Growing a True Multi-Specialty Practice with Dr. Nick Marongiu

Hey everybody. My first podcast show I did was called Associates on Fire, part of my AssociatesOnFire.com program to educate associate dentists on all things financial as they step into ownership. And some of the great episodes I really enjoyed doing were on dentists journey into and out of dental practice ownership. And I've got a handful of these from a few years back that I just think are so valuable and relevant and, and because they were so early on, they didn't get a whole lot of attention. And I want to project them out there because I think they deserve some attention. The stories are so great and we tend to learn a lot by hearing about our peers and their experiences and the challenges they faced and the opportunities they faced and all of that. I just think it will be super valuable. So I'm going to rebroadcast these. Hope you enjoy.

Welcome everybody. Excited to have a new episode of the Association Associates on Fire podcast. And as you know, we continue to roll these out typically about once a week. Sometimes they come in a little bit more frequently, sometimes a little bit less frequently. Always trying to juggle these in with practice CFO and.

Our company services as a outsourced CFO for dental practices, doing accounting, tax, financial planning, business and business consulting, and wrapping it all together in an overall master plan to help our doctors accelerate their financial independence. Today we have a longtime friend and one of the earliest clients of practice CFO. This is Dr. Nick Meranju. Dr. Maranju, welcome to the program.

Hey, thank you, Wes. Pleasure to be here.

Let me give a little bit of context about you if that's okay, Nick. I'm just gonna call you Nick throughout since you and I are good buddies and we've done vacations together. We've, we've just done a lot together because I moved down here 2013 to San Diego from Oregon and I think I met you in that same year, maybe 2014. But it was pretty much at the inception of my, my own journey of forming a company practice CFO and getting that off the ground from scratch. And I have always had a heart full of gratitude for Nick because we were talking about this before the podcast started. Nick has been with me as I've created my systems over the years. And Nick is very much a system oriented individual, I think in all aspects of his life, but especially in, in his business, more so than virtually every doctor that I work. I would say, Nick, you are the most process systems oriented dental practice owner perhaps I've ever worked with. Which is one of the reasons why I wanted to have you on the program. But Nick has rode through the ups and downs with me over the years at practice CFO as we've built out our systems and tried to always improve the quality of that service. And I just want to personally thank you, Nick, for just for always being there with us and giving feedback and being so productive in the relationship together.

It's been a great journey. We started when it was just when it's a one man band. It was you in a single 10 by 10 office and you blossomed into the windows serving folks.

Yep, it was a. It was a little dungeon. It was decent, decent little place, nice part of town, but it was small for sure.

You mentioned the ups and downs and got a good friend who's been hurt a number of times and competitively played sports and whatnot. And he has this saying about if you're not breaking something, then you're not, you're not learning fast if you're pushing the limits hard enough. But that's part of doing systems integrations and growing a company. If you don't challenge yourself and you not willing to run into those hurdles, the ups and downs, then you're really not pushing the company to grow and to serve the clients. So I appreciate what you've done. Yeah, it's been ups and downs, but it is all for the greater good.

I appreciate that. And you know a lot of that, that commentary right there about systems and processes. I'm going to want to jump pretty deep into that for you and your practice. Let me give you a little bit. Let's give the listeners a little profile of your practice. It is called Scripps center for Dental Care and it's in La Jolla, California. And La Jolla has more of a kind of a coastal section and then they have a little bit more inland, kind of a big business area called the utc. And there's a big hospital facility where. What is that? An hmo. What? I call it an hmo. Scripps Medical Center. It's big, big name here. I don't know if it extends beyond California, but it's a huge name, a very high quality name here in San Diego. And you happen to be located essentially as a part or within the geography of that facility, right, Nick?

Yeah. Directly on their main campus at Scripps Memorial Hospital campus in Zimit, the Excellence in Medicine Mid rise building. Right. On the main hospital campus. So a thousand doctors in the building, only three dentists.

Now.

You are not technically a part of Scripps, however, a long time ago, because this is a multi generational practice, correct? Some partner a long time ago, I'm sure you could tell me exactly who it was was able to lock in that name scripts which you no way you'd get that today, but you were able to lock that in through a legal agreement. Now you have Scripps center for Dental.

Care.

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Scripps Oral Health Scripps Dental care used to be within the hospital and offering comprehensive health care within the institution of Scripps Health and scripps. Org Many, many years ago, two generations ago, and Dr. Ray Stewart was one of the partners at that time. And when Scripps as an institution decided to not continue with the oral Health Program, Dr. Stewart agreed to continue the patients in care under the label of Scripps center for Dental Care to maintain continuity of care and to move those patients from the institution of Scripps Health into Scripps center for Dental Care.

And I think that the name, that brand, which is a quality brand around here, has definitely served you well. But I will also say that is not the reason why you have such a successful practice. There's a lot more to that. It's the leadership of your predecessors. It's now your leadership as you run this practice. Just a little bit of a profile. This practice is probably about, I would say four to five times larger in terms of collections than your standard Dental practice. Nick is the full owner of his, of his practice. He bought it out a little bit later on we're going to get into Nick's journey into the world of a DPO dental partnership organization where he has helped co found with a couple other dentists and a few other people. An organization that bands together private practices to give them various benefits of a broader team and benefits of scale. So we'll dive into that. If you're interested in that concept of a DPO or even if you're not interested, but you want to have a better understanding of what's happening in the industry, stay tuned for that. That might even be a separate episode. We'll see what time permits here. But that's going to be part three of a three part journey here which I'm going to outline in a second. But going back to your practice, it is a multi specialty practice. You have various specialists come in a couple days a month. You have a thriving hygiene program. Your, your hygiene is compensated very differently. My understanding is it's 100% production based compensation which is unusual. So in every.

Well, it's a hybrid model.

It's a high. I've never seen a model run in your compensation in any other practice the way you do. But your hygienists are also paid very, very well because it's a very productive practice. Also you do a lot of cosmetic work in your dental practice. A lot of that because of your predecessor was highly regarded in the area of cosmetic dentistry as well. I think you market that very well. And so that typically makes for a higher revenue, higher profit practice when you have a strong cosmetic element to it, which you do. How many staff do you have there at your. How many team members do you have there at your practice?

Nick kind of fluctuates and depends on how they qualify, but about 28.

And how many specialists do you have come in?

Six specialists and they're in one to two days a week.

And do you want to just list off those specialties?

Yeah, it's prosthodontics, orthodontics, periodontics, oral surgery and endodontics.

Great.

One of my missing perio.

Great. And then the.

Former owner who was your partner for a number of years before you bought them out fully and we'll get into that detail. Does a lot of cosmetic work as well. And he's there full time still, even after selling his interest to you? He's largely full time still. Correct.

As full time as he wants. We would welcome him whenever I get him about two and A half days a week.

Got it. The amount of production he does in, because he's also a client of mine and I know him very personally and really enjoy him, is pretty incredible off of those two and a half days a week. But again, he's very highly regarded, I think, in that space. Anything else about the profile of your practice that you like the listener to know, to get to know who you are and what you're doing right now in your dental career?

Yeah, the practice profiles you kind of listed, it's a big multi specialty practice. So it's a game of juggling on a daily basis and a lot of really clear systems and clear expectations to be able to have a team that large work together with at this point, we have 10 total providers, we have four GPs and six specialists. And being able to have everyone work together cohesively, it does take the right person and the right team mentality to make that work.

The interesting thing when I compare your practice with say a standard.

Practice is.

Your production level. You personally as a producer is.

I would say, even lower than a lot of my other practices that are say doing 1.5 to $2 million, which is a good standalone practice. That is a very good standalone practice. You're quite a bit bigger than that. And your production level, you personally is less or lower than that doctor's production level in more of a standard setting like that. But that is by design. Is that not Nick? And why did you evolve that way? Why did you choose that type of ownership?

