a husband wife team, I think I know what it feels like to be an actual team member. And even now working full time in the office, like I still feel like a team member a lot of days with also the owner mindset.

Yeah. Before this podcast is out, I want you to dispense some wisdom to the spouses of dentists who are involved in the administration of the practice at some level. Because I'd say of my clients, I feel like half of them, their spouses are involved at some level or another. You're unique in that you were a hygienist. Now, how much hygiene work are you doing? Not much.

Well, as of yeah, two months ago, I have been doing no hygiene and working 45 plus hours in the front.

Yeah. You've become sort of the chief operating officer of your practice in so many, in so many ways. So I'm going to want to hear some wisdom on that. I'm marking down that question, but I want to still focus a little bit right now on investing in yourself and investing in your team. One of in fact our very first video in the associates on fire program, Fuel Cell one. After we sort of give the introduction to the program and our AOF certificate program, the test is we jump into the timeline of events in the life of associate and I and I say you come out of school, first thing you want to do is you want to soak up all that clinical knowledge. You can keep your student loans really low, try to set some money aside, do all that stuff. Then you eventually you buy your practice and then you, after you buy your practice Then you, then you buy your home and then you can set up a retirement plan and then you start paying down your student debt, maybe refinance into personal. Well, you guys sort of following this and that, you set some money aside early and all that stuff. But one of the things I mentioned, all of those is continue to live like a dental student. Student. Because if you can, the compounded return over time is going to be dramatic because what did that allow you guys to do? It allowed you to sort of reinvest a lot of your income and your first year just to, if you're okay with me sharing that first year, buying that basically startup practice, you guys first full 12 months, January through December, you guys did, As I mentioned, 913,000 and your operating income was 46%. You had $417,000 of profit after paying your overhead expenses. And your debt on your balance sheet was.

$142,000, which was a SARIC and a sensor loan. So that ratio after one year of very little debt and what is a very healthy bottom line profit. But you guys didn't take $416,000 home and go spend it. You guys reinvested a whole bunch of that. You set it aside. In some accounts we got a 401k going early, so that's now growing and been doing very well and compounding all that stuff because you continue to live like a dental student. Now I say that a little bit facetiously. We're not totally like a dental student, but you lived on a budget, you were frugal in what you did personally. You bought a house that was well, well within your means. And now it's giving you all this opportunity to reinvest in buying these new practices, buying equipment, self training, investing in consulting for your team, taking your team to the Crown Council event every year that just sort of creates this great roadmap for you guys and setting goals and visions for a team.

I guess there's no question other than saying I can't tell you how valuable I see as an outsider that that has been for you guys and how I encourage my associates to try to replicate that, to live the right way financially in those early years to create those opportunities for you guys.

Yeah, it's, it all comes down to mindset. And I'll go back to as a husband and wife team, you know, marrying a woman that is not a big spender. And I know you can't ask that question when you're looking to propose to a girl or a guy, but.

It makes a giant difference Just like getting married with the intention of not getting divorced. I mean, getting divorced ruins you financially more than anything. Right? So finding the right partner.

Is huge. And being able to coexist with each other and being able to work together and then go home together. We have a lot of friends who. The guy's a dentist and his wife is a hygienist, and his wife works as a hygienist at another dentist's office. And I just go like, the value. When Nicole is doing hygiene at our office with an ownership mentality, her production, her ability to produce profit for the office is out the roof because of her. She's talking about restorative dentistry to the patient because she gets it that what she's doing as a hygienist is feeding the restorative the dentist schedule. Right. And so she's able to teach the rest of the team how to do that. And it's infectious. And so working in another office, I mean, not only are you is that hygienist.

Getting paid at another office and not taking advantage of being an employee within your corporation at your office, but your wife, your biggest advocate, is in another office producing for another dentist and enrolling patients in treatment and getting them excited about treatment for another dentist, not you. And it's. I get it that not everybody can work together, but if you can, it's amazing. And that could. That goes true with being in an administrator in the office, you know, and we'll let you talk about being a spouse and what that means, but it's. It's. It's huge when you can team up on all fronts.

