The Stories of Thriving Practice Owners: Golden Grove Dental

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.

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Welcome back, everyone, to another episode of the Associates on Fire podcast. My name is Drew Phillips, and I'll be the host of today's episode. For those who haven't had a chance to check out our Associates on Fire program yet, I'm a CPA and CFO advisor at Practice CFO and one of the instructors in our Associates on Fire program. Be sure to check us out at www.associatesonfire.com. today's show will highlight the experiences Dr. Matthew Delgadillo and his partner, Dr. Alice Chun, have had during their search to find the right first practice to purchase. We'll cover the key points that they focused on during their first year of ownership and a number of other helpful notes that should help aspiring practice owners on their journey. I've been fortunate enough to work directly with Matt and Alice from the beginning of their practice search through today, and hopefully for many more years to come. During our time together, we've learned a lot from one another, and our goal is to share a number of those lessons with you all today. Unfortunately, we don't have his partner Alice on the show today, but she's here in spirit and has been a big contributor to the overall progress of their practice. So, without any further ado, I want to introduce you all to Dr. Matthew Delgadillo. Welcome, Matt.

Thanks, Drew. Yeah, happy to be here. Looking forward to this conversation getting started.

I'd love to chat about where you began in your journey, which is where everyone starts, which is the educational experience. What did you find important or unique about your educational experience and how does that relate to your practice ownership journey thus far?

Yeah, I mean, we can go all the way far, as far back to, like, undergrad, right? So, like, people listening, you know, I was a science major, biology. And it wasn't until my junior year that I started realizing, okay, you know, I've actually got to figure out what's. What's my next step. So I started looking to, okay, I could be a teacher, I could do research, could be an MD dentist, something along those lines. And to be honest, I saw the income that a researcher, a teacher made, and I realized that that really wasn't going to afford me the lifestyle that I wanted. So I dove a little deeper into being a medical doctor or dentist. And I shadowed my dentist at home, and I volunteered quite a bit at the hospital. And for me, the hospital just seemed so boring. Nobody really knew the patients that well. I mean, it was like in and out. I really didn't get a lot of time with the doctors. They always just seemed really busy. But then my dentist, I mean, all of his patients were his friends. I got to do lab work with him. The staff was all pretty friendly, and it just seemed like a much happier environment, so. And, you know, lucky enough, I chose that path, and I'm really happy about choosing that path. And so it worked out really well for me. But anyways, yeah, so I decided I wanted to go into dentistry. So that led me to being a student at Loma Linda School of Dentistry. And I was really happy with that education. They gave a really strong clinical background, taught you how to. How to think on your feet. Um, and so, so that worked out really well to set me up to have a good footing or, or basis to. To take on being a new dentist.

I guess I should say, where in your. Maybe was it your undergrad while when you met that we were shadowing the dentist? Or maybe it was at Loma Linda. But at what point in your sort of educational experience did you just decide that I want to be not only a dentist, but I want to be a practice owning dentist? Dentist?

Yeah. You know, I can't really pinpoint where I heard this.

But I know sometime in dental school, I felt like I heard it over and over again, but they said that, you know, the number one mistake that the dentists make or new dentists make is waiting too long to buy a practice. And so you kind of dig deeper into that question, like, okay, well, why is that a mistake? Right? And if you, if you dig deeper, you talk to other practice owners, you realize that, you know, as an owner, I mean, yeah, maybe you have a little bit more stress, but you have a lot more freedom over your schedule. You can, you can be as busy or as not busy as you want to be, and then you have a better lifestyle because of that. And obviously your income, you have more control over that. And so coming out of school, you know, my, My goal was to always to have a practice or be an owner within two years. I don't know why two years was the magic number, but I just thought, you know, within two years I was going to be ready enough to take that step. And I almost kind of saw it as, like, for those of you who have, you know, who are into investing, you know, they always give you the example of the two brothers, and one starts saving early and one, one starts saving later. I always thought that, you know, once you become a practice owner, all those benefits start compounding. And so the sooner you can start that compounding effect, the better off you are. So that, that's just kind of how I, how I approach that.

Well, I love that you related that to investing. That's, it's a special place for me. So it's, I think that in just not short little blurb there, I think I personally, I already knew about you, but what our listeners probably just learned about you is that you're pretty methodical in terms of defining what you wanted from a pretty early stage. You know, you knew that you wanted to make money that supported the lifestyle that you wanted to live. You knew that you wanted to be a practice owning dentist within two years of graduation or finishing residency. And maybe it's more related to who you are as a person. But I think if I have, if we have listeners here that are, that are still in their educational process or even in residency, stressing the importance of trying to think introspectively and define what those goals are for yourself. And I think that, and the reason why I stress that is it, it really does lend to a, to a situation where you're, you're able to not only define what you want, but then go after and find exactly the areas and then the practices or the private practices that you want to work in that are going to foster exactly what you're, what you're looking for. And if you don't define that, then, you know, you're sort of just going through the motions, which I think is really cool that you did that. Um, so, so moving on. So you at residency or you want Loma Linda, the residency. And then when you were knowing that what from what you just said that, that you wanted to be an owner and you wanted to, you know, have the lifestyle that you wanted to live. What did that influence where you were going to spend your two years as an associate? And if so, you know, in what ways?

Somewhat, you know, so, you know, I met my wife in dental school and you know, she, we're both from California. We kind of tossed around the idea of leaving California, right, Because everyone says that like, you know, California is saturated and whatnot. We decided to, we both found jobs kind of in the more Sacramento area where she's from.

