465: Dr. Kristine Grazioso | South Shore Children's Dentistry

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Imagine you're a dentist and you spend your whole day around the chair...   Well, Olsen has over  40 years of experience in making those long hours as comfortable as possible for both the dentist  and the patient! ‍If you're a dental professional looking for high quality, cost effective, dental equipment, check out Olson dental chairs!Click this link and mention this episode for a limited time FREE installation with your purchase!‍‍Guest: Kristine GraziosoPractice Name: South Shore Children's DentistryCheck out Kristine's Media:‍Advisor Email: [email protected] Website: www.sherodentaladvisors.com‍Practice Email: [email protected] Website: www.sscdsmiles.comFacebook: www.facebook.com/kristine.love.peace

‍Other Mentions and Links:Dr. Arnold WeissBoston Children's HospitalDelta DentalBlue Cross Blue ShieldMassachusetts Dentists Facebook PageMetlifeCignaGuardianStarbucksDentrixStart with Why - Simon Sinek‍For more helpful tips, strategies, ideas, and marketing advice:

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Facebook Group: https://www.facebook.com/groups/2031814726927041‍‍‍My Key Takeaways:

Your staff needs to be on the same page if you’re switching to fee-for-service! They have to believe in it for it to work effectively.Believe in your practice, have good customer service, and be good at what you do. With these points of focus, your office will thrive!Tracking is especially important in a fee-for-service practice. Make sure you know where your patients are coming from so you can optimize your marketing.Take the extra time to double check the data you’re putting into your practice management software. If you feed it data with even small errors, the generated reports can be misleading.Know your geography! Do practices around you ALL take insurance? This will be helpful info when deciding whether or not to drop insurances.Ask for help! Don’t be afraid to ask your fellow dentists for advice. Many of them have been where you are now and would love to help.‍

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Michael: Alright, it's time to talk with our featured guest, Dr. Christine Graso. Christine, how's it going? Hi Michael, how are you? I'm good, I'm good. Thanks for asking. Thanks for asking. If you can, Christine, start off with telling us a little bit about your past, your present, how'd you get to where you are today?Kristine: All right, so I am a pediatric dentist and I started my practice in 1999, way back when, when things were really different. There wasn't the technology we have today, there weren't the rules and regulations necessarily. So things have really changed. But I have been a dentist for 30 years and a pediatric dentist for 27, practice owner for 23.it's been a great ride. I love it. So was Michael: practice ownership always something you wanted to do or how did that come about? Kristine: I, yeah, I think I always knew that I would be an owner, how that would look. I didn't know, and I really didn't decide to be a dentist till I was a senior in college.So it wasn't like a lifelong dream. It just kind of happened and it ha and I love it. I wouldn't wanna change anything. Yeah. Michael: What were you wanting to do before that? Kristine: Oh, let's see. First I started as an wanted to be an attorney and quickly learned that was not for me. Then I thought an optometrist, and then when I got into physics junior year, I realized, no way, not my strong point.So I had a little bit of an existential crisis and had to figure it out, and dentistry kind of fell in my lap as an option. And I got a job in a dental office, happened to be a pediatric dental office, and. I knew immediately it was immediate that I had found what I was gonna do for the rest of my life.So I was really fortunate in that. So Michael: what was the immediate thing where you're like, this is it now you came home, you're like, I'm gonna do this. Kristine: What was that? It was really more of just a feeling. So, The first day I walked into, I got a job as a dental assistant and I knew nothing. I knew nothing about dentistry.And this dentist, who is many pediatric dentists, know his name, Arnie Weiss. He mm-hmm uh, took me in and said, I'll teach you everything, you know, work in a year with me before you apply to dental school. And We have a deal. So he took me in and it was really just a feeling. I had this overwhelming sense of this is where I belong, and this, I loved it.I just loved it. So it really was not really tangible, but I just knew. Mm-hmm. Michael: What did you learn from Arne that you still take Kristine: on today? A lot of the behavior management he is a master at, he's retired now, but he was a master at behavior management and you know, how to charm the little kids. So I learned really, that was the main thing I learned, but I learned a lot more than that too.Michael: Yeah. But that was the thing, the ma major, major takeaway Kristine: how to yeah. How to deal with children, so, Michael: Okay. Yeah, that's interesting. So then you went into dental school and then from that point on, you decided to immediately own your own practice. Was it in dental school or was it out you were associating?Kristine: Nope. I went to, well, well you have to do a residency to, to go into pediatrics, but I had to break a year between dental school and residency because I was getting married to someone who was in the medical school and he had to go immediately to residency and as a dentist you can just go out and practice.So I waited and followed to where he did his residency, which was Philadelphia. Pennsylvania and applied to my pediatric residency, then worked for a number of actual pediatric dental offices, then learned so much, went into my residency, leaped and bounds ahead of, if I had just come outta dental school.And then I came back to Massachusetts and worked with Arnie Weiss again, and I thought I would likely. Become a partner with him. But due to geography and my husband and I choosing to leave the city and move down onto the south shore of Massachusetts, I knew I wanted to open my own practice. So it was kind of gradual.And then I opened a practice and had a baby at the same time. Oh, me. So talk, talk to me about Michael: that then. How. How was that? Was that any moment where you thinking like, maybe, maybe