Can we talk about that subject of leadership and culture? You've both been leaders, you've both created a culture. Before the podcast, we were talking about this concept of team output, that the team output can be so much greater than an individual doctor's output by themselves. And what I find in dental practices very often is the doctor sort of use him or herself. As I'm the producer here, my job is to produce. Oh. And then I have these people around me that are going to sort of set a few things up, but really, this is about me and my production, and hopefully my hygiene will produce. Well, your view is entirely different. Your view is we are a single unit as an entire team, and my success is dependent on your success and vice versa. We're in the yoke, in this thing together. And I think the only way to, as you use the term, enroll, the only way to enroll the team into this, sort of recruit them to that Mindset is very, very effective communication. And people like you and me, you know, I went into an accounting program. You, you went into dental.

They don't teach anything about communication in our programs. So this is sort of a skill set that maybe you're born with some of that, but a lot of it is, are you trying to shape skills in you that were not formally educated during your years of education? Are you taking the time outside of the operatory to learn those things?

How important has it been for you to learn those leadership skills that are completely unrelated to hands and mouth dentistry? And because we're acknowledging right now that that's a huge part of the success, how have you gone about acquiring that sort of skill set? And how have you create, used it to create an incredible culture in your office that is sustained this level of growth and success?

I that right there, when you were reading Our numbers of 916,000 collections Our first year, that has. I was able to do the dentistry, but my success as a dentist, and you listening, your success as a dentist is directly tied to your ability to sell yourself and sell your services. And what I mean by sell is enroll the patient to see the value of doing the treatment and what it's going to give them. And so where does that start? It starts with, don't talk. Don't sit there and talk. Ask questions. Ask questions nonstop. And when you are able to ask, hey, Wes, what is most important to you? My new patients, our new patients at our office hear that question three times. They, by the time they sit down with me, they've already been asked that question three times. What is most important to you about today? About your teeth. And then shut up and let the patient tell you what's most important. And then the whole team and me as the dentist, use what's most important as our foundation for the entire conversation. For example, Wes, what's most important to you about today? If you say, they're going to say one of about four things. They're going to say, I just want to keep my teeth forever. I just want to. I want to look, I want to be confident in my smile. I hate the dentist. I hate being here, and I want to get my work done and be able to get through the appointment, right? Or like, I want to find a solution that fits within my budget. It always falls into a couple categories. So if somebody says to me, like, I want to keep my teeth forever, that's what's most important to me. Well, now, your whole conversation around Perio.

It'S not selling them Deep cleanings, which is what's so prevalent in our industry right now, is like trying to upsell deep cleanings. And. No, dude, it's about the conversation now turns around into, man, all this bleeding that we're seeing in these pictures, you know when we're just around all this puffiness around your molars and all this white chalky stuff that's slammed around all your teeth, what that's doing is it's ruining the foundation that's holding your teeth. That's why most people lose their teeth. So if you want to keep your teeth forever, Wes, here's where we're going to start. We've got to get the foundation healthy, right? So I'm. That's a huge. That's enrolling you and seeing the benefit of spending fifteen hundred dollars on a deep cleaning, not just a drive through polishing. And so that is when you can convert your. Our desire to talk and to tell the patient what they need. I always say, like, nobody needs anything from me. Like, nobody needs anything from me. It's about me discovering what they want and, and helping provide solutions that's gonna give them what they want. That is the bottom line foundation of success as a dentist, especially moving forward, especially moving through Covid here, where volume dentistry is dead. We can't see. You can't see five patients at a time. So what do you have to do? You get one patient at a time. Whether your practice is set up like this or not. Mine is because I value this so much. Where I want to have uninterrupted knee to knee conversations with that patient so that I'm finding out exactly what makes them tick. And then I can provide solutions that's going to help them get them there. And I preface it all, Wes, with Wes. You can tell me anything that I tell you today that I recommend and that we talk about. Feel free to tell me no, you're in the driver's seat. You could leave here and say, thanks, Dr. Libby, I appreciate all this information, but I'm going to go look for somewhere cheaper or I'm going to hold off on everything that's perfect. I want to give you that opportunity. And once you give the patient the opportunity to say no, it just opens up a whole new relationship that is all about connection and enrollment and.