And pursued that route.

So location wise, you kind of chose just based on, you know, ease of access. Yeah.

Where we wanted to be, what, what felt familiar.

You know, kind of to, to bring it back to what you said about like defining your goals. I feel like that's one thing that I could have been better about in the beginning that, that I would, you know, recommend to everyone who, whether it be buying a practice or any of your goals, is really like narrowing down what you want because if otherwise you're kind of just meandering and you can't, you can't be decisive and you can't take action. Right. Because you don't know what to say yes to if you don't know what you want. And I think in the beginning, you know, I had a little bit of that as a problem as far as what kind of practice I wanted to buy and where I wanted to buy. You know, as an associate first year out, I didn't think too much of it. I just wanted to get some experience, you know, save up some, some personal working capital and whatnot.

And you were fortunate, you know, to. In, and I know this just because, you know, you and I know each other, but you were fortunate to find a really great private practice to work and as an associate and just curious, you know, how you found that and how that opportunity presented itself and how maybe someone else listening could search and find an opportunity like that and that fosters sort of that next level of growth that you experience there.

Yeah, you know what? I actually, you know, I just, I found the job online. It was just through, I think, like glass door indeed.

But you know, I know other doctors had applied to that job, but I happened to be in the area visiting my wife's family and I knew I was going to be there, so I decided to bring like a suit. And it was, I didn't have an interview yet, but I just went into the practice and said hi and just gave him like a face to the name and introduce myself. And I guess that, you know, the, the owner, doc, he liked that being able to meet me and.

You know, just taking that initiative, I guess. And so I was actually still in school. I remember because I had to do the interview. Oh, that was cool. After class and so we called and we had a really long interview and that's how I got the job. But yeah, I mean, it was, it was a great associateship. He's a really successful dentist. Really, really nice, like high end private practice, fairly high patient flow, great team. So, you know, you learn a lot about how to run an office, how to how to talk to patients, how to provide quality care. You know, just a lot of different nuances that, that you wouldn't get maybe in another type of office.

And you know, those experiences even more important for those that have the desire to be a practice owner, because ultimately if you're like Matt or if you're like a lot of the associates that I talk to that, that are on that ownership path, you not only want to be an owner, but you want to be the best owner that, that you can be and have a thriving practice. And it's. What better way to, to, to do that than to experience that firsthand and one that's already been established.

Yeah. And you know, it's good to, to make relationships with people wherever you go. So I mean, I still, I mean to this day I still text the office manager and ask her questions about staffing or how do they do certain things because, you know, they've been doing it longer than I have. And so, you know, it's nice to be able to, to still benefit from that first job, even though I don't actually work there anymore.

As it relates to being an owner, which, which you are now, what were things in that particular practice that you.

Found that gave you the level of confidence that you needed to go and find a highly productive practice from, from the start that maybe you would not have had otherwise?

You know, in dental school, you know, you see like one patient for four hours, right. And you, you know, you don't get exposed to how many, you know, and that in a busy practice you really see how much work there is to do. There's no shortage of work. And you know, when you have a well run team, um, it's almost like you're, you're on this like train that has this momentum. And as long as everybody's kind of pointing their momentum in their same direction, you just kind of, you just kind of ride that train and give a little bit of direction. Um, and it, it just seems to, to work out pretty well.

Did the owner that you worked for in that associateship, did, did he spend some quality time with like treat on the treatment planning side and, and sort of the soft, soft like chairside skills when you're talking to patients. Yeah.

So, you know.

Before I actually started, because I was waiting for my license to kick in, I think for a couple weeks actually I was just shadowing him and just basically following him from room to room, watching him do exams, getting introduced to the patients, watching him treatment plan, getting to know the staff. And so that was Kind of my first introduction into seeing how he talks to patients and how to treatment planning. You know, the staff actually, you know, they've, you know, you're a dentist, but they've, they've been in dentistry longer than you have. And so a lot of them will, will give you advice too because they want to see you succeed. So you can learn, you know, not only from the owner, but also from the hygienists and you know, assistants and whatnot.

Yeah, it's surprising, right, that you know, you have this, credentials this as the doctor and then that would on the surface sound like you've got it all figured out. But you know, you can learn a whole lot from, from tenured staff that have been in a well run practice for a long time. It's very true. Well, subsequent to your associ, you know what, when you were trying to identify, you know, probably in the, you know, at the year mark, right. You're probably starting to get the feel that, you know, I was coming up on my two year note that I wanted to be an owner. Did, were there areas, did the same forces that, that drove you back to Sacramento for your associateship, did they, did that have a lot of underlying drive to where you actually wanted to buy a practice? And, and in addition to that, you know, picking the location, what were some things that you were looking for intangibles or non intangibles in the practice that you actually wanted to buy. So from an operational perspective.

So you know, I, for a while there I had, you know, you hear a lot in dental school and outside of dental school that rural areas are, are like the last place to, to make money. And, and because all the cities are saturated and whatnot. And then myself being from the Central Valley, I thought, well, let's go rural. So we moved back to Fresno for another job.

With the hopes of finding a practice in that area and not only to take advantage of a better practice opportunity, but also a lower cost of living.

And so that was one of the steps that we took towards finding a practice. We wound up not actually buying a practice in Fresno. We did buy a practice in a more rural area. But I would say to the listeners who hear that a lot about being rural. So yes, being rural is probably a little bit easier if you find something on the outskirts of a big city. But I know plenty of people in cities that have great systems and great practices. They can also do really well and they live where they want to live because it's important. Right. I mean most people have a Spouse and both, both parts of that team have to be okay with living, you know, wherever it is they live. So just keep that in mind.