I shouldn't open the practice right now. Put a pause on it. Kristine: I had the moment immediately after I gave birth for like the first month, I, I said something to my mother along these lines, do you think you could have told me what it felt like to be a mother?You never once told me that maybe I would be like, whoa, what am I doing? So I had that Feeling. And then when my son was 11 months old, I got pregnant again. And I was just in the process of actually building out the space that I still am in more than 20 years later. And. I think I was a few months into that pregnancy doing the build out, having to make decisions.Also having, still another baby at home that I had some second thoughts, but my husband kind of put the kibosh on that. He is like, nope, you've come this far, you've got it. You're just hormonal. And truthfully, at the time it didn't feel supportive, but he was a hundred percent right. And you know, I have to say, I think that I have been very fortunate.I was never five days a week clinically, ever since I opened my own practice, other than during the pandemic years. When I went all in again, I really, I practiced three days a week and that was a wonderful way to balance being a mother and a practice owner. Michael: Mm, okay, gotcha. So it's always been three days a week up until the pandemic you said.Kristine: For me personally, the practice grew to five days a week. I have, I had associates probably starting at around year seven or eight. So, but I, you know, one thing, and if young dentists are listening to this, that I think it's lost, is don't realize that it takes time to grow. It doesn't just happen immediate, so your practice isn't all of a sudden you're open and you have a hundred patients that week.It just doesn't happen that way unless you go someplace that is just, you know, there's no other dentist. But where most dentists seem to like to go there, we have a lot of practices already, so it takes time. So it wasn't a big deal to start at two, three days a week and grow it and grow it, and once those days were full.and then I want 'em to expand to other days to hire someone else to help me with that. So I think that's a really important thing for younger dentists to realize is that it's not immediate success. And just like when you come outta dental school or residency, you're not gonna make the same financial living that someone who's been doing it 25 years is That's not how life works. Yeah, Michael: that's true. So then, Christine, let me ask you, when will it feel like. When, if you were examining me and you're like, okay, Michael, let's, you're on year five and you, you should have grown more by now, or is it like, no, it's okay. It's okay. Give it, give it a more, when, when is the breaking point where it's like, we're not growing, I, I I need something, I need something to change.Oh, Kristine: I think you always should keep seeing forward growth in the, even in the first few years. But, so it was easy for me. I had a husband who worked and. We weren't counting on the money from my practice right away. I did, I actually, I, I should mention this, that I stayed in other jobs. I was an associate for the first two years that I was opening my own practice was another funny story. So, a good friend of mine from dental school, also a pediatric dentist now, her boyfriend at the time, was a pediatric dentist and he opened his own practice while we were still kind of getting out of residency and doing. That. And he used to say, I keep looking at my bank account and I think, all right, next week I'm probably gonna have to shut down.And then eventually as you get towards the end of that first year, it changes and you start seeing that you can support the bills and you're not only living uh, you know, you're not paying yourself. That's, I think, another mistake. People think, oh, they should be making all this money right away for me and colleagues in my.Generation, we just assumed we weren't really paying ourself right away, that we kept investing in the business. Mm-hmm. That's kind of a different philosophy I see these days too. They all wanna be making a lot of money, but can't necessarily right away. You have to put the time in. That's what I'd say.so I think it's really hard for a practice to fail. So just be like, oh, I'm just gonna give up. I, I do think that's kind of hard to do if you are in an area that your services aren't necessary. So, I mean, don't open up when there's five other pediatric dentists within 10 miles. If you open a practice there, it's a little bit harder, right?If you are in an area that practice is necessary or you buy an existing practice, that seems like a good way to go. And you. Are good at what you do and you offer really great customer service. 'cause to me that's really the key. Customer service is the key to success. Then you are going to see yourself grow and become successful, and then you just have to decide what success means to you, because it means different things to everybody.It's not only that you make money. Mm-hmm. That satisfied in your life, in your career, that you have the lifestyle you wanna have, that you have time off, you have time with your family. All those things lead up to what I would call success. Not just how much money you make. Michael: Got you. How long or did it even take you a while for you to realize that when you were starting out, your practice, having your children and everything?'cause I feel like that's like your, you're boggled down in the moment. You're, did you also start your practice, have a child and you were an associate. Yes. Kristine: Wow. Yes. And then I think I got out of, oh, and I started working a day a week at Boston Children's Hospital teaching in the residency.But that didn't last that long. That was only like a year and a half, two years. So there was a lot going on, and I think especially women, we just multitask and go forward and we handle a lot. So then Michael: what did you feel was being spread too thin in that whole moment? I mean, what would you have done differently Kristine: if anything, the one thing, it doesn't fit what you're asking me of what I would do differently as far as time-wise, but what I would've done differently is had a greater appreciation for, Purchasing the real estate.I do not own the real estate associated with my practice. I've always leased and I felt back then, how could I possibly buy it? I can't afford this. I wish I understood that I could have taken loans and it would've been okay to have some debt regarding real estate from my practice. So early on I wish I had done that.It seemed so expensive. But now in hindsight, all these years later, it wouldn't have been, I. Michael: Hmm. So that's the thing you wish you would've done is Yep. Bought the whole Kristine: building and everything. Yeah. Or found a, a space and built a building. It seemed unattainable to me. I do think that younger dentists these days are much more willing to do that, to take on the debt, and they're not as risk averse, but, For me, back then, it was too overwhelming and too scary to contemplate doing.Yeah. 