A bond that helps. That leads to doing more dentistry, that leads to making more money. That leads because you've created value for that person. And money always follows value. It's not the other way around. Money always follows value. So if you're creating value for people. If you're creating value for your team, profits, production, collections, all the numbers we spend so much time looking at and thinking about, drop all that. How are you providing the most value for the most amount of people? And it starts with your team, starts with your wife, it starts with yourself and like going, what do I love? What I, what I'm doing? What would I change about my profession or about my office if I could change anything? And money wasn't an issue and time wasn't an issue, and what's the magic wand? Conversation and.

Have those with yourself. Create value for your team, create value for your patients and the money will follow.

It's like it all has to start. And I think any life coach will basically say, this is. It all has to start with you. Your self belief, your level of integrity, your vision.

The consistency with which, the way you live your life relative to who you want to be, all of those things. Then it starts to flow out of you. And the way it's almost like you have an algorithm, the way you're talking to patients, there's almost an algorithm. And what it does is it's converting something that normally would be classified as a cell into a provider of solutions. Because.

Your first unearthing what the need is, which sometimes you would think would be easy to find out, hey, what do you, you know that they would just come in and tell you what they need. But a lot of times you have to help the patient and sort of same thing in my situation with people in their finances. You have to help them sort of discover or vocalize and put in words, what is the thing that matters most to them? What, what's the pain point? What do they need? Once you know that, then it's not a sell.

No, you're finding solutions and you're always going back to that because I know you can feel when you're with a client, Wes, and you're asking those questions, you can feel when they've found what's most important to them, it's authentic. They're able to say, sometimes it comes out as tears, sometimes it comes out as. But there's an emotional, there's an emotional.

Component to this that is huge that we got to get our DDS degree logical thinking ABCD in a system, get all that out of the way and start getting, paying attention to the emotional side of it. Because until you dial in emotionally with somebody.

Nothing else is going to happen. Like it's not. But when you can dial into that and you ask the question of like, how do you train yourself to be able to enroll people, to be able to do this? And it does come down. It's the same concept as life coaching. And business is business. I mean, business of dentistry is the same as any other business. So get out of a doctor mindset and start getting into and training yourself and reading books and podcasts like this and. And focusing on how you are relating to the person in front of you. How are your relationships? How are you asking questions of your friends that allows your relationship to go deeper, because that's the exact conversation you're going to be having with the patient on Monday morning in your chair. That allows you to go deeper, which leads to a more profitable practice. I mean, I can't stress enough how when you lose sight of that.

Everything starts to change. But when you hone in on that. And Nicole is so amazing with patience, but also with our team. She is so in tune with the emotions of our team. I have three daughters and a wife, and I have 12 women at work. And I am. I am sometimes missed a lot of the times, most of the time, miss the emotional connection of the team of women, because men and women think differently. But Nicole, that's another huge is. She is so in tune with.

Our team members, feeling like they are taken care of and safe and that our success means their success and vice versa. And so if we can start getting in tune with that, you're going to see dramatic, dramatic positivity coming out of it.

Well, that's what I was going to say about team output, is that Landon is very good at, like, I feel like what's missing with a lot of doctors is the team doesn't really feel like they care about them personally. And that's one thing that Landon is really great at is, you know, when we hire somebody, we. We do care about you personally. And our whole vision is that we are leaders that grow and enrich people. And if that means that you're not working for us in a year because you got an amazing job somewhere else because of tools we've given you, like, we want what's best for. For our team. So we, if we encounter you in our life, we want to make you a better person. And he's really good at making people really feel like that. And I think one of the biggest things is our team output is we have agreements that we all are committed to and we don't have little talking circles. Oh, it's the team versus the doctor, the doctor versus the team. If there's a problem, it's a shut door, you know, like, figure it out and, like, handle it so we all can be on the same team. And another huge thing that I feel like Landon does that is lacking sometimes is he really trust the team. He's not a micromanager. And he gives each position.

You can handle it a hygienist, he. He gives them the power to really be able to step into their power. And it's not a micromanagement type of office. It's. Everybody is a stakeholder in our office. Nobody is just an employee. And those people who are just employees don't make it in our culture because they realize it and they select themselves out.

I think that only works when you, as the, as the leader, are defining those expectations, as you mentioned, and you're being pretty specific about those expectations. And then you tolerate the fact that there's going to be mistakes made in their attempt to achieve those expectations. And you have to be okay with that. You have to be okay to accept the mistakes that are going to be made in your pathway toward ownership. One of our themes here at practice, cfo, is extreme ownership. We read this book called Extreme Ownership, and it's. Yeah, exactly. Great book and some good podcasts there now, right now. And so.

