Dental A Team Podcast

Many Dental A-Team clients have been able to successfully pull back on days worked while maintaining practice success, and Kiera's here to tell you how they did it (without feeling guilty). Kiera touches on multiple ingredients to scale back successfully, including developing current associates or bringing on new ones, picking a date and making a plan, knowing the ins and outs of your numbers now and in the future, and more.

Episode resources:

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Transcript:

Kiera (00:00)

Hello, Dental A Team listeners. This is Kiera, and today is a great day. I am excited to talk about how to create more and do less. so many dentists want to scale back, they don't want to work as many days. And we have several clients that have successfully been able to go from where they were to where they wanted to be and be able to do it really successfully and not kill the practice. Some do, some genuinely do.

But today I want to work with you and talk to you about how you are able to do this successfully and not call like slow down completely your practice. So I hope you're excited for it. I'm excited for it. Welcome to the Dental A Team podcast. If you're new here, welcome. I'm Kiera Dent. I love podcasting and I love all things dentistry. If you're an OG and you've been here for a long time, thanks for hanging out with us. and for all of you listening, thank you for sharing our podcast and making it one of the top most elite dental podcasts out there.

I come in and I give you guys the best of the best. You go out and you share it. You like it, you review it, you share it with your friends and colleagues. And I just want to say thank you because you know our mission is to positively and measurably, I added a new one, everybody, positively and measurably impact dentistry in the greatest way possible. And our clients tend to see a 10 to 30% increase in production. we just had an office and like their numbers weren't as high as I wanted them to be. I was a little disappointed in it. However, we were doing multi, multi-millions.

And we were able to still grow them 1%. Now you might be like, 1% here, that's not something to brag about on podcast. No, and we're in the upper, upper, upper millions, 1%, and increasing their collections by 3%, and increasing across the board of multi-locations their diagnosis on an average of about 15 to 20% per location and increasing their case acceptance. Those things, well, yes, my first year was not sexy.

It was still in the upwards of 500,000, all in of how much they were able to grow in one year, which is very impressive. but what's super rat is I feel like we gave them the diet, the exercise, and they don't quite have the six pack yet, but they're on their way. So just so you know, our clients tend to see massive results. and also they do that in their life, not just their business. So I guess I care about your PL and your numbers.

I also care about your life PL and how are you living and is this the best life you've got, which is why today's podcast is so fun for me because how do you actually scale back and work less days without destroying it? And like I said, I have a dentist, he's working three days now, about to go down to two days, and the practice is growing exponentially. I have another dentist who's down to two days because that's what she wanted to work, and her practice maintained what she did last year working five days. So, just so you know, she didn't grow.

But she also didn't lose. And so there's ways to do this and there's ways to do it successfully. So I just want you to know that you've got to be preparing for this. We can't just say, like, my gosh, I want to do this because we can't just like delete a day. But I will say that there are a lot of ways that you're able to do it. A lot of times it's developing a doctor, sometimes it's maximizing your schedule. So I want you to know that, like, also when you scale back and you want to step away, please get rid of that like mean girl, mean guy on your shoulder that's saying, like, you're just not gonna care about your practice. Like, no.

You still care about your practice, you still love your patients, you also care about yourself and you want to have the best life. You built a business to have your best life. Your business should be serving your life. And I want you to just keep that as a mantra. Whatever life you want is totally doable. There is no playbook of how to run life. There's your playbook of how you want to run your life. So let's make this business serve your life. So there's a few things that I want to go over today. I want to talk about like the timeline and how you reduce clinical days.

How you can develop current associates if you want to. You don't always have to. Like I mentioned, there's another dentist and she just cut back days and we were able to maintain her same production. And how to like look for other future associates if your practice is not there yet, because there might be certain things that you want to do. So I am so excited for you. I really do like to help dentists become CEOs of their practice, help them become the business owners that they were meant to be, not the business operators, and really truly obsessing about the life that they're living, not just like the paycheck they're taking home.

I think you can have both. I don't think it needs to be an or my paycheck or my life. I think it can be my paycheck, my practice, and my life all together. So let's build this backwards so that way stepping away becomes a planned transition as a so de instead of like it being a production emergency. So number one, I want you just to kind of put a date on the on the calendar. So we love to work with our clients. I follow the traction model, one, three, 10-year goals. What are we looking at? How are we building that? What is your future? And what's that date? this year I said I wanted to be.

Fully in the CEO seat by September. Well, guess what? It's past September and I'm not fully in that seat. So just because I put it on the paper doesn't mean that it's automatically going to happen. However, that is the goal that is the star that is the lighthouse on the hill that helps us get closer and closer. Am I closer today than I was in January when I set that goal? You better freaking believe it. Am I perfectly there? No. Were there setbacks and unexpected things? Of course.

But that's not what, like again, goals are stars to guide by, not sticks to beat ourselves with. And I really want you to take that. I want you to hear that. And I want you to take that mantra on. So we're gonna set the day of where we want to have it. And then all we have to do is work backwards. In our in-person Doctor Mastermind, yes, we bring our doctors and our leadership teams together twice a year. And it is freaking lit, guys. Like I am obsessed. Doctors are telling us it's one of their favorite things Dental A Team's putting on. We just did one of these in September and had almost a hundred people in the room. Like it was just an epic.

Like I love a good brainstorm mastermind think tank version of people that are just there. Like not everybody's at the exact same level. There's so many different people there. But to just learn and obsess and to walk out of there as a better person and to rub shoulders with really smart people and to be one of those really smart people rubbing shoulders as well, like our clients are the best. So that's something that intrigues you. reach out. [email protected]. Come be a part of it. If you think you're one those awesome people.

And even if you're curious or you're doubting yourself, that means you actually are an awesome person. So come reach out, [email protected]. I'd love you to be in the room with us. but while we were there, we were talking about like what their goals need to be and where they need to get to. And it was fascinating because people get so obsessed about their goals and their pieces, but then they have the the how, right? So they're able to talk to other people, they're able to ask other people how they did that, what's the steps that they took.

So that way they're able to learn from other people's decisions as opposed to just needing to do it on their own. So when you're looking at this, put the date on the calendar. What's the date? And we're gonna work it backwards. And that was something I was meaning of at our mastermind. We literally just took this of like, what hours do people want to work? How many vacations do they want to have? What's the production we need to cover our costs? We do this with our clients. We actually build you an annual plan of what is our what do our costs? How much does it cost to run our business? How many days do we want to work?

Got a lot of doctors that want to take a week off every quarter. By all means, let's put it in there. It just changes what we got to produce per day. But that's very easy. Like it genuinely is easy. I said this on the podcast a few weeks ago. if you want to add 10 grand to your practice, you need to add an extra 600-ish. 625, I think is the total dollar amount per day if you're working four days a week. That's it. 625 in dentistry is a couple fluorides, an FMX, doing an extra filling here or there.

It is not a lot. And that's what I just want you to realize is dentistry is so incredible on how you're able to do this. So stepping back can actually be sooner than you thought it was. So I want you to put a date of where do you want to be? Do I want to be down to three days? Do I want to be down to four days? And let's be realistic. Like for me, saying going from like all in to just being in the CEO seat, like that was pretty aggressive. And I didn't stair step it back to say like what specifically needs to happen and when. We have been pushing hard, we've been interviewing a lot of people. And guess what? Some of them work, some of them didn't work. That's just

Okay. Just like you're probably gonna interview associates and they're going to work and they're not going to work. That doctor that I mentioned, who's working three days a week, his practice is booming, he's probably gonna end this year at 5.5 to 5.6. and he's working three days a week. Well, guess what? He had to go back in the chair. We lost an associate. So certain things don't always plan, but as long as we have that guidepost for us, we're going to actually get there with a lot more ease. So what do we want? What does it look like? How many days? What's our production at currently?

And then how are we going to like move things around? Do we need to have more doctors, more space? Are we going to cut some of our insurance plans that aren't paying as well? Be careful. Don't hear that. A lot of you just heard that and you're like, curious that I can cut insurance bonds. Do it strategically. You can if it makes sense. and then what do we need to have financially happen before we're able to make that change? So if you want to go down to three days clinically in 12 months, let's look at your production, let's look at your associate's production or just yours. I do have some, especially female doctors, nothing against my male doctors.

I think female doctors when they have babies, they're like, gosh, like I need to be home with my kiddos. So I need to produce this in two to three days as opposed to working four days. Well, we just look and you gotta increase your dollar per hour. So you've got to get better at your diagnosis. You maybe need to get better at the procedures that you're offering, and you gotta make your days count. I watch this at the dental college a lot. My female doctors that had babies, they could get out of that sim clinic by five o'clock because they had a baby waiting for them and they were on their way out.

Where some of my male doctors shouldn't have to get home as quickly. They were maybe there until midnight. Now that's not a complete across the board. I'm not being sexist at all. I'm just saying I've watched people have this in both sexes where they're able to get out the door by that or they're able to produce more. a lot of times when we're working with doctors, we'll say, like, perfect, we want to cut you down to three days. We have associates. Everybody needs to increase their dollar per hour this quarter by fifty or a hundred dollars. So let's go look for that. Let's see what we can do. How's our diagnosis? What are we diagnosing? What are we closing? What

Like, which lever do we need to work on? And then sometimes they put a star chart up for offices. I know that sounds so silly, but if you're tracking how many days you're hitting your goal, what we track and measure improves. And so we're able to easily increase your production, which then means I can do more in less days. Did you hear that? More in less days, and you get the life you want. So work backwards from your desired schedule and sometimes even just noodling. I remember I sat in a conference one time and they were like,

Dream big. And it was like, you want to have a private jet, how much does that cost? You want to have an in-house nanny? What does that cost? Your dreams might be closer than you actually think they are. And I felt like that was such a pivotal moment for me because I'm like, you're right. Like I don't even know what a private jet costs. I have no idea what an in-house nanny would cost. I have no idea what like having somebody come cook food for me would cost. Like I just didn't know that. And for you, it might not like, well, what would I need to produce per day to work three days and still make the same amount?

Let's just run the numbers. Math is math. And I love it because it actually makes sense. And then you're like, okay, well, right now I'm producing 5,000 a day. Well, if I bumped it up to 6,000 a day, I could cut down a day potentially because I'm making an extra thousand every single day. Maybe it's not quite enough. Maybe I gotta do 2,000 a day to offset that extra day. But math, math. So don't remove this clinical day until we know that the math is going to math. And we're gonna look to see do we need to replace this and bring on an associate? Can we maximize and shorten our days? And ultimately, what's the vision for your practice? Because if you shorten your days, you're probably gonna lose some of your patient base.

Right? Like I'm not here as many days. You can produce more on less people, but may we need to have hygiene running. And so check your state laws to see can hygiene run when you're not there. Looking at those things, those are gonna have it, but put a target on our schedule and an actual date beside it of what day. And then have that on your mirror so you're constantly looking at it. So we get much closer to it. Now, if we're gonna develop an associate, this is a zone of like how like the doctor who's now working three days doing over five million. they

Created a million dollar associate. And we talked about that in our mastermind of what did he do to make this associate a million-dollar associate in one year after hiring him straight out of school? Now, this doctor is a great doctor. We actually had that associate speak. So we had both sides of the coin: the owner doctor mentoring and the associate doctor being like groomed into this. But you've got to, you gotta look at this. What's their production per hour? What does that associate want to make? What's their case acceptance? What's their procedure mix? What's their clinical confidence? What's the patient communication, leadership and team relationships?

And procedures that are still being referred to the owner. You as an owner, if you know that you want to cut down days in like a year or two years, let's start grooming our associate and getting them to be able to take things over. So that way you're able to do this higher level procedures. Your associate's able to still produce and crank and you're able to really grow them into the provider that you need. So if you're doing most of the larger restorative or you're doing a lot of the bread and butter, please don't just dump all that on your associate. They're probably not gonna produce as much and they're not gonna be as happy, but that could work. So

If their day's a $3,500 day and yours is a $7,500 day, well, let's do the math and figure out what we need to each produce that's realistic and reasonable. And then we set those targets for both of you. Owner doctor starts to fizzle out by this date. Associate doctor starts to pick up by this date. We work together right now to get both doctors producing what they need to produce. It becomes so fantastic. And then owner doctor starts to elevate the associate doctor. Owner doctor starts passing some of those procedures to the associate doctor. We make sure associate doctors

Clinical dentistry is doing really well, that their patient case acceptance is doing really well. We refine, we put them into courses, we give them access to higher things. There's a lot of things you can do to really grow this associate. And it's so fantastic because this is where we're able to then figure out what does each doctor need to produce? What does each person need to do to be able to get to the numbers that we're actually looking for? And it becomes like just this fun math equation for you. Math maths. And that's how you're able to do less with more. And sometimes just knowing that number is going to help out.

And getting your associates say, I want you to be a million dollar associate. Let's work you towards that. Let's find out what their goals are. Put them in courses. There's tons of awesome courses that you can do to increase their clinical skill set while you also mentor them. Most of my doctors, when they're doing this and they're wanting to transition, are meeting with their associates weekly. So please don't think that this just comes with a hope and a wish. There's hard work, there's elbow grease, there's things that we put into play to get us to where we want to have. But again, that work is going to pay off undue dividends for the rest of your life.

So let's make that a reality for you. now if you're the doctor who's like, I don't want to hire an associate, I want to cut down days. Fan freaking task, but don't you dare tell me you're annoyed that your practice didn't grow last year. Like, I'm just gonna throw that out there because there's a doctor and they're like, Well, Kiera, I didn't grow. And I'm like, I am aware of that. You are absolutely correct, but guess what? You didn't go down either. So you're working three days instead of five days and you're making the same amount. I say that's a whole freaking win because, well, yes, your numbers did not increase 10% or 20%. You cut down.

days. You got your life back. You can't put a monetary number on that for me, but you were able to do that. And to me, that sometimes we're doctors like recognize that's also a win. And if that's still covering our bills and it's still giving us the life we want and we're able to be with our kids more, that's a win too. So I want you just to look at that of like, all right, what's my base and where am I going? Am I hiring associate? Do I need to develop my associate? How many days do I want to work and what's the production and the the revenue and the take home pay that I want let's do that.

Now let's work it backwards. Let's build that annual plan. How many hours per day? What do I need to be working on? what do I need my associate to produce to be able to offset this? Or what might like what are my days? I'm not here to say that you can't cut your days and also grow your practice. I just know usually your first year doing it, you're not usually going to grow your practice, but we are gonna grow your life. Then after that, we're going to increase because we are seeing less patients. So less patients mean less diagnosis opportunities. It's just math. Like it is. So we got to get really good and we gotta look to see where can we add more new patients.

Maybe we need to cut down insurances, but by cutting it, we got to then build it, right? So there's just not as much space to do it. Very doable, and you are able to do that. But I just want to do some call-outs of realism. Let's make sure we're setting realistic goals as opposed to aspirational that we can't actually achieve. Both are great. Let's just make sure that we're being realistic for it because everybody's happier. So I just want you to think about it. What's the date? What's the target date? What do you need to do? How do we need to produce that associate? And sometimes having a team member sit here. This is what we love to do.

We, as your consultant, get to get you and your team rallied. We can say, like, doctor wants to be at three days. Let's build the plan. There's no guilt. There's no like, my gosh, what's my team gonna think? No, this is your life. We're here to say let's rally, just like everybody else. They want to live their best lives. Let's get your associate on board. Let's help your associate see the goals. Let's run these team meetings for you. Let's help you realize that it is okay to be selfish to live the life you want. That is okay. And you should live that life. So, and then we also help you figure out like,

We did with this other doctor. What does our associate need to produce? What are things that we can help you with? Here are the goals. This is what the reality sells us. Now, how do we make that happen? Let's look at our procedure mix. Let's look at our block scheduling. Let's look at how we're closing cases. Let's look at how much we're diagnosing cases. Having somebody sitting alongside of you can make these goals become so much more real, as opposed to you sitting there trying to like keep drafting the dream without a plan to execute. Your job is to dream, our job is to execute that dream for you with your team.

So reach out. I'd love to help you. [email protected]. But this is a way that you're able to continue to scale your practice while also scaling your time and availability with your kids and your family. Both can be true. You don't have to sell to a DSO. You're more than welcome to, but you don't have to to get the life that you want. So let's make it a reality for you. Reach out [email protected]. Commit right now. I want you to put a timeline on when we're going to be there by reducing clinical days.

Let's figure out what our numbers need to be. And either we accept that we're gonna reduce or we accept that we need to get an associate. We need to get them producing more. And then also we can hire if necessary to get to that future level. I want you to commit to yourself. This is the time for you. I know you're able to do it. And if we can be a a partner in the journey, a cheerleader, or like somebody who's strategically pushing this dream along.

Like I said, not all of our numbers are going to be sexy, but you better freaking believe we're always going to cover our feet and we're always going to get you going. And sometimes we got to build the foundation before we're able to run. That is part of the journey. That's okay. This year I set a goal. I wanted to be out. Guess what? It didn't happen. We weren't able to find the right people. And I'd rather sit here than hire the wrong people. That doesn't come from a lack of effort. Sometimes it just doesn't pencil, but guess what? We at least have the guide rails. We have the guide posts and we're going to get you closer and closer and closer. I know with full confidence.

Probably by end of year, I'll be very close to it. September was a little, that was like very aggressive. I'm okay with it. I also knew if it didn't happen, this is what it is. And these are the zones that I am willing to compromise, but I'm not willing to compromise here. Your dream is much closer than you think it is. So let's make it a reality. Let's make 2027 your dream life. Join us. Like come be in the room with us. Be around great people. Your net work is your net worth. So look to see who your friends are and are those people pushing you forward.