'cause the property has always been expensive here in Massachusetts. Right. But in hindsight, it's, would've been a smart thing to do. Michael: Yeah. I mean, you were already taking a lot of risks, Christine, if you think about it. You know what I mean? Sure. You were doing a lot. So it's kind of like you think about it now you're thinking, oh, I gotta take another risk on, you know what I mean?So maybe hold off. at that moment you were thinking that, so I could totally, I'm putting myself in your shoes. Understand that, you know, So now you're in your practice, let's, if we're rewinding back, you decided to start your own practice and where you're at now. Mm-hmm.And has it been, when did you start going fee for service or have you always been that way or Kristine: So When I started, the PPOs weren't really, they were just starting to come into the environment and the people I worked for, Arnie Weiss being one, and then another practice In Needham, Massachusetts, they all just were in network with just like these premier plans.So Delta Dental, premier, blue Cross Blue Shield, they used to call it indemnity and that was pretty much it. So that was the advice you got and you took those and at the time it was, you know, an 8% discount. reasonable help build your practice. It's just that over the years and there, honestly, there was only one pediatric dentist that I knew that was completely out of network with everything, and she was like, this unicorn, we didn't even, I didn't even think about it or understand it.I was like, I don't even know what that's about. because everybody took these two plans and then as the PPOs started coming in, I just always said, no. No to all of them because I was like, why am I gonna take that discount? Why, you know, I knew what it cost to run a practice. Mm-hmm. But the overhead was, this is a little bit of a long story, so I'll tell it and you can interrupt me when you would like, So I took those two plans and I really didn't pay that much attention to what was going on. I just went about my business. My practice was growing. I ran my business by my gut. I wasn't data driven at all. I didn't look at the numbers that much. All I knew is I was profiting. I every year. I made a better living, even through the recession of 2008.You know, growth happened. I had this a, a vibrant practice that I loved and it was, it was becoming profitable and I never like, looked deep into the data. 2016 hits and one of the large insurance companies sent out every dentist in Massachusetts, a contract that was basically most, a lot of people just signed it because we hadn't, we never used to have to renew our contract.I hadn't signed a contract since I opened, you know, it was like, 15, 18 years, they never used to make you resign. All of a sudden we get this big contract. And some of us were like, what is going on? And they basically were trying to force us all into a P P O, 30% pay cut kind of right up front is what it looked like.So some of us got really nervous and started, we hired attorneys to review it and realized there was no way we could sign it. It opened my eyes and I really started digging into the numbers and I noticed that, oh boy, I wasn't taking an 8% discount anymore. We were down to like 17% and it was only going to go up.So then when all this was happening, you saw, wow, you know, when you weren't paying attention, they were discounting your reimbursements more and more. And that was routine in the practices of insurance companies, and I was supposedly not in PPOs, well, they were acting like PPOs without calling themselves that really, so, well, a couple things happened.I realized there was no real good place for dentists to communicate and we were also. Being told you couldn't communicate because you would be under collusion, so you're not allowed to talk about this stuff. So a group of, I formed a Facebook page, the Massachusetts dentist Facebook page, as a place for dentists to have to communicate.We were, I hired an attorney to make sure that there was no collusion or anything that was said. They monitored my page so that we made sure we did everything correctly, legally, and at that same time, we didn't feel that our dental society spoke for us in this matter. They were kind of agreeing with the insurance company and going along with it.So a group of us got together and over a. A matter of 4, 5, 6 months, we formed an alliance and we made it a nonprofit. Again, had attorneys to make sure we did everything right. And we became a, a force that went in front of the division of insurance and lobbied the legislature and we had our attorney's right.An appeal to the Attorney General. So we did everything legally and it kind of got my, I got fired up for advocacy. I really did, and at the same time I realized that I couldn't sign that contract anymore. It was taking away all my rights as a dentist, and I felt like the rights of my patients, there was too much control from the insurance company.So I started, I. Working with my office manager to really look at what it would mean to go out of network. And I talked to a lot of pediatric dentists around the country who had already done it many years before. And in other parts of our country, people never even took insurance. This was just normal what they did.But up here in Massachusetts, and I know other states you, you went in network with insurance, so. I started really doing my research, as they say. I talked to a lot of people. I read books. I got on every Facebook page I could that would talk about this, and then I made a plan. In my office and I spent two and a half years educating my staff, making sure our customer service was elevated and we made a, a deadline that as July 1st, 2020, we'd be out of network with all insurance.So I was getting out with the two insurances I was in and also with Medicaid. I had started being a Medicaid provider 15 years prior because I wanted to do the right thing. I wanted to help patients and I wanted especially to help my special needs patients. So I decided for me, I had to drop all at once because I didn't want any one group of people to feel that they were being discriminated again.So to me it was easy to go all at once. Now I wasn't in 20 plans. If I was in 20 plans, I would've done it differently. So just coincidentally the drop date of my insurances. 