You have to build into the equation that people are going to make mistakes if they're. If they're really trying to get to that higher ground of extreme ownership. And I think that's what's helped your team. The interesting thing, when you guys bought the team from the general dentist, who had recently bought it from a prosthodontist, and it was, I think at the time, doing maybe five, six hundred thousand dollars a year at best. But there were three team members. Two of those team members are still with you today, three or four years later. The same team members are producing so much more by way of value to the patients, by so much more by way of collections and culture and all of that, it's because I think they. And I've been in your office, I think that you've created these sort of spaces of ownership. You've led them, you've set expectations, and it's really created this huge sense of reward that everybody has. And you take them to the Crown Council, and I went one time to the Crown Council, and I saw how it affected the whole team and brought you all together. I think that's one of the most distinguishing features in the Libby practice is the way that you handle both the patients, as you were talking about, but also the way that you're Handling, handling your team. One of the things that this allows you to do, going back to the culture and the relationship you have with your patients, is your patients feel that connection as you were talking about. This allows you to do things that your standard transactional based practice will never be able to do and do it well, which is to remove your dependency on the PPOs that's in fuel cell three of the associates on Fire program. We talk about that, we run the numbers and we just show how you can be doing actually so much less dentistry and making so much more money. If you can get rid of the PPO, if you can maintain your patients or let's say 90% of your patient flow and go out of network with your PPOs, you're going to like double your, your bottom line. And, but how do you do that? If everybody is there because they're trying to get a cleaning at the lowest cost or a crown at the lowest cost, whatever that is, they probably will go down the street and the insurance company is going to send a letter to that patient as soon as you got a network, basically telling them that they need to go down the street. Almost like it feels like they have no other option. But if you have a relationship based practice and you, and you sort of meet this early and head on, then you can do that. Now you guys are just in that moment where you're booked out really far. The insurance companies are playing total tricks on you right now and you're going to start removing some of these in network PPO plans. Tell me how you're feeling about that and how you think it's going to go with your, with your practice.

Well, I want to do a little background on. So when we started the practice, we Nicole negotiated with two insurance companies and we, we, we went with two because we got, we were able to negotiate a fee that was, that was, we felt was plenty fine to, to go with. I have never seen the value of being in network with those patients. Like we don't get a lot of patients from the, the network, but we've always just had those two. Aetna and Cigna we bought A year and a half after we started, we were outgrowing this little four op, converted house, old school, little office. So I started going, we need another space. So we started pricing out what it would take to build out an office in San Diego. And that just gets crazy when, when you're thinking about just parking. And we came across actually through Wes, through you, you introduced us to this doctor that was selling seven ops Beautiful office. And I really pursued buying that practice because of the, I just needed a space. The hardware, yeah, we needed a bigger space. Seven ops and a beautiful build out that had been done by a high end prosthodontist here in San Diego in the late 90s. And so we ended up buying this practice and I, when I walked in, Nicole and I walked in with the selling doctor, she was on her way out, she was at the end of her career and just didn't really care anymore, I believe. But I looked at the wall and there was a whole wall of old pros, charts of full mouth rehabilitations that he had done over the years and he had passed away tragically. But I saw, what I saw was just opportunity there and it didn't matter how much it cost because we were getting a bigger space and I was seeing these charts on the wall going those are the types of patients that I want to treat and those are the types of patients that, that work that was done 20 years ago is going to have to be redone soon sometimes.

And not patients that were dependent on insurance.

Right. And no insurance. And so that was our second purchase. We, we came in and we blended two teams. Some of the new team weeded themselves out, some of our team weeded themselves out and.

Allowed us to get a new space and take on, to grow our practice rapidly. This last transition we've did, we bought last December. It was a dentist down the street and great guy and we didn't do our homework like we like looking back like we wanted to. I just wanted to maximize our space because I. We just expanded to eight operatories and he is contracted with Delta Dental. And one thing that and every other insurance company too, Nicole does every morning is when we're doing our huddle prep, she says, okay, Dr. X, you are scheduled to produce $10,000 but after insurance reductions that drops down to 3,800. And so you're able to see like his schedule is jam packed. Right.