Or they ones that maybe aren't growing you and you're the biggest fish in the pond. Come be a part of it. I'd love to see you there. Reach [email protected]. And as always, thanks for listening, and I'll catch you next time on the Dental A Team Podcast.

This episode is about decision fatigue as a leader, and how to inspire your team to answer their own questions. Kiera talks about why practice owners so often create dependency with their teams, and gives specific steps for how to about-face those problems so that they're being solved without your input.

Episode resources:

Subscribe to The Dental A-Team podcast

Schedule a Practice Assessment

Leave us a review

Transcript:

Kiera (00:00)

Hello, Dental A Team listeners. This is Kiera. And today, I hope owners I'm speaking directly to you. If this resonates with you, hype five. You're not alone. it's the owner interruption problem. Like, why the team keeps pulling you back in when you're like, listen, all of you could solve these problems. And teams, this is for you to figure out like what are we doing and how could we actually fix it so we're not reliant on our doctor because I know you don't want to. So I think that this is something we're like.

Doctors and myself included, CEOs out there. I feel like sometimes being a CEO is death by a thousand cuts, aka being pecked to death by the number of questions people want you to solve on a daily basis. It's called decision fatigue. Like literally, there are studies out there that, like, if you're going into the judge, like if you ever have to go have a judge like determine your fate, you don't want to catch them right before they go to lunch, nor at the end of the day, because they've had all these decisions, they're actually angry and they do worse sentences. Like, truly, there's a study on this.

versus the judge at the beginning of the day or right after lunch, they do nicer sentencing. So if you ever have to get in there, I hope you never do. But literally it is statistically proven that there is decision fatigue. And so if you've got like 50 questions coming to you, you're exhausted, you're like, my gosh, like Jason sometimes is like, hey Kiera, what do you want for dinner? And I'm like, I just look at him, he's like, got it, decision fatigue, I'll figure that out. Like that is part of the game. But if we're getting all these questions, it might not be our team's problem. It might be that we've actually unintentionally trained them.

To follow this process. So a lot of times we think like, hey, this is just normal leadership. Like, I need to be an example. I always need to be there for my team. And the answer is like yes and no. Like there can be both. if we're constantly having interruptions, constantly having little questions come to us, it might be that like leadership systems are missing for you. And so I want to give you guys today like why our team keeps pulling back into these daily decisions where you're like, honestly, you know what type of gluma to order, order it.

How sometimes owners accidentally create dependency, like unintentionally, and like being a founder-built company, I can relate with the best of you all. This is Kiera not coming in here with judgment. This is Kiera coming in with a giant hug and saying, Hey, I see you, I hear you, and let's get you out of that because there is a path out. And then just like some ways for you to stop being the bottleneck in your practice. So, just so you guys know, we're the Dental A Team. We started about 10 years ago. Can you believe it? That's wild. And I was obsessed with all things dentistry, being a team member.

To a practice owner, to a CEO of multi-million dollar businesses, I realized there was a complete gap in the industry where I needed like team members, like what teams need versus what owner doctors need. Like, hey, let's bridge that gap. And so we created a Dental A Team. I'm obsessed with all things dentistry. I'm obsessed with helping doctors and teams live their absolute best lives, learn the numbers, be able to say yes more to the things they want in their life, having your business work for you rather than the other way around. I genuinely believe and I've seen that running a successful practice can and it should be easy for you.

So if you're struggling and you're like, practice ownership is the worst part of my life, reach out. [email protected]. I'd love to talk to you. I'd love to give you guys like free analysis of your practice, like what are some quick few quick things? because a lot of times you probably know the path, but it just sometimes feels like this overwhelm of like, gosh, there's so many things. And sometimes you just need somebody who's not sitting in the practice with you every day, who's been there, done it, done it successfully so many times over to kind of pull you out and say, this is what we actually need to work on. Let's focus on this. So reach out.

[email protected]. I'm obsessed with our practices. We meet in person. We fly to your practices. We do it virtually. You name it. There's probably a different way that we could coach you in your practice. And we do it with fun. Lots of confetti, like not real confetti, but ultimately I believe that life is meant to be fun. So let's have fun. Let's get you successful. Let's help you have the best practice. And realistically, I'm so glad you're here listening. If you're obsessed with this podcast like I am, leave us five stars, share it with a friend. That is the way you're going to help us get into the hands of every practice out there and just know.

That is a massive, massive, massive thank you from me for all of you that have followed us that have been a part of this journey. And if you're new, welcome. If you're an OG who's been here since the get-go, welcome. I'm obsessed with you and I'm rooting for you, and I'm your biggest fan, and I hope you know that. All right, let's get into it today. We are not going to be having every decision land on your desk after today's episode. All right. So, step one, I think back to this. I remember there was a girl named Ashley that I used to work with. Ashley was awesome.

All I did, like she'd given the information out, but I knew if I just texted her or emailed her, Ashley would get it right back to me so fast. Fun fact, you probably are the Ashley in your practice where your team comes to you, Doctor, you're the best, you're the fastest, you're the easiest answer. I know if I come to you, you're gonna give me an answer. I know that you can have it. I don't have to like wait and wait and wait and remember to follow up with you. So we've created this dependency because the problem is that speed creates dependency. If I know you're the fastest path, I'm gonna go to you. Just like when we were kids, am I gonna go talk to mom or am I gonna talk to dad? Who am I gonna get the best answer from?

That's who I'm gonna go talk to. Same thing with your team. They're going to like so what it looks like is a team member comes and asks a question, doctor immediately gives an answer, team member returns tomorrow with another question. Does anybody like you feel like you're on freaking psycho? And you're like sitting there trying to do your notes and like hey doc, what about this? And you're like, Yeah, yeah, yeah. And you're just doing your notes like you're on autopilot. You think that you're doing the best for your team I'm getting them the answers. Absolutely not. Because now your team stops critically thinking.

confidence decreases. They feel like they always need your approval. You are the one who knows all the answers. And owner becomes a solution to every single thing. Trust me, I've been in this boat. Sometimes I'm still in this boat so much. So one of our team members, literally this week, she sent me a slack and she's like, Kiera, I feel bad bothering you about this. What color of pens do you want? And then she slacked me again and was like, I don't know why I'm bothering you about pens. You're the CEO. Stay out of the weeds. I got this. And I was so proud of her and I was so proud of myself because guess what?

For so long I have been the answer person. Being a founder who starts something, like you're the one, you're like, you gotta be the scrap who knows how to do everything. But morphing into the CEO, like, you want to become the CEO of your practice, get out of the weeds. Get a team that can make these decisions for you. And a good way is to push back and to say, like, hey, what do you think is the best answer for this? Because when I stop becoming that fast answer, they don't wanna come to me. And I like, if Ashley would have just put up a little wall and been like,

Well, she did. She did one time. I remember I was like, Hey, Ashley, can you send me this stuff? She's like, here it's in an email. Never went back to Ashley. I was let me go check my emails first because Ashley's gonna make me go check my emails. She trained me, just like you, doctor, to like, hey, what do you think? Or hey, is this in our operations manual? Or hey, I trust you, you've got this, go make the decision. It was fascinating because there was another office that I just worked with and I was on a call. So like they were talking to us about working together consulting and

It was an office manager and a lead hygienist, and they were on the call. And I was like, Hey, does your doctor need to be here? Because I know most of the time team members can't make these kind of decisions. And they're like, No, our doctor's worked with us for 18 years. We know we got this. He trusts us to make this decision. I kid you not, later that day they came back to me. They're Yep, we're signing up. I have not spoken to that doctor one time and they have signed up. They're working with us as a client. And I thought about how crazy cool that there's a doctor who's given that much autonomy.

trust in their team. They didn't even go ask, like they talked to them a little bit, but they were able to make a very large decision for their practice. And I've never met the doctor. So my question for you is like that team knows how to be critical. They know how to ask the best questions. They know how to ask the best answer. And kudos to that doctor for empowering the team to like be autonomous and to own it. Like I was like taking notes over here. Let me take notes from that doctor because I was very impressed that this team could literally make that type of decision. So when we have this

I would recommend that every single time that you have a team member come to you, and this is hard. Like to me, this is like weight training. Like I hate doing bicep curls. I half the time I try to cheat and I only do like halfway up. I don't want to like go all the way down. It's like, no, no, no. We need to flex it. We need to strengthen that muscle of having our team be able to make independent decisions. So I don't want you to be the fastest answer. I don't want you to always be the answer. Your team is never going to learn to solve. So this week, when a question comes to you, I want you to ask them, what do you think we should do?

Just start asking them. If someone slacks you a message, write back like, hey, what do you think we should do? They will critically solve. We need to give them the power to do that. And you need to retrain your team because you train them that you're the number one. And you need to train them, like, no, you're the number one. Like, think about that doctor. That's why I want to give an example. I was beyond impressed with this other doctor of like, you literally have given your team so much ownership that they feel like they own this practice. They're making the best decisions. That doctor was nowhere to be found. Kudos to that doctor, and I think a great example of someone who in real time has done that.

Okay, number two, clarify ownership. So decisions have a home. So a lot of times it's like, I don't know who owns this. So I doctor, I'm just gonna go to you because you seem like the easiest person. This is where like an org chart or an accountability chart really comes into play. And I'll tell you what, this is like a swear word for me. I absolutely hate accountability charts. Org charts, I feel like I'm constantly reworking them because people are like, well, who do we ask for this? And I'm like, go back and look at like I have to have ours printed out. We've like shaken our whole company up. And you gotta have it where people just know, like, who do I go to for simple issues?

When I work with teams on quarterly, I ask them, like, all right, who do I go to for ordering? If they all can't give me a unified decision, I know we've got a a problem there because they don't know who to go to. If I say I need PTO, who do I go to? If I say, Hey, who does this? In our company, I started doing this and they're like, I don't know. I was like, cool. We got to clarify this, and that's why decisions are coming to me or to other people, because people don't know who to go to. So we gotta like watch out. Are they escalating simple issues? Are we constantly having our managers ask for like routine decisions that we have already told them, like, you're good to go on this?

constant uncertainty. Well, great. We need to define what ownership looks like clearly, who to go to, like who owns this outcome, and like what are the decision making boundaries? So for example, like that practice, they were allowed to make like up to $100,000 decisions. Like fantastic. Our consulting's not a hundred thousand, it's less than that. But that team was able to make these decisions of a hundred thousand. For you, you might be like, I've never given away that much. Maybe it's 5,000, maybe it's 500, but let them make decisions up to a certain amount where they don't need to come and ask for your approval.

Also from there, ask them like, are you good? Like, you got this, like I trust you, like you got the decision, make it. So instead of you having like all the follow-up on you, have people own outcomes. So there's two parts of this, like on an org chart, who is responsible for this and having the KPI or the outcome. So like your treatment coordinator owns schedules full and case acceptance being there. My scheduling coordinator owns hygiene full and how much are hygiene schedules there? My billing coordinator owns 98% collections and less than one month's worth of AR in there.

Also, anything that comes with billing, I go talk to Sarah. Anything that goes with treatment planning, I talk to Johnny, like whomever it is on the team, but it's their outcome. So they know what's expected of their role. Plus, me as a team member was like, who calls on unscheduled treatment? Johnny does because they're over treatment planning. Perfect. I know I can go ask for this. Like, what happened with this patient who didn't get this done? Who's over labs in your practice? Who's over ordering? Who's over ordering for an office? Who's over ordering lunch? Doctors and office managers, if you're doing it, you're doing the wrong thing.

Have somebody else, someone else can do this job, have somebody who's like the party guru of the practice where they do the birthdays, the anniversaries, the lunches, like have them take care of that. So you never have to think about here's the budget, take care of it. We have someone on our team who does it for us. And she's like, here, what do you want? And I'm like, I genuinely don't know. Like this is a decision I don't want to make. What's the budget? Girl, I trust you. Rock on, go for it. What protocol is missing so that way you have full autonomy. She came back and she's like, hey.

My budget doesn't tell me how much I've spent. Is there a way for me to figure this out? Cause I really want to own it and never have to ask you guys questions. I feel like the angels say, I was so proud of her because I'm like, she's critically thinking, she's thinking about what she needs to do because she wants to make this decision independently. Rock on. Let's give her this runway. Here's some solutions. You got it. You you can take care of it. As much as I can give ownership the clear outcome, what do they own? What's the budget that they can go up to? Beautiful. Because when everything belongs to everyone, nothing truly is owned by anyone.

So let's make sure there's a clear owner who to go to. So this way your team's not constantly coming to you. They will come back to you until they feel like they know who exactly to go to. So I would just look to see, like, you can even write down like what are all the questions coming to me that might give you and that you're like, here, I'm never doing that. Listen, we have AI now. Just put on your phone, have every question come through, pop it in there and say, which are my common topics? Like, what do I need to look for? That's gonna help you tremendously. But genuinely.

Build an org chart, put accountability things, what's the KPI associated? Who do we go to? And then play popcorn in your team at Morning Huddle. Hey, I need to do PTO. Who do I call? Hey, my kid is sick. Who do I call? What's the protocol for that? Hey, we broke down the computer system. Who do I call? IT broke down. I need to order these supplies. We are over budget for something, but I need an approval for something. Just ask those questions and see: does the team know who to go to? And if they say doctor, doctor, doctor, doctor, doctor.

You've got a problem. You got to retrain them of who to go to and give that power and authority to someone else so they can work and not need your your constant oversight. for me, there are rules. Anything that's gonna sue us, anything that's financial over X amount, and anything that's gonna be reputation management of like those are no-go's. I will still have stamps of decisions. Everything else beyond that, let's give you a budget, let's give you the things, you guys have it. Things are going to have mistakes, but I'd rather my team do that than be peppered by a bajillion decision. Choose your heart. It's your your choice. All right.

And then we want to build leadership layers before you need them. So a lot of times doctors like think, like I'll tell you, my first leadership team was me and one person meeting in like an apartment lobby. I kid you not, that's where I had my first leadership meeting. I didn't know what I was doing. But you don't need to wait until you have a large organization to build leadership. You can have leadership put into place before you become overwhelmed. And a lot wait till they're overwhelmed and it's like, I need you. I need you to take care of these items. So when it's broken, it looks like every issue comes to the owner.

Office managers don't have authority, so they're always de like, doctor, what do you think about this? Like the office manager should be able to make decisions with and without you that you can like confidently feel good about them. The team waits for approval rather than taking action. So if you have that, every decision is primarily coming to you, office manager lacks authority and team waits for approval instead of taking action. We know we don't have the leadership layers in place and doctor is gonna keep coming back to you. So instead, the flip side of that coin is we have team leads.

We hold leadership meetings. We empower decision makers. So like let them have the autonomy. Let them see how they're going to make decisions. It might not turn out right. And for me, this is like, cringe. I absolutely like loathe it. I really love things to be a certain way. I love my house to be a certain way. I love my life to be a certain way. Like I and it has unfortunately gotten worse and worse and worse. We didn't have kids and shoot, blessing and curse. I feel like I've gotten like, I can have my life exactly the way I want it to be. That's not super beneficial for a team when things don't always go that way.

But the answer is you've got to have this in place. And me having a leadership team, like these are your leads. We remind them all the time if you've got questions in these areas, here's who you go to. So that way they can move. The team feels like they're not waiting for you. And as your team gets larger and larger, used to be me and one team member, we had like four team members. Now we've got like twenty five across different like states, and we've got people in other countries. It's getting larger. Your practice might have more. I've I teams that have fifty plus people. I've got teams of a hundred plus people. Like this is something where we build today for future.

This accountability. So create a leadership team and have weekly meetings. Help them see, like when an issue comes up, doctors, sit back and be quiet and let your team like I have to really like pick me, pick me. Like I'm so used to having the answers that I have to sit back in leadership meetings and see how would my team process and give them like, hey, this is your realm. What do you think is the best thing for us to do? This isn't my job to solve it. This is your job to solve it. And I need you to own that. You really empowering them, but you will see there will be significant time in your day that you're not spending.

on solving problems. And if you're nervous about how people are solving it, ask your office manager to give a rundown every single week. Like, hey, where are we at with things? Until you know that you're synced up on how you'd make decisions. And I want to really caution you that just because they make a different decision than you does not mean that it's a wrong decision. So be really cautious and watch yourself to make sure like, hey, is this just me being nitpicky or is this really a big zone that needs to be taken care of? The goal is

is for you not to be needed for everything, is to build a team that can thrive without you. And this is also where I'm really big on you taking vacations. Go take a vacation, see what breaks when you're gone, see what things fall apart. Send your office manager what breaks when they're gone. We need to have people gone to see what breaks down, to see what systems protocols, more decision making authority that can be made. there's an office manager I remember and her doctor, unfortunately, got hit on their ride home on a bicycle. They lived, don't worry, but they had to go through a ton of hospital

And this office manager had to jump in and just start making decisions, how to hire an associate, what things to do. This office manager has kicked it. And I'm so proud of her because she literally jumped in and saw, like, I gotta start making decisions. And this doctor giving the autonomy to this office manager, like, that's who you want. Like if something happened, could your office manager click in and make all those decisions that maybe aren't the same as you, but you know it's gonna take the practice in the best direct direction? That's the type of person you want next to you. That's the type of leadership team you want to create and foster. So

Choose a leader in your practice and like help them, like all your leaders, help them create their decision-making abilities this quarter. So a quick recap of that, stop being the fastest answer. Instead, ask them, hey, what decisions like what do you think would be best for this? Clarify ownership, make sure everybody has an org chart. We know where it's gonna go, what everyone's outcomes are. And then when someone comes to you, be like, Am I the right person for this or who should you be chatting about with this? Ask them, they'll go. They'll start to like reroute their path. And then the other one is build a leadership layer. So start to help those leaders.