Yeah, and I think some of that stems from the training. When trained at Loma Linda, finished in 2010, enrolled into a hospital residency for the year after, really figuring things out. Had always been within a team of individuals and a team of specialists. So all the care I had always delivered had always been team approach and team driven. So making that decision, looking at the industry and the market, all right, go to a solo doc and be by myself. Four chairs, two hygiene, two doctor chairs. I had no experience in that and I really didn't have a driver and ambition to go down that model. I was also worried about getting bored. One that doesn't sit still very well and always trying to push the envelope. And I get criticized by my wife. She says, you're always driving. Why have goals if every time you achieve the goal, you just make another one? You're always driving for something that you never. Her perception is you're never happy with where you are. And my happiness comes from the drive toward the goal and always raising that bar. So knowing that about Myself and what brings me professional satisfaction kind of steered me toward this multi specialty approach and being part of a larger team, being able to treat patients fully, comprehensively, but not having limits on how I was practicing and what types of cases we were getting involved in. What drew me toward that multi specialty.

Concept of a practice? To answer your question directly about where my production is now relative to the team, as the years have gone on, the production that I personally do is a little bit different than what the office production is doing.

And if you want to talk from the CFO and the financial side of it.

My production at this point.

At this point winds up being over 100% of what my production is because the team is producing and covering the overhead of the practice. And that was another one of the goals early on was, well, how do you create a system looking at the practice of dentistry? The overhead is so high, liability is so high. You know, you work so hard producing chair side and it feels like you get so little pay at the end the day relative what you're physically and individually producing that work with your hands chairside. So it was. I had a goal a few years ago, seven years ago now. Well, how do I build the team around me and build a structure that allows me to be able to realize all the work that I personally do chairside and building up the team around me and building up the specialists and the other docs around me has allowed.

That, which is a different. It's almost a. It's almost like a different career path than fixing teeth. And obviously you still do dentistry and you run a dental practice. That's not a different career path, but there is within it, it is a, it is a, it's like a different stem. I'll say, within dentistry, what you've chosen to do. The thing is, I think in concept there are a lot of dentists who aspire to that.

In practice, it is very, very hard to do. And I think it's hard to do to no one's fault of their own. Partially there's a lack of training, of course, to dentists in dental school on the business side of dentistry. Hence, part of the reason why practice CFO exists is because of that. It's part of the reason why I created the Associates on Fire program is to try to give some of that education. But even then it's limited to sort of strategic financial decisions. And there's so much more to what you're doing in that concept than even just what we provide. Because you're very much in the operations, you're very much in the billing, you're into the client or patient experience, you're into training, you're into overseeing other professionals and hr. There's so in marketing, there's so many dynamics to it that fall under leadership and business ownership. And I would.

One might think, okay, great, so Nick is only working one or two days a week doing production, and then he's out surfing the rest of the time. You and I know that that is not the case. And I don't think you're working any less and have worked any less than your standard track in dentistry. In fact, I think you've probably worked a lot more. You've just had to spend a lot of time working outside of the operatory and in your business office or at your home office, structuring. What are the processes, the workflows, the philosophy, the leadership, and all the tasks that you have to do in order to build out that structure of a business. And so I'm excited to talk a little bit about, actually quite a bit about that as we go down your path here.

I break it down of working in the practice and working on the practice. So it's 28 hours a week working in the practice in clinical patient care, and it's 30 scheduled hours a week working on the practice. So it's just shy of 60 hours a week. And it's been about that since the transition.

It's funny because I've always classified myself as somebody who works on the business and is systems focused, but not even I have.

Counted how many hours I've allocated to working directly with our clients and how much is on the business. But I can't say that increasingly I work on the business only. I really only work with about six to seven clients these days, and my client is the business, which has about 32 people here at practice CFO. And as you grow your company in collections and people, and inevitably it grows in complexities. And if you don't have a way to corral or guardrail those complexities and organize them so the energy is all flowing in the right direction, in many cases, you're going to end up working more and making less. And that is the more common outcome. In my experience working with dental for almost 15 years, that's the more common outcome that I see. Which is why when you came to me and you said, hey, I'm thinking about forming kind of an alliance with some other dentists, and at that point, I don't even think you or even I knew what the concept of a dental partnership Organization was, but in concept, you sort of saw it going to the next level in merging systems and processes and branding and all of that into a broader organization. That's why with you, I said, okay, I've seen this fail a lot with doctors, but with you, Nick, I could see this being successful. And you're in the middle of that right. Right now, which we'll get to that as well. So I'm going to divide up your journey in three phases. The first phase is your associate phase out of dental school at Aloma Linda. The second phase is going to be your phase as a partner and as a practice, as a private practice owner. And that'll be when you bought in your first.

What I'm sure you'll mention is your first 25% of equity into the partnership, and then eventually you bought out the remainder 75% a few years back. So that'll be phase two is after ownership and then, I mean, after associateship. Phase three will be merging your practice now, operationally speaking, with other. A few other private practices in this space of the dpo. That's how I want to break this out and we'll see how far we can get to today and if need to break this up into another podcast. I think there's so much rich content here that I would love to just take our time in each of these spaces, if that's okay, Nick.

Let's do it.

Okay, so you graduated. Let's actually go back a little bit before then. Why did you choose dental and when did you choose dental?

So leaving high school, going into college, knew I wanted to go into health sciences. I wanted to work with people, and I wanted to always have this desire to fix and to make things better.

Always thought I would go into medicine. Spent some time shadowing medicine, and I was far too impatient to appreciate medicine. So the immediate gratification of being able to diagnose and fix a problem and see the results directly of your work is something that really gave me a lot of desire and drive and that was lacking in medicine. Out of some conversations with some MDs, they saw that in me as well and said, hey, check out dental. Same thing. We're, you know, you're in healthcare, you're helping people, but you get that more immediate gratification of diagnosing a problem, fixing a problem, as opposed to in medicine, where more of it was based on a lot of monitoring symptoms, prescribe something or do something, and then wait and see if it makes a difference and then make a modification, wait and see if it Makes a difference.

And the immediate result really had a appeal and resonated. So I checked out dentistry and fell in love with it immediately. Being able to use my hands to produce the results and help somebody in the process. Real time was the motivation to go into oral health and dental. So made that shift in undergrad, went to UCSD for undergrad studies, left ucsd, did some research in neuroscience for a short stint. So got the exposure of working in a lab and being isolated for 12 hours a day with rats. Realized that was not it for me either, you know, in that process, continued research upon going into Loma Linda and hit the clinic floor running and never looked back.

And interestingly, I think dental, especially when you came in what year did you enter graduate and actually enter the dental field professionally?

Professionally in 2010. So post the 08 dip.

So 2010 and even today, but especially back then, dental different than medical in that medical has very much consolidated a lot as an industry. Large institutions, large business, big equity has went in there a long time ago. And so you have these big systems, these big companies and I just wonder how you would have found your freedom to create and construct in I think a more a pre defined and established.

Space like. Like healthcare. I'm sure there are some spaces where you can do what you do, but in dental it's still very sort of fragmented and there's a lot of Legos that aren't put together. I think that's been a source of satisfaction for you in dental and still wanting to put those Legos together and create something that you believe in passionately serves the patients.

The right way. Which is why we'll talk about the DPO concept again. So you graduated 2010 and you come out as an associate. Did you go straight to Scripps center for Dental Care or did you have some other stops along the way?

Yeah, I went to Los Angeles, went into a gpr, West LA VA and ucla. So did a year in a PGY one. I was already licensed and took my vacation and leave time away from GPR moonlighting and working down in San Diego. But yeah, spent the year doing a residency.

And how did you learn about Scripps?

It's a great one. So when I was at Loma Linda, started an aesthetic or cosmetic study club. Got involved with the American Academy of Cosmetic Dentistry, the aecd. Established the student study club at the university and had series of guest speakers monthly for several years. Got involved in doing a lot of reconstruction cases while a dental student, Dutla Melinda, did several full mouth reconstructions. Did smile designs.

Most institutions, most academic institutions don't have that really built into the core curriculum. So. So I spent quite a bit of time with educators in the AACD to be able to learn the techniques and to learn smile design principles and learn the cosmetic attributes, to be able to produce the results I was expecting myself to produce for these patients.

Through that, ended up meeting one of the mentors I worked with throughout Loma Linda. I met Dr. Weston and ended up partnering with them, you know, down the road here in La Jolla, years later. So it was through some of the study clubs and dental school.