But it is, there's, it's not worth it, man. It's not worth. Because when we start doing in office milling crowns or you send your work out to a good lab and you're going to use good materials and you want to do the best work possible. You're paying, let's say $200 a unit for your ceramics. Well, the insurance company's reimbursing you 650. It's a game that is a no win situation in our opinion. And so to answer your question about dropping PPOs, there's, there is it is a the replacement. And what has to be in place when you go to cancel these PPO in network contracts is you've got to have that relationship. You've got to have the ability to have the in person conversation with the patient. And our, one of our sayings is some will, some won't. So what next? Like, if a patient doesn't value your services and they just want something cheaper, who's in that? You're not going to change their mind, let them go somewhere else. But the beauty is, is that you could see, I truly believe that if a practice dropped a PPO and they lost 50% of their patients, they would still profit just as much or more. Because now what are you doing? You just got rid of half your schedule, so now you have twice as much time to have those relational conversations with the people that are there. And guess what? You're not doing single tooth dentistry anymore. You're talking about sedation complex, complex restorative cases that are all done in one visit instead of 10. You know, so it is a, it's a scary, scary thing even for me, like thinking about, you know, us calling Aetna tomorrow. I don't know what will happen. I don't know the ramifications, but I do know that we're fully committed to that, to creating value for people. And if we can create value for the people that are in front of us, you will thrive beyond belief being out of network with insurance because it's going to weed those patients out of your practice who are just there for a cheaper cleaning, you know.

But I do think that talking to dentists and teams like, you have to be 100% committed to having, having those hard conversations. You can't just drop the insurance and be like, yeah, we don't want to be a part of it. Like, you have to have your whole team on board to have those conversations of Wes, we can no longer give you the care that you deserve and that we want to provide with being contracted with these insurance companies, we are still happy to bill out for you. We are still happy to make sure you get everything you can from your insurance company. Company. However, we cannot be binded to what they tell us. We can and can't do and provide you the care that you deserve and need. And that needs to be a conversation that your whole team, not just, not just the front desk, not just the hygienist, not just the assistants, even the doctors, everybody on board, if they call anybody, that's the conversation they're going to receive and in my experience we have had some people leave and just recently we've had three patients come back. They went to an HMO office or an in network dentist. They realized, man, I am not getting this one on one care. And now they have come back and they realize the benefit of going to somewhere that is going to take the time, that's going to use the best materials and they're getting it done once and they're getting it done right. And I think if your whole team A believes that and two is committed to that conversation, it is scary. I am scared to drop these two companies, but I'm also committed to that conversation. And the people that are going to see value, those are the people I want to treat and the people that aren't going to see the value. I wish them luck. And I also always let them know, hey, if anything happens and you're not happy where you go, we are always here to serve you. And giving them that option to come back, not you need your X rays fine, like getting, just treating everybody like I'd be happy to give it to you. Can I take some time to explain, explain to you why we're doing this, what the difference might be and if they still want to go somewhere else, great. Wes, I wish you the best of luck and we are here always to serve you and we'll be happy to take care of you if anything changes.

The interesting thing about that is that you want to present yourself to the community, to your patients, prospective patients, as you're kind of the dental office that I think people truly do care about, about their teeth, they care about the oral health. Sometimes they need to be educated on that a little bit. But getting them sometimes to recognize its value in relation to other things demanding for their dollar like that trip to Hawaii or the next big screen TV or the latest model of the iPhone, all that stuff. But if they can sort of view your office as the dental office and then they're going to be willing to pay a little bit more. I really believe that about people, that they will pay more if they experience a value coming out of it. And when you tell somebody we're out of network because it doesn't allow us to provide that value.

We would love to service you, but we get it. If you don't, that's totally fine. It's almost like you're saying, and this might sound bad, but we don't need you patient, we care about you, but we don't need you. And there are plenty of people who want to use us and we're not worried about finances. We're not worried about that thing. And that sort of has this effect in their mind of then wanting to stay even more. Because you're showing through your actions that you really believe in the value that you provide. It's not just the sales pitch, it's you. You as a business provide a value that you deeply, deeply believe in. And you're willing to say farewell to a patient because of that.