Have the decision-making authority, make decisions, get that muscle built where they really are refining that, and you're going to have it. This is something where, like, you getting bombarded all the time isn't a sign that your team's incapable. It's a sign that you've trained them that way. Hi, I'm Kiera. It's nice. I like to speak honestly to you. You've trained them that way. And the good news is if you've trained them that way, you can retrain them into a different path that's easier, that empowers them, and it makes them actually a lot happier of teammates. So the more ownership your team has, the more freedom you gain.

And I really hope that you take that on. The more ownership your team has, the more freedom you gain. So empower them, trust them. And if you struggle with this, sometimes doctors, it's hard to get out of your own way. And I love our team to be a mediator for you, to say the things that like I just said, hi, I'm Kiera. Like that's that's that's a you issue. but let's let's work through it in a way that's very professional, very complimentary, but also helps you get out of your own way and empowers your team to do this. We've trained that office manager for about eight years who took over her doctor's practice and

Doctor's doing great. The team's doing well. It's a very large practice. And they didn't skip a beat. So hey, if you want our help, reach out. [email protected]. This is your life. This is it. If you feel like your practice can't function without you, it's not a people problem. It's a leadership opportunity for you. So reach out. The best leaders don't create followers. I've got this over here. A sign of a good leader is not how many followers you have, but how many leaders you create. And that's by Gandhi. So think about that. How many followers do you have versus how many true leaders do you have that have decision-making authority and are making decisions?

Think about that. And hey, if you need help, reach out. We're your friend in the dental world. We're here to make your life so freaking happy and exciting. So reach out [email protected]. And as always, thanks for listening. And I'll catch you next time on the Dental A Team podcast.

Feeling a too-light schedule load lately? Tiff is joined by DAT podcast first-timer Diana to share the secret sauce for killer referral systems, and how to design one that works for your practice and grows from the patients you already have.

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Transcript:

Tiffanie (00:01)

Hello, Dental A Team listeners. We are here with you. You have me, Spiffy Tiffy, that is one of my favorite nicknames that Miss Kiera Dent has ever given me uh with you today. And I'm so excited to bring someone new on with me. We actually, I just realized this morning that I haven't had Miss Diana on with me yet today, or yet at all. So today is her first recording. I want you guys to give her a giant welcome. I hope you're hooping and hollering in your cars.

or your offices or your bedrooms or your shower, wherever you're listening to this podcast, because it can be done anywhere. I hope you are giving her the warmest welcome. Diana is fairly new to our team as of 2026, but she's been a consultant for a while and she's been in the dental industry for long enough to um know way too much about dentistry. So

Diana (00:49)

Yeah.

Tiffanie (00:50)

I'm excited that she's a part of our team. I'm excited that she's here with me today and personally, Diana

is like super close to me, so hopefully one day we actually make it to get together. She is here in

Diana (01:01)

Yeah.

Tiffanie (01:02)

Phoenix. Diana, I would love it. I love you dearly and I'm just so happy you're here. So Diana, thank you for being here. How are you doing today?

Diana (01:10)

Thanks for having me, Tiff. I'm doing really well.

Tiffanie (01:12)

Yeah.

Diana (01:12)

How are you?

Tiffanie (01:14)

I'm wonderful. It is beautiful outside

Diana (01:16)

Okay, good.

Tiffanie (01:17)

and I can't complain. I feel like it's getting hot again though. I know. I know.

Diana (01:19)

We've got great weather today. Uh let's hope that doesn't happen. We are at like

a really good place right now with our weather. So let's not let's not make it mad.

Tiffanie (01:29)

I know. And there's like ants outside, you know, we go on our little walk and there's like I'm like, what the heck? There's so many ants. My fiance's like, Yeah, because they think it's spring. I'm like, that's fair. We did just get so much. Yes.

Diana (01:37)

My daughter saw a worm on the ground the other day. She had

never seen a worm before 'cause it never rains in Phoenix.

Tiffanie (01:43)

Yeah.

Diana (01:43)

And she was like, my gosh, it's a worm Like, Yeah, those are that's normal.

Tiffanie (01:49)

For those of you listening who are not in Arizona,

Diana (01:51)

Mm.

Tiffanie (01:52)

It is November right now and most of the country is experiencing beautiful fall weather. The leaves are changing colors, you're like snuggled up in your cozy clothes and you're just loving life. And we have flowers blooming and worms coming out. And we have our second spring of the year. So

Diana (02:12)

Right.

Tiffanie (02:12)

and then it's gonna be dead cold. By dead cold I mean like fifty six degrees. So that's fine.

Diana (02:18)

Mm-hmm.

Tiffanie (02:18)

Anyways, cold for us is

cold for us. Anyways, Phoenix is amazing. If y'all want to come visit, come visit. We do as of the recording, the time of this recording, um, we do two masterminds here in Phoenix where our doctors and our office managers come visit with us. You get a full day and a half revamp of all kinds of stuff. There's so much stuff that we do. So if you're interested in visiting Phoenix as of right now.

That's where we're hosting them. reach out, [email protected]. We'll be happy to have you here. Diana, I'm excited about today's topic because for me personally, selfishly, a lot of my clients this week, this week um is call week. A lot of my clients have been down in new patients very like for months. Our new patient trend has been down. And a lot of my clients have been experiencing like lighter schedules.

October, September seemed to be fine. So September may not be a thing anymore. It might be a thing of the past. But October, I had some offices that really struggled and specifically my pediatric practices seem to be struggling. But so today I'm excited to pick your brain. I know that you've worked with a lot of clients, um, not just in Dental A Team. I know you have a lot of clients with us. So if you're lucky enough to work with Diana, you're welcome. Um

But also outside of The Dental A Team, you've worked with a lot of different practices, different types of practices, a lot of dentists and teams. So I really wanted to pick your brain today on some things that you've seen work that we can share with the listeners here on really building and designing an awesome referral system. And I think marketing chooses our topics, just FYI. And I love how they worded it today.

They didn't say like how to get new patients. It was like a referral system because no matter what, our patients are coming to us by referral of some way, whether it's internal, external marketing. So I just I really appreciated that. So how do you suggest and how do you work with your practices, Diana, on really designing that referral system to generate those new patients back in the practice? What are some tips you have?

Diana (04:30)

Yeah, absolutely. So I am a I'm so big on how a referral should be a byproduct of an exceptional experience at your practice. Um and I compare that to really anything in life. If I'm driving down the road and I see a billboard for a new restaurant, yeah, that restaurant looks really great. Um and I might see an ad in a magazine or an ad on TV or an Instagram. Um, but the best restaurants I've ever been to have come from someone.

Saying, hey, you've got to go try this new place down the street, right? Or

Tiffanie (05:02)

Yeah.

Diana (05:02)

my favorite steak is from this one steakhouse here in Phoenix, right? So referrals come from a another patient having a really great experience. And so, you know, my number one focus when looking at referrals is looking at your internal referrals. And I do think a majority of your new patients should be coming off of internal referrals. Um

And so I've made a couple notes about like the top four, four to five things really um that are really gonna make that system work for you. And the first one I love to talk about is like just look at who you already have. Who are those top 25 to 50 patients in your practice who love your practice, who show up on time your appointments, right? They pay for the services you give them.

They're always like chucking in with you. Oh, how was your day? Like you guys are having honest conversations. They've been patients with you for a long time. Their families come to you. Those are the patients that we want to work with, and those are the patients we want to build off of. So use what you have, use those patients, get to know them better, get to know where they go golfing, where they frequent um, you know, what restaurants do they go to, what schools do their children attend.

Those are the kind of things that you wanna take. So you're actively listening to them and you can have honest conversations and you can relate and you're building that trust, but also you can use that in the future to kind of build off of that. Go to those schools, right? Sponsor those schools, go meet to those, go to that restaurant, drop off some new patient referral cards, right? Work with those businesses and find find a way to connect with those patients and honestly.

Just asking them for referrals too, right? Those kind of patients are the ones that you want and you want more of versus the patient that might be late, you know, chronically late, never pays, never, never shows up on time. You're constantly have having to reschedule. So my first, you know, the the first thing I would say is look inside your own company. Who are those patients and build off of those? Um yeah.

Tiffanie (07:07)

Yeah, I love uh we had a

um I don't know if you probably remember this. We just actually spoke about it last night on our doctor's only mastermind, which everyone should know every Tues every first Tuesday of every month. If you're a client of Dental A Team, we do have a doctor's only mastermind. So I hope that you're joining that doctors. if you're not, reach out [email protected] or your consultant and we'll make sure you get that link. Anyways, we talked about it last night, so I'm sure you remember. There was a doctor who came to our

in person mastermind in September who said that she takes this like giant cookie. I think it was to the person who referred or it was to the new patient. One of the two, either way is phenomenal. But she takes this giant cookie as like a thank you and it has the um office information on it, but it has like a thank you so much for referring to our practice, like we're whatever it is to the person who had referred or to the new patient. And I thought in conjunction with what you're saying, like target those people

or highlight those people that you want and those people who are already referring to you and do something that's like grandiose and exceptional that makes their their experience even better. Because I

Diana (08:16)

Right.

Tiffanie (08:16)

think to your point, Diana, that helps promote their uh desire to recommend it. Because again, places that I've loved came by recommendation. And Diana makes me think, and we'll get to your other ones, I promise you. Um

But you like sparked some thoughts. It makes me wonder how much of our affinity towards that service or that restaurant, like wherever we were referred to, I wonder if part of the affinity towards that place comes because a trusted person in our life recommended that place. So we're already going in with the filter that this place is going to be great. So while it might not be the best steak I've ever had in my life.

I've already decided that it probably is, and I love it because someone told me that that was the experience I was going to have, because that was the experience they had. So you like subconsciously put on this filter, and it could change the experience if I had found that place on my own. No recommendation. My experience might have been different. It's hard to say, I don't know, but psychologically I feel like that would be

like an outcome of having those referrals sent by someone who's experienced it. But then on top of that, to your point of an exceptional patient experience, making sure that every patient gets that consistent experience because what really sucks is when you go in even with that filter and you go and the place sucks. Maybe you got a different waitress and it was like the worst experience of your life and you're like, Diana, you're crazy. I can't believe you love this place.

And the referrer is like, my gosh, I've never recommended you know what I mean? Like so when that patient experience differs

Diana (10:05)

Right. Right.

Tiffanie (10:08)

and they're getting something less than what they were told they would, that's a huge aspect too.

Diana (10:14)

Yeah, absolutely. I mean, making sure that patient experience right off the bat is good. And it's always going to be constantly changing in your practice. That's, I think that's the beauty of us going into the practices and having that option to go in. Um, because we can, you know, one one office might think they do have that exceptional experience and we're able to like pinpoint things that they're not seeing because then they're in there every day. They're thinking, yes, this is great. Um, and we're able to look at it from a different um viewpoint.

but the point of that is creating such an exceptional experience that those patients are coming back to you. They are paying their balances, and then they're referring and telling people about you. That's what

Tiffanie (10:53)

Yeah.

Diana (10:53)

you want. And that it all starts with just having the best experience possible within the practice. Um, and it's connecting with your patients. I always say it's not what you know, it's who you know. And that's really important in this scenario of like.

Those 25 to 50 people, get to know them, ask them questions. A, it builds trust within the appointment, right? They're more likely to say yes to treatment, they're more likely to come back. Um, but then you're also gaining so much information that you can use later on down the road as well, right? Like, what where are they going? What are they doing? And like, how can we build off this relationship?

Tiffanie (11:30)

Yeah. Yeah. I love that. And building that, I know you've got some more pieces to that, but building that like into your daily routines to spot, audit, and look for those people is part of that too. And to your point of like us coming in person, we're able to see where are we consistent with any experience and then where are we inconsistent and something just to not to totally derail us, but like my side asterisk for the listeners, like I want you to check.

your stuff, watch your patient experience because what I have seen in my years of consulting is a stellar new patient experience. And all of our focus goes in on the new patient. And then the recare is like we're running behind or they don't get the cookie. We're out of cookies. We're out of chopstick. Like they're not, they're getting like a less than stellar

um experience because all of our focus is on the new patient experience. So I like Diana, and you used this earlier as a patient experience, making sure no matter what, it's consistent across the board, that's how you're going to continue to generate that. And to your point, Diana, that's your referral system, right? Like it's

Diana (12:42)

Right.

Tiffanie (12:42)

literally built in. And then you're ensuring that the team is looking. Yeah. Yeah. Yeah. So I'll let you keep going. I there's other pieces you've got

Diana (12:45)

It's the consistency. Yeah. Yeah. No,

yeah, that's great. Um, it is the consistency. But um, and just to piggyback off of that, the second point I was gonna make was build the referral build your referral system into your existing appointments. So the best referrals come from like unsolicited c compliments, um, and just those a little bitty, like tiny expressed gratitude like bits of gratitude, right?

Anytime a patient says, like, that didn't hurt, or my gosh, my teeth look great, or um, gosh, I didn't feel a thing, those are compliments, right? Those are, those are key indicators, like those should ring a bell in your ear of like, aha, right? And that should be your like trigger to say, Oh my gosh, that's such a great compliment. If you have any other family or friends that, you know.

would enjoy this experience, we would love to welcome them in our practice, right? Or something along those lines. Just asking, right? There's no harm in asking. ah But just building that into every single appointment of, you know, and there are going to be some exceptions, right? Like we're not going to have 100% all the time like every patient is happy. But you majority of the time patients are happy and they're not going to be like, my gosh, this is the best ever. They are going to say little things that are going to trigger you to ask for that referral. And that should be built into every single appointment.

Um and then identifying opportunities in your morning huddle. So, and I, you know, I talk about this a lot. Morning huddle is so important for many different reasons, but I do think it's that time of day to prep, um, prep for the day and get a lot of things out of the way that are not going to cause like logistical problems or you know, it's just gonna create a smooth day. And one of those things is identifying opportunities in your day to ask for referrals, right? Who do we have

Tiffanie (14:33)

Right.

Diana (14:34)

coming in today that we haven't asked for

asked for a referral from or what new patients do we have coming in? Do we know where they came from? Do you know how they heard about us? And use that as well, right? So

Tiffanie (14:47)

Yeah.

Diana (14:48)

make sure like during a new patient appointment at the end, you're giving them a referral card and you're asking them to send you new patients. And on top of that, once they do refer to you, which is my next key point, is what are you doing to give back to them? Like what are we doing to return the gesture?

And you know, I know so many offices out there talk about um, you know, giving them a credit or, you know, giving them some type of gift. That's great. Um, and I I pretty much keep it simple in this of like a handwritten thank you note is probably the best gift you can give as well. Um, even, you know, I've taken my dog to the vet before, like when he was really sick. And the best thing I got from that, where I always refer to this one vet, even though he's 30 minutes away from me, they sent me a handwritten.

letter like we're so sorry this happened, right? We're gonna take good care of him. Like we're here if you need anything. Things like that are so important. And the handwritten gesture is just it's over the top. Um it's so much better. And it shows the patients that you've taken the time to sit and write something out. It doesn't have to be a long letter, but just a simple thank you. Thank you for sending us your referral. You know, we love having you as a patient here. Um

So yeah, I think, and that really is like closing the loop. And there are so many things I know we're

Tiffanie (16:07)

Mm-hmm.

Diana (16:08)

gonna get into talking about, but those really top four like starts with the experience, knowing like knowing who those top patients are, networking with them, building it, building that system of asking into every appointment. Um, and then identifying it in the morning, prepping ahead, knowing before the day starts who you're gonna be asking, and then closing that loop of thank you for sending them to us.

Tiffanie (16:31)

Yeah, I love all of those. And there are a million ways like to do anything, right? So we could talk about literally anything here. Um, but I think you highlighted some really amazing pieces there of really taking a look at your patient experience, your service level, your commitment to excellence, I think during the appointment, pre appointment, during the appointment, and post appointment. So really looking

I think is that system design? I think you nailed it, Diana. I think everyone here needs to go look at what are we doing prior to a patient's appointment? A new patient and a recurring patient, like our reactive or our recare patients, what are we doing prior to their appointments to ensure that they're prepped and ready? Are we, you know, making sure that we're confirming? Are we using great verbiage? Are we standing out, like you said, to your point of?

Getting a letter in the mail in return, that's exceptional. I had actually uh I needed a plumber today. I was actually I needed a plumber for a while. Um, but he came today. And I called her this morning, I called the number, just Googled, looked for the best reviews, by the way. Best reviews, most reviews, so make sure your reviews are there. Uh and I called and she was wonderful. The lady who answered the phone was like, Hey, great, how can I help you? Her name was Tiffany.

And I said, My name is Tiffany. So of course we hit it off there. And I said, Hey, I need I need this disposal looked at. Like, what do we've got? And she's like, Awesome news. I actually had an opening come up this morning. I can have them there sometime between 9 and 11 today. And this was at 8 30. I was like, phenomenal. That sounds great. She said, Great,

Diana (18:14)

Right.

Tiffanie (18:15)

let me get you in my system. She said, Is it an Y or an IE? I said, Your name must be Tiffany with an IE, because nobody asked that question. But that was the like above and beyond, like.