Yeah, no, I think that that's an interesting segue there for, you know, Matt's spouse is, is also a dentist. Her name is Alice and she's, she's, she's wonderful. She's awesome. And you know, having a dual doctor family definitely has its own set of dynamics. And in situations that come up, what were things that, how did you guys collaborate and approach, you know, the purchasing process?

So, you know, I was, I, I had in my mind like this gung ho, like, I'm going to buy a practice right away. Right. So I was probably.

Too, I guess, like, or less. Less discerning because I had this like, angst like, I need to get a practice right away. And she was a little bit more picky about that. And so it worked out pretty well because no, I, I might have been more open to buying a practice that didn't have the proper cash flow or thinking that we can bootstrap something where no, like the right practice, that's not it. Like, we need to keep looking. And so that worked out really well. And then, you know, having, if you're a two doctor, you know, family or couple, you have the opportunity, if you're willing to work together to buy a much bigger practice. And we all know that like the dentistry is undergoing like consolidation. And why is that? Right. It's because economy is a scale. So if you can, if two doctors can practice out of one building with the same staff, you're going to have better, better margins. Right. And so you can use that to your advantage if you're a couple. And I think a lot of people maybe don't realize that.

And there, I mean, taking it one step further as a couple, you know, you could probably relate that to, okay, well, I could just find a partner and you know, accomplish the same things. And, and that in a lot of ways it is true. But there are some inherent added cash flow benefits to being married. And, and there just is not that everyone needs to do that route. Obviously it's probably nearly impossible to do that. But I, I do find that, you know, that that's, that is the dynamics that that happen ultimately.

Yeah, I mean too also, I mean, because, you know, we kick around the idea of like in the future, I mean, nowhere, nowhere now, but maybe in the future, like, okay, let's have an associate, but, you know, or associate or a partner. But like, let's say my schedule is is slow or I don't have a lot of production. You know, we're a couple and we're the same household. So, you know, no big deal if, if my production isn't high for the day versus you have a partner and your, your partner's slow. You know, your partner's not going to be very happy because your partner doesn't get to see the money that you produce.

Right.

Well, it, it adds a little bit of a complexity because you always have to make sure both doctors schedules are, I guess, equally full or, or whatnot.

Yeah, no, that's a, that's a, A great expansion on that point. Absolutely. All right, so you. And, you know, you guys found a practice and really, you know, I think to highlight super unique opportunity where they had that they, you guys found a location that housed two separate practicing practices. Right. And you guys had the brilliant idea of, okay, they're already in the same building, let's just buy both and combine them. And it just so happened that they were both ready to sell at the same time. So kind of like this almost kismet type situation where it was, it was just sort of a perfect storm. But kind of walk us through like, you know, because evaluating that deal with you on the front, it was very interesting. Right. Consolidating P and Ls, trying to identify like insurance differences. Right. Because we had one that was Delta Premier, only one that was Delta PPO plus Premier. So, you know, a lot of things at play there. So just kind of walk them through your experience.

Yeah, you know, it was an interesting situation. It was like Drew said, it was two separate practices in one building. So if you walked into the practice as a patient, you wouldn't think it was two practices unless you started talking to somebody. But yeah, what was interesting is, you know, it was a female doctor and a male doctor. The male doctor had been there for a long time and the female doctor had purchased the practice, I don't know within the last five years.

But yeah, so she was ppo, he was Premier.

He had the larger patient base, the healthier practice. Her practice was a little smaller.

But the biggest differences or changes in the practice were changes that we wouldn't really find out until we actually bought the practice. And so.

You can, I guess, use our story as.

Like an example of like, even if there are inner turmoils in an office, it's probably still going to work out. But essentially these doctors really didn't get along very well.

And you know, so they had. There's a lot of conflict and so we had to come into a practice and not only trying, you know, keep up the production and stabilize, but also.

Transition the team to. To not want to be like side A and side B, you know, now everybody's on side C. Yeah, right. So that was. Yeah, yeah.

But I mean, it was. Yeah. I don't know if you want me to talk about anything else regarding the practice as far as. I mean, it was like. But, you know, bread and butter, not really any specialty.

Yeah, no, I think that. Perfect. Right. So when, you know, when you're evaluating, as with your two years of associate experience. Right. You don't want to pick on something that's from. Like when you look at a production report, like, oh, this is. This is 10 years worth of CE that I've got to do. Right. So, you know, as you were doing your own due diligence, I think the listeners would love to know things that you were highlighting that were giving you the checks that you needed. Yeah.

I mean, the big thing is, like, so I would go through and look and see, okay, like, well, how many profis did they do in a year, how many periodic exams? And then from that, you know, you can break down and figure out how many active patients they have or how many patients are actually seeing a year.

It's kind of hard to tell if somebody's like, over or under diagnosing until you really get in the practice. You can look at percentages and things like that.

But I mean that, honestly, that's like, the biggest thing is to look and see how many. How many patients are there. Right? Because, you know, dentistry is pretty forgiving and pretty nice because, you know, every. Every six months or every month, really, you're. You get a whole new fresh start, right? You get a bunch of new faces.

And.

If your office, let's say your office is maybe not optimal at one point, you know, maybe you have a bad day or a bad week. That's only one week out of your whole entire patient base that. That had that. And so you get to start over again, you know, the next week.