Correct me if I'm wrong, but I seem to remember somebody telling me you were like this. What would you call it? A studie body president there at Loma Linda.

Yeah, and I'm just going to touch on that with the. The DPO concept. So, yeah, very heavily involved all the way through graduate school. So was always involved in the class leadership and then the university leadership, was the school president and then was the school delegate. So spent a lot of time representing the institution professionally and academically, all the big national meetings and the state meetings as well, and was the liaison between the institution and the organizations representing healthcare and spent all four years lobbied for policy in state policy and lobbied for national policy as well back in D.C. spent a lot of time on the road, actually, during dental school. So.

Didn'T create much of a conflict other than the fact that it wasn't allowed to participate at Saturday events, because I was there representing Loma Linda, which is a Seventh Day Adventist institution, and recognizing the Sabbath, but was still allowed to participate and represent the institution. So, yeah, quite a bit of student leadership throughout the years, several different levels.

So there were a lot of relationships there that have proven to be key to your network and your career today, because some of your partners today in the DPO you're involved with also went to Loma Linda. Did you know them back then? And is that where the relationship sort of found its inception?

Yeah, that's exactly right. We were. So the other two partners that we have now, Dr. Weston Spencer and Dr. Landon Libby. Landon Libby was a year behind us at Loma Linda, was also very strong in leadership at the university. And then one of my classmates, Dr. Weston Spencer as well, very involved in leadership, was more involved with direct class leadership. But those were those bonds they began very early and we worked a lot together going through training.

So you met Dr. Weston back then and you met these people who you're working with now so closely in building this dpo. So Relationships matter, one could say for sure, relationships matter who you connect with and maintaining those connections and just knowing that. And this is the same for me. It's not a who, you know, thing. That's a different. That's a different subject. But it's nurturing networks and relationships where you contribute to that in a way that benefits people. And then you, of course, receive the benefit of being a part of that network with people. And I find in dental those relationships are just so valuable. And we should also mention. I'd be remiss to not mention that your wife, Jen Santoro, now Jen Moranju, is a dentist as well. Did you meet her at Loma Linda? Is that another relationship also started at Loma Linda?

Well, the formal relationship started at Loma Linda, but no, we went to undergrad together.

So you got some history there with Jen?

We do, but she went to the other. The other dental school, as we like to call it. She went to University Pacific.

Got it.

So we did a lot of flying back and forth as well. Or if I was out at a meeting or speaking, then she would come and meet me at those meetings. And that's how we spent time together during dental school. So it was a lot of bouncing around.

And I sort of actually met you through Jen, because we were. When you came to us, I think we were looking at Jen, who was buying a practice at the time, and we were going to represent her. And you were with her at the time. So a lot of credit to Jen for what she's done with her own practice. And just one of the sweetest souls that walks the planet, your wife. And so very much dental runs in this family. Okay, so now you graduate 2010, you come out, you do, I think you said that, GPR up in LA. And then you get connected with Dr. Weston again, and you come down to Scripps and you come on board as an Associate, what, 2011?

That's correct.

And let me ask you this question. I think a lot of associate listeners are interested in this subject, is when did you.

Broach the subject of future partnership with Dr. Weston? Was he the sole owner at the time?

No. Historically, the last 50 years, there's always been multiple partners. So when I came on board as an associate, Dr. Ray Stewart was a partner as well as Dr. John Weston. So the two of them were partners at that time.

And when did you raise that subject of partnership? Because that's always a delicate subject. The current owner is sort of like, okay, settle down, associate. I know you're motivated, but let's Just get your feet wet. You're only a year out of dental school, whatever, so we'll touch base with that later. And then in your mind you're thinking, yeah, but I want to put my blood, sweat and tears into this. I want to help you, I want to grow it, I want to make it my own. How do I know I'm going to do that without being, you know, escorted out the door in a couple years after I made some contributions to the practice? How did you handle that conversation, that narrative?

It's a gamble just like everything else. You go in your gut feeling and you're going to read the setting. You have to spend time in the practice to make sure it's right.

In my personal situation, I was very focused on what I'd wanted and that was a multi specialty practice. I wanted a large practice. I wanted the challenge. I wanted something far bigger than myself. I didn't want to build anything around myself or brand myself. I wanted to build a system.

So.

And I didn't want to do de novo. There was the, the funding was challenging at the time. De novos in San Diego didn't really. You had to be privately funded. You couldn't get a bank to give you enough money to get something off the ground. And it's just because the density was so high. Here in La Jolla, I knew where I wanted to live. I knew I hated driving, didn't want to commute, so I needed to have practice near where I wanted to live. And for the type of dentistry that I knew I wanted to do, I was also restricted socioeconomically or demographically about where I could have that style of practice. So that was the drive. We, Jen and I had kind of isolated a few beach cities. Santa Barbara, Newport and La Jolla were the areas that we looked into. And hands down, our favorite area, we both went to ucsd. And UCSD is situated right here in La Jolla.

It made the most sense and we found opportunity here. That brought us right back. So I came in pretty strong knowing that I wanted something. It was the only multi specialty practice that was truly multi specialty. Come to find out, a lot of people say, oh, multi specialty. Finally get some details. Oh, I have a surgeon one day a month. It's like, well, it's not really multi specialty practice, right? So it's a large practice and it has some room to grow and it had the bones and it had a really good foundation already set. So it was going to be a better starting platform for where I wanted to take the practice or Where I saw myself going.

How many operatories do you have?

11 operatories.

How did you feel when you came in as an associate? I'm not sure what your experience up in LA was like and the size of that operation, but how did you feel stepping into such a large. I mean, you've grown it, but even then it was a pretty sizable practice. Was it. Was that a daunting experience for you? And if so, how did you. How did you tackle that?

If it's a daunting experience, her daunting start may not be the right start.

No, I was. I was supercharged. There was. I mean, looking back, I was probably didn't know what I didn't know at the time, but now I came in with all kinds of energy and excitement and felt I could conquer anything and just wanted to charge the whole time.

That's what you didn't know. I thought about that a lot. I know for me, I didn't know what I didn't know when I started practice cfo. And there's. There's a lot I know I don't know that I'll say, 10 years from now, wow, what if. How would my career have been different or my life different if I knew those things? And I've decided that that's an asset. That's a good thing sometimes to not know. To not know you may not do it exactly. If you knew just how much time or sacrifice or risk or monetary commitments it was going to actually take out.

Of you in this situation. I was just lucky that my energy didn't push me back out the door. So Dr. Weston was patient enough with me to keep me settled and calm enough and not disrupt the balance and just say, all right, it's too much leave. So I was fortunate that that didn't happen. The one thing I did push on pretty heavily because I was. I knew what I wanted and I wanted to be here. You made a comment earlier about, you know, working your butt off and then you're out the door a few years later, and then you don't really get to see the sweat equity ad at that point, if that's the case. So I did push. And within a couple of months of joining the practice as an associate, I did have the practice full appraisal run on the practice to set a basis because I wanted to be able to measure over time because I knew what I was going to do. Dr. Weston didn't know me that well. We'd known each other for several years, but had never worked together professionally. I knew what I was going to do with it.

So.

And it's, it's absolutely understanding. He didn't know what I was going to be able to do with it and didn't know whether I was going to burn out or walk out. So there's definitely this. It's an interesting relationship that's got to be balanced between an associate and then a, an owner who's looking for a partner or looking for a buyout. And there's not a. There's no perfect solution or perfect answer for it. It's just a matter of clear communication. And.

When I brought it up, that was the way that kind of settled. All right, I don't need to have a clear path, I don't need to be told when, but I do need to know what the value of the practice is today, because I know what I'm going to commit to it and I want to make sure that I can measure my value add. And that was really important to me and I made that clear. I think Dr. Weston appreciated that and understood it. So we moved forward with the full evaluation. But I wasn't pressing for. All right, in this many months, this is what's going to happen. Like, we definitely didn't have that kind of a, of a communication about it. It was more about just assessing the present value before working so that I could measure the sweat equity.

I think that's a very intelligent decision because equity can be subject to interpretation.

Oh, yeah.