It goes back to that selling concept. I mean, we've had patients come from other offices saying they're trying to sell me xyz. The funny thing is, is we end up diagnosing the same thing. It's just that we honestly spend the time and explain to the patient this is what's going on. We show them things. We. We include them in the conversation. Conversation. And by the end, they are booking the treatment that at the other office, they were like, oh, they're just trying to sell me. They're now booking that same treatment because there's explanation, there's investment, there's giving them the yes and no question of, hey, can I let you know what's going on? And it goes back to the same insurance conversation providing value of, you're in the driver's seat, and this is what we can provide, and this is what is needed.

I think, I think our profession, dentistry, has sold itself short. I think we hold ourselves small as Dennis, in what the value of our services are really worth. And I'm by no means saying that it's about charging exorbitant fees, but.

The service that we are creating and knowing that, knowing the value of the service you're giving is huge in your ability to.

Relate to people and to hold true that.

I'm doing a fantastic thing. And those that see the value in that will be here, and those that choose not to those that choose otherwise, because that's what they're choosing. They're choosing otherwise. That's okay. We wish you the best of luck. And what's happening right now, in my opinion, is that young dentists are coming out of school with a serious deficiency in what they're truly worth and what their time is worth and what the skills that they just spent freaking 20 years honing and learning, and they're part of the 0.1% in the world that has this knowledge and this skill and this tactical ability. We come out thinking that we've got to go to the lowest common denominator and we've got to work for companies that, that. That pay us Something that we all gripe and complain about but nobody does anything about. So what if, and I know this is a, this is, this is a conversation that's happening all over, but what if we could all realize our true value and potential as dentists, as providers? It doesn't mean that the cost to the patient. I'm all about bringing access to care down, providing more access to care and doing it at an affordable rate. But I would love to choose what affordable rate I'm able to give when I'm treating patients. I love the ability to go, you know what, I can do that for 35% off. I'd love to do that for you. And we'll do free sedation for you because that's, and they, their response is, oh my gosh, thank you, I can make that work, let's do it right. And that's way more heartwarming and value to me than feeling like, dang it dude, this delta dental just took 60% of what I could have made off of this. That creates resentment, it creates disconnection from the patient because now we start looking at the patients as we're resenting them because of their insurance. That's the antithesis of true relationship and relation based business. And so there's got to be a shift in getting out of, of the mentality that we are working under a PPO and I, I'm excited to be a part of that shift.

The, the great thing that you guys have going for you as dentists on this concept of selling of value get. Getting people to say yes is something they need, is that this is something they really do need. I mean, what do you need more than your, your health and your, we all know there is this oral, systemic sort of connection there. This is, this is a need. And sometimes patients don't recognize that till I always call it the moment of crisis. And at that point it's often too late to save a tooth or now they're going to pay a lot more money because they decided to wait. There are great salesmen out there selling things that people don't need every day, all day. And people are saying yes to that every day, all day. You guys have the comfort to know that when you're selling something that a patient needs, this is like the most important thing that they could possibly need is the health of their body, the health of their mind, the health of their teeth, their smile, their self perception of themselves. And so don't ever feel bad for selling. You shouldn't be upselling, but finding out what they need and then giving them solutions. You should. Dentists, they're always just a little too concerned about pushing a patient. If there's ever an area. And pushing isn't the right word, but of learning how to get patients to say yes, that's the process.

We're focused on us.

When you get concerned, when you feel like you're pushing somebody, you're focused on what you think is best for them. Forget all that. Get to what is what they want for themselves and give them. Like Nicole alluded to earlier, every single conversation that I have with a new patient starts with, we're going to go through your entire mouth. It's going to be a lot of dental talk. I'm going to make sure it's. I'm explaining everything. Is it okay with you if I find anything that's out of the ordinary or needs attention? Is it okay, okay. That I bring it up with you? What does every single patient say?

Yes, of course.

That's why I'm here. Why? And everybody laughs. It is the. It's like clockwork, dude. And I say that my new patient exam. I say the exact. I say the same jokes, I say the same thing, and my assistant reacts the same way because it works. And when you ask that question, is it okay if I show you? Guess what that patient did. Guess what that person did. They just gave you permission to let it rip. They gave you permission to tell them what is everything that would benefit them. A new smile. Veneers. All of a sudden, veneers become a tool and a solution to help build their confidence that they have never had. It's not. Hey, Whoa. You need 10 veneers. That's gonna. No, dude, that is. It's a tool that is helping move them towards what they've already stated they want, and they've given you permission to tell them what is possible. That changes, Wes, the entire scenario, it changes the entire practice. It changes the entire outlook and how you relate to every person, whether it's on the phone, in person, after the fact, money issues, time issues.