'cause you had a plan, you had to give six months notice to one company. 90 days was right. In the beginning of the pandemic, so things got a little messed up in the process, but here I am three years later and I'll tell you what, no regrets.No regrets. I love that. My practice is, we're not a truly fee for service practice. There's different terminologies. I call it an out-of-network practice because we still do all the work for our patients. We, the part of the customer service we give is to do all the insurance work. We file for them. We still look into things and we accept assignment of benefits on all the plans.I always accepted assignment of benefits on. Like the MetLifes, the Cignas, the guardians that I was always outta network with. So we didn't change anything for those patients. The plans that won't do assignment of benefits in our state, our Delta Dental and Blue Cross Blue Shield. So now my patients have to receive that check.And that was a big hurdle to overcome. But now that we've overcome it, it's really not as big of a deal as every dentist think it's going to be. It's not. You just have to plan and appropriately Train your staff and educate your patients. So, most dentists are a little bit afraid of doing this because they're afraid they'll lose all their patients.So that means they're gonna lose out financially. And you know, many other reasons, but every dentist I talked to had told me, you are gonna lose patients. You are gonna be slower, but you're going to stay the same financially. And frankly, they're right. So it's a different mindset. It's taken me a couple years to accept, you know, my head and my heart coming together to realize that we are slower.We do have less patience, but the profitability in the end is the same. And I'm a really, I've changed and I'm really data driven now. So we track everything in my office. 'cause I wanna know, And this is a big point. I, I started actually marketing. We hardly ever did marketing before, and now we put a lot more effort, energy, and money into actually marketing.But where it used to be, so I told you in 2016, 17, I looked and we were probably at a 17% discount. It went up. By the time I dropped in 2020, we were over, like we were probably 21, 20 2% insurance fee discount. Now my dis my discounts or my write-offs or adjustments, better word to use instead of a discount.But adjustments are one to 2% a month. So, so you can spend more on other things like marketing. Wow. That was a Michael: fantastic though. It's fantastic how it all kind of, You created this whole movement, right? Especially when it came down to, to Massachusetts. You talk about making a plan and training your staff.Can you kind of break down to us instructions wise, like what is the plan that you created? Kristine: Well, the first thing I did, and this was on advice of one of my colleagues, he had me read a book by Simon Sinek called, start With Why, and I read that book and I found my why, and then I decided to educate. My staff on the why, because one thing that really surprised me was.They were not on my page. They were like, no way. We can't do this to our patients. Mm-hmm. Everyone's gonna leave. I wouldn't pay more money to come for cleaning. They're used to, they were not on my side. And I thought for sure, because I, you know, I thought, well, I've led them in, in every other aspect of this.They're just gonna say, okay, well you're the owner, you know, and that was not the case. That was a big surprise. But it was really good because it made me work harder. It made me work harder to train them. In addition to that book and then presenting my why, we did a full day staff meeting, slides and everything about the book.I. About how I found the why for me, how I what it meant, and then teaching them to understand it. We also did a whole day staff meeting on customer service, and we used the Starbucks example. We read a couple books about Starbucks and we used their customer service model. We broke it down into dentistry.And so, and my office manager, she was, she was really in charge of that presentation. She even went and gave that presentation at like dental courses and stuff because it was really good. So we spent time, I literally spent time and then we spent days role playing, role playing, role playing. I. By the end of all this, my team was bought in.The ones who weren't kept it to themselves, and they came to me six months. A year later, they're like, oh my gosh, Dr. G, we thought you were crazy. Like, we're like, we thought you were gonna destroy your practice, and this is the best thing you ever did. They're happier. They like the, the pace. truthfully, the hardest, most difficult patients.99% of them left. all the great patients stay. So my front desk will tell you that it's rare for them to have, they're not chasing people for money. They're not being argued with, they don't have like the people who give attitude. And unfortunately our world's a little crazy right now. All the crazy we see everywhere is in every dental office too.Makes sense. Right? So that's true. So that's how, how we did it, we, we. I made sure I knew what was important to me and that my office manager was on the same page. I have a fabulous office manager, I have to say fabulous. And she and I work really closely together. And then the other dentist in my practice, one is my associate, but we're partners in a second practice.I do have a second practice and she, you know, I made sure they all agreed and, you know, understood where I was coming from so that it was just, it was a lot of time and effort, but it's so worth it. Yeah, Michael: no, a hundred percent. So you got your whole staff, first of all, I guess, to get on the right