You know, one thing that I find interesting when I'm. Now that I've been in the industry for, for some time now, and, and, you know, I feel like I'm definitely not as clinically knowledgeable as. As matter or any others, Dennis. But, but I, I've studied so many production reports and, and then translated that to, you know, cash flow differences, margin differences from an operating perspective, because, you know, I'm the math and finance guy, right? So I think of almost Everything in terms of numbers. And you guys helped keep me health, healthily balanced by keeping the clinical aspects in focus, which is, you know, obviously something that I don't have on my, on my, my side. But one thing that I found that I find interesting is, you know, you have, let's say, an example practice that someone, an associate is exploring to buy is doing, let's say one, one and a half million, 1.7 million. And then we get in the production reports and they've got 3,000 active patients. They're doing, you know, 6,003 surface composites. And you're like, well, can I run this practice by myself? And without knowing the differences in production reports, you know, I would say, well, not practicing dentistry that the way that they're doing, but with some treatment planning changes, I think for sure that we could maintain the same collection level and potentially enhance the margins. And so. And the reason why I'm saying that is because there's so many, like, small nuances when it comes to understanding whether a particular location or particular practice is suitable for a young and a new dentist. And I encourage everyone, right, to pick people on your team that have studied the, the, the inner workings.

From, from multiple practice or many practices so that you can sort of, you know, just dissect it in a, in a way that, that sheds light and gives you confidence. Because ultimately I, I think something that I really love about Matt and Alice specifically is they were confident, you know, going into it. They, they knew that as long as they surrounded themselves with the right team that they were, and had the right motivation and showed up every day that they were going to succeed. And I think that that is.

Words that everyone couldn't, can use as they're starting in this process themselves.

Yeah, I would say to kind of, to continue or touch on that would be, you know, you were talking about like 1.2, 1.7 million. So like, you know, you said 3,000 active patients and all these feelings. So that, that's, that's a bit much for one doctor. Right.

But, you know, the way practices are valued.

I think let's say you buy a practice that seems a bit like, audacious, you can afford to lose patience and you'll probably still be okay and you'll make plenty of money and you can probably still pay your note if you had an already highly productive practice with a lot of patients. Right.

Flip side, let's say you're fearful. It's a lot harder to buy a practice that is smaller and then grow it to that big high Level.

Yeah. And like one. And even one piece further. Right. Like sort of where we meet in the middle of the first example that I gave, an example that you just gave, where maybe a 700,000 collection practice, it's, you know, relatively slow moving. And then in the middle, right, you've got the doctor who's been. Who's got 15, 20 years of experience. His revenue per patient's like $1500 a year per patient and he's doing 1.5, but with like 600 active patients. That, to me, right, you look at the production reports, probably some, some heavy specialty work going on. That, to me was probably more risky than taking on the. The practice where 3,000 patients, a whole lot more than one doctor could handle. But you could sacrifice a lot more there as you learn and cut your teeth as an owner.

Yeah, definitely. Yeah. I mean, you can, if you just have, you know, a ton of patience and you just fine tune things, it's much better. The other, you know, the other way being a, being a super GP is, I think, a lot more stressful.

So what were some things that you changed? Actually, before we get to the change aspect, what are the things that, in those first 90 days, which are such critical, such a critical period for a new owner, right, there's so many moving parts. You're basically not getting any sleep. And added that you had a kid that was really young, going. At the same time, what were some of. What was life like and what were some of the things that you'd want to highlight for the listeners that you had, that you had to overcome?

First word that comes to mind is stressful, but, you know, you get past it.

So what, I mean, for the first 90 days, you know, the big, the big thing is going to be, you know, if you have a practice that, that has any, any significant amount of insurance as part of collections, you know, there's going to be a lag there. So you're going to be relying on your working capital, you're going to be relying on your CPA like Drew to tell you that everything's going to be okay and the collections are going to catch up once, once the insurance and network verification is done. But, you know, the biggest thing is really going to be, I mean, maybe this is just us, but just managing, you know, personalities. At the end of the day, you know, dentistry is dentistry, you know, we all know how to do a crown prep or, you know, do a filling. You all can somewhat talk to patients and tell them what they need, but it's just going to be managing that team because you're new to them and they're new to you. And so, you know, learning how to do that proficiently in a way that everyone feels like they're being led in the, in the right direction is going to be challenging because you may be coming into a practice that did, you know, didn't have that like, like our practice. So I would say the people aspect is going to be, you know, one of the more challenging parts in the, in the first 90 days, but also clearly defining your vision to the team so that it's really clear moving forward. Because I think that's really critical that they see what you want in the first 90 days.

And you know, people will say that there are natural born leaders and that is true. But leadership is, is a learned skill.

No one I 100 agree with that.

You know what I mean?

So who did you lean on? Because it wasn't me, you know, who did you lean on for the leadership side of the equation to get, to get your team united? And you had that unique, you know, obstacle just in itself. But who did you lean on in that from that aspect?

Yeah, so Alice actually is a lot better at that than I am. I'm a lot more non confrontational. So I had a lot more trouble feeling comfortable telling somebody when they were doing something wrong or telling somebody this is the direction I want to go, not that direction. She was better at keeping an eye on that thing and being able to translate that to the employees so that we could be clear as far as what we want. Because we, you know, you, you're, whether you think or not, your, your team, they want clear expectations. They don't want to just assume, you know, they, they want to know what's, what's going on.