And especially when you're the one who've been in the practice for a while and you know what you've contributed to it. But it's hard sometimes for business owners to know what the market would compensate as equity and what the market would not compensate as equity. And when everybody feels they put their heart and soul into it, and yet the outcome is not always going to be the same from an equity valuation standpoint. It just gets very, very subjective and very, very sticky. And so at the onset, it's worth it to pay a few thousand bucks to, to go get a valuation, even if it's just something that is a basic baseline number. And then later on, when you go to buy in, you follow the same calculation methodology, just with the updated collection number, expense number, et cetera. That way you have the apples to apples comparison to say, here's how much, based on the methodology we used, that the valuation increased by, and I will usually advocate to, to have some agreement in place, preferably written, where, if it goes up, let's say by 4 or $500,000 in the valuation over say a three year period, then maybe you split that equally because it's not all. The associate who created that, the platform was there for you to step into that, the seller furnished for you, but the seller also wouldn't necessarily have been able to increase that value without you. So it is a shared contribution, typically, I find in any increase in value from the point, point of entry of the associate to the point of buy in of that associate. Incidentally, I have a separate website I've mentioned from time to time called practiceorbit.com and on there it has a sort of zestimate for the valuation of a dental practice. If you know Zillow has the value of your house, they sort of invented that whole concept of these consolidators online like Redfin and Zillow. Well, I created one that does it for a dental office. Except since there's obviously not an MLS, you just put in the about six or seven fields from the tax return and literally in about 30 seconds it will tell you a fairly good accuracy what the price of that practice might be. And so that can be at least a baseline if you just want to do a back of the envelope valuation. Otherwise go get a professional valuation, pay a couple thousand dollars and you have that documented for a later conversation.

And hands down, was a priceless investment. It's not significant, although when you're coming out of school or residency, every dollar seems significant when you're in debt, a half million dollars. So. But it's, I think our valuation at the time, it's been years, of course it's been over 10 years, but it was 2,800 bucks. So to do a full valuation, who paid for that? Oh, great question. Split.

Okay. I find that typically if you have a reasonable seller that they'll say, yeah, that makes sense, I'll pay for half. And honestly, if they said no, I'd still go just pay for it.

Absolutely right. The value at the time, I don't even know because we weren't working with you. You were not here, not in practice. Cfo, you didn't exist at that time. But the practice at that time was, was the production or the collection row is 2.4 and it was valued at 2.18.

So evaluation on that number. Yeah, it has, it's come up a lot since then.

Yeah.

And that was factored in when you bought out the remainder of the practice or. Or when you bought in the 25%. Of course.

Yeah.

How long from the time that you.

Entered the practice to when you bought in your Initial ownership.

So keep in mind mentioned that I was supercharged coming in. So now I'm, now I'm split. But at the time, so when I came in those early years I was doing far less work on the business, a lot more work in it. My clinical hours were 45 to 48 clinical hours a week. And I came in and just started cranking. I was working night clinics until 9:10pm, start with patients every day at 7:30. I did Saturday cases by appointment and prepay.

I cranked right out the door. And I think that helped show a lot of that commitment and what I was going to do with it and what I wanted to to do with the practice. So the opportunity presented a little bit earlier. I was also probably a little bit too, I don't know, for lack of a better term, I was probably too cocky at the time and like nope, I'm ready to go now. And like I said, Luckily Dr. Weston called me down and didn't just push me out the door because I'm sure there are a lot of times where I annoyed him quite a bit about being too pushy in the earlier years.

Because after about six months, you know, we closed out that year. I worked another few months so it was less than one year in and I started pushing again and he laid out a six year plan before I could, before I could partner. And I.

Thought about that for a while, kept working for a few more months and coming into the fall, my second fall there, so it had been about a year and a half. I was like, alright, well.

Cranked, proven and I know what I want to do and I know what I'm capable of doing. And I countered this the plan with we can work out a partnership agreement that starts the first of the year or I'll be looking for an alternate practice environment.

So I definitely came back pretty strong and.

It all worked out well in the end. It was probably sooner than Dr. Weston wanted, but the partnership ended up working out timing wise overall because Dr. Stewart was phasing out and I was willing to commit every spare minute that I had in the practice and on the practice. So the direct answer is 18 months. The proposed partnership was six years and we did it at 18 months.

And I'm sure you would have had it done after four months. So I guess one could say there was some compromise there on both sides. And credit to Dr. Weston as well because.

One of the challenges of leadership is knowing how to accommodate and satisfy the highly motivated professional who wants, really wants in the door, now wants it in the door now, because they believe in themselves. They're sure putting in the work. Hopefully they're putting in the work. If they're doing the talk, they need to be doing the walk and knowing how to give them a belief that the path is there and. But also not being sort of like offended by the excessive.

Maybe aggressiveness of the demand. I don't know how to say that the right way, but just credit to Dr. Weston, I think, for handling that right, because I think it's been a success story all around for you and him in that practice. And he's an extremely motivated guy himself. He's done a phenomenal job in that practice. Carrying the baton for all those years, continues to play an important role in there. So I love to hear that. So about a year and a half in, then you buy in 25%. This was an interesting scenario because you bought into, and we won't get too deep into this, but you bought into a C corporation. Most dental partnerships are formed as a partnership, which, a partnership is a legal term as a type of entity structure. You have sole proprietorship, which is if you don't do anything legally, when you organize yourself as a business, you are a sole proprietor. If, if you're a, if you want to incorporate, typically professionals like, like dentists or CPAs will set themselves up as an S corporation. But if there's more than one owner, you set yourself up as a partnership. So you're not a corporation, you're a partnership. And I won't go into the tax reasons why, maybe I'll do that in another podcast. But it's very unconventional to be set up as a corporation, especially a C corporation, as opposed to an S corporation when you are a partnership, because it restricts how you distribute profits to the doctors. And so in the valuation, and in the valuation, it is harmful to the buyer, because when you buy stock of a corporation, you do not get to deduct from your taxable income the price of the buy in. Let me state that again. When you buy stock in the corporation of a dental practice, you do not get to deduct the purchase price from your income. And if you buy what's called the assets of the dental practice rather than the stock, and you move those assets like dental chairs and equipment and what's called intangible, an intangible asset called goodwill, you move those assets into your own personal corporate, your own corporation, you get to then deduct through what's called depreciation, the purchase price and significantly reduce your taxable income for the first five years, and then for the next 10 years, you're still reducing it through what's called amortization. And so when you bought the stock, you got zero tax deduction on that. And so there was, there's definitely some workarounds and compromising in other areas to make that work out. And then you eventually converted to an S corporation for tax purposes. And then now you own it exclusively as an S corporation, which is kind of the standard format now. And we may mention later how the DPO is structured too. But that's, that's how you are, you are set up. So that was a little bit of CPA talk there on how that worked. For anybody who is buying into a dental practice and is partnering in and it's a corporation, give me a shout. Just go to website, my website, precfo.com, reach out to us. We can give you a little bit of guidance on that because it is definitely, definitely more complicated. Are you looking to buy or sell a dental practice? If you're a seller, how do you find a strong list of potential buyers? There's no MLS or Zillow for dental practice sales. In such a fragmented market, many dentists selling their practice feel discouraged. That's why I built practiceOrbit.com practice orbit is modernizing how dental practices are bought and sold. It's a platform technology. Y' all know them. Zillow, Airbnb, Uber, and OpenTable, just to name a few. These technologies do two things. First, they help match buyers and sellers by centralizing the marketplace. Second, once the match between buyer and seller is made, these technologies help them navigate the sale to a successful close. Here are a few of the features inside a Practice Orbit users can determine a reasonable sale price for practice in just minutes. All they need is the most recent business tax return. Practice owners can use the directory to find important service providers like practice brokers, attorneys, accountants and bankers. Practice owners and their brokers can invite those service providers into the platform. So all parties are coordinating the sale together. Practice owners will have a beautiful digital listing of their practice, like a home on Redfin. And importantly, the listing will be anonymous. And personal information like your address, name and pictures are only released after an NDA is signed and approved. Approved by you or your broker. Practice buyers can create saved searches to be auto notified when new listings come on the platform that fit their desired specialty and location. And hey, dental practice brokers, you can list all your practices on the site for free. By doing so, you'll get access to Practice Orbit's Large pool of buyers, all of whom have created profiles and saved searches to be auto notified when new listings come for sale. You can use the platform to introduce your listings to a target targeted set of buyers. Additionally and optionally, you can use the platform tools such as a built in NDA, a customizable LOI and a workflow tool to navigate the sale from LOI to closing. In fact, you can manage all your listings on the system from listing the practice, to NDA to LOI and finally to closing the deal. Create your free account today at www.practiceorbit.com.