mindset, to understand your why, right?Instead of being like, Hey, do this, do that, do this. We're changing it up, right? And then maybe they might have in front of you been like, okay, yeah, but behind your back they're like, what the heck is Kristine: she doing? Right? They wouldn't be able to effectively communicate if they didn't believe it. So you have to have the staff around you that believes it.And I think that scares some people too. They look, they're like, I don't know that this one, that one. And then finding staff right now, we all know it's a challenge. We're, we're living in a very different time right now, so it's under understandable to be worried about that. You actually though end up needing less employees when you go out of network and your fee for service because you have less patience.You just do. It's rare that you don't, right? Rare that there's exceptions to every rule. Nothing is a hundred percent, but, I'm in a saturated area. When I opened my practice there, there were two pediatric dental practices within, five to 10 miles of me. They were there before me. Then maybe a year or two later, another one opened maybe 20 miles away, and in the last 10 to 15 years, four or five, six or seven, I can't remember how many have opened within 10 to 20 miles of me.So we're saturated and I'm the only one out of network. So it's possible to do. But you have to make sure that you believe it, that you are good at customer service and that you are good at what you do. I, I have great pride in my practice and it's not all about me. I said, I have other people who work with me and for me, and they live my vibe and my dream, and I thank them for that every day.That's, you know, I, it's clear to me that they are doing it the way that I dreamed and wanted without, they don't parrot me. But, you know, that's, mm-hmm. I don't know Michael: if that you do. Yeah, no. You do what you want. Yeah. Yeah. And so you officially went out of network before the pandemic, right? Like Kristine: literally like little July?Well, we gave the notification, but the actual date was July 1st, 2020. So we just got back into our offices. We were out from, I. Mid-March until we started being back for emergencies mid-April and then we kept back to like back to normal business June. So we were only in our office a month normally, and it wasn't normal, it was anything but normal.Mm-hmm. But seeing, you know, all kind the full schedule of patients, but all socially distance and all that. But we were only in the office for a month. And I will say that we kind of were so wrapped up in all these changes with the pandemic. I mean, we changed so much that we let. Go of all the planning and all the, the process of being on a network.So when July came, it was a little bit of a nightmare. We had a tough month. It got better each month, but the, it was a little bit out of our hands. I mean, I look at it and I was like, we were in such chaos in the pandemic that the chaos of going outta network. I'm kind of glad it all happened at one. Yeah.Yeah, that's Michael: true. In that month, what was out of control at that time?Kristine: I, we could have had better conversations with the families about being out of network. Mm-hmm. But we were also wrapped up in asking about the. You know, if anyone was sick, did they have a fever? Did we do this? Did they were calling from the car? I honestly, I can't find fault with us because it was such an unusual time and every dentist knows like crazy.Yeah, yeah. You know, and especially in Massachusetts where a state that really believed that it was a dangerous virus and all that, we weren't running our, you know, People were scared up here. We had, we'd lost a lot of people early on in the pandemic, so people were Michael: scared. Yeah. Yeah. A hundred percent. I agree.Now you mentioned to get your team involved, right? Let them know your why. Things like that. Does that involve just like, all right, we're gonna do a team meeting, 45 minutes. Let me show you this thing. All right. Everybody's on board. Cool. Let's get, let's hit the ground. Or how, how often the consistency Kristine: I would say every couple of months we had full day staff meetings or half day staff meetings, and we talked about it at morning huddle all the time. And no, it was, it was intense and it would've continued to be intense had the pandemic not happened. You can't just have, you can't just talk about it in two minutes.We did role playing, months of role playing. I still actually break out into role playing I still check in. It's three years later and I notice some things might've slipped a little 'cause we've kind of gotten comfortable.So I check in with the staff and if I'm like, well, we could be saying it this way. We have a quick meeting and we talk about it. And we role, role play a little bit because, again, Well, that's one thing I learned. This is off topic, but you can't just sit back. you have to have your finger on the pulse of your practice.And I will tell you that even from a distance, 'cause I've been a little distant from my practice the last six months, but even from a distance, I keep my finger on the pulse. Even if I'm not physically there, I am working behind the scenes and I'm diving into the data and I talk to my office manager every day and I check in.So that's really important for practice owners to remember. Micromanaging is one thing you don't have to do that. I've been guilty of it, especially in the last three years. I did a little bit too much of that, but again, we all were thrown up. You know, we didn't know what was going on, but I do think you have to know what's going on and I do believe you should look at your data.Michael: Yeah. So you're the one who always, how often, what data, what data are you looking at specifically? Like I know like, okay, yeah, let's look at production collection and things like that. But when it comes to specifically what are you keeping your finger on the trigger, what are you like saying, okay, office manager completely trust you So where does that Kristine: fall? right now we're really, because we went out of network, we are really good at tracking new patient calls where they were referred from. If it's multiple places, knowing where, how many of those calls convert to an actual visit, what the people who don't convert, why they didn't.Was it because we're out of network with