My tooth hurts after you worked on it issues. It changes everything because it's a. It's a relationship now. And you've already asked for permission to do this to them. You haven't told them that they need anything. It's a huge difference.

And, babe, I think it really goes to what you said in the very.

I think it goes back to what you said. Coming up with a clear vision and knowing that you're not diagnosing because you want to sell. I Had a doctor say to me, I feel like a fox coming into a hen house and I'm the fox. And I was like, wow, like, what does that even mean? Like, and I feel like a lot of dentists feel like that, that they're this greedy dentist that is diagnosing so they can make money, which sometimes you do have patients that will make comments such as, ha ha, I'm paying for my dentist kid's school or something to that effect. But just knowing like I stand for health, I stand for, you know, like overall comprehensive care and knowing that about yourself as a dentist, as a young dentist, knowing why you're doing what you're doing and believing in what you're doing is really helping somebody long term overall health. If you have that, that shows through, it's not going to be a selling game at all. It is really, you are concerned about somebody and you'll never be that fox in the hen house. You will be a true like compassionate person that is, is just helping somebody see the best health and what they ultimately want.

One thing I want to mention about dropping the PPO is if you can have that relationship based business, if you go about that process the right way. You mentioned scripting, I think is really important. Sending out a letter before the insurance companies send out a letter. I really believe it's valuable to then call after they get that letter. Call your patients that are in network, explain to them why and you go through that process the right way. But if you can do that, you and you were talking about the finances, you could do 50% and probably still be better off. Well, your overhead is exactly the same. When you're getting paid 1300, 1400 dollars for a crown is when you're getting paid 550 dollars for a crown, you're still paying your staff the same thing. You're paying your labs and supplies the same thing. Your indirect cost of space and all the incidental supplies, everything is still the same. And you have.

More profit because what's your profit on a $600 crown? It might be 100 bucks. What's your profit on a $1,300 crown? It's going to be five times that. So you've got to do like five crowns under the PPO and network fee structure in order to meet one crown out of network. And I wish all dentists would really understand just how much they're giving away by letting other people dictate what they're worth.

And I want to touch because everybody listening to this is going to go, yeah, but If I had a, if I had a full schedule, especially young doctors when I started out, you're, you're in a panic to fill your schedule, right? You, you think that you need to fill your schedule.

I would walk around and knock on houses around our office and invite them in. Like, my goal was to shake for five people's, five new people hands, new people's hand a day and personally invite them in. I had this mentality like, I can't wait till my schedule is full. Now, five years later, I'm booked out a month and a half. I don't even have an hour slot to fit somebody in. And it's, and it's not a good situation. So the, the, it's not a good situation because you don't have the freedom and availability to be spontaneous. That patient walks in with a broken tooth and they need a root canal crown buildup. Hey, guess what? I've got two hours tomorrow. Let's do it. Come back tomorrow. Let's get you on some antibiotics. You're filling your, the spontaneity is creating motion with your team. And if you are on a PPO schedule and you are jam packed and you go, oh, dang, if I drop this ppo, my schedule is going to be half open. Guess what? That's a good thing because it allows freedom and flexibility for when that opportunity arises, the team goes, what's the soonest you can get down here? Come down right now. We can see you today. Right? And there's so much value in that of being available and having that opportunity the next day for a patient that's going to show up, we'll start a lot of days with huddle and we'll notify. Okay, Our, our next availability. We got a crisis in hygiene for tomorrow. We've got a three hour SRP block that hasn't been filled tomorrow. Everybody heads up. We got to fill that. Lo and behold, an hour or two into the day, you've already diagnosed a new patient that's coming in and filling that SRP because you noticed it and you had it available. So I want to inspire people to think not just about the money, but about the availability of your time and your resources to have conversations about more comprehensive dentistry and availability to treat people in the moment. It will pay off in tenfolds.