Matt has the, Matt has the, the nice ability to make complicated things seem very easy. But one thing that I always find is challenging. You know, you're, you're either going to have a situation where the, the staff really loved the selling doctor Right. It was an amazing, happy situation. And it's a spectrum and you're going to have it all the way down to where they can't wait for someone to buy them and take over the ownership piece. But regardless of where you fall on that spectrum, you know, getting them used to your personality and getting them aligned with the vision that Matt was describing, you know, which is so important to define, it still has its challenges. Right. And your vision is going to change over time, of course. But what, what were things that you did with your staff specifically? To help bring them on page and, and, and help them to be supportive of your vision.

You know, I think one of the biggest things is just having really open communication. So, like, the staff, you know, will often say that they're, they're really happy with the way that we communicate, because whenever, you know, not only are, I think it goes both ways, right? Like, we expect them to be open to what we're saying, but when they come to us and tell us something, like, we're going to listen and, and we're going to take that input and do something with it. So by, by them knowing that we respect their opinions and how they feel about this office, because obviously they've been here longer, I think they're going to be better at being receptive to what we have to say. I think, you know, sometimes as an owner, like a dentist, doctor, whatever, you know, we get like, oh, you know, we, we know everything. So don't say anything. Just do what I say. But I think if you just listen, I think your employees have a lot, a lot to offer. So by reciprocating that, it just makes your job easier to bring the whole team together.

That was really well said. You know, there's a fine line, I think, right? We're listening and being receptive to patient, to staff members that have tenure and have experience in the industry and.

Getting them on board with maybe changes that they may not be comfortable with and drawing that line where you still have sort of the leadership control. And where do you, where do you think that you found, like, at what juncture do you think you found that voice?

Well, you know, in the beginning, I think we were just riding on the goodwill of the owner Dr. So, you know, he was really like you. He was one of those doctors that was really well respected, and the staff knew that he wanted us to succeed. So by virtue of that, they wanted us to succeed because he wanted us to succeed. But as they got to know us, you know, I think, I think they realized that we were, you know, similar to the, to the previous owner doctor and that we cared about, you know, not only about them, but the patients and, you know, the growth of the practice. And so that was a. Something that they could align themselves with and be on board with.

Go ahead.

Sorry. What role did the seller play post trend, post sale, after you guys had the keys, what role did he play in the next three to six months or so?

You know, he, he was hands off. I mean, he was, he's ready to retire. So, you know, he wasn't, he Wasn't in the office anymore. But you know, he would, I know he would talk to the staff. And because our staff, we kind of asked a lot of them in the beginning, we changed softwares, you know, they were still on like half paper chart, half, half some kind of archaic software. And we switched to open dental. It was that in combination with insurance verification or credentialing. So, so there was a lot to manage there.

Right, because you guys, the previous owners, they, they weren't collecting or they weren't defining insurance benefits at the time of service and collecting at the time of service, isn't that right?

Yeah. And so he, you know, I think whenever they had frustrations, I think they would maybe probably talk to him and he would say, you know, it's going to get better or whatnot.

But beyond that, I mean he didn't, he was pretty hands off. He, he has a lot of friends in the practice and so he kind of blessed us with the goodwill. You know, Dr. Matt, Dr. Ellis are good people, you know, and that helped the transition, but he was pretty hands off. He kind of let us just, you know, move freely and do whatever we want without much input. It kind of worked out pretty well.

It definitely, it definitely worked out well. So. All right, so we're past the first 90 days, you know, and I'm still learning a lot on the billing side, the insurance world, you know, non covered service, all of it. Right. And, and even as much education as you have received as a dentist, that's a whole new world. Right, so what did you guys do in that first 90 days to get more familiar and more comfortable with the building aspects?

You know, I'll be honest, I probably could still learn a lot more.

But I really, you know, I checked the numbers quite a bit on the reports on open dental. They're like third party services that you can, that you can attach to your software and keep up to date on things. And, and I don't really get bogged down like in the minutiae of things, but just make sure that the big macro numbers like collections are correct production. All these metrics are being followed correctly. And I know that if the metric looks good, then whatever it takes to get there in that metric, then it's working. And if a metric starts to fall, then I'll take the time to talk to the front and figure out, okay, well what's changed or what are we doing wrong? That's not working. Because I feel like that's one thing that maybe stresses a lot of people out as an owner is.

Thinking they have to know how to do everything. I mean, I think it's important to know somewhat, but to have your hands and everything, I think is going to make for a pretty stressful situation.

That's fair. That's a fair point. So other than collections, I mean, let me ask you a question. What was the outstanding treatment plans? How did those look? And I'm sure because half were paper charts, half were digital, I mean, it's probably not the easiest thing to assess, but I mean, do you feel now, you know, what are we, 18 months out or 14 months out? Since you were being owner, how do you, how do you feel that the treatment plans that you inherited, what state.

They were in, they were definitely conservative.

The, you know, the, like most probably older docs, you know, there was a lot of watching, a lot of patching being done. And it's kind of funny when you get to talking to the staff.

You.

Know.

They'Re really on board with more comprehensive treatment and because they see the detriment or the downside to not having those larger comprehensive treatment plans. So I would say, you know, to the people who are buying practices of.

Conservative dentists, that it probably is not going to be as hard as you think to switch things over to a more modern treatment plan.

I love that you just said that. And I think because, and the reason I say that is it is usually a common, fearful sort of thing for, for a lot of new owners, you know, you're never going to get a perfect practice. Right? It doesn't, doesn't exist. But.