their, their insurance? And that's. Pretty much what it would be. So we track all that and I'd get a, a report on new patients every single month. We also implemented a few new things that we are doing to try to increase our new patients, and we track if we're seeing a benefit and we've found some interesting things.So it's all about the new patients. in, in the new patients we track, where these referrals come from. So are they coming from families that are already our patients? Are they the siblings of the existing kids? Are they coming from the pediatrician, from other dentists, from Google, from Facebook?Where are they coming from? And then we really have been looking to see where our resources should be going for when we market to these things. Because before it was kind of willy-nilly marketing, but now we're looking, so we're tracking the data to see where our marketing. Efforts are paying off and where we should invest more, where we should invest less.I, of course, the financials, I look at the production, the adjustments, all of those things. You know, they like to say KPIs, key performance indicators. I couldn't even list what all those are. I know what I wanna know in my practice. those are the main things that pop into my head right now.Michael: Okay. Okay. And do you have like a software for that mainly, Kristine: or, I'm using Dentrix currently. I've been using it since I opened. Every program has flaws and I'm looking to go to the cloud, but that's another project. So Dentrix, we, we spend a lot of time and effort making sure that the information going into Dentrix.Was correct so that the report's coming out because there's flaws in reporting in almost anything. So if you don't have good data going in, you're not gonna, you're gonna get flawed data coming out and a lot of practices suffer from that. And we have checks and balances. I have two different, three different women who have different tasks, and they are the ones who will draw the data.They and I have monthly meetings now. I get reports on everything. and we meet and they tell me what I need to know so that I'll stay on top of it. 'cause it's easy to just like not think about it. Mm-hmm. I also, another thing, having my finger on the pulse of things, I even now have a clinical meeting every month where they have to report in.What's going on with equipment? Are there any equipment, breakages, what do we need? You know, any of the issues there. I need to know what, make sure they're on all the same schedules for, making sure the autoclaves are clean and all these things. We are very systems oriented, so we have tasks, charts, and check boxes for everything, because if you don't have a system in place, Things don't go the way they're supposed to.And that's like, you know, now I think dentists are better at starting their practices that way. Back when I didn't even have a computer when I started, you know, it, it, and then eventually I got a computer. I used to do all my billing by hand. Mm-hmm. Set. I wrote out insurance forms and sent them off. I mean, it was so different.Really different than today. We didn't have the technology, they didn't have digital x-rays, you didn't have digital charting, none of that. Mm-hmm. So it is a little bit different, but I think the quality of your data going in is so important to get quality reports coming out. And then my office manager's really good at, she set up a lot of spreadsheets that do the calculations and everything.So you are able to do it on your own. You don't need to hire companies, but if you're not good at that, then they do have companies out there. Yeah. To get Michael: the right, right. Data. Interesting. And. You mentioned marketing. What right now is working where you're like, this moves the needle and other stuff where you're like, no, let's, let's drop it or invest less into that.Kristine: So interestingly, back in the day, the things that were the number one referral sources for pediatric practices. Now I can't speak to general at all. This is all pediatric, where you wanted to have a presence in the schools, the pediatricians, things like that. The schools are a little bit less important, it turns out.So you don't need as much of a presence 'cause people don't really care about hearing from the school anymore or the fact that you visited, which, you know, it's kind of sad, but it's true. Really online presence and I'm not talking about your Facebook posts, that's not what builds a practice. I don't care what anyone says, you have to do it, but it's really you being talked about in.Town groups, mommy groups, and then your Google presence, your s e o placement and all of that. Michael: Okay. And reviews. Are you doing, Kristine: reviews are huge. I should have said that. Yeah. Having good reviews I think are really important. 'cause nobody will pick their dentist now if they haven't checked out their reviews.So if you have strong reviews, I don't have an exorbitant amount, maybe little under 500, but the majority of them are five star and they're all authentic. we do ask people to give them to us when they leave and you know, only a small percentage do, but. Still Michael: that's stoke really, really good.Yeah. Like yeah. I thought you were gonna say, oh, I only have a little under like, you know, 50, but five hundred's. Fantastic. Kristine: You know what I mean? Yeah. I'd like to get to a thousand. Who doesn't want a thousand? Michael: Yeah, no, that's really, really good. Okay, that's interesting. And so I have a question when it comes to now, ' cause this happens sometimes, Christine, where you've probably heard of it and it is in your Facebook group, I'm sure.Like where it's um, They are a startup, they're about to open, but they want to go a hundred percent fee for or out of network or fee for service right now From the beginning. Sometimes, I mean, we've been on some interviews where they're like, Hey, I'm, I'm gonna take on insurance 'cause I can't make it.And then sometimes they're like, I'm gonna fight through it. I don't care. where's the balance here in your opinion? Like what, where's the good mindset? Kristine: So I think the balance is you need to know where you're opening, right? So all of my friends in the south, they never took insurance.So if you're opening in North Carolina, you don't need to take insurance. You'd be crazy to take insurance right from the start. Yeah, take