I know you have to go pretty soon, Nicole, but I need you to stay just for two more minutes and tell us. A lot of my clients have spouses that are involved in the practice at some level, administratively. You're unique in that you've done both hygiene and now you've moved in more to an administrative role and some. Sometimes I, In a couple cases, I work only with the spouse. And in fact, over the years, perhaps you and I have worked together more than I've even worked with Landon in some ways. And sometimes that can be hard on a spouse, and sometimes it's hard on a spouse when they are married to a dreamer and you're the one sort of balancing the books at home and you have the kids and you want to spend money, some here and then all the time demands and all that. What is your advice for the spouse of a dentist who is as elected at some level to be involved in that practice?

My advice would be. And it's advice that I try to give myself every day. We have been so successful because Landon is a dreamer. And if I wasn't at least open to that, we wouldn't be where we are. And with that put in place, like we have agreements of. It's not, I think, creating agreements with each other. So it's not let's go buy everything because a dreamer, it's, hey, what are we both comfortable with? And when we hit xyz, then you can go get a prime scan. And I think I would say acknowledging each other's strength and knowing that one person might be better at the dreaming vision and the other one might be better at the. The finances or the, I guess, details of something and I guess balancing each other out, not squashing one another or like Landon said, I. The ball and chain sometimes and being okay with being the ball and chain and owning that. That you're okay with being that. That role in the. In the practice, in the relationship without squelching somebody else's dreams and with believing that. That your partner, your producer is going to continue to produce and get you to the point where you want to be.

And the ability to fight and the bill.

Yeah. To fight fair.

Fight fair. Because we, we fight.

We do.

We'll be honest. We. We. We have fights over this in the office sometimes.

The team knows.

We both know, like, everybody fights. You're gonna have fights. If you're not fighting, you're. You're holding something back, you know. But our. What we've learned is our ability to fight fair. Like I used to say things early on in our relationship that I knew would be targeted, like arrows in the back. And I knew it would just get her. Get a reaction out of her, like the ball and chain. That's horrible. I'll never say that again. That's, it's, it's funny. We laugh about it now, but it was like, my whole intent was, that was like, you're just a Debbie Downer. Like, and that's not true at all. And so it's like learning how to fight fair and get through it, and we fight, and then we're able to take our time and mull it over individually and then come together.

And know that we're the best teammates.

And my other advice is this is I have friends that are dentist wives. And my biggest thing is if you are willing to work, if you're open to working and raising kids, like, there's no better person to work in the practice other than your spouse. Nobody else is going to care about it as much as the two of you. And don't just be the wife that brings coffee and no, hi, guys. Be committed. Be committed to the process. Show interest in the practice. Even if you don't know dentistry. And I would say if you can make it work to where you can be involved in the practice as an administrator, you don't need to even know much about dentistry. I would highly recommend it because, again, nobody's going to care about the practice as much as the two of you. And if you both can be in there creating value, creating value to the. The team, you guys are going to be a lot more successful than when it's apart. When you're at home with the kids and you're exhausted and he gets to go produce and be around adults. Like, just be a team together and know that you guys are both, whether it's you staying at home, doing all the books and he's there practicing, realize that you guys are both producing a lot to the overall operation.

Let me thank you guys both for being on the show. I want to end off with a little plug for a book that Landon recommended back in your early days by Phil Knight called Shoe Dog. Remember that book? And you recommended. I'm like, who's Phil Knight? Always. He's the founder of Nike. And I read the whole book, and I loved it, even took notes on that thing. And it so much reflected somebody's journey of defining what a vision that they wanted to unfold that really impacted a whole sort of industry around. It started off with running, but obviously it's gone bigger than just running shoes. And that journey of him from success and near failure and trying this and struggling over here and how it affected his personal life and all this stuff was just such an inspiring story. And it's your own story, is sort of a path similar. It's a journey where you're just learning and you're taking risks and you're going for it. And it feels successful at some times, and other times it might feel really hard. And you know, my own story of starting practice CFO and trying to build something there, that book was a great motivator for me. It was a great story. So I appreciate you recommending that. And I recommend that to any associate who's listening to this podcast that they're looking for something that's just really an interesting, exciting and motivating story. You thank you both for being on the Associates on Fire podcast. We are going to do a second segment a year or two down the road because I only got through about a third of the agenda that I wanted to, and there's so much more that associates can learn. So thanks for being on the program.

Thank you, man.