Let me get the name correct. Let me get you in this system. She walked me through the steps and I said, I said, I found you guys because of your Google reviews. And you know she said, Diana? This is case in point to your um your handwritten letter. I said, I found you guys because of our go your Google reviews. And she goes, you know, you could tell she just stopped. She goes, Our customers are so incredible. They leave us the best reviews. They are so

Diana (18:48)

Right.

Tiffanie (18:48)

kind. They refer people. Like the moment that I said,

Google reviews, it wasn't like, cool, awesome, I'm glad they're working. Which I've said that, right? Like, cool, awesome. I'm glad they're working. That's why we want to make sure they're there. It was she paused, she took a breath, and she was sincerely grateful for every review. They have 208 reviews for a plumber. That's wild. And she took a moment and she literally just sat there, like so grateful for every review that they had. And I thought, she's doing that.

Also in response to those reviews, like she's making sure

Diana (19:24)

Right.

Tiffanie (19:25)

that the customers, which aka would be your patients, know and understand like how valuable that is as a referral source and just as a gratitude and a thank you. And I think if we take a little piece of that to your point of like going above and beyond, like it's so easy to get busy. She literally just slowed down. She said, Yeah, we have incredible customers. And she was like, I'm so excited.

To add you. Like I'm so excited that you're in the schedule today. So you're gonna get a text. She walked me through every step. It was the best experience of my life. And it was a plumber I found on Google this morning. But that's that

Diana (20:01)

Right.

Tiffanie (20:02)

experience, right? Making sure that no matter what, the patients are getting this exceptional s service and experience and you're acknowledging all the pieces along the way, which is something I think you did a great job at acknowledging today.

Diana (20:16)

Yeah, thank you. And I again, you're a hundred percent right. It is the experience. And you know, if if I have a friend that's coming from out of town to Phoenix, I could give them five restaurants of like, if you're hungry here, just go eat there. Or I

Tiffanie (20:31)

Yeah.

Diana (20:31)

can give them five of my like top restaurants. I have a Google, like I have a notes sheet in my phone and I like I have it by city, I have it by like area, I can tell you where to go because I know that they're gonna take care of them, they're gonna offer them the best service.

And that's where referrals come from. And you can add on to that. Like we're just giving you the skeleton of it all. You add the meat and bones of, you know, what do we do after? Do we send them a cookie cake? Do we go to their practices? I'm sorry, their businesses. Do we, you know, follow up with a $50 credit? What does that look like? What are we doing for the experience within the office? Um, you all are responsible for doing that part, but it's the biggest issue, the biggest concept of all of this is just making sure it's consistent.

Tiffanie (21:14)

Mm-hmm.

Diana (21:15)

Um,

making sure it's implemented everybody knows how to do it and that the patients just they walk out with a smile and they are ready to come back and they're ready to tell someone else.

Tiffanie (21:25)

I totally agree. And with that, I think those are your action items, you guys. It's

Diana (21:29)

Yeah.

Tiffanie (21:30)

evaluate. Uh I think identify, like Diana said, identify those patients. And I would like Diana said, identify every day who's coming in today that we can ask for a referral from? Who's coming in today that we can personally thank for a referral, even if we've already thanked them? Like, hey, thank you again for sending Joanna. Like she's been such a pleasure in our office, right? Like, how can we identify those people in Morning Huddle?

What can we say to them? Get your verbiage right. And then identify areas where you can ramp it up on your experience, your patient experience, not just new patient, because you want everyone referring to you. So I think those action items, identify the people every day, identify your experience. And then my last one, and Diana, if you have more to add, add it. But my last one would be to identify your thank you. How are you going to respond?

to the referrals to show your true gratitude and inspire more referrals back to your practice.

Diana (22:27)

Yeah, I love it. And now that we're thinking about it or we're talking about it, last year I had a really good friend call me and she said, I need a new dentist for my daughter. And I said, Yeah, I'm gonna send you to our dentist down the street and didn't think anything of it. And two weeks later I received a handwritten thank you note with two free ice cream scoops from our local ice cream parlor down the

Tiffanie (22:48)

How cute.

Diana (22:49)

street. And I just loved it. Um so that and I wasn't looking for anything, I didn't even think anything of it.

I don't even know how they knew it was me, to be honest. But um yeah, I mean things like that, that's like, yeah, I'm always gonna go back to that dental practice just because I love that. They're so sweet. They add those personal touches. Um so find where your personal touches are and create make that part of your experience and the referrals welcome.

Tiffanie (23:12)

Yeah, I love that. And find a local small business that you can promote like that because that's huge. They appreciate it, they value it, and I guarantee you they're gonna refer people to you too. So help everyone.

Diana (23:25)

Absolutely.

Tiffanie (23:26)

Helping is helping. Amazing, Diana. Thank you so much for our time together. Thank you for these amazing

Diana (23:31)

For having me.

Tiffanie (23:32)

ideas. Of course.

course. We will have you back many more times. So um you guys get ready. You're gonna hear awesome tips and tricks from Diana and and truly Diana, you your mind um goes deeper and I love that. So thank you for going deep on this today, for taking the time out of your day and meeting with me. And

Diana (23:51)

Thank you.

Tiffanie (23:52)

yes, and on the topic of referral and reviews, everyone

Drop us a review down below. Give us a little five star. We love to see that. Let us know what you're going to implement, what you love, things that maybe you do. People do read the reviews. I say that every time. I know because I'm one that reads them. If you haven't yet, go leave us a Google review. We have a competition right now. It's November and we are competing and we want to see all of the Google reviews and let them know that Tiffany and Diana sent you for that Google review. And Diana will get a little gold star and maybe

Diana (24:25)

Mm.

Tiffanie (24:26)

a little.

We're not sure. So go do that. Leave us a review here. We want to hear it. Leave us a review on Google. We love to see that. And truly, it helps people know that this is a worthy cause. And as always, whatever you need, we are here for. We want to help support you in the best ways possible. So if you are working with us, reach out to your consultant. If you are not yet working with us, or you just have some ideas you want to share, or you know, ask us [email protected] or head over to TheDentalATeam.com and set up a free practice assessment with our team.

And with that, everyone, go to your action items. You heard them here and we'll catch you next time. Bye bye.

Diana (25:03)

See you later.

Special guest Sheela Roth, director of clinical operations at Pearl AI, is on the show! Sheela talks with Kiera about how practices can best incorporate AI into the patient journey (as a co-pilot, not a human replacement). Whether you're hesitant or gung-ho about using AI, there are areas in your practice that can only improve with automation, and Sheela and Kiera talk through the pros and cons of them.

Episode resources:

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Transcript:

Kiera (00:00)

Hello, Dental A Team listeners. This is Kiera, and today is an exciting day. I'm obsessed with this company. I rave about them. They are coming in with even more force and vigor, and it's great. I'm obsessed with Pearl. They are doing so many good things. They have been on our podcast before, and I'm so excited to have Sheela here. Sheela has a very strong clinical background, so I'm excited to chat shop on all things clinical with AI coming in. Pearl AI. You guys know them, you love them. And if you don't know them, it's gonna be a great time. So, Sheela, welcome to the podcast today. How are you?

Sheela Roth (00:29)

Excellent. I'm doing great, Kiera. Thanks for having me. excited to be here and and talk to you and your your audience about where we're going in AI today.

Kiera (00:37)

I love it. AI, I think, is so I want to come up with like a catchy phrase and I

Sheela Roth (00:43)

Okay.

Kiera (00:43)

haven't like made it punchy enough, but like accelerated innovation or like already like people are either on the accelerated innovation. I need to like really make this punchy, or it's like this scared out of my mind and I'm not gonna touch it. And I don't have like quite an AI version over there of like anxious.

Intellect, maybe I don't know. It's not

Sheela Roth (01:06)

Yes.

Kiera (01:07)

intellect, it's like that, like anxious, like they're so freaking scared of AI, or they're like on this accelerated innovation and they're taking it with with stride. So I feel like we got two camps that are listening and I feel like so excited to educate them on what is Pearl AI. I mean, I'm we're on the road with you guys quite often sharing and talking about it. But Sheela, some of the listeners maybe have never met you. Tell us a little bit about your background, how you got into Pearl, and then I'm gonna work on my punchy AI analogy over here.

if people are listening to you on that.

Sheela Roth (01:35)

Yes, it is a great

start though because you're right. You're you're in one of two camps. You're either embracing or you're, you know, resenting, if you will, or maybe a little curious. So maybe maybe artificial interest, right? That could be one. Yes. Yes.

Kiera (01:49)

Hey, there we go. Or anxious interest. Maybe it's the anxious interest

and the like accelerated innovation. I like it.

Sheela Roth (01:56)

I love it. Well,

yes, again, excited to be here. I am currently head of clinical education at Pearl. This is my sixth year here. I think the interesting part for me that's been so much fun is being able to see all different aspects of the practice. And as I still actually consult for my practice I've been in for 25 years on Saturdays, I have actually been able to work with different AI parts of the practice and

really understand how it's helping us. So as a as an assistant back in the day, moving into hygiene, what I learned as a hygienist was the true nuggets behind practice growth. So started a consulting company and then ended up working for Pearl. So I'm really happy to be here, but also really happy to share about the truth and the myths. That's really, I think, would satisfy both of those camps.

Kiera (02:49)

Yeah, absolutely. And I mean, I did throw it into AI. I think we nailed it. They said anxious interest and accelerated innovation. So I think that that's a fun, like we did it on our own. We didn't even need AI on that. The anxious interest is a really

Sheela Roth (03:01)

Ha ha ha.

Kiera (03:02)

good one and the accelerated innovation. and I really do think that that kind of bridges the two camps out there. I think I'm like anxious interest. I don't think I'm accelerated by any stretch, but I'm starting and I do agree that we need that middle of like already.

Interested, like maybe that's it, the anxious interest, the already interested, or the accelerated interest. Like maybe those

Sheela Roth (03:24)

Yes.

Kiera (03:25)

are the three we've got. because I do think it's gonna be really fun to talk. And I will say, dentists listening, please and team members, get on the bandwagon of AI. You are gonna get dated so freaking fast. Like I thought about it and I'm like, man, this is how business owners felt when the internet hit. Like, this is how they felt

Sheela Roth (03:42)

Yeah.

Kiera (03:42)

because they've been doing

like I was seeing this reel the other day and this girl was like, gosh, where was Claude when I did my last practice transition? And I thought about that and I'm like, can you imagine dentists? And some of you listening are those dentists, so please like let me know if I'm on track. But like working where yellow pages and billboards and like

Sheela Roth (04:00)

Ha ha.

Kiera (04:01)

commercials were the main shebang. And then the internet hit and you were like, yeah, that's never gonna take over. Like, we're just gonna stick to trying and true. And then you're like, wow,

Sheela Roth (04:09)

Yes.

Kiera (04:09)

nobody's finding me because everybody's on the internet. Like, what is that?

And now us we're like, well, we're on the internet and we podcast, we do this. And I'm like, yeah, AI's whooping our tish. Like, you got to get over there because AI, I mean, you're hearing 40, 50 million dollar companies have five employees and 40 bots. Now you can be a purist and say, Well, I only want employees, and I'm gonna say you're a purist that's about to go out. Like, I am not here to get rid of employees. I am very much here to say that like hashtag post-COVID hiring has been a beast. A lot of people haven't been working.

A lot of people don't want to work anymore. The industry shifted, like hiring people are Gen Z coming in who don't want to work all the time. Like, no shade to the Gen Z. It's just we are living in a completely unprecedented time with employees wanting to work in offices that I'm like, AI is here to serve, AI is here to help. And I do believe, like the other day, I'm like, I think I'm sitting in the day and age where yellow pages went to the internet and now internet has gone to AI. So welcome. I think it's fun. Sheela, though, you know a lot more than I do. So take it away.

Sheela Roth (05:13)

Well, that's such a a great way to start as well. You know, we we talk about this in and I'm sure every dentist and hygienist, any

team member on the call has heard. Remember when we used to dip the radiographs and then we never thought we'd go to digital and here we are in AI, right?

Kiera (05:28)

Yeah, so.

Sheela Roth (05:28)

But I do think to your point, we don't really need to replace the humans, but repurpose the humans is really

Kiera (05:35)

Mm-hmm.

Sheela Roth (05:36)

I think the world we're living in, you know.

There's lots of different ways of AI, and it's beyond the radiograph. And I think that's the exciting point is how do we actually become more efficient with AI as our co-pilot, you know, throughout the

Kiera (05:49)

Mm-hmm.

Sheela Roth (05:49)

entire patient journey. an example is, you know, in a practice I st I still work with, we have an insurance person who sits in a room by herself all day long, right? And she does like that. She does. I kind of envy that.

Kiera (06:01)

I'm sure she loves it though. The insurance people loved their isolation. They're always

like, please don't make me go answer phones here. Don't put me in the front. And I'm like, I could never live back here. Like I worked,

Sheela Roth (06:12)

I know.

Kiera (06:13)

Sheela, this is funny. I know I'm going random to like off topic. I used to work for like an accounting firm. Like, I did one of those like

Sheela Roth (06:19)

Mm-hmm.

Kiera (06:19)

temp agencies. I worked in a lot of different jobs. And I remember walking in, they were in like audit season. There was no music. And I was like, all you heard was like, click.

Sheela Roth (06:26)

yes. Yes.

Kiera (06:29)

I'm like, how do these people live here? Like I would die. Like I'm clearly not meant to

Sheela Roth (06:33)

I know.

Kiera (06:34)

be a CPA. It was in college and I'm like, well, I'm surely not going the accounting route. I can tell you that's not my jam. Like, not for one minute. So I'm grateful there are people that way. I just know that

Sheela Roth (06:42)

Yes.

Kiera (06:42)

that's not like, know thyself and be free is what I would say. So go back to your billing person.

Sheela Roth (06:46)

Yes.

No, it's it's true. I I walk in her office though and I'm like, so nice in here. What do you do? All this is great. There's little Granola bars and little coffee.

Kiera (06:56)

Yeah.

Sheela Roth (06:56)

I'm like, we're on the other side, man. We haven't eaten in eight hours. So but what I have found

Kiera (07:01)

We haven't even gone to the bathroom in eight hours, Sheela. Like, let's be real.

Sheela Roth (07:05)

I know it is true. Yes, when she was starting to use AI just to augment some of her insurance verifications and such.

She now gets to work forward-facing with the patients. And

Kiera (07:19)

Yeah.

Sheela Roth (07:19)

that I think for her, she's like, initially I thought that wasn't gonna be fun, but I really like this and I really enjoy working with patients again. So that that is the point of buying back some time to bring the humans back. You know, when you

Kiera (07:34)

Mm-hmm.

Sheela Roth (07:34)

look at simple things like adopting AI, chair side, that's one thing, right? And you look at the pathologies that are on the radiograph, and you can have this conversation. Doctors are like,

I'm experienced, I don't need AI, which is very true in a lot of ways. But when you think about AI being spell check for your x-rays, right? You look back and you think, okay, did I need to look at that? I'm really glad that little yellow or pink thing popped up. The magic happens though in two things. When you sit next to a patient and you can show these images.

And we can stop talking finally, right? Kiera, you know you and I talk a lot, especially in hygiene exams or when the doctor

Kiera (08:09)

Mm-hmm.

Sheela Roth (08:12)

walks out of the room when you're explaining dentistry. We can stop talking and let the patients ask the questions. So in the big picture, this allows them to accept the dentistry they want to get the doctors want to get down earlier and more often, right? And I think

Kiera (08:27)

Mm-hmm.

Sheela Roth (08:28)

that's the big win there is to be able to have that happening throughout, you know, the entire patient journey.

Kiera (08:36)

Yeah. No, and I love that you said that, Sheela, because like let's talk about, let's talk about what I said. A $40 million business that has five employees and like lots of bots. I do not believe that that's the future of dentistry. Like I genuinely don't believe that we are not going to need dentists doing their work. I don't believe we won't have chairside and I don't believe that we won't have hygienists. And I don't believe that we're ever gonna become like McDonald's with a kiosk. Even McDonald's with a kiosk has people. All right. So like let's just accept that. Humans still like humans. And I

I mean, I checked

Sheela Roth (09:04)

Yes.

Kiera (09:04)

into a hotel. This was one weird one. And I was like, huh. I walked in. It was super late at night. There was a little screen. I clicked on it. Some humans still showed up though. It was a virtual human. It wasn't an AI. I'm sure in the future it will be. But like that was weird. I'd never go back to that one because I'm like, I don't know if I trust you. Now will the world pride progress? Yes. So could I see in front office teams? This isn't to say anything. We're still going to need you. Like my husband's a pharmacist. And I'm like, yeah, half of his stuff should get automated. But we are still gonna need people to oversee. We've proven that forever.

That you still will need that human oversight. But like you said, I feel like how many people love having conversations about financials and like presenting treatment plans? Not a lot. Well, your AI on the x-rays does 90% of the hard work for you. Patients are already bought into saying yes to that before they even come up to it. Doctors, how many times do you get so annoyed with that hygienist like tiptoeing down the hallway, telling you that they need an exam?

Sheela Roth (09:53)

Okay.

Kiera (09:55)

I feel like there was a really funny meme that had like the little dog dancing, like and they're like, that's how you feel. And all the hygienists in the doctor, like,

Sheela Roth (09:58)

Yes, yes.

Kiera (10:01)

I see you. Like, and you're like, I know. And the assistant's sitting there, like, we're sweating. We're like, I see Sheela coming back around. Dentist is

Sheela Roth (10:07)

Ha

Kiera (10:08)

still prepping. And we're like, huh, don't like have your eyes get crazy because that patient's gonna be like, What's going on? And I'm like, keep your freaking sunglasses. I don't wanna be staring you in the eyes. Like, this is real life, and they're stressed out. But like,

Sheela Roth (10:19)

Yes.