Okay, so now you step into ownership and tell us about that part of your that leg of your journey. How did things change when you became a partner? At what point did you have more discretion to start putting your Dr. Mirandru fingerprints on your processes? And how did you evolve?

Yeah, not a lot. You know, on paper things changed and like on taxes and returns and whatnot and a lot more paperwork.

Rapidly learned that at 25% everything becomes, you know, 24% ownership company. You don't have to report it hardly on anything so it doesn't really change anything. But 25% or more, it changes all the qualifications and you get linked for liabilities and things definitely get more complicated very rapidly.

Yeah, the C Corp was a fun one to navigate. The company had been around for several decades. The company was formed far before S Corp ever existed, which is the why it was a C Corp.

Then. Their conversion over the years to the S certainly made it make it easier for the taxes and for the flow of the company.

Outwardly not much changed within the respect of the team. The main thing that was driving that was that Dr. West and I spoke a lot about teams and leadership. You see his cabinet behind me. If I ever opened that cabinet right there, that upper one, it's got about 70 books in there about leadership, about management, about psychology, reading people, treating people, about motivation, about drive. All sorts of self help professional books that I worked through over the first few years here in the practice. We spent a lot of time going through those books and Dr. Weston incorporated me early in the quarterly team meetings, doing trainings with the teams and really embracing how to build the team around you and continually work on the team to be able to provide the experience that you expected them to provide for your patients. So from the outward face was always treated as.

You know, as another doctor in the, in the group from the very beginning. We try not to have that hierarchy of who's who in the group, especially with having 10 different docs, we want to make sure that everyone works together on a team, that there isn't that ivory tower. So not a whole lot changed. To be Frank Wesson, that's probably a little bit unusual when the partnership begins.

Now. Over time though, you gradually started to insert the Nick Moranja mentality into processes. And.

I'm sure that there were already processes in place. Meaning you don't get a good sized practice with great people like your predecessors without a certain layer of or platform of processes upon it. And also great people. But you've definitely molded it to be your own over time. Is that a safe statement?

Yeah. So for those first few years in the partnership. So every day I just chuckled just thinking back on the amount of time that I sat here at night.

Every day I would analyze the day. This was before having kids, before getting married even, and a lot more free time then. But into the clinical day, everything is wrapped, team is gone. And then sit there and analyze, reflect back to that clinical day. What went well, why did it go well? What didn't go well and why didn't it go well? And start to pick up the systematic patterns. All right, if this didn't go well, it had to have been caused by something. Is that something that I did? Is it something that the team did? Or is it something that the system failed to provide for? So I literally kept a journal and I would write out every little thing every single day, kind of cataloging and paying attention to the trends of what was happening in the practice, what was happening with patient outcomes or patient satisfaction in team member satisfaction too, or employment issues and really trying to figure things out. And what that turned into as the years went on was the standard operating procedures. So creating SOPs for every aspect of the practice and defining the, all the workflows and not just clinically, you know, how to prep a tooth and how to bond a tooth, but defining from the very beginning to the very end, from the first phone call the patient takes, developing the scripting that had the, the best traction with the patients on conversion.

I mean, even scripting directions, how to get to the office, we just worked through every little thing and documented it to be able to have a guide for consistency. What I found is that we do trainings over and over and over, and after a couple of years found that, well, we've talked about this three times and yet here we are having another team meeting, talking about it. And it was because of not having enough detail and not having enough guidance in the existing procedure manuals. So really defining every aspect of the SOPs helped. It is a. It's a bit of a double edge. And so now I've got the little ones, right, the little kids, and we do sleep training. We did it early with them, and it's great because they sleep 12 hours every night like clockwork. And it's been a beautiful thing. The downside is that we have to schedule and build everything around their sleep schedules because they don't tolerate changes very well as a result of being so regimented with their sleep training when they were babies. And.

So back at the office here, everything has been so well documented and so defined and so structured and systematic with the approaches.

Alex, who we'll talk about later, I'm sure Wes says that he gets a laugh out of the office because when we do make a change that the teams freak out because it's something different because they're so systematically trained on how to approach things.

That it does. You lose a little bit of the individual creativity or freedom within the team just because being so, well.

Kind of dialed in with systems. But the trade off is that everything is very predictable. So our outcomes are very predictable. Between the phone rings, it's very predictable about what's going to happen, how that patient's going to flow or who that handoff is going to be going to. And having those defined standard operating procedures for how we do business is what's allowed the growth that we've seen here at Scripps.

Do those SOPs feed into strong patient experiences as they come in the office, or have they at time been so rigid that maybe there wasn't flexibility there to accommodate some nuanced circumstance with the patient?

Can you speak on that briefly?

Yeah, I mean, it's an interesting question because talking about the, you know, we get so rigid. Well, how do you accommodate the flexibility? Because you're inherently in a business of treating people which are the most unpredictable, you know, elements that we have to manage on a daily basis. And yeah, that's. I mean, it's gonna sound funny, but that unpredictable nature of treating humans is part of the standard operating procedures. So, yes, in short, it addresses that exact thing. So there is a. There is a format that there is a system when they are with a no show for three to five minutes and we can't call them or we can't get in touch with them, there's a system. If they're 5 minutes, 10 minutes, 15 minutes late, there's a system. There's a shift in how the assistants respond to it. There's a shift in the chairs that are used.

All that stuff is in the systems.

No system addresses everything. Because I'm so systematic in the approaches to make things predictable, it's kind of funny. Something will come up and now I'll get the challenge back from the team. Because for so many years I've said the system is the system. Like, how can we fix this system? When something doesn't work right, it's not the fault of an individual, it's the system that didn't serve the, the problem, the system didn't serve the patient. So it's always the system, system, system. But what I find myself now, in 10 years of being so system driven, the team comes back to me about, all right, what's wrong with the system? You know, what didn't happen, right? And now I find myself saying, all right, let's all calm down, let's step back, let's look at the system and let's keep in mind Systems address the 95 to 98% of our flow and then we get that little bit of wiggle at the end to be able to make up the difference. I never used to say that though. It was always the system.

You conditioned them well. Because if 90% does of the flow does fall within the system, then you should err on the side of the system. When you're training your team to, you know, a protocol within, within the, within it, do you find that as you get, because you're, you're not, you're in the, you're in the minority of the production, the practice you personally do you find that that distance between you and patient experience in the chair and the operatory with other providers poses a challenge to you to maintain high quality experience, not just the clinical care itself, because a lot of patients aren't totally able to discern whether they've had a good clinical outcome or not, maybe till years later, but they know how they feel. And sometimes when you have somebody who isn't the owner of the practice doing the talking, that the patient may not feel that same love and care as the owner, him or herself. How do you maintain that experience with the patients? Given such a systems driven practice that's.

Really building the right team and not building up. And again, this was the style, the practice that I wanted to develop and it's not the right practice for everybody, hands down.

You asked a question earlier too, that I didn't want to get into it because it's kind of a funny topic. But when did you get to start to put your stamp on things and that Was I fired? I hate to say it, but there were people on the bus that didn't belong on the bus because it was the wrong mentality.

So when I was able to make some decisions that that stuck to be able to change personnel, there was a shift in personnel. There were five people that were let off the team very rapidly and immediately that set the rest of the team on fire for production and for growth. The culture, the morale, everything just shot through the roof. And everyone came together.

And coming into the office, it was easier for me to make that assessment because I didn't have the 10 or 20 year personal relationship with these team members. And some of them, two of them were actually providers the practice.

So.

The important thing is building the right team and the right people and then building the team.