But you just said about being, being able to change the treatment planning style of the practice is, is super important. And, and ask you the next question, really.

What subsequent education have you under that have you taken on to sort of help, well, round you from the comprehensive treatment planning process? And then, and then one step further too. How have you in the first year or so been able to.

Grow in getting patients to be receptive to the comprehensive treatment plan that you want to subscribe to?

You know, one thing that's been kind of nice is just having conversations with other dentists about, about treatment planning. You get to see how other people treatment plan and what they prescribe to their patients. So like I'm part of a study club here in town and so there's other doctors that meet and we go over cases and you get a feel for, you know, how some of the younger docs like yourself are treatment planning and the older doctors and what works, what doesn't work and why. And it helps you Feel more confident about, about what you treatment plan and why versus just being like an island. And you get that same benefit from going to CE as well. So that, that's, that's really going to help you. One thing I would like to do is to get started on the Koi's.

Ce.

Glad you said that. If you, if you didn't, I was going to. Who introduced you to Koi's? I can't remember.

You know, I've seen a lot of people on social media do it and it seems to be really beneficial to the doctor's quality of life. The way they practice and giving them the confidence to treat.

I guess just, I don't know in a more comprehensive way versus just like single tooth dentistry because I feel like a lot of times, you know, we're just waiting till things break and then we fix them. But why not? Let's fix, fix them. Understand a problem before it becomes really serious and fix it before it gets to that.

I personally have the, the luxury of, of being.

Of seeing both sides like as a, as a patient, right. Of, of going to an office that's, you know, has the. Subscribes to the sort of cois method of comprehensive treatment planning versus the, the fixer dentist and me as the patient. And you know, I'm probably slightly biased here, but I appreciate it. Right. I feel like the conversation is more guided to aligning with what my sort of vision of what my mouth could be and then sort of tying that all together for me, giving me step by step sort of the lineage of how it's going to happen. And it's that it's just cool. It's just a cool experience. And I think that the office culture from staff all the way to the doctor is, is heightened by, by taking that approach because you really start to change lives as opposed to just fix people's problems. And, and when you have a patient's life that has just changed before your for your office's eyes, that could be super motivating. It really can be.

Yeah. I think it's, it's really beneficial because you're, you're providing, you know, an elevated care to the patient, but to kind of keep on the, you know, treatment planning. Probably one of the single most important things we did in this office was we bought intraoral cameras. So you know, we, we bought them for the hygienist, we bought them for our room. And I mean the, the ROI on those cameras has got to be insane.

Because I mean, how is, you know, you take a picture of someone's cracked tooth or their, their cavity.

I mean, it pretty much the picture does all the talking for you. And you know, what I like to do is when I do open up a tooth and we see that cavity, I like to take a picture of it, you know, the cavity first and then take a picture after it's been cleaned up and then take a picture of the, the restoration after. That way the patients can see the value in what you've done. Because you know, dentistry, it's kind of interesting. You know, you come to your exam and nothing hurts and then the doctor tells you that you have something wrong and then you get a shot and then you leave sore with less money, but you don't know what happened. So.

Right, right.

I mean, so having pictures to give them some value as to what you did, it's going to help them next time when you tell them something's wrong, they already understand that value and what you've done for them.

And not every patient is going to be cosmetically driven. But I still think to your point, the educational piece and visually being able to tie in what you're doing and how it impacts the future of their mouth is even for a non cosmetically driven patient is going to keep that goodwill or enhance that goodwill, I should say, with them. Okay, well, so what, so right now where you are, what do you feel is most important next? What are the next steps that you, what are your goals for 2022 and 2023? Maybe even.

Yeah, so for, for us, you know, we bought a, we bought a fairly large patient base that was, that's really too big for the, for the space that we're in. So we're currently doing some remodeling and adding some chairs so that we can add, add some more hygiene days. So just increasing that capacity and just dialing down the systems. So I mean, once, once you get to a point where, where you have the practice size that, you know that's about as big as you can manage, then it's about fine tuning things to make, to make your, your day easier to, to make your, your take home higher on a schedule that maybe you don't have to work as, as, you know, as hard. Um, and then beyond that, probably adding some more specialty procedures to kind of get away from, from relying on, you know, the typical, like PPO fillings and whatnot, bringing in some implants. We just bought a cbct.

And Alice is, is doing a lot more Invisalign, which, which inherently leads to more, you know, cosmetic dentistry.

Absolutely. So I think what to summarize, really, first step, make sure that you can run the ship the way that it was being run, more or less as. As it. As it was before. And then get more strategic in what areas to. To focus on to, you know, slow, maybe, maybe, I think rightfully like to slow down, but make to do more, be more productive, but also at the same time slow down, which is, you know, maybe slightly counterintuitive, but that is where that strategic direction ultimately leads. Leads you to. And then what about. What do you think that. I know that you're adding an operatory and there's probably some aesthetic changes that are happening in the office as well. But do you feel. How important. Do you feel that. That the aesthetics of the office and the type of comprehensive dentistry that you're wanting to instill in the office, do you think that those are interrelated at all? And have you made any changes, if so, or do you plan to?

I think aesthetics matter. Matter less to the office, matter less to the patients than we think. If you look in some of our operatories, the carpet is like 16 years old and pretty tattered, and patients will always say, like, oh, your office is so nice. I mean, as long as things look fairly well put together, patients aren't going to leave you because it's an ugly office. Doesn't mean that you shouldn't remodel and keep up to date. But I think you shouldn't let that stop you from buying, like, say, an older practice because obviously the patients are still going there. But definitely, I think if you're going to start getting into more, like, comprehensive treatment, planning, expensive cases, I think it helps to have an office aesthetic that matches that because.