Kiera (10:19)

doctors, imagine you now can go in, hygiene exams are already teed up, they're ready to go.

And you're not missing things because there's so many dentists I have. And again, you can have this if like this is you and you don't have to confess it to me and Sheela. But there's dentists who are like, man, today I was so busy and I know I missed that. Or in six months, that patient comes back and you're like, shoot, we missed that. Like that's okay. You're human. And I feel like this does just make it accelerated. It's the like buy back your time. It's do less and create more. Like that

Sheela Roth (10:44)

Hm, yes.

Kiera (10:46)

to me is in when you can see it in that way, like Claude's freaking rad.

It used to take me like

Sheela Roth (10:50)

Mm.

Kiera (10:50)

a week to get something turned around. And I'm like, you just upload your brand guide. You've got things delivered. We verify

Sheela Roth (10:55)

Yes.

Kiera (10:56)

it on our side. That stuff is so cool. And I think, just go back. I'm sure the person who had the washing machine introduced was like, I'm not using that. It is so much more pure. If I just sit here and scrub down this freaking board, I promise you that's what like I'm promise you. She's like, no, this like gets way better. Like, you're not gonna get the dirt out with that little spin thing over there.

Sheela Roth (11:17)

Yes.

Kiera (11:17)

But then

guess what? She tried it and her shirt actually came out pretty darn clean. Guess what?

Sheela Roth (11:20)

Yes.

Kiera (11:21)

The dentist who tries it, it didn't take away their dentistry or their expertise. It just helped them

Sheela Roth (11:25)

Yes.

Kiera (11:25)

out. To me, that's the space where I'm like, there is so much cool stuff that we can be doing. I would just say be careful that you're not the lady on the scrub board or the man. I'm not gonna say it was just a female, but we're 2026, so it could have been both. All right. Like, I don't know.

Sheela Roth (11:36)

Okay.

Kiera (11:39)

Like, don't be the person who's like scrubbing that scrub board, like taking so much extra effort.

Because we're not willing to recognize that it's here to stay. And it actually makes us better as society. And like you said, Sheela, it gives you more time to talk to your patients. You're not sitting there and being like, uh-huh, uh-huh, when they're yapping about their kids while you're trying to scan the x-rays and hope and pray you don't miss one of those shades of gray and you miss that cavity that in six months you're gonna be like, dang it, it was there and I missed it. It helps you to be more intentional with the patients, gives you that little edge. Like you said, I feel like it's the little Disney magic for you.

That makes you

Sheela Roth (12:11)

Mm.

Kiera (12:12)

look even more incredible without losing any credibility with your patient. There's my rant, Sheela. Take it from there. I'm sure you got more to say.

Sheela Roth (12:19)

No, that's great. I I was my son was telling me he went to a concert and he's like, you know, mom, all I do now is I upload my credit card and then when I go buy a hot dog, when I walk into the stand, it's automatic with my face. And I thought, This was like a year ago, and I'm like, No, you can't do that. And what if your card gets out? And now I'm walking into, you know, a baseball game thinking, I don't have to carry anything. This is great. Right? Imagine if our patients

Kiera (12:41)

Nothing.

Sheela Roth (12:43)

could do that. They just walk up and they pay, right?

Kiera (12:46)

How

cool. Like it's creepy and awesome. Like there's things that are scary. But Sheela, something as you were saying that, I think that society, call me crazy. But as I've been watching society change, like even just in the last year, AI, like you could tell when it was AI photos on your phone. And now

Sheela Roth (13:02)

Yes, yes.

Kiera (13:03)

my gym trainer, she's like, Kiera, pick your photo shoot images. So I did. And she looked at it, she's like, every one of these you picked is AI. And I was like, well, I like how they look. So like, but I I didn't realize that.

Sheela Roth (13:11)

Yes.

Kiera (13:14)

And so I think the world is getting so much that like AI is so good. There's a lot of great things and it's moving so fast that I think people are

Sheela Roth (13:21)

It's been impressed.

Kiera (13:21)

craving more and more of real. Like there's times when I'm like, I actually don't want to be on a call. Like, do they have Granola or an auto running in the background? Like, and even now going in person, one of your people taught me of like this cool little pen that you can have that like records conversations. But it's like, I want so much more to be face to face with people. Like, I think we're I think AI is taking so much awesomeness.

out of our hands, like the washing machine, right? To

Sheela Roth (13:45)

Yes.

Kiera (13:46)

where they would get to sit and have dinner together because we're not spending hours on that freaking scrub board. Same thing with AI. We're not spending

Sheela Roth (13:51)

Yeah.

Kiera (13:52)

hours creating all these things or looking at our x-rays or sending all the billing things that now we

Sheela Roth (13:56)

Yes.

Kiera (13:57)

can have intentional conversations with our patients and have that human connection piece, which every dentist wants, every patient wants. To me, I feel like that's the edge that if you're willing to take on with AI, you can actually have more of an edge of humanity as opposed to being replaced by AI.

Kiera (14:11)

So, Sheela, I really feel like it's this awesome opportunity where we get to add more of that humanity back into the workspace. Like, people want and they're craving this human aspect. They're they're so afraid of everything that's AI now that I'm like, and every dentist, every team member, every patient has been craving and craving and craving for years and years of like, I just wish I wasn't so rushed on my exams. I just wish I had more time with the patient. Well, guess what? Your freaking fairy godmother showed up and her name's AI. So

Sheela Roth (14:36)

Ha ha

ha.

Kiera (14:37)

Alice

incredible. Like I wish it was Alice in Wonderland, but like didn't quite work with that AI analogy. But really, I think that if people can see it this way, and I know there's things to be scared of, I know there's things to be cautious of, but I think like be cautious and still execute. So that would be my two cents. But Sheela, you're way more into this. All the things that Pearl's doing. I know there's x-rays, I know there's other things, but like as a hygienist, how cool is it with Bola even? And I know you guys I think have something similar from what I heard. Like hygienists don't have to period chart anymore.

As a dental assistant, I'm so happy I don't have to hear from you, hygienist. Asked me to come pariochart for you. Like none of us enjoy it. None of us. And so it's a like these things are winning. It's winning.

Sheela Roth (15:12)

Amen to that. Yes. You're a strong one. Yes, absolutely.

It is it is a true joy to think about bringing back the good old days of dentistry, right? Where you had a few minutes to talk to your coworker, grab a cup of coffee, not as hygienist, but when you think about exactly

Kiera (15:26)

Don't because then you're gonna have to go to the bathroom. Like, don't you dare grab that coffee.

That just is gonna be pain later on.

Sheela Roth (15:32)

Yes, that's true. That's true. But

when you think about AI through the patient journey as a co-pilot, I think that's my my favorite analogy because, you know, before I used to go in 20 minutes early, I'm sure you did too. Look at my patient's chart. Do they need x-rays? Do they need to probe? What's the unscheduled dentistry? All that's done for them. You know, take the burden off the front desk, right? And you can serve your patients way better. To your point, you just push a button and you start recording your entire hygiene visit. Doctor

Kiera (16:00)

Yeah.

Sheela Roth (16:00)

comes in.

Open Pareo chart, the entire thing is summarized. Of course, you're gonna do what you do with every AI. You're going to review, verify, and then submit. And that's the best

Kiera (16:10)

Mm-hmm.

Sheela Roth (16:11)

thing here is the time saving. People are getting out on time, notes are complete. There's just a way now where if we embrace the radiologic side, the chart audits, the schedule highlights, you know, there's so much out there for us to take that deep breath without the staff.

That we not all of us are missing staff members, right? And

Kiera (16:33)

Mm-hmm.

Sheela Roth (16:33)

the first thing that goes out the window is notes or claims

Kiera (16:36)

Yeah.

Sheela Roth (16:37)

or charting or prepping for the next day or morning huddles. And that's where we can rely on AI as a co-pilot through the whole journey to review the x-ray, look at the last visit. Is there anything on the x-ray that wasn't addressed and not treatment planned? In addition to providing a roadmap for every provider per patient. And I think that's a huge win for hygiene and doctor.

And

then let's audit the notes for you. Make sure you're attaching the right x ray and the right narrative for your claims. That to me is the greatest thing because you always have the ability to check along the way. And that time saving applies to everybody in the practice whether you're going to spend more time with your patient or believe it or not, a little more time with each other. And that's

Kiera (17:22)

Mm-hmm. Yeah.

Sheela Roth (17:23)

been the win of embracing AI, I think, along the patient journey, beyond the radiograph.

Kiera (17:28)

100%. I'm glad you talked about some of these things because as you said it, I also, you know, I'm I don't work for Pearl. I know a lot of what they're doing and it's always innovating. And I know there's a lot of AI companies out there. Like it is popping up like daisies out there. I'm like, all right, you go to a conference and there is AI upon AI upon AI. I

Sheela Roth (17:45)

Yes.

Kiera (17:45)

hope, I hope, and I'm just gonna throw this out there because I think Pearl's on its way there and I think there's a few others on their way there.

Please do not AI Schmorgersborg like we've currently done with all the other softwares that you can add to your software. Like,

Sheela Roth (17:56)

Yeah.

Kiera (17:57)

I feel like it's like everybody has a subscription, everybody wants us to add it. And dentists are like, so we use Mango for this, and then we use Medento for this, and then we use Swell for this. And that's nothing. I love all those companies. I listed off some of my favorites. But like, wouldn't it be so awesome if like one could do it all for us and we're not having to have like, like I said, I feel like it's like the hodgepodge like software over there. but as you were saying.

Sheela Roth (18:17)

Yes, yes. We are all looking

for that, right? To your point.

Kiera (18:20)

Yeah.

Sheela Roth (18:21)

And like one thing that I thought was really interesting as far as like keeping it cohesive is think about like before you start SRPs, sometimes we need to update the x-ray, or sometimes before you prep, you might need to take an x-ray because you're missing the apex. And now AI

Kiera (18:40)

Please

Sheela Roth (18:42)

will go in, it'll say, We looked at your last x-ray.

We've also looked at your insurance. By the way, here's a quick warning. You've got to take a new x ray today. So the fact that it's working throughout the entire journey is what the dental space has been looking for. To your point, we used to have 10 different individual

Kiera (18:56)

Mm-hmm.

Sheela Roth (18:59)

companies doing this. And quite frankly, the space is tired of the 299, 299, 299 with, you know, 299 different companies. So you want

Kiera (19:05)

Absolutely.

Sheela Roth (19:08)

a cohesive company that can work alongside you every step of the way.

Kiera (19:13)

Yeah, absolutely. And as you said it, I it makes you just feel like those are the cobwebs, like consulting hundreds of offices. This is the stuff that just irritates and like rubs teams raw. Like, okay, you gotta prep your day, you gotta prep for morning huddle. And they're like, here, I don't freaking have time. You want me to do one thing more? And it's like, all right, cool. So like this is this is

Sheela Roth (19:29)

Yeah.

Kiera (19:32)

just I'm like, I know, trust me. Get faster at your x-rays. Like that's what I'm telling you to do. And instead of having to be like robots, we're operating at such a high level.

These little things like to me, I feel like AI is just sweeping or like greasing the wheels for us so things move smoother. Like, do we have to prep our charts? The answer is no. Do we have to have all of our narratives in for claims? No. Like those things can come later. But does that speed everything up and make everything run more smoothly? Yes. Just like, do I have to change my oil for my car? The answer is no. But I'm gonna have problems later on, right? So it's a like this just makes it to where these little smooth things sweep through and make it a lot easier.

Sheela Roth (20:10)

Yes.

Kiera (20:10)

And I'm so excited because I think AI, like right now, I get it. You you're blossoming in this area and then we're adding these other ones. So I understand why there's still like 200, 299 products out there for you to choose from. we're not 99 products on the wall, we're 299 products on the wall. Like, enjoy. But it's a space of just like choose some that are gonna like alleviate the stress on your team and make it, like you said. I loved how you said it does allow us to get back to the good old days.

I had a photographer come in from Spain and he and I were chatting. He's like, it's so weird because the US is so obsessed about work and productivity. He's like, that's all you guys talk about. He's like, in Spain, we work, but we like that that's like secondary. It's who am I having breakfast with? Who am I going to meet at the coffee shop? Who's coming over for dinner that night? And work is just like a little inconvenience in the middle of the day. And I was like, that is such an interesting thing, but I feel like that's how humans actually are meant to be. I think that's the fulfillment.

I think that's the less stress that we're all seeking is like we want to show up and we want to like enjoy our time with our coworkers. We want to have coffee in the morning. We don't be like, I gotta get to the office 20 minutes before because I gotta prep all this and I gotta run through my patients and I gotta get like nobody loves living that way. I think we've just turned it. And I will say I think that that's why COVID shook us all up. Everybody woke up, I think, for the first time in years to say, like, maybe there's a better, different way that we could do this. And I think that that's where AI is serving is that better, easier, like you said, co-pilot next to you.

that just cleans the dust out of the way so you can you can do the part that you love and that you really enjoy.

Sheela Roth (21:41)

Yep, absolutely. And to your point, you know, we spend more time at work than we do with our families, right? And we

Kiera (21:49)

Mm-hmm.

Sheela Roth (21:50)

want to have time to spend with each other. But I think at the end of the day, when we think about AI, it's really for the patient. If I'm a patient, I would love that you've verified my insurance so that I'm gonna have

Kiera (22:02)

Yeah.

Sheela Roth (22:02)

an accurate quote. I would love that the AI looked through the last x-ray. I would love that you have gone through my chart and you can tell me today when I come in.

What unscheduled dentistry or remaining benefits I have, and that you've done everything you possibly can to make my mouth as healthy as possible, probing, charting, whatever it is, and that you've documented everything correctly. So I think when we really slow down and think about what are we all doing every day, we are here to serve our patients. And using AI to do that, using other things to do that throughout your day, that's the foundation for practice growth, is that that patient has such a great experience.

And you're not sitting there trying to type your notes while you're talking to them, like, yeah, what are you doing this weekend? You know, and you're trying to type your notes. Like, that is a terrible experience. We all experience that when we go to the, you know, regular MD and they're like, so how are you? And they're like, basically in another room, they may as well be because they're not looking at me. And I think that's

Kiera (22:57)

Mm-hmm, mm-hmm.

Sheela Roth (22:58)

the joy of embracing AI is to bring back that one-on-one time with the patient and make sure that the AI agents are doing all the mundane tasks we don't want to do.

Kiera (23:11)

Yeah.

Sheela Roth (23:11)

And

that's where I think it is becoming really exciting and the the gifts to the front desk to allow them to do simple things, chart audits or recall lists or whatever, they're seeing a change in culture. And

Kiera (23:23)

Mm-hmm.

Sheela Roth (23:24)

that's the silver lining of AI.

Kiera (23:26)

Yeah. Gia, I love that. Tell us a little bit about what Pearl does. Cause I know Pearl, we I mean we've mentioned it. You are with Pearl and I love as a clinician who's done this. I also love that there's dentists on the board that have done this. Like that's something I really do enjoy about Pearl is I do think it's coming from a very dental centric. and my favorite companies tend to come from very dental centric. What are some of the things like I you listed it's like radiographs, what are all the pieces that AI currently is working in Pearl's Ethernet, if you will.

Sheela Roth (23:55)

Yes. to your point, Kiera, what I love most about Pearl is before I get into just a quick summary, our engineers and our leaders are spending so much time in practices understanding the friction points. We're not just sending a CS rep. We're sending our, you know, chief technology officer, we're sending our CEO. They're sitting chair side with the clinicians. They're seeing, if you move this button over here, it would make my

radiograph review faster. Or if you could record my my notes and then help me coach my my associate dentist to be able to be more performant, then that's the huge win where you're seeing companies that are really working alongside the dentist understanding and solving their friction points. So we all know that radiological AI is out there. And what that means is you take an X-ray, whether it's in your imaging system

Or your regular sensors, and in 30 seconds, you're going to see cavities, calculus, paraphrase relucencies, notable margins, all these things pop up in real time. You can hover over any and re-rease them. You have full control. Then you colorize that and you show small things like: do you see this yellow one? It's still in the enamel. We're gonna keep an eye on it. And that's a big practice builder where this little pink guy has moved past the enamel into the green spongy part of your tooth. That's where we all started with AI.

When we then migrated that into our practice intelligence schedule, we allow teams to know we've now looked into your practice management system. We're going to create an entire schedule that's going to identify unscheduled and AI findings right inside of a schedule you work in. You move that into practice management RCM, where you go ahead and say, great, let's verify. Let's verify all the insurance for you, help you submit your claims, and also record your notes.

your periodontal charting. So you have second opinion radiographs, you have practice intelligence for practice growth, identifying opportunities, auditing all those charts, doing an entire morning huddle fills the schedule. It'll find opportunities for you as you hover over everything. It'll say, here's unscheduled fillings, here's unscheduled sealants, here's unscheduled period. So you can maximize your day, but you put on top of that the the barrier that we all see with our patients, the how much is it going cost?

Right.

We

Kiera (26:19)

Mm-hmm.

Sheela Roth (26:19)

have the verification right there, chair side. Hygienists can find out can I take x-rays? Can I do fluoride? One click and they can see that in their operatory. And then lastly, we get out on time. We have Pearl notes. And I think the nice thing about Pearl, again, is it's aligning with those templates. You can customize it. You know, we have hygienists now getting out on time because they

Kiera (26:40)

Mm-hmm.