That aligns with your core values and what your purpose and mission are and keeping that drive going. And for us it was building that team around the brand. It wasn't to build a certain individual. So having, you know, at this point you're at 10 docs, we don't ever build a doctor. So you ask, well, how do I maintain that without me doing the majority of the work? So much has gone into building the brand and building the team around that brand to emphasize it. And then over the years hiring the right people that have the same values and the same morals to be able to appreciate what that means doing the right thing and taking care of the patient first, patient centered, patient driven care and trusting that you, every decision you make, you make it the best interest of the patient and, and as long as you make the decisions in that aspect, the outcome will always be the right outcome and the patients will always be happy. So we definitely are careful with how we make the decisions and the outcomes are assessed, they're measured as well. If we don't measure it, we really don't have a way to be able to see that. So we pay a lot of attention to the patients, the feedback and the outcome measurement. So I don't have a short direct answer for you other than you got to have the right people. You're in an industry business of people, you have to have the right people.

I think in your line of work, my line of work, really, in what business does this not apply? I just think it applies even a little bit more in a services based business where people have a feeling as they go through their interface with your company so directly in a way that impacts them in your, in your case, impacts their oral health, their smile, a lot of their self confidence in some ways from those things. In my case, it impacts their financial health, their sense of financial well being. And that's an experience that comes with a clinical outcome that we all want to be good, but it also comes with how do people feel about that outcome too. And as you grow a business with a lot of people, if those people, they may have great resumes, but if they don't care and that doesn't come through through in their tone and their language, that will lead to, even if it leads to a positive clinical outcome, but it's not felt that way, then it's not going to work. And I think I mentioned to you that I've got a new business leadership program we're putting into place here at practice CFO called the Entrepreneurial Operating System or the eos, also known as Traction. And it's kind of a popular business leadership.

Construct that's out there for a lot of small businesses right now. And I learned about it about a year and a half ago. We are in the full swing of implementing this and one of its main themes is everybody's got to be on board with the leadership program and the branding and the philosophy and your way of viewing life within the business. And if they're not on board and won't get on board after a few attempts, then you do need to let that person go because it will create immense friction not just in their own role, but everything that interfaces or touches that role is going to feel it and be slowed down by it. Hard decisions. I know for me that's especially hard to let somebody go just because, I don't know, I'm not that type of personality. I'm sure it was hard for you too, but it's exceptionally hard for me. And so I'm actually at a, at a point where I have. In this leadership system, you have a person who's called the visionary. That's me, that's the person with the ideas who's sort of running in different direction and proposing new things. Can be a bit of a loose cannon sometimes. Doesn't follow through on all the ideas and is late meetings, you know, late to all their meetings. And I'm like, yep, I'm checking off all those boxes. But then you have.

Then you have what's called an integrator. And the integrator is the person who has both feet planted on the earth and who puts guardrails on ideas and on the visionary. In my office, that person is Janine, who does a phenomenal job at this. But that person is less.

Emotionally attached I would say to some of these decisions. And so in some, some.

Hiring or even firing decisions are delegated to her to make those. And I will be involved where I need to. But in order to lead and give vision to a company, when you start to get north of 20, 25, 30 people, in some ways, you have to have somebody who's starting to handle some of that ground level work administratively in your size practice had about 25 people place plus or minus. Do you have, would you say an office manager? I hate to use that term because sometimes people give the term office manager to a, you know, a five person dental practice. And an office manager as I see it, is just something much bigger than that. They act as a proxy to the owner, almost as if they were an owner in making a lot of decisions with a lot of discretion. Do you have somebody like that in your practice? How have you nurtured that role? Maybe what perhaps problems have you had in trying to create that? If you are.

Yeah, the office didn't used to have one.

Certainly now the office has grown quite a bit. Doubled, more than doubled. So.

Now we have a full time office manager. There was someone who had been the team and the office is complex, it's a lot of people. And getting it all to work together takes a very deep fundamental understanding of how it has to come together to be able to work the way it does. So we took one of the lead clinical.

Assistants or lead clinical coordinator who had a long history in the practice and had a, for lack of a better expression. She had very thick skin and she could manage and lead people and was very direct. And.

She over the last decade stepped into that role of being the true office manager and some other training. And she's not in the clinic at all anymore, but is doing all the things that you just talked about as far as executing the plans, doing all the meetings, the follow through, doing all the coordination with all the doctors, with all the team members and compliance and doing the hiring, firing, doing all that stuff. As the office grows, if you get caught up in that and there's not a right or wrong. Actually, I want to make that comment too about use the expression getting folks off the bus that weren't right. And it's not that any of them were bad people. It was just it didn't align with where we were going. And folks, not everyone wants to change and not everyone's capable of some of the change that needs to happen if you have a clear vision of where you want to go. So it's really just Finding and placing folks where they're going to succeed the best and where they're most comfortable to succeed and accelerate.

So putting our office manager in that position, relieving some of that time for me to be able to focus back on the bigger picture and the overall growth freed me up to be able to do that because I was getting bogged down a little bit because I was getting too caught up in some of those day to day operations and management of the team and the practice. So the office manager became very important. I agree at 5, people don't really need an office manager. But as the office grows, you really do need to have someone with a grip on things and someone that you can trust and can really act in your best interest in the practice. Best interest when you're not available.

So I'm a big believer in, within this traction leadership program that I'm involved in. It makes you start off with this thing called the Vision Traction Organizer or vto. And when you do that, you are defining what you stand for, a mission statement or a purpose statement. And then you define a ten year game plan, then you define a three year game plan and then a one year game plan. You define what your who you're targeting in your market. For example, we target clients, dentists who are doing at least a million dollars in collections every year, preferably maybe 1.2 plus, because those offices typically need more of a strategic CFO level oversight and insight in their practice. And we're very specific on that. And there's a lot of dentists we don't take because they're not a good fit. But it makes you start from the top and then work your way down. And in creating this theme, this brand, what do we stand for? It's like one of the most highly rated TED talks is a guy named Simon Sinek and he gave the talk called the Golden Circle. Have you ever heard of that one?

Yeah. Great. Absolutely phenomenal.

It's really good. And he talks about of course Apple and how they do their marketing. Right. Because they focus on the why. That's become a little bit more of a theme these days. Maybe it's not as innovative to a lot of business owners, starting with the why, but he really dives into that. And I know that such human nature, even still when I'm talking with a prospective client, to want to tell them all the hows, what we do and how we do it and all of that stuff. And it's just so tempting to do that. Or when you're with a patient, I'M sure the equivalent would be telling them how you, how you do your work and how it's better than the dentist down the street and what specifically you're doing. And instead of why do you exist as a dentist and why are you there in their life and how can you make an impact in their life? And that's the theme that you run your life as a business owner on. Well, if you're a practice cfo, and I believe every dentist really should do this, especially if you want to grow a larger organization like, like yours is, you have to create that. Why? What do you stand for as a company? You need to put it on your wall. You need to refer back to it in your meetings. Why do we exist? Why do we exist and give people a sense of purpose? That it's not just about cleaning teeth or for me, it's not just about getting financial statements to the doctor and filing a tax return. It's about accelerating financial independence and organization to free them up to do those things in life that matters most of them, whether that's being with family or a part of their faith and doing charitable work or it's travel or stargazing, whatever the heck they want to do. My goal is to create a financial platform that allows them to get there and even do it in the process as well. That's really what we stand for. It's on our wall. Enabling doctors to thrive financially. Big letters. And then the thrive is an acronym for different themes. We state, stand by Team oriented, Highly innovative industry experts. Responsive Value Surplus, Extreme ownership. Maybe I missed one there, but. And we have these meetings every month and we're always circling that theme. And then when we hire people or we do reviews, it sort of comes back to those themes.

Have you found that you have to sort of create this overriding theme in order to almost traffic control the energy and the practice so that when you're far away from the different lines of hierarchy in your company, you know that they're all looking to sort of North Star, that when they have to use their discretion, that they're channeling those decisions in that discretion toward that North Star so that even though you're not there, or maybe they're in that nuance that isn't following within the process and the sop, you feel confident that they're still going to make the right decision. That is consistent with the why of Scripps center for Dental Care.

Yeah, I think you stole some of the pages out of my SOPs about onboarding. But.