The patient is going to have more confidence in you because you're in a nice, like, nice office. For example, the oral surgeon that we refer to, his office is like the Taj Mahal. And I would bet money that if his office did not look like that, it would be a lot harder for him to sell, you know, $25,000 treatment plans.

And it's an evolution, right? Like, one of the. One of my biggest joys of working with people at Matt's stage in their career is that we get to a, do things the right way in the beginning and avoid a lot of mistakes. That's super awesome to be a part of, but then. But b. Is to. To transition an older practice like this one that has the foundation to be whatever we want it to be and then make it this. Make it like the oral sword, church and Taj Mahal. Right. And that's ultimately the direction that the Matt and Alice are headed. And I think for our listeners. Right. He said, he mentioned cbct, he mentioned intraoral cameras, he mentioned new chairs and additional operatories. And those things really happened sort of to the latter half of these 14 months that you've been in as an owner. Right. We, we. There were a lot of steps that we ensured that were taken care of first before we strategically brought those pieces in. In the same way that we will strategically wait until the right opportunity to maybe gut the practice a bit more and, and bring more the, the Taj Mahal feel to, to. To it. One thing that I, I think that I had to do a little convincing with Matt in particular just because he was in a rural area and marketing is one thing that most people in rural areas don't feel is necessary or was to. Was to get a good marketing partner on board that was able to have the online presence that resonated with the more grand overarching vision that he and Alice wanted to portray in his community and as a clinician. All right, well then what about C.E. matt, you mentioned Kois, but is there anything else like that you've. That you think that is important?

Yeah, so I mean, I think, I think being able to not only restore but place implants is really important. So I, a couple of years ago took the aid maxi course, about a year long course. So really extensive. Pretty much gives you everything you need to know how to place an implant. And so it kind of gives you the confidence you need to move forward with that.

Believe it or not, patients are really happy when you tell them that you can offer all the services in your office. They really don't like leaving you and going to another doctor. So if you can provide that, that service to your patient, it's a lot better for them.

It really helps to sort of tie in the comprehensiveness that you're from a treatment plan perspective that you're trying to do as well. If it's all can be accomplished in the office, I mean, that is obviously the grand plan. And then what about, what about equipment? You know, we talked about some pretty key pieces to, in order to place implants, we have to have a CBCT machine. Right. But what about, what about other pieces of equip that you feel will in the future add value to the practice that you would like to.

Yeah, so one of the things that we purchased fairly early on was an Itero scanner. And not only does it make, you know, our crown delivery appointments easier, but Also, the patients see that you're up to date. Right. Because a lot of them have never seen that before. And so it gives them more confidence in your treatment as well. And it's got.

Does everyone get. Does everyone get scanned in your office?

You know, we're working on it. We're trying to. We really need to implement that because it's funny, I would say one of the most common things people say as soon as you scan their teeth, they always say, wow, my teeth are so ugly. I mean, it happens all the time. And so just by showing somebody their teeth, you know, their malocclusion or their wear patterns, it's pretty easy for them to almost like self diagnose, hey, I need braces, or why are all my teeth broken?

And. And so. And which is a very sensitive, you know, segue. Right. To first let the patient identify almost for themselves. Right. But then how do you gently.

Show them what their teeth could look like? With your help.

Yeah, and that's, that's the hard part, right. Is, you know, trying to tell them, like in a nice way, you know, your teeth maybe not ideal and they could look better.

I know it is super hard and there's technology out there that's especially. It's getting even. It's evolving even more so every day where we're. Where we're able to take what you would call maybe more or less a perfect mouth and then. But put it in. Put it actually in that patient's face so they can see.

Yeah. So one thing we want to move towards is virtual smile type type program where, you know, we can take photos of the patient and then virtually show them what their teeth would look like had they gone through, say, Invisalign or Invisalign and indirect restorations. Because until they see it, it's hard for them to put the value on what you could do for them.

It really is. It really is. And you know, the virtual smile stuff, a lot of it is really still focused on online and sort of more toward, like ad funnels and, and. But it is being refined. And I'd love to see a lot of my clients especially bring it into the office and into the operatories where it's, you know, patient side by side, where you're actually able to digitally transform their. Their mouth right before their eyes as opposed to needing to be behind a computer, you know, at home, potentially even.

That will continue to evolve. That is something that I personally love. I think the virtual smile stuff that Matt mentioned, there's a lot of platforms out there that, that can accomplish this, but it's been.

A bigger. The, the transition for patient acceptance on virtual smile is, is been heightened and accelerated because of COVID One of the benefits. I think one of the, one of the, one of the few of COVID.

It's, it's nice because I mean traditionally it was like, you know, first you have to get the patient to, to want to pay for a wax up and then you take an impression and the lab makes a wax up and they, and they, they see these teeth, but these teeth don't mean anything to them because they don't, they don't know what a pretty tooth looks like and it's not in their mouth.

So I'm speaking from experience as I know it's tough to sort of take that wax up and then visually see what it would look like in your face, on your face. But Matt, I know that you have, that you're bringing on a new advisor that's, you know, more practice management oriented this year and that that's one, one of the new things that you're adding. What are you hoping to, to accomplish with them? And, and what, what are the areas that you guys are going to explore together?