Sheela Roth (26:40)

have their own templates. They're talking like regular humans, and the AI is trained to understand that this is how you want your clinic to know.

So it is really the ability to work with one company that will go through the entire patient journey and allow you to, like you said, Kiera, spend the time where you need it. And that's the joys of having a system that understands the friction points throughout the entire practice.

Kiera (27:07)

And I love that, Sheela. That's why we're a huge fan of Pearl. If people are interested in adding Pearl or like what it looks like, they don't want two hundred and ninety nine, two hundred and ninety

Sheela Roth (27:16)

Yeah.

Kiera (27:16)

nine options. I think that's funny. We should take that and coin that. I'm I'm on a punchy roll with you today, Sheela. So it's a good it's a good day over here. How

Sheela Roth (27:24)

They love it. I love it.

Kiera (27:25)

do they how do they connect in? What does it kind of look like working with you guys?

Sheela Roth (27:29)

Yeah, super easy. We'd love to do a demo. We like to invite the entire team. see if it's a good match for you. You can start with one or all products, and you're up and running within the next 24 to 48 hours with your AI detections, and within seven days, we will go back and look historically at 18 months of information on your practice management system and your existing radiograph. So I'd say a 20-minute demo is the best place to start, and we can get your team started right away.

Kiera (27:57)

Awesome. And I do know if you guys mentioned Dental A team, Pearl does take great care of our clients as well. So be sure to mention that. Sheela, so fun to have you. Any last thoughts you've got on AI before we wrap up today?

Sheela Roth (28:08)

No, hopefully the two you know, the two categories we talked about today, the one team that's a little concerned and anxious versus the team that's ready to go all in, hopefully we brought everybody maybe closer to the middle. And I encourage

Kiera (28:21)

Yeah.

Sheela Roth (28:21)

you to pick one part of AI. I mean, I could not do my job without an A ri AI running through my emails, reminding me who to reply to, right? And we know even as dentists and clinicians that what we see Monday at eight AM on an X-ray is not what we see

Friday at four PM. So I think the important

Kiera (28:40)

Yeah.

Sheela Roth (28:40)

part is you still have full autonomy. And I think that's the joy of embracing AI because you s you're still the pilot. It's just the co co pilot.

Kiera (28:50)

I love that. And Sheela selfishly, what's your what's your AI in your inbox? Like tell us that little nugget there. You drop that. Who are you using?

Sheela Roth (28:58)

So I am using town. I should get some some honorariums from town, but it

Kiera (29:03)

Seriously.

Sheela Roth (29:04)

is, it'll literally go in and say, Good morning, Sheela. Let me tell you about your day. And it goes through my entire day and it'll also go out and say, you're meeting with Kiera. Let me tell you a little bit more about Kiera. It is the best thing that I have ever invested in in the last 60 days. There's also Muse. Muse does something similar to that as well. But Town will also go and reply to all my emails. And again,

It just sits there and waits for me to confirm. So

Kiera (29:31)

Mm.

Sheela Roth (29:32)

I would suggest trying to buy our own time back. I don't want to be sending emails all night long. I want to be hanging out with my family. So that's how I'm embracing AI is to find the mundane tasks I'm doing and have someone else do it. I'm still gonna oversee

Kiera (29:48)

Yeah.

Sheela Roth (29:48)

it, but why would I wanna create emails when I can have an AI do that for fifteen dollars a month?

Kiera (29:55)

Awesome. I was like, I'm just so like you plug that in a little bit. I was like,

Sheela Roth (29:58)

Well.

Kiera (29:58)

hey, that's a good nugget because this is how we all learn. Like in our doctor mastermind that we have, I'm like, all right, everybody like bust out your AI. What's everybody using? What are we all trying? Because it's so fun that it's new, right? None of us really know what the heck we're doing. We're all a little bit like wild and crazy and loose on it. But I promise you, when they were first making washing machines, they were all a little wild and crazy, like, what soap are you using? And like, did you put it? Right? Like, all right. So we're doing the same thing just in our own world. So

I love that share. I love Pearl. All of you, reach out. Like do yourself a gift. Try it out. It's not going to hurt you any. If you don't want to do it right now, you don't have to. If you don't only want to adopt one thing, the x-rays are awesome. I think that it helps with case acceptance exponentially. Other things are just a nice cherry on top that help, but like hearing you're getting team out on time, maybe just go run your payroll and see how much overtime you're paying. And it might pay for itself that way. So reach out. Sheela, I had a pleasure of having you on. Thank you for being here today. I really appreciate you.

Sheela Roth (30:52)

Thank you. Thanks for having me.

Kiera (30:54)

Of course. And for all of you listening, thank you for listening and I'll catch you next time on the Dental A Team Podcast.

Success doesn't come from attaining perfection. It comes when you're looking to improve each day. Kiera talks about specific ways you can improve your practice without expecting perfection every minute of every day.

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Transcript:

Kiera (00:00.792)

Hello, Dental A Team listeners. This is Kiera, and I am so jazzed about today's topic because I think that this applies to practices. I think it applies to life. And fun fact, my husband and I were chatting about this the other day. So I'm very excited about it. And consistent doesn't mean perfect. And this is honestly how great teams move forward and have excellent results. And it's such like a fun, like little piece for you guys that I just think are gonna help you set your practices apart. So

I am really excited because I think so many people in their practices feel like I have to have this perfect practice in order to hit the highest heights and all the great things. And the reality is you don't actually have to have that. You just need to have a consistent practice. But we have to be good, consistent, not just consistent. So I want you to know that like perfection really does like have this high bar, unlike canny feeling about it, where I have to be perfect, I can't make any mistakes versus like, hey, if we're consistent, we're consistently good and we're consistently getting better.

That's really what this is about. So I hope that you guys take this. I hope you realize that this is a great way to become an elite practice. It's a great way to set you and your team apart. And I really want you to know that just if you are a consistent practice, it doesn't mean that things are going to go perfect for you. It does mean that things are still gonna have happens. Like I I want to just dispel that so many people feel like, my gosh, I need my practice to be perfect. I need to be at this level in order for me to hit this level of success. And I want to just dispel the A, that doesn't exist, B, you're never gonna get there.

And see, you can actually get there a lot sooner to a happy, successful practice without having to be perfect. And so some people are like, I want my team to be on autopilot. Well, guess what? You're probably never gonna get there. Like teams don't exist on autopilot. We can get them very systematized. and a lot of that's gonna start with consistency. So today I want to walk you guys through like how chasing perfection can actually slow your practice down, where consistency really matters most, and what are three ways to build a practice that ultimately gets better without expecting perfection.

So, if you guys don't know us, we're the Dental A Team. I'm Kiera Dent. Yep, Dent really is my last name. It just took me three fiances to get there. So it's a great time. I love my life. I love helping dentists have the best, most fulfilled life that they could possibly ever have. That is ultimately what we're here for. I do believe that building a successful practice should and can be easy. So ask yourself, like, what if this could be easy? Because with Dental A Team it can. So if you are wanting to get help and help your practice, we help practices across the nation. We literally have practices in almost all 50 states.

Kiera (02:19.918)

and have worked across the globe and genuinely love to help teens, love to help dentists, just find their niche, find their happiness. I believe that your business should be serving your life and not the other way around. So let's help you have that same success. If you want to reach out, [email protected], be part of our family. We meet in person, we have a good time, we help flourish you and your team. So come hang out with us and just know our job is to truly make your life as easy as possible. So I want you guys to to just think about like what happens is

Like a practice is creating incredible results and they aren't perfect. And like when we're executing on fundamental consistency, we can have predictable outcomes. I love Disneyland so much. Disneyland is one of the core companies our company models after. And there was this great quote that said that they're able to create predictable magic with the systems behind the scenes. And I would venture to say that those systems are the consistency pieces that they have. Like you show up to Disneyland every single time, the grass is mown.

You show up and there's gonna always be flowers or decorations. There's never gonna be trash on the floor. They are going to make sure that they always have the right treats for you. people love Starbucks because of consistency, not because it's great. A lot of people just need consistency in our world. And so I really want you guys to just like see that there's some simple little shifts that you can help your team so that way you guys stop chasing this perfection model and you start building consistency. And Jason and we're talking the other day and we talked about how he said, Kiera, I'm really proud of you. You're very consistent.

And I thought about it and I was like, A, thank you. That's a huge compliment. And B, I wasn't always this way. I remember when we were at Midwestern, he was in pharmacy school. I had my goal board on the on the wall. I've always had a nice goal board there. And I remember writing a little sticky note and putting it there. And I said calm, consistent. And there was one other one. I don't remember what it was. but I did not feel like I was consistent with work, with my life, with my routine. and so just so you know, I believe that consistency can be not just born and built in. I'm a walking proof of that.

I believe like what can we put into place to make consistency easier? I don't like people to have to remember. So for example, like I'm always going to plan in my planner every Sunday. I just set that as a date. I never forget. I always do it. It's not super fun, but I'm going to do it because I believe that discipline equals freedom. Other things to be consistent on. At the end of every month, I transfer money like profit first. I have set like triggers in my brain so I don't have to remember. It's the atomic habits by James Clare. It's the stacking principle. So every Sunday, I plan my week. Every

Kiera (04:42.124)

like 30th, 28th, 29th, 30th, before the last day, before midnight of the last day of the month, I transfer money for profit first. At the end of every quarter, I review my PL, review my goals. In December, I always set goals for the next year and I review them. Again, those consistent pieces are what your you and your team need. So I just want you to know of like when we're going through this, there's a lot of ways that you can just build this muscle and let's stack. So number one is like define what good looks like. So we can't ask for consistency.

If we don't even know what the standard is. So a lot of times, like, I want a perfect schedule. Well, great. Like perfect for you versus perfect for me versus perfect for this doctor. Like, what does a perfect schedule look like? So we need to make sure that, like, how do we all answer the phones? What is our scheduling process? What are our financial agreements? What are like, how does this doctor work? Like some large practices that have a lot of doctors, and every doctor works with different pr like different cement or different composite that like makes ordering really hard and very inconsistent. And then doctors are annoyed when

Different assistants come in and they don't know how to assist you. So, how can we get all of our doctors to be similar? How can we get all of our hygienists? Like hygienists, you want your doctors to get in and out faster on an exam, set up to where you guys all introduce the doctor the same. We all hand off our patients the exact same. That's going to exponentially help you all. So when you guys have successful, like to get that consistency, let's define our standard processes. And I look at it like, okay, well, we could define a lot of standard processes, but what are the main ones that are really going to give us bang for buck? One, how do we answer for new patients?

Two, how do we schedule? Three, what's our policy? Like how soon do I need to get people in? Do we have a block scheduling protocol? Like all that right there is just gonna fix your block scheduling right then and there. And if we all follow, then what are the rules of the game if we choose not to follow through? Also, what do we do for phone calls? What are we doing for hygiene? What's our hygiene period protocol? All of the hygiene need follow through on that. What do we all do for that? How do we set up our financial arrangements? What's allowed? What's not allowed? What's our treatment tracker? How do we follow up on treatment plans? How do we set up rooms for our doctors for different procedures?

That's like in a quick nutshell. And then there's business sides too of like how do we track our marketing ROI? When do we look at our PL? When do we review every business expense in the practice? Those different things, but like that's the core process of a business. And if you get those and we set standards of we always schedule to this, our hygiene's always here, our reappointments there. A lot of times these standards could also be considered the bulk of your KPIs within a practice, because then we're gonna be able to have set standards and rules of like this is what we expect. We expect 98% collections, we expect 98% reappointment.

Kiera (07:08.472)

We expect 30% period protocol. We expect our schedule to be scheduled to goal every single day. We expect one or two openings every single day. That helps. Then we document it, we train it, we repeat it. It becomes like this is your SOP if you guys want, this is your operations manual. This is how you create consistency within your practice. And so just like simple little things in practices where we see this is like every patient gets reappointed. I've got a practice and they're like, tell us why reappointment is so important. I'm like, well, you guys are sitting at 90%.

I gotta go chase 8% of your patients and get them back on the books. If you're seeing 500 patients a month, that's about 50 patients a month. And that's gonna compound over time that we're chasing down. Versus if, hey, take the blood pressure, make the next appointment, tell the patient this is when you're going to see them rather than asking. 95% of them are going to be there. Then we work through and we muddle through the couple of people that aren't gonna be easy for you. We now have just fixed our reappointment. Your patient, like your production, all that's going to go up.

But we have this set standard of this is our reappointment and this is how we do it. Other things for this of like, we want to make sure that our hygiene perio protocol is there. Well, let's create a perioprotocol together. How do we co-diagnose it? What do we say? What is it like four millimeters and above with bleeding? Is that when we diagnose period? Some practices it is, some practices it's not. What's our standard of care and what's the expectation? And what happens if I choose to be your hygienist who wants to do some bloody profies?

Also, hygienist, let's give you some great verbiage for this of how do we talk to a patient who might be having these periods like they've got period and we don't want to talk to them about it. We're embarrassed by that. That's okay. Let's give you this. Like, we don't change our standard, we just give you the tools and solutions so that way you can work through it. Consistency really does start with clarity. And then clarity is going to also need to have us hold accountability because I can talk, talk, talk, talk, talk. But if I don't hold accountable, then I'm just talking to you. I'm seagull, I'm seagull, what do they call it?

It's called seagull leadership where I come, I squawk, I shiz with a Z, and I take off. We can't do that to our teams. We've got to come, we've got to talk about it, we've got to set standards, have the processes documented, and then hold accountable to that line. And truly, discipline does equal freedom. Think about if you're practice, we knew we always hit 98% reappointment, we always hit 98% collections, we always schedule to goal at least 75% of the way, three like three weeks into the month. So next month is already scheduled.

Kiera (09:26.411)

We hit our case acceptance at a certain percentage that we've agreed to. We always have our overhead at a certain percentage. Like just imagine how your practice would be if those were what we did consistently, month over month over month. That's a freaking dream. And I just listed up only five things for you. So really this consistency, this is where I don't want to be perfect. We can still make mistakes. We can still be late. We can still miss lab appointments, like whatever it is. But we've consistently hit this. What if we then add on like labs have a set process and we always are checking it? We color code them.

So we never miss our lab pieces. There's so many little ways for you to just hold this consistency. But notice I started with the five like very big ones that are going to impact your production, impact your patients, impact your reputation first. And then I went into like smaller things like labs. That would be nice to have. I want you to fix them, but that's not gonna move my practice forward as fast. And I really think when we're looking at consistency and discipline, what's gonna drive me forward the most? I could sit here and say, well, number one, I want to be consistent with making dinner every night. That's great.

But I could also be consistent with planning my week and reviewing my PL every single month. What's going to move me forward towards my goal? Well, maybe if I'm trying to eat healthy, making dinner every single night that's healthy would definitely move me towards my goals more. Me if I'm trying to hit production and profit, me planning my week, planning my schedule, reviewing my PL, that's gonna drive me there more. So what really is the biggest pain point with the biggest bang for buck? That's where we're going to start. So I want you just to say, like, where do we start? We're gonna pick an area where our team is inconsistent and ask, have we defined what good looks like?

Do we have weat documented? And is this really the most important need today, or is this a nice to have rather than a must have? Okay, point number two, we're gonna coach on the miss instead of expecting perfection. And this, I think, is something for me is like sometimes when people miss, it isn't automatically failure. Like we need to be pushing hard, we need to be making mistakes. And honestly, it's just information, it's not like our whole team has failed. And so when this is broken, we have like

one bad day becomes a huge issue. Leaders become frustrated. Team members hide behind mistakes. People are afraid to make decisions. And that's like if you have that culture, then we're expecting perfection. We're not allowed to have mistakes. When we are allowing our culture to make mistakes, like we identify what happens, we coach to the gap, like all right, there was a miss, let's coach this. We fix the protocol and expectations, we reset the expectation, and we try again tomorrow.

Kiera (11:47.682)

And I will say that sometimes I sit in camp A, not Camp B. I know camp B is better, but I like to control so much. But it's an illusion of control and it's not true control. In our mastermind group, when we meet in person, we're talking about the paradox of control, and I'm so excited. But the reality is, like, does you don't want them to be perfect. You just want them to make it better the next day. Now, if they continue to miss, yeah, that might be when you like clamp down and you're like, hey, we need to fix this. But I think there's pieces of like,

There was an office and they just wrote in and like, hey, we're we have team members that are not gonna be there. Should we skip our leadership meeting? And I'm like, hard no. That consistency, like we never miss our leadership meetings. Even if people are gone, we have a way to fill them in. We never miss our morning huddles. We never miss reappointment. We never miss following up on our treatment trackers. We never miss our period protocol. Like those things don't get missed. And when you start to put those processes in play, your practice can move forward. It's not like, well, it was busy, so we just didn't do period today.

well, was busy, we just didn't fill the schedule. my gosh, Mrs. Jones called and she canceled her appointment, like we just couldn't fill the schedule. Absolutely not. Like, what is our standard that we are absolutely not going to tolerate below that and hold to that and coach to that? We do not. The goal is like never getting off track. Like we will get off track. It's getting back on track faster and holding a true standard rather than just saying a lot of words but never actually executing on it. So I want you to look at like number one, do we have a defined process? That's number two. Number

Number one. Number two is the next time something doesn't go as planned, what do we need to adjust to have this work the next time? And then implement that and hold people to that standard and expectation moving forward. That is going to be an absolute zone for you to really have like your practice move forward in a great way and to truly win and to keep consistency because things will break no matter what. There are times, but like I do not miss on my Sunday planning.