In our onboarding pack we have all the stuff that we've developed over the years that guide the team to be able to do that and the two things that we continually come back to and we referenced them and they come up, if not daily, every couple of days in various aspects. But the stuff we developed, it was important for me, for the team morale and the culture, because again, I wanted to. I didn't want a practice built around me as an individual, I wanted a practice built around the patient with the team, to serve the patient. So it was a slightly different approach to it. So I didn't develop any of that content directly. It was all developed by the team for the team. So we invest quite a bit of time in training with the team as a whole. We do it all together.

Whether that be leadership development, doing the more the executive work at the company, all together as a team, developing strategies and goals.

And how we want to achieve those and the metrics that we want to use to measure to get there. But one of them that we did together many, many years ago was the why we did the why we exist. So we spent four hours together and it was just on why we exist and had all these great fun conversations, started in big groups, broke up into small groups and shifted around different departments so that you're working directly with folks that you don't use. You usually work with. So finance working with the assistants or finance with the hygienists and front coordinators with, you know, hygienists, etc. So clinical and non clinical working together. And it was interesting at the end of the exercise that the variation, the amount of the key points that we came up with, why we exist were very similar. And then we worked together from that point to refine the key elements of why we exist. And that's something that we do live by. We challenge each other on. So something will come up in the office and be like, oh, what do we do? And then someone, you'll hear someone chime up, why do we exist? You know, down the hallway and they'll be speaking to one of the points and it's to guide you on how to make that decision. And it was a super valuable exercise and something that continues to come back to serve the team and serve the patients they're working with and then to further facilitate the why we exist. You got a big team, you got to make decisions on the fly constantly and everyone needs to be working together and it's inevitable to have the breakdown within the team and the dynamics when stuff happens right as structured as we are. I know that I'm going to do a procedure and I might run late and that could cause a problem with something else. Right. So being able to adapt to some of those changes, as much as we try to prevent them, we have to be able to make a decision that's in the interest of the patient.

And we were having a problem years ago and team members were getting upset. The team members being able to.

Work together and resolve things or just make a decision that made sense, that people could reproduce, to be able to move forward in the moment. So instead of letting it go, we ended up spending a full block in one of our quarterly team meetings. And we focused on the Eisenhower box. And if you've never done an Eisenhower box or if you don't know what I'm talking about, look it up. It was a ton of fun. And what I did for three or four months before that meeting, when things would happen in the office, I just wrote them down. So It'd be like 5 simultaneous incoming phone calls, no one available to answer the six tone. And on our phones every call is answered within two rings. So I just wrote down that instance on this day this happened. And then there'd be another day, a missed appointment, or, you know, the little things that happen that create these little ripples throughout the day. And for months I just kept a list of them. So we all got together and no one knew what the meeting was about. Then I presented the Eisenhower concept, the Eisenhower box, and how to make a decision. And it's basically a two by two grid. And you have urgent, non urgent and important, not important. And you place your situation, your decision within this box and you do a self assessment and it will guide you on what you do with it in that moment. And then we broke up and we had the list of all these different things that had happened the past few months. And each team member had to work through their Eisenhower box about how did they classify that event, you know, was it urgent and important, was it non urgent, but it was important, or was it urgent but not important, et cetera. And then what we found was that by area of the office, there was a discrepancy about how to assess a situation. And what we found is like this department over here and these similar situations, they address all of them as urgent and important. Yet the entire clinical team addressed the exact same situation. Non urgent but important. And what it made us realize was there is a communication disconnect based on what you're engaged in and what you're consumed with. And it was a super valuable exercise and it broke down that barrier with folks getting frustrated with each other because people ended up having that realization that, yeah, we're busy, you got a lot going on, you've got patience, you've got this, you've got that going on, you've got check in and check out and it's easy to get consumed. But it's not just you that's in that situation. Everyone in your team is also in that same situation. And you're all serving the patients, you're all part of the system to make it all work together. And it diffused this tension and this accusation of why didn't you do it this way, why did you do it that way? And it was super interesting. And they just realized how different all their roles were, but that all their roles were unique and super important to the overall picture to produce our why we exist.

So highly recommend it. And that's another one that still pops up in the office. You know, some would be like, I don't know what to do. And you'll hear the grid or someone will draw it up on the whiteboard in the lab in the back. So it's, it's a great exercise.

So that box, that box, I read in 7 Habits of Highly Effective People, Stephen Covey, I wonder if he got that from Dwight Eisenhower. I don't know. Is that why it's called the Eisenhower box? Perhaps, yeah, maybe it originated with him, but that is something.

Or they call it decision matrix as well, depending on which book you read. Maybe that's Covey's term, is the decision matrix. I learned it as the Eisenhower box.

One of the, one of the themes in leadership in general, this is very much a part of this program I'm involved in right now. This traction program is, they call it lma, Lead Management Accountability. One of the things that I've always understood in concept as a leader, but it's really hard in practice, is to allow or step out of the decision making process and letting others make that, those decisions. And maybe you come in at the end as sort of a final approval, but you're not necessarily doing the vetting or the analysis. Let me give an example on this. Right now at practice, CFO, you know, we've got 33 people. We have a, a need for people to have their own credit cards for different things. Maybe they're taking a client out to lunch, maybe they need to buy a new computer for their department, whatever. And so we're looking at spend management softwares and credit cards and there's a number of them out there in the fintech financial technology space. And you incidentally introduced me to Divi, which is one I did a demo with today. Really cool technology. And I know you're putting that into place and you're practice to create some accounting streamlined processes and controls, which is totally awesome. I feel like we could do a whole podcast on how you run your accounting since we've had a lot of history on that together. But going back to my point here is that it is very hard for me to say, okay, I'm going to step outside of this decision, even on this decision of spend management and which credit card. I've had our integrator, Janine our call her our operations specialist do demos and I'm just saying, okay, I don't need to be in all the demos. I'm going to let her be in the demos. Or our director of accounting, David, David Burasak. As we've looked at different accounting softwares for possible conversion, I'm letting him run with most of these demos and then I sort of come in after he's done the initial analysis. So instead of me taking six hours in all these different demos, I might take an hour. But I trust him to do it, to vet it, to document it, and then to be able to deliver it to me so that we can make these decisions together. That is still a very hard thing for me to do is letting go of a lot of the details from beginning to end. And yet if you're running a company of more people, I mean 35 is still a very small company. I can't imagine. Like I have a brother in law who is the CEO of the trade desk and they have thousands of employees. I don't even know how you do that if you don't delegate and trust and find the right people and do that extremely, extremely well. Is that something you've learned to become more comfortable with? Delegating to others and letting them use their discretion and trusting in them?

Yeah, but that was something that I had to focus on doing because you put a lot of yourself into what you're growing and it very easily becomes a me company. So I was very aware of that and chuckling because it's something that I absolutely wanted to have. But you have to have the right folks making those decisions, of course. And once you develop those individuals. It's something I still struggle with. When things came up, I have a manager and I have an operations manager and the two of them still would come to me and ask questions and eventually it got it to the point where they would not ask questions, ask me direct questions in front of other team members, just explaining how if the management or the upper management within the organization, in front of the other team members is asking myself for direction, that it undermines the authority or undermines the ability to lead the team when I'm not here. It gives the perception that the team is not managed by the manager, but the team is still managed by one of the owners or partners somewhere.

So after breaking that down and kind of going over and having these conversations about the importance of the optics and what that means for the team to see a strong leader, to see a manager that they could rely on and trust, that could be able to guide them. I developed a phrase, and it was from my neighbor who runs a company, and this guy's a cracker. I should introduce you to him. Guy that dropped out of high school or something, very young, very cocky, that he knew more than the teachers and ended up being wildly successful and has done really, really great things.

I know he's super, super rare, better off playing the lottery to win that stroke of luck or just being that bright to excel like that. But I was having a conversation with him one day, and this is years ago, because I was struggling with this, like, how do I get my manager and my ops managers to. To make a decision? And he said, well, when they asked you a question, do you answer them? I'm like, well, yeah, they're asking me a question. He said, well, you're. You're positively reinforcing them to not make a decision. Every time they ask you a question, you give them an answer directly. You're reinforcing them to not do what you want them to do. So, yeah. He said, have you ever considered changing the way that you respond? I'm like, great, let me hear it. What are you doing with your teams? And he says when he's having a meeting, when one of his directors, he's the CEO of this company, and one of his managers or directors has a question, his response, he never answers directly to the individual's question. He responds simply with.