it, help with it. But don't be in network. North Carolina, South Carolina, all you know. I would say know your geography, so know what's going on, and then talk to the area practices, the dental community, we should be helping each other. Not, we're competition, but, we don't have to be competition in that way. As a matter of fact, I, my office manager has gone into a woman's practice near me who opened up right near me in the town. That was my main draw, and we tried to help her with running reports and looking at the financial data.'cause she just wasn't doing it. I don't know if she is now or not, but I'm like, why not help others? It, it's, Silly to not, right? Mm-hmm. You come on a podcast like this and, and share, you know, I opened, I told you I had the Massachusetts dentist page. I also run the fee for service pediatric dentistry page.I opened that. It's all about sharing and helping. So go ahead and call the dentist around you. Too many of 'em are trying to hide all the time, and like most of them didn't. No one called me and said, I'm opening a practice near you. when I opened, I went to the two practices around me, met with them and told them what I was doing, and they gave me great advice.Nowadays, people just open and they hide it from you. I don't think that's a good idea. Go talk to the dentist around you. Ask for advice. Find out who's in network and who's not. If no one's in network, you'd be crazy to go and network you. You have the patients are, know what that's like. So I think that's the most important thing, You need to be educated in what it all means. And here's the other thing. New dentists often have no clue about insurance at all. I didn't. Mm-hmm. You know, I didn't, and I'm still learning. There's so much, I don't know. 'cause I never took all these lower end plans. I call it a lower end plan, but lower reimbursing, pain in the neck, p p o plans.But I look at it like, why would you ever wanna work for 50% of your charge? No one goes to work and gets. Discounted. So And if you wanna give to me the best care with the best materials that you could afford, all that you need to be reimbursed. 'cause another really important point is being busy is not being profitable, right?Mm-hmm. Profitability and busyness are two separate things, and that I. I wanna jump back. Remember when you asked what I checked the data? Mm-hmm. Profitability is so important and it often gets overlooked. People look at their production, what's my production? What's my collection? But where's your profitability?What's your overhead? How, you know, that's what's really important. that's true. And then, and back to choosing insurances. the point I'm at today, I like it this way, So I'm happy I did it, and if you can open without ever starting to take these low paying insurances or insurances, that really, it's not only about the reimbursement, that's a big part of it, because that's how we run our businesses.But it's about, Basically the control the doctor, patient, patient relationship gets interfered with. If an insurance company's in charge and can say when a patient come to you, what services they can have, all those things. So better off not being controlled by a third party administrator.Michael: You're technically, I guess like they're the leaders, right? Kind of thing. They're the managers and they're telling you like, what, 'cause the patient's gonna do it, right? Like whatever my insurance covers kind of thing. And then, They get, they get boggled down with that. But that's interesting.Okay. Because yeah, like I told you, there's sometimes where people, they're like, man, Michael, I'm gonna have to take, I, I'm doing everything I'm gonna, but I never thought about asking them like, well, why'd you pick where you're at? Right. Like Beverly Hills, why are you in Beverly Hills right now where everybody else is taking on, like Delta Dental right.Kind of thing. starting off, it's hard for them to just fully be. I love you. You know what I mean? Kristine: Right. 'cause you have to build a reputation. And I will say, so, you know, I had a 20 year reputation, before I went out of network. So I admire the people who start that way. But just now knowing what I know, like I said, so many of my colleagues started that way.It's just, you just have to know what you're doing and how to talk about it and how to explain it, and your staff has to know, so, Michael: yeah. Interesting. And one of the last questions I wanna ask you, Christine, is throughout the process, let's talk about from the moment you decided to own a practice till today, what's been some of the biggest struggles or pitfalls that you've experienced?Kristine: Hmm. you know, I can barely remember way back when because it was such a frenzy as we talked about being a young mother or wife, and then owning my own practices. So I think the biggest pitfall people don't understand is the emotional toll it can take because you feel very responsible to your patients and to running this business and to your family because you, you're trying to make money as.to support your yourself and your family. So it can be emotionally draining. And when you work with the public, and in our case it's the parents, because the kids, you know, they can. Scream and cry or whatever. You never blame a child. You understand behavior. You, your goal is to try to make it as good as possible, but people can be cruel.Their parents. So you, I think growing a thick skin is really, really hard. And we take things on so personally because we're providing care. It's what we're doing, we're giving all day long. So, that's a struggle to learn how to, you know, deal with the public You're just, you're opening yourself up to it because it gets, if you get attacked verbally or nowadays, these reviews that people leave for you, we didn't have that back when I started.you take it personally because we all, you know, our practices are our babies, really. And even if you're an associate, you would take it personally if someone said something negative about you because they can go right. Other struggles are time management because it's hard to do it all right.You, you have to find a way to prioritize and then realize that your practice isn't the most important thing in your life. It never can be. It's important because it's your livelihood and you wanna take care of other people, but, you have to put your family