I do not miss at my end of month. We do not miss our meetings in any of our departments. I don't care if people are out. Like we have Monday off. It's a holiday. That's usually when we run our meetings. We reschedule it to another time that week. We don't miss. And I think when people can bank on that consistency, that to me just creates like comfort. It creates consistency. Like that's the word. And that's going to create continuity for you as well. People live. Like, why do you go to Starbucks? Because you know it's going to the same thing every single time. So we keep going back to it, even if it's not the best.

Kiera (14:04.385)

Like most team members thrive in routine. People like that's human nature is have routine. Why do you go the same way home every single day from work? because it's routine, because you don't have think about it. So this consistency is creating routine, which makes jobs easier and like culture more fun. So step three is like let's make sure our wins compound. So it can be boring to have consistency. It can. Like there is a lot of boring that happens when things are consistent. Like it just feels like vanilla.

Just think about investing. Investing is not fun and people try to like add sprinkles. Nope, it's just vanilla. And if you consistently do it, most of the time you're gonna end up on top. Same thing if we just do like plain vanilla ice cream in our practice and have it consistent, it's going to go there. But it can be very boring. So like just imagine your practice, like morning huddles run every single day. ARs recei reviewed every single week. KPIs are reviewed weekly and monthly, and then we we coach to that. Patients are reappointed at ninety eight percent or

Collection percentages at 98% always. Unscheduled treatment is consistently followed up. Team meetings happen and they're very productive. Like, wow, that's great. But every one of those little things can become very boring and very like mundane. But guess what? That consistency actually creates clarity and it allows teams to flourish. It is not fun to do some of these items. Like nothing's crazy about that. But that's going to transform your practice. So having very much these consistent pieces. Now,

I can run a morning huddle and do it consistently, but it can be junk. So it's gotta be a great morning huddle that actually pushes towards winning. I can reappoint my patients, and if I'm hitting 98%, there's really nothing I'm gonna change about that. If our collection percentages are 98%, I'm gonna double check and make sure I've got less than one month's worth of AR. I'm not gonna touch that, I'm gonna move on. But every one of these little checkpoints within a KPI scorecard, if they are checked off consistently, your practice will thrive. Like that's just math, the math maths. So

When I look at a KPI scorecard, also looking at the vitals and the metrics, let's say your reappointment's at 75%, like this other practice there at 90%. Bumping it up to 98% doesn't happen because of one awesome meeting. It happens because we have set into place, we blood pressure's on, we reappoint, we look six months in a day out, reappoint them. Odds are Kiera, you're probably gonna come in on a Thursday at one o'clock because you're already seeing me on a Thursday at one o'clock. Don't ask me, don't make hard decisions. Just put it in there and like let's bump that number up to 98%.

Kiera (16:26.071)

That just cut down a ton of people working hard on something else. Our team is gonna flourish, our patients are gonna thrive. This helps so well. We do this week after week after week after week. People are like, Kiera, how do you get practices to do this? And I'm like, it's the simple things that seem boring. Like, how do you grow practice? a great morning huddle, and we track KPIs and like we coach to that based on whatever the KPIs tell us. That's it. That's really it. And you're like, wow, it sounds revolutionary. It's not, it's very simple, basic things. And so from that.

I want you to know that people look exponential, like so extraordinary from the outside and inside, they're just consistent. Like Starbucks, they're consistent. That's why you go back. Practices that are consistent make patients want to come back. Practices that are consistent make team members feel like it's very easy. I know my job, I know how to get my gold stars. I know how to like leave and like really leave a great impact. So I want you guys to look at this of like, what are the wins that we can do? What's the boring mundane that we're gonna get us into that's just consistent?

Morning huddles, if you don't have that, start there. If you're not tracking KPIs, start there. If we're not looking at our KPIs and measuring up to that, start there. If we're not hitting a KPI, let's start there. Like whatever one it is, I want you guys to look at this, commit to executing consistently for 90 days on that and improving that metric and that number that's ultimately going to drive you forward. It does not have to be hard, guys. We need to define what good looks like. So everybody knows like what our standard is, and we need to coach and hold to that. Then we need to coach on the misses. It's okay if we miss, let's just fix it, let's improve it, let's go for it.

And then we need to let the small winds compound and create the consistency that really is vanilla boring. But guess what? That vanilla is always good. I can go get a vanilla frosty and it will be great. I can get vanilla ice cream and I'm really happy with it. Would I love sprinkles or would I love chocolate or would love something else? Yes. But do I hate vanilla? Somebody might hate vanilla. I hope you're just getting the analogy here. It's not something I'm gonna go right home about, but it is something that I'm can always bank on to and whatever yours is. Maybe yours is chocolate. Chocolate's not super great.

But it's always good consistently, always good. That's what we're going for. Your team is going to have bad days. You are going to have things where things go off the rails. I'm going to have days where like my week is freaking psycho and I don't want to plan. We're going to have months where I don't want to look at those numbers. But guess what? We show up and we do it anyway. That is what discipline looks like. Discipline and consistency are things that actually create freedom. And you're looking for this freedom. And I'm going to say, where are you lacking that consistency? Where are you lacking this tracking? Where are you lacking having your team know what the standards and expectations are?

Kiera (18:52.299)

Where are we not holding accountable? Let's start there. And if you're struggling with this, like, my gosh, it just seems like everything's broken. High five, you're not alone. A lot of practices feel that way. A lot of them do. And there's nothing wrong with you. I want you to know that every practice is going to be on top. Every practice is going to be at the bottom. Every practice is going to go through ups and downs the entire time. It's what you do in those ups and downs is ultimately going to determine. Do you continue to go down or do you continue to go up? It's a decision for you. And I'd love to help you. So reach out. [email protected].

You do not need to be perfect. You need to be consistent on the things that matter. And I hope today we gave you a lot of those. Please do yourself, your team, and your practice a favor and take care of these items. It does not have to be hard. Like I said, running a successful practice should be easy. And these are some great ways for you to do it. Go be consistent, not perfect. Perfection is an illusion is the lowest standard. Consistency is something that you can actually achieve. So go do it. Go make today amazing. Reach out if we can help you in any way. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.

It's time to stop cringing when your office manager suggests role-playing various client interactions! Tiff and Nikki break down the powerful benefits of role play (or practice simulation) as a team, including:

• Building muscle memory

• Getting comfortable with uncomfortable conversations

• Communicating the same way across the board

• And more!

Episode resources:

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Transcript:

Tiffanie (00:01)

Hello, Dental A Team listeners. We are back again. This is our consultant takeover. I'm calling it that. we used to call it that. I don't think we call it that anymore, but I like the consultant takeover. Miss Kiera Dent, she is our CEO or co-founder or our founder, not our co-founder, she is our founder. she is our guiding star and our lighthouse in this world. And gosh, she puts out a lot of podcasts, you guys. So every once in a while we like to give Kiera a little break and record some of our own and spotlight our incredible.

Consultants. And if you haven't met our consultants yet, please pop over to our social media. We've got like welcomes, we've got hellos, we've got all kinds of information on all of our ladies here and truly how inspirational they are and how much work they do with their practices. And today I am spotlighting Miss Nikki and I am so excited to have you here, Nikki. I truly enjoy just talking with you. I love our time together and I love

Nikki Mack (00:56)

Mm-hmm.

Tiffanie (00:57)

watching.

You shine. Like I you were just in offices, you're going back in offices. She's on boots on the ground a lot recently. And I value that. I appreciate that travel is hard. And we love you for all that you are doing out there. And it's just so fun to see the recaps from your office visits and hear all the great things from the doctors and the teams and get to watch you shine. Cause I know most of the consultant team, like we feel the biggest hype, right? We get the most excitement from being

in office and we love our calls too, but that in office just does something different. So Nikki, I am excited to have you here with us today. Thank you so much. How are you? How has travel been? How has like what are you prepping for? What has life been like out there on the road?

Nikki Mack (01:45)

Yeah,

good to be here. I agree with you. I love my meetings. I have some teams. I'm like, my god, I get to start my day with these guys. I get to wrap my day with these guys. But being in office is different. It it fills my cup in a way that's just hard to explain. I think it's because I miss those days. You know, we we lived that life, right? So I know what it's like coming in and huddling with your team and being excited about something that happened and I just love to kind of soak up that energy because we have such great clients and their teams are just

amazing to be around. So I have been boots on the ground a lot lately. but it's kind of fun. You know what? I get to see leaves changing.

Tiffanie (02:22)

Yeah.

Nikki Mack (02:23)

I get to see these beautiful offices that our teams live in. And I'm a people watcher. So you know what? Some time at the airport between flights and things, I kinda dig it. It fills that little cup too that I just get to like watch people at life. You can tell who's going on vacation, who's probably also on a work trip, right?

Tiffanie (02:43)

Yeah.

Nikki Mack (02:44)

And I love it. It's it kind of makes it interesting and it's something new. So I like it.

Tiffanie (02:49)

Yeah, I agree. I agree. I've actually had like Monday morning flights, those are the biggest commuter flights, you know. I've actually been in line in flights where like two guys who are not they don't work together, they don't really know each other, but like they end up on the same flights together all the time. So they're like chit chatting behind me and I'm like, This is kind of cute, you know, like you get

Nikki Mack (03:09)

Mm.

Tiffanie (03:09)

all walks of life everywhere you go, but we value and appreciate that. we love you for your travel and

Gosh, it's we're wrapping up the year here. So this is kind of cool and it's kind of crazy. I keep telling everyone, I'm like, which I think because you and I both like we go out next week, right? So we travel. I feel like travel weeks are like blank weeks in the calendar, right? We're super busy, but

Nikki Mack (03:32)

Okay.

Tiffanie (03:32)

we're not home. So it's like I lost that week is almost what it feels like, right? Like I'm doing something really cool, but it doesn't count in the month. it feels like October is like over. Cause I keep just, it's like.

Nikki Mack (03:43)

Hundred percent I had that thought.

Tiffanie (03:45)

Early

October in recording this and I just I feel like the whole month is gone and like tomorrow's Halloween. It's not, but that's what it feels like.

Nikki Mack (03:50)

Yeah.

I'm already thinking about the beginning of November and who's hosting.

Tiffanie (03:55)

Literally.

Nikki Mack (03:56)

Like what are we where are we doing?

Tiffanie (03:59)

Literally. And I'm like, do we put the Halloween cat out? Like, is there really been time? Like, what's the point at this point? Halloween's tomorrow. Like, no, we've got a whole month ahead of us, but I don't

Nikki Mack (04:07)

Thank you.

Tiffanie (04:09)

know that we're putting the cat out, you know? Whatever. Whatever. It does fly. It does fly.

Nikki Mack (04:11)

Yeah. Time flies. I agree with

Tiffanie (04:17)

with all of that, we do travel. We are boots in the boots on the ground at this time in our company. we love being in person. We love what we do, and we also do virtual really freaking well. And

Kiera and I a long time ago, we did not do as much virtual as we do now. And we had, you know, I don't know if any of you remember six-ish years ago, the world shut down for a couple of months. And, you know, it kind of it it brought some fun things to our company. And something that it brought was it really pushed us to innovate and it pushed us to figure out even better ways that we can reach clients and reach people.

All over the country and world. Honestly, we have Canadian offices. We've worked in Australia before, like we've worked all over the place. So it really pushed our innovation, which is a huge core focus in our company. used to be a core value. It's since changed. That's okay. It was innovator die, which is kind of rough. but we innovated, we did not die. Our company did not die. We innovated. We got really good at virtual consulting, meaning kind of how Nikki and I are here today on this podcast. We meet with teams.

virtually and and doctors, office managers, like whatever it is that we've determined your practice needs and do a ton of work in in virtual. And then also we have our practices that do in person. And Nikki, I wanted to pick your brain today because I think you're really good at this. We've kind of you already know what I'm gonna say. We've we've talked about this, but I think something that you just mentioned, I originally chose this because this topic because you did it in office.

Recently, and you did it in office for an office who I hope is listening because you will know who I'm talking about, who didn't want to do it right. And they didn't want to do it virtually. and I'm not sure that they were really sold on it in person, but then you just mentioned prior to coming on here how you set up an office manager, we'll call her, to s to do this on a on a meeting you weren't going to be a part of. So as a virtual, this is a virtual team. So you have your in-office team that you did it with in person.

But then you also have a virtual team that you helped that manager prep and plan for a meeting where she would do this on her own without you. And this is role playing. So Nikki is like a phenomenal role player. She's great. And Nikki, I think you're you've got consulting background, you've got dental background, but you've also been a teacher. And I think that education background, that teaching background helps you be such a phenomenal role player.

But when you said that today before hopping on that you actually helped that specific practice set up their team meeting, I thought, my gosh, this is even more than just the you know a case study of you doing it in person. So walk us

Nikki Mack (07:01)

Yeah.

Tiffanie (07:02)

through that. And I think there are some key pieces here. One, I would love to hear why, Nikki, you prioritize role-playing, why you think it's important. And then like the how-tos in what you see as the results, like especially.

having done it for a practice that maybe didn't want it and it wasn't the team, right? It was the the maybe the management doesn't prioritize it too. Walk us through all of those pieces.

Nikki Mack (07:26)

Yeah, of course. So I think first off, role play is so important, guys. And like the reality is everyone hates it. I mean, that's like across the board. It's not just dental. It's anywhere you go. You say, like, we're gonna role play this, and people cringe. And honestly, I lean into that with teams, right? When I talk, I'm a big fan of transparency, right? I know you don't wanna do it. Cool, we're gonna do it. And here's why. it makes such a difference. Cause here's the thing.

We are humans, right? And human nature, we have to practice things to be good at it. That's it. I mean, that's like kind of the baseline of it. You have to practice things to get really good. And when we talk about the things that we go over in role play, that's not creating a chart in dentrix, right? That's not filing our cases from the lab. These are those communications and interactions with our patients and sometimes even with each other.

That all build on that patient experience and what we are doing in our office, right, for our patients. Every way that we relate to them, that we build a relationship, that we build a trust, and eventually are able to help them get the dental treatment that they need and want, right? And we have to be, in my opinion, so good at that that it's just second nature, right? And you're not reading from a script, but we've practiced verbiage.

And we're so comfortable with it, just kind of, you know, in our core that we can roll with it and have those conversations and help answer patients' questions, right? Help address their frustrations, whatever that is. And the only way that you get to do that is repetition. And so I mean, I guess you could be awkward for a hundred patients, or like we could just practice with our team, right? And

Tiffanie (09:13)

Yeah.

Nikki Mack (09:13)

who better to be awkward with than your team, right? Get it out with them, get in the habit.

And then that way with your patients, you are just like a cool cucumber and very collected, and it's a lot easier to deal with them. So it it's rough, no one loves it, but we have to do it. It's how you get better, it's how you get confident and just make it muscle memory. So that's my why. That's why you have to do it. I've lived through different iterations of role play in different jobs, right? I've been the team member role-playing with the consultant, I've been the consultant, role-playing with teams, and I'll tell you what.

We role play as a team. We have those conversations. We're consultants. And if we're talking about a new strategy, system, concept, you know, something that we maybe haven't been rolling out before, we train each other. We practice talking about it. Cause I want to make sure that I know what I need to know so I can help you get all the information that you need. So that's the why. The why is you have to, right? Like that's just how we get better. So that's where I start.

And then here's how I approach it. And I'm gonna share two things. one, so we were recently at a CE, the Western Region dental conference, event, conference. You know what I mean.

Tiffanie (10:31)

Mm. Yeah. Convention.

Nikki Mack (10:34)

Western Region people, you know where I was. and

Tiffanie (10:35)

Yep.

Nikki Mack (10:36)

there was one doctor who was speaking about case acceptance, you know, relationships with his practices and

Amazing speaker, first of all, had so much great information and he's taught and ran a bunch of practices. But he said a phrase that has stuck with me since then and he said he stopped thinking of it as role play and he thinks of it as practice simulation. And he talked to his team because a pilot has to do so many hours of flight simulators, right, before they even get in the real plane. And then part of their continued training and certification is more of that simulation, more of that practice.

And he said, if it's good for a pilot who I definitely hope is doing those hours right before they're flying my plane, it's good for us too. We have to do those simulations, we have to do those reps to stay really confident and make sure that we're delivering the information to our patients the best way we can. So I've just kind of kept that energy, I guess you could call it. And it is true. Role play is uncomfortable. Practice simulation is how we give our patients the best experience that they can get.

And it's super important to, you know, frame our mindset. So then I'm gonna walk you guys through it. You ready? I hope I hope

Tiffanie (11:52)

Really?

Nikki Mack (11:52)

your earbuds are in. I hope you're on the treadmill, wherever we're at, get ready. when we're doing role play or practice simulation, don't come in with a set plan. Now we know as leaders, I know as a consultant when I go into a team, usually something that we're struggling with. maybe we just started offering financing through like cherry or care credit.

And so comfortably relaying that to patients is an opportunity. So I I know a little bit, but I don't walk in with a set agenda. Okay, today we're role-playing and we are gonna go over this scenario, this scenario, this scenario. I like to get team buy-in and have that conversation. Hey guys, what are areas where you're working with patients that you get the most pushback, the most questions, or see consistently that patients are just

not easily confident, right? Or maybe you're not easily confident because you're new to the role, new to the system, new to the thing we're explaining. And how do we work as a team to support that? Because the thing is, if you have a question about it or you're not fully confident on it, I bet you someone else on the team is too. And we just haven't had the conversation yet. So we build a list based on what are you guys truly seeing? There's some common heavy hitters, Tiff, I'm sure your teams tell you this too.

