Keith Miller, president of Partnerships for Dental (P4D), returns to the podcast to share how his organization has grown from two to 40 locations since 2017 —now 41— while many competitors have faltered under challenging market conditions. With refreshing candor, Miller reveals the financial discipline that has kept P4D profitable despite rising interest rates and inflated practice valuations across the dental industry.

At the heart of P4D's success lies a disciplined approach to acquisitions and operations. While competitors chased growth by paying 8-9x multiples for practices, Miller's team maintained strict financial criteria, focusing on practices generating at least $1.5 million with multiple providers. More impressively, they consistently deliver 35-40% EBITDA increases within the first year post-acquisition through supply chain optimization and operational improvements without disrupting clinical staffing.

The conversation takes a fascinating turn when Miller describes how the dental acquisition landscape has fundamentally changed. What was once a robust arbitrage opportunity—buying practices at 3-4x multiples and selling consolidated groups at 10-15x—has compressed dramatically. Today's buyers pay 6-7x while consolidated entities might only command 9-10x, leaving razor-thin margins after corporate overhead. This shift has created significant challenges for highly leveraged groups, especially with interest rates soaring from 3-5% to 11%+.

Miller also shares innovative approaches to post-COVID staffing challenges, including technology partnerships that have cut insurance collection times from 30 to 15 days. The episode concludes with personal insights on wellness routines, including daily ice baths and sauna sessions, providing a glimpse into the discipline that carries through both his business and personal life.

For practice owners considering partnerships or entrepreneurs building dental groups, this episode delivers essential perspective on creating sustainable growth in today's challenging dental marketplace. Visit p4dentists.com to learn more about their partnership approach.

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