Yeah, you know, I would really like them to, to help, you know, streamline our front, to dial in the systems so that we can pretty much be as, as efficient as possible with our schedule because we're, you know, we're to the point where we have a very healthy patient flow, healthy number of patients. Now it's a matter of, okay, our schedule's busy, but maybe we're not being the most productive as we possibly could be. So just really maximizing that.

And what's nice about this specific advisor is they have some skin in the game. So you know, they, they don't benefit if we don't benefit, basically.

So another way, another way of saying that is they're getting paid based on the growth that they provide.

Exactly right.

So in my opinion, my preferred compensation structure when it comes to consultants, because otherwise there's a lot of, a lot of fluff that can potentially go on for, for a number of months without any actual changes to the profitability and the financial components of the, of the business, which is ultimately what we define a consultant as really just in general is someone that adds value and that's, it's nice to see when they're compensated on the value that they add rather than just a fixed payment. And do, I mean in your search like I think how hard was it to find someone that was willing to be compensated in that way.

You know, I've never heard of that before. I think it's pretty rare. I think it's easy for, I think it's easy for people to just accept, you know, this is the flat rate and, and we may or may not get results.

I mean it's, I'll say this, I have. Matt is not working with someone that I, that I referred him to on the practice management consulting side, but I do personally have a couple of practice management like and some other more niche consultants that, that I've worked with closely in the past and they're all compensated in that, in that way. And I think to Matt's point, it's really, it is really hard to find, find those types of people. But when you do, you know, that's why I, you know, I rarely partner, you know, with people in the dental industry just because there's so many, so many great people out there. But when you find someone on the consulting side that or is willing to put their, you know, money where their mouth is, so to speak, it's really good. It's, you know, that the partnership is going to be a strong one.

Yeah, no, I agree. I mean, I think like. So one thing that we want to implement that follows that same kind of trajectory is, is like production bonuses for our staff. Right. Because I, I think people when they see their work tied to a reward and it's scalable, I think, I think you get more input and bonus plans.

You do you 100. I think the, the hard part with bonus plans is there's, there's a thousand of them out there, right? Maybe a million even, I don't know. And everybody's got a little bit of a different flavor and how they want to prescribe it. But the ones that work are the ones that are, that directly tie the employees inputs to their bonus output. And you know, to have a practice management consultant that come in and really structure one that's sound and, and does that, that's what's really key. You could be asked you know, what's, what's, what's a bonus plan? I can, well really just depends and you really need someone like on a, on a more hands on basis that to, to implement that because it's to all the other things that you're working on and doing so.

And then last topic here Matt, is, is, is insurance and your thoughts on it? You know, the, over the last 14 months or so that you've been an owner, do you feel like insurance is beneficial? Do you feel like you want to keep that in your life or do you feel eventually you'll move away from, from insurance?

I mean it's, it's good and bad, right? It's good because it helps patients say yes to treatment, but it's bad because they, their compensation is terrible compared to like UCR fees. Right. And so you have to find that balance. I think as we move forward, you know, insurances have, have shown that they, they have no, no motivation to, to pay us more. They probably want to keep paying us less every year. So we have to figure out ways to combat that. Whether it be, you know, charging, charging a lab fee for a crown or are, you know, not worrying about covered benefits and explaining to patients what they really need and that their insurance is probably not going to cover it and that their insurance is probably, is not actually insurance. That's probably a bad, a bad way to name it.

One of the benefits of being in network with people, especially once you get your online marketing established, you get 100ish Google reviews, things that we didn't actually talk about today, Matt, but things that you did right, you, you guys are over 100 Google reviews now, even a rural area. And then you're on this insurance in network page. It's almost like SEO, right? You know, the lower your fee schedule is with them, the higher you're going to show for the patients that are looking for a new dentist. And then they correlate that or they go to the, they go to your Google reviews, they see how many you have and then they make their decision, you know, to come in or not come in. And so that is one of the benefits of being in network. You're going to have a, have a healthier new patient flow. And there's an episode that I did with Ben 2 and A on non cover services, something I've talked a lot with Matt and Alice about implementing. And that added margin that you can accomplish through, I think Matt said lab fees for, for crowns is one of them. And with that added margin you can be more confident with those new, with that new patient flow of being comprehensive in your treatment planning, knowing that it's okay if 30% of them say no because with that added margin we, we don't need as many new patients. Very interesting dynamics. An internal debate on, on in practice CFO as well as to what's the better strategic play there? Do we go out of network and just be completely out of network or do we play the insurance game for the patient flow and, and try to make up the margin with out of pocket charges. Very, very interesting topic.

But, yeah, I think it depends on your goals too, right? I mean. I mean, we're far away from that. But, like, you know, what's your. What's your exit strategy if you're selling a practice that's all fee for service, you know, it. Your. Your numbers with you as a doctor look better, but, you know, your goodwill doesn't transfer as well because those patients, you know, they can go anywhere they want, Right. So you have to keep that in mind as well.

Well said. Well said. And I think to your point that we made at the very beginning about, like, having sort of an excess of patients, an excess of new. New patients, too, gives you as a new owner, you know, while you're learning to have the opportunity to make mistakes and not necessarily be detrimental to the. To the overall practice, so. Well, cool, man. Matt, I really appreciate it. You know, having new owners on. On the program that have done really well and have a great plan in place is super helpful for everybody coming behind them. So I do appreciate your time on the show today.

Yeah. Thank you for having me. It's been great working with you this past 18 months. Alice and I have been really happy, and thank you for everything.

It's been a pleasure.