and yourself first. Yeah. Michael: When did you, how did you realize that, Kristine: My mother has always had always said about me that she would call me Chrissy.You know, Chrissy, you really work hard, but you're not a play hard too. I think I just always, you know, I don't know how, but I'm kind of blessed with Emma. Positive, optimistic person. But I'm a realist too. I'm not, I'm not like living in some naive world. But, so I think I was really kind of just lucky and I'm, I am an extrovert most of the time.I like my alone time, but I like to be around other people. So I think for me, I never really had a realize it. It just was what I did. I always surrounded myself by a lot of people, friends, family. I just always did. Part of why I think I was good at being a practice owner and a pediatric dentist, 'cause I really like people.I'm not the person who says they like dogs better than humans. I like humans better. I love dogs, don't get me wrong, but I call myself a humanist. So, Michael: yeah. So was there a moment where you started realizing you're going away from that and you started just owning just all about the practice all the time or?Kristine: No, I never made it all about the practice all the time. Mm-hmm. That's my point. I guess I just never did that. I've worked really hard, but I always, three days in the office, four days with my kids, so I was like a stay-at-home mom. But yeah, when they went to bed, I stayed up late and would be at my dining room table doing the ledgers.But it's just the process. I look at it as like the process and the way life, you know, is, and I here's a big thing. Ask for help. That would be what I would say. I always ask for help. I was never afraid to, I'm not afraid to ask other people for things because I know I would do it for them.So many people think they have to do everything on their own, that it makes them weak if they ask for help. So if you're a young practice owner, get a few mentors. Go online now we have Facebook. It's so, you know, for as much as we hate social media, there are some benefits. You have, thousands of people who've done this before, sharing their knowledge with you, listen to 'em because they've been there, you know?So yeah, I, don't know if I answered your question. No, that's, yeah. Michael: Yeah. I love that. And then real quick, for the emotional draining part, Where it feels like we gotta grow thick skin, but still be super loving to the, parents, the children. But even then, when you are, sometimes you're like, we, you were just in my office and you left me this review.How come you didn't tell me that in person or or even just emotionally draining in general, what advice do you have for that? Kristine: it took me probably 10 years to realize that I just needed to get away. I always liked to get away, but I didn't do a lot of that. You know, you don't have the money.You have young kids, you have the practice. Around 10 years in, I'm also an empath and I used to take on every problem of my staff. Hmm. You know, members, I, I would feel their pain and I realized that it was sucking me dry. 'cause I was always feeling everybody else's pain and worrying about their problems.So I got really good at what I call compartmentalizing and putting it where it belonged. I could listen to it, I could feel it. I could understand it, but I had to let it go. I'm not exactly sure, you know, everyone has their own method to do that. But I started just making sure we got away as a family. We went on vacations and I, didn't communicate with the office very much, if at all.Sometimes there was some communication and I always regretted it. I could tell you and So getting away, making time for yourself, and I did a lot of, you know, the catchphrase, self-care, but I early on started doing that even when I couldn't technically afford it and things like I would get, I.Massages. to the point I was doing weekly for many years, but, or at least every other week because it relaxed me, but it also did help with all the neck and shoulder pain from being a dentist and it, the relaxation. I would do girls weekends away and leave my kids and my husband because, Again, I needed to recharge with other things that were just fun, right?So I think that's really important is to take care of yourself. And I do think everybody, male, female, should I. Talk. So if you don't, aren't comfortable talking to your loved ones or your family, or you need outside, you should get therapy. I think that everyone could use therapy at some point in their life.I tend to talk so much. I'd be in a therapist all the time, except I talk out loud to all my friends. So, No, but I do think that's really important for, that goes back to what I said about relying on other people. So many people think they have to be in charge. They can do it all, and they shouldn't have help.I really believe you need help, and I think you need it emotionally. You need it in so many ways. So you just have to find people you trust and can rely on a little bit. We're not islands alone here. We are in communities. So to me, that's the biggest piece of advice I could give. And then, Not to be trite, but really focus on the good in your life and focus on what you do have, not what you don't.And that goes a long way, you know, telling your blessings as they say. Michael: Mm-hmm. Wonderful. Christine, thank you so much for being with us. It's been a pleasure. But before we say goodbye, can you tell our listeners where they can find you? Kristine: Oh, sure. Well I didn't mention this and it's, I hope it's okay. Just recently I did open a consulting company with another dentist and her office administrator, and we're calling it Shero Dental Advisors.So if anyone wants to talk to us about some of this stuff I talked about going out of network and fee for service, please visit us at. Www shero dental advisors.com. Although the website's really still under construction, but you can email us at [email protected] and shero is SS H E R o or you can Facebook message me.I'm Christine, love Peace on Facebook. Many pediatric dentists might know that My website is www.sscdsmiles.com. So there you go. Michael: Awesome. So guys, that's all gonna be in the show notes below, so definitely reach out. And Christine, thank you so much for being with us. It's been a pleasure and we'll hear from you soon.Kristine: Thanks so much for having me. I enjoyed it.‍‍