It'S a great question.

Let me ask you this now. If I wasn't here, how would you handle this? What would you do next? And then he asks, guiding. If they respond with exactly what he would want them to do, Then he said, he reinforces it and says, that sounds like a really great idea. I think you should try that, or I think you should move forward with that idea. And if they respond with something that she doesn't want. Instead of saying, no, no, no, don't do that, do this. He redirects. So he says he's conscious always talking with his directors and managers to never correct and never to tell them what to do. He asks leading questions and directing questions so that they will arrive at his preferred, you know, action from the question. And it was a super interesting concept and I've been doing that consciously the last couple of years, and it's been, it's been super interesting and it works.

And I would think that it's almost like, it's like having training wheels on. At some point, that person starts to feel confident in their decision making because you've allowed them to make those decisions, and then the decision plays itself out. Hopefully they have enough success stories that they have the confidence to make those decisions on the their own. I definitely ran into that problem here. Everybody for so long felt like every decision that had any weight on it had to stop by my desk. And so it was like, take a ticket, there's like a line or anybody going to get coffee stops by my office to tell me what's going on. And like, I have to know everything going on at the company. And it got to a point where there was a short period of time where I'm like, I love practice cfo, but this is starting to suck. This is starting to get in my grill. It's messing with my life, my balance, and it's not fun. And so that was really the point when I pivoted and I started looking at a leadership program and how to create better structure and delegate and do this whole LMA concept, lead, manage and accountability. And it's definitely been a game changer for me. And there's a technology we use called traction tools, which helps us to have basically run that on a tech platform and stay organized with it. But that was really, really important to make that decision. And I am going through that learning process myself still on how to feel comfortable being out of it, because I need to be out of it. And I came to that recognition and then also conditioning everybody at the company to follow a.

Structure where they can make decisions within this context of our why and our how and who we stand for. They can make those decisions or that there's a leader in their area or department that they can go to and have that support. And not everything's got to go through the, through the WES approval desk these days, which has been a good change for us. So right now we're.

It is, we're almost to an hour and a half. So we're going to journey here. I want to finish off on one subject, and I think what we'll do is we'll take. Try to plan for another episode where we go through this next phase of your journey, where you're in right now with this concept of the dpo. I know there's a lot of people out there. This is a hot topic. There's a lot of interest going on in this space. There's a lot of emerging DPOs, large group practices that are trying to centralize their operations and get benefits of scale and to create sort of hybrid models as well. Excited about that. But I did want you to tell me if you're comfortable or if this is space you think we should spend any time on in your journey. You were on the board of the California Dental association, the cda. And I don't know if this is like a private club thing, you're not allowed to disclose what's going on in the inner chambers or whatever, but maybe you could tell me how that experience was, maybe why you did it and what you learned from it. If you think there's something to glean there from that other dentists can, you know, get. Get from you and that experience.

Yeah, that. That's the segue to the dpo. So I don't know that we're going to be jumping into dpo.

But you decided to do that before you probably even knew the concept of a dpo, right? So why. Why did you originally decide or. And how did that happen? Were you invited? Did you have to submit?

I started in dental school. I was involved with the California Dental association and Dental School. I was involved with the American Dental Association Dental School, serving on various councils and committees throughout the years. Been on several other boards as a liaison and both as a board of director member, all kinds of local, state and national organizations. And the drive really was putting a lot of myself into the love the profession. I love the. The practice of dentistry. I love working with the patients and love the industry as a whole.

I also felt a commitment to be involved on the policy side. If you're passionate about what you're doing, I think that.

You have to be willing to get involved on the other side of things that govern the industry.

Have a firm belief that you can't complain about something unless you're willing to get involved and do something about it. Like you can't complain about the president if you have. If you don't vote, there's just a fundamental, you know, discrepancy. There.

So with regard to dental, I felt like if I wasn't willing to participate in shaping and forming, being part of the conversations happening that, you know, really dictate the industry, you can't get frustrated with the outcomes, you can't get frustrated with things that are happening. So I do devote quite a bit of time to the industry and on the organized side of whether it be lobbying for policy or professional organizations, because I do think that they're very important in shaping the industry. That involvement the last 15 plus years or 18 years now, really though, it was part of that driving force in looking at the practice of dentistry and looking at the landscape of the profession and being part of something that was emerging. So I don't know if that's a direct enough answer for you, but the fundamentals was getting involved to be a part of the future of the industry that I love so much.

I think that's an important part of your story. So I did want to mention that, just hear a few thoughts from you on that. And then to round out this leg of your journey, the pre DPO transition, you bought out the remaining 75%. Was that 2019 if I remember right?

1819. Yeah, 1918.

So that's when you became 100% owner of Scripps center for Dental Care. I do think it's, I thought it was brilliant to maintain that name and not to rebrand it as Nick Maranju. Are you dds? I think Nick Maranju, dds. You know, which is, which is the more traditional thing to do. And in some ways it's the easier thing to do when you're trying to create branded connection with individuals and invite them into your office to become patients. And they feel very, it's very personalized. It's probably a little bit harder if it doesn't, you know, feel that way for patients when you're getting started. But when you, when you want to break that sound barrier in a way and become more of an enterprise style dental practice, large group practice, just a bigger thing at some point. It's not about you, it's about the brand of the company. And there's a distinguishing, you distinguish between the brand of you, the doctor and you of the practice, which is a lot of personalities at play in delivering that client experience. The last thing I'll end off on is I'm sure everybody here is asking how, how Dr. Miranju, have you done all of this in your, did you turn 40 this year? 40 now. Right. How'd you do all this in your short 40 years. Because that is a lot. I mean, going through dental school and being on all those boards and everything and it's just. You have quite the resume there. Well, Nick and I, we debate on the subject of the need for sleep.

And I read a book called why We Sleep Sleep. And I'm always trying to get as much sleep as I can, which ends up being somewhere around maybe seven hours. And I feel pretty dang good at my seven hours. Honestly, I struggle to sleep past seven hours. I wish I could get my eight. Nick has always argued that we could sleep on less than that. And that amount of sleep you need is a little bit unique to your DNA. And so I think Nick has just maybe slept a little bit less than most of us have to do what he has done. And I hope someday I'm gonna win out that argument and live till I'm 110 when he lives to 90.

Nick, thank you for being on the, on the program. So much great content on there. I think your history is rich with a lot of details and I'm excited about the possibility. I won't say possibility. I think we need to make it happen, Nick. I think we need to do episode two, your journey over really the last maybe three years, getting deeper and deeper into the multi, not multi special. You've already done the multi, the multi location, multi partnership DPO structure. I'll give a quick intro. It's called Saving Private Practice Dental Management. And it's in some ways a reaction or a fight back against kind of your large, very corporate, somewhat impersonal dso. It's how do we create something that is a hybrid, something that is a private practice that feels like a private practice that leaves the discretion to the doctor that has all those awesome benefits of private practice, including I think better financial opportunities in private practice. But how do we also create synergy and connectedness across our operations and motivation as a group of people and fun at the same time and benefits of scale with your vendors without going sort of DSO route. And so that's why they named it or coined it Saving Private Practice Dental Management. And some people may say, well that's, that's kind of an oxymoron there. But in reality what he's trying to do is essentially that and make sure that there's a space for private practice to remain amid all the consolidation, all the roll up that's happening in the dental industry right now. So it's a really cool next leg of his journey. And I'm part of this a little bit as well, since I've known Nick, and all of the doctors have been clients of mine, so I've been sort of recruited into, into, into this as an effort of. Of mine, too, to explore it as, as a. As a growing area in the dental space. So I'll even share my own thoughts on it as well.

Awesome, Wes. I look forward to it. It's been the most exciting part of the last 15 years. Has been the last few years and, and really running with that, with the DPO model and, and seeing the growth and the success. It's been a lot of really fun times. It's been very exciting.

A lot of content in that one soon to come. So thanks again, Nick, and we'll see you next time.

All right.

Thanks, Wesley.