X-rays, right? How come my last dentist didn't tell me I needed this? my gums feel fine. What are you talking about? I just want a regular cleaning. There's there's ones we see a lot, but having the team be able to bring those to the table and identify those opportunities as a team already builds a layer of, this is how we're gonna support each other. Because there's always someone who's like, I have the perfect phrase.

I have this thing that I've come up with that I always say and it works. And that's how we have that knowledge sharing because that's the underlying goal of the role playing, not just getting comfortable as a team, but sharing our best practices and tips with our teammates so that we are all communicating the same way with our patients and building that relationship on that level.

Tiffanie (13:59)

Yeah, that's beautiful. Earlier you said your why. And what that made me think of is getting really com excuse me, getting really comfortable with something in an uncomfortable space. So that when you're face to face with it in the real world, it's not as uncomfortable there. Because I think something you you keyed in on is that people like people hate role playing, right? Nobody it's a rare occasion you walk across somebody that's like, my God, I can't wait to roleplay. Like it's uncomfortable and it's uncomfortable.

Mostly because we feel like we're being judged by the people we know. And so in a team setting, we're like, I don't want to look stupid in front of Joanna. Like I work with her every single day. I don't want her to think I don't know what I'm doing, right? Or in front of my doctor, my leaders, my manager. Like, I don't want to do these things and look stupid. But the reality is to your

If I can practice here where I my fears are so built up because talking to a patient, like I'm not usually worried, and maybe I'm crazy, maybe I'm the abnormal one, but I'm not typically worried that this person's gonna think I've misspoken or said something done. Like I don't go into every conversation that high strung. But when you tell me I'm in a role playing, that role play, like that high strung comes immediately. And so if I can

practice it and practice it and practice it in a safe environment that feels incredibly unsafe and and unpredictable, but I can practice it here until I can flow through it with you. When I get out into the real world, into the jungle, and there's a patient standing in front of me that comes at me with this objection, my emotion won't spike so quickly because I've already done that and I've lived through something that's more difficult than this patient. I don't

Like, I I'm not gonna see Joanna tonight, you know. Like, I'm not gonna see her maybe tomorrow morning. Like, so that emotional spike that we get, that fear that pops up, is less because we've already done something more difficult than this, lived through it, and our subconscious is like, Girl, you got this. You've already lived through harder than this, you know what

Nikki Mack (15:59)

Yeah.

Tiffanie (16:02)

to do. And so not only do we get like the repetition of and the memory, so we build that habit and we build the memory, we also

keep our emotions more in check because the role play was such a higher emotional point that our body is like, this is easy.

Nikki Mack (16:22)

Yeah. There's that muscle memory. Well and

Tiffanie (16:25)

Yeah.

Nikki Mack (16:26)

'cause I don't know about you, Tiff. I've never been a part of a team roleplay where the people role playing went easy on each other. So to

Tiffanie (16:33)

Yeah, yeah, yeah, that's fair.

Nikki Mack (16:35)

your point, you've had it worse because we all like, my gosh, this is our chance, right? Every objection I've ever heard, I'm ready to spit it

Tiffanie (16:42)

Yeah.

Nikki Mack (16:42)

out person that I'm I get to be the patient, amazing, right?

Tiffanie (16:46)

Yeah.

Nikki Mack (16:47)

So yeah, you've lived through I guarantee if you've role played with your team, you've already lived through everything that a patient could throw at you and

Tiffanie (16:53)

Seriously.

Nikki Mack (16:54)

tenfold. So when then when with your patient, easy peasy, I tell teams a lot too, think about your new patients. When we're doing a new skill, something we've role-played, man, your new patients are your best audience because they don't know a different you yet. They're still meeting you. So anything you stumble or maybe don't say, they definitely have no idea. And you get to work through that.

And you had that foundational start with your team for sure.

Tiffanie (17:20)

Yeah.

I've had piggybacking off of that, I've had role playing, I do role playing in office too. And I've had role playing and and I'm like, all right, guys, how did it go? And inevitably every single time there's a there's a pair over in the corner somewhere and they're like, I couldn't get her. She just like legit wouldn't. And I was like, Yeah,

Nikki Mack (17:38)

Right.

Tiffanie (17:40)

well, that's fair. It's usually a hygienist that's like, nope, nope, nope, nope, nope. Right. My hygienists

Nikki Mack (17:44)

Yeah.

Tiffanie (17:45)

are like hardcore.

And they're like, you're not selling me. I'm like, eventually your patient would have said yes. Like, eventually, or you would have set up the like that's fine. Like, they say no, no, no, no, no. And you set up the follow-up. So that's

Nikki Mack (17:58)

Mm.

Tiffanie (17:58)

a learning tool as well. Like, you couldn't get, you couldn't get Jessie over the hill. She wouldn't say yes. Great, set up your follow up. Like, what's your next step? So, to your your point of full embodiment of role play, it's you're not, you're not trying to convince.

your team member to just say yes or whatever it might be, but you're also like, okay, cool. Well when a patient doesn't say yes, what is my next step? And my next step is the follow-up, right? So we're not just like, I failed. Like, nope, fine. Great. Here's my next step. Awesome. I'm going to follow up with you. I love it.

Nikki Mack (18:34)

hundred percent.

And then you get to pull the good because then that's the takeaway after, right? We don't just role play and then dismiss. It's okay, what went great? What did you guys hear that maybe you haven't been saying that you want to use? Or what is something that you maybe do differently? Cause almost nothing is a wrong answer in a role play. you know, pretty pretty sure it may not be our best answer, but it's probably not wrong. But this is our chance to recalibrate as a team too and decide like yes, we want to say that, right? We love that language.

Tiffanie (19:04)

Yeah.

Nikki Mack (19:04)

we're gonna utilize that, that's important. And everybody gets that chance to observe, elevate and participate. And that's how we take that forward, right? And grow as a team. So that's your action items after it's done. What do we learn? What are we gonna do differently? And then we're all gonna listen out and support each other after.

Tiffanie (19:23)

I love that. I love that. All right. If you had to build action items for our listeners here on this topic, Nikki, what would it be?

Nikki Mack (19:33)

Okay, so if I'm going into a team meeting, my preparation action items are what are some opportunities I know as leadership that we need to strengthen up, right? Tighten up. And then coming into it with the expectation for my team that I want to hear from them. What are your areas that we need to work on? What are areas you personally struggle on? Or what's a conversation that you know is tough, but you feel like you're a rock star and you nail it and lean on them to build that list? Then when we role play, you have to discuss takeaways.

We can't just role play and celebrate what did we learn, what went really well, what is something that we could all take from that, and then deciding if there's any unified team verbiage from that. it comes up a lot around period. Great, we're gonna say active gum infection, we're gonna say periodontal disease, whatever those languages are, things that become office verbiage, be firm on that. Take that away, and then follow up.

Listen to each other. my God, Tiff, I heard you with that patient that other day. It was exactly what we practiced in the meeting. You did great, right? The patient was super happy. Follow up, share successes, and then do it again. Because you're never done with role play. We're always perfecting and and working on it.

Tiffanie (20:47)

Beautiful. Thank you. All right, guys. If you were driving, go back, listen to this again. Nikki, this was incredible. I am so

Nikki Mack (20:56)

Mm.

Tiffanie (20:56)

happy that you role played in the office the other day and it went really well. because I when I was told to come up with the topic, I was like, I want to probe Nikki's brain on

Nikki Mack (21:06)

Okay, cool.

Tiffanie (21:06)

role playing. So this was incredible. This was great for me. I love the flight simulation, like

you know, like comparison there. I love that. You've given me an idea for my in-office meeting next week. So thank you so much. Thank you for being here with me this morning. teams that are listening, doctors that are listening, go implement these things. She gave you the action item. So if you're driving, go back, listen again, write these things down, go do a team meeting and then let us know how it went. We want to hear from you. [email protected]. What worked really well? What got stuck? What can we help you with? [email protected].

As always, drop us a five-star review below. And I would say if you don't share this one with someone, whether they're in the dental field or otherwise, any company, any person, anyone can utilize this. If you don't share this, goodness gracious, that is just going to be so sad. So go share this, tell a friend.

Nikki Mack (22:00)

Yeah.

Tiffanie (22:01)

And Nikki, thank you again. And everyone out there, we will catch you next time on the Dental A Team podcast. Bye.

Nikki Mack (22:08)

Okay.

Did you know you can change the entire culture of your office in three months by leaning into consistent leadership and clear standards? Kiera shares how to know what truly matters for your practice, including returning to the basics of leadership, future visualizations, and core areas to focus on.

Episode resources:

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Transcript:

Kiera (00:00)

Hello, Dental A Team listeners. This is Kiera, and I am so excited for today. I am hoping some of you are going to join me. I am on a 90-day like comeback challenge. And so I thought it'd be really fun to share something that I'm doing in my company and in my life right now in hopes that it can benefit you guys because truly in 90 days we can change how our entire feel of our practice is, our business is, how we are. And this isn't like a retreat, it's not a pizza party.

It's just consistent leadership and clear standards. And I want you guys to remember that like culture is not a place where everybody gets along. Like that's not what this is. But culture is where our team experiences every day, how people communicate, how we solve problems, how we handle accountability, and honestly how we treat each other. So we're gonna go through a 90-day challenge. I'm in the middle of it. So I don't have like, this is what happened. Don't worry, we'll have a part two to this podcast of like how it's going. but I just recognize within our company and our culture.

Sometimes instead of adding more, it's the need to cut. So what have we been doing? What things should continue to maintain and sustain versus what is really necessary to get rid of? And it was interesting because I had a call out of something like, Kiera, I don't think you're having a good time anymore. And I'm like, I'm not. I'm drowning. I'm dying. I feel like everything's being piled on me. We've had a lot of crazy things happen in the company this year. So I don't feel it was a like overnight sensation. It was just the stack of a lot of little things. And

So what we did is we just all band together, right? We had somebody leave on maternity leave. Then we had a second maternity leave. And then we had some different pieces come up and we had some team turnover and some team additions, like normal day in, day out of business, right? but what we noticed is we just kept going. We kept operating as full steam ahead. So it was like, all right, this person's out. Britt, you're gonna take this, Kiera's gonna take this, Tiff, you're gonna take this, Dana, you're gonna take this. And it was dispersing of tasks. Well, then what happened is everybody kind of felt like they were.

Just like piecemeal together. I've said many times in our company it's felt like Willy Wonka. And I'm like, I only have half a person for this, I got half a person for that. Like it just has felt a little messy. And so when we work with this, it's a space where then communication starts to break down, culture feels heavy, like the owner doesn't know if they want to be here or if they don't want to be here. and you've got to change leadership first. So it was a couple of days ago, and I was like, all right, that's it.

I am setting up a 90-day comeback challenge where we are going to love where we work. I'm going to love where I work again. And I have been the like yes girl saying yes to so many things in the company, thinking I'm helping our team out. Well, what I realized is I'm not being buried. I'm running lead consultant. I'm running sales operations. I'm running the marketing. I'm running podcasts. I'm running, I got a pretty large client load. and in saying all the yeses, and it's cra fascinating because I have a bracelet that says no on it. And I I failed to say no.

But again, we're doing it out of like necessity, right? Like these things come up. You can't like maternity lease going to happen. People are going to be out. People are going to get sick. People are going to turn over. But what we don't have to do is keep running at the same speed. And so what I started doing is I'm like, all right, I feel like there's that that corny analogy of the gardener. And what does the gardener do? They need to go out and they need to prune. And my husband and I were

Working the other day in the yard and I was it was just a day and I took the pruning shears and man, my husband said, like, I he felt sorry for that bush. Like I just whacked that thing down to nothing. I was out there just chopping away. I had my music blaring. And I realized that sometimes we need to cut in our companies as opposed to continue to add. I think a lot of times on the podcast, like, well, let's implement this system, let's implement that. But today I really wanted to talk about like what do you cut and how do you cut? So number one, I had to get my mindset right. So

Things that are non-negotiable for me are working out. Like I gotta work out because I gotta exhaust the body, tame the mind, as Dan Martell says. Like we gotta make sure that this pent of energy gets out somewhere. So I know I'm a better boss when I'm going to work out. So that's my first box that goes in. I am getting back on track with those things that I know are going to protect me. So phone goes on silent at 5:30. I don't answer any more text slacks or emails. That's out because I got to create some mental space for me that I have some shutoff time.

Sleeping eight hours every single night. So we're working on sleep hygiene and making sure that I'm eating and getting the like physical exercise. Like that was part of my reset. Was I was like, I gotta get back to human basics. I've been running for a long time on this. So check yourself. Are you as a CEO putting your oxygen mask on first? Are you having that? Number two is gratitude bookends. I realized like

I can sit here and complain a lot about things, right? When things are just chaotic and mayhem, it's easy to be like, my gosh, our schedule's not full. my gosh, this person, this, my gosh, this. but what we what we say and what we focus on, we create more of. And I realize like, I don't want create more of this. So I need to bookend gratitude. Like I'm okay to have issues, but I can say like, my day is outstanding. We have this issue, and I'm super grateful for an awesome team.

so that way what I'm starting with and what I'm ending with are always positive. And again, I'm a few days into this, I'm about two weeks into this, and I've noticed it's just forcing me to spin for like what am I grateful for? I have a bracelet on today that says find the joy, and another one that says grateful. And so, how can I be more grateful, even going through the quote unquote suck of success? How do we maintain that gratitude space? Number three, meditation every morning, money and journaling, mindfulness.

So every single morning I started it. If you guys want to join me, I do Joe Dispenza as a meditation. I've done a lot of different meditations over the years. I really have loved Joe Dispenza. I went to one of his courses. I've just found that it helps me like laser focus in on the life that I want to achieve. What are things that I don't want to be doing right now, and how do I actually maintain that for myself? So every single morning I throw on a 15-minute meditation, literally the second I wake up, it's a visualization, it's a creation of what's the life in the business and the company that we want to create.

I really believe it's it's easier to get above the clouds and to think about this. So it's like perfect, we want to have this, we want to have this. And that way I'm priming my mind, I'm priming what I'm looking for. I'm turning on that reticulated activator. Like, let's go look for these items in my world. Like, if I keep saying, my gosh, team's turning over, my gosh, we're stressed with this, my gosh, we're cash flow low, like we're not. But if I say that I'm going to create that, so I don't want to create that. So be really careful with the words we're saying as well to ensure.

We're creating the life and the practice that we want to have. After that, I go through a journal. I have it. I threw it on my nightstand, so I can't pull it on the podcast and show you. I like these adorable little notebooks. I think that they're really pretty, and I like to write in pretty notebooks. So I have a notebook, it's the same one I write in it every day. And today, like I literally have written like we're on day six of our 90-day comeback challenge. I'm on day seven of my 90-day comeback challenge, and I'm going to be consistent with it because I believe consistency, focusing, and forcing myself into a 90-day comeback challenge.

Like I like a good challenge and I like to stay consistent with it. And I know it was great. I started on the first of the month. So it's helpful for me to know what day I'm on. But hey, you don't need to do that. Let's just start today. Let's get into our 90-day comeback challenge. And it can be for your physical weight, it could be for a relationship at home. It could be of your company and team. It could be on building the next level. I don't think that I've done a quote unquote cut reset in a really long time. And so for me, it's like great. What are the simple things? And let's boil it down.

the four core basics of the company. So for me, it is our profit margins. It's our like case acceptance would be an equivalent for you guys. And then it would be on like our like new patient bringing them in if you want. and then like whatever it is for you, like those are kind of the core four of our company. Like what are the core four true functions for you guys and your practices? I'd say it's your production and your collections percentages, which is going to tie to your overhead if we keep that in a solid space. I track your case acceptance, your new patients and your hygiene production and perio. Like

That would be my core four or five if I'm trying to go into a cut lean what needs to be removed. And I'd really be assessing what's truly working in our practice. Like, are we just working because we've always done this? Or are we like needing to continue this on? For us, marketing, I feel like that has become this like gumball where we just keep adding and snowball is probably a better way. I don't want you thinking I'm like, like, could you imagine somebody who keeps their gum and just adds to it every time? Like, please know, like, let's do a snowball, that's a better analogy.

But it just keeps snowballing, right? So we're just keep adding and adding and adding. Well, all of a sudden our marketing department got so heavy and overwhelming. Like we could not lift that giant snowball that we've created. And instead, like let's cut that down to a more manageable. Like what things really need to happen? What things could we automate? What things could we make easier in our practice and our lives that would actually make this easier? So back to my month, my morning. We meditate, we write in the journal. Every single day it's what I'm grateful for, what my accomplishments were from the day before.

What improvements I need to make coming up for that day? I'm only allowed to write three of each of those. Gratitude's allowed to be whatever you want it to be and be very specific with it. Three accomplishments every day, max three improvements. It can be less than that. What was the joy that I had from the day before? Something that really just lit my soul on fire. What's something that I love about myself as a leader or as a person? What are my goals for the year? I write that every day. And then what are my results that I'm going to get from today? That way I'm laser focused on the future that I want.

on my core four of where we're going in this 90-day comeback challenge and how we're going to get through it, making sure I'm taking care of myself first. Then as a leadership team, we boiled it down to these are the core four and every single new initiative, every single leadership meeting we have, if it does not apply to this today, right now, it gets cut out. We also went to the marketing department. We're taking it to the consultant department. Like if this does not move us forward, we are cutting this out today. We're cutting this down. We're getting rid of it. Let's reassess everything. It's kind of like fall cleaning if you will. Like you look through and you're like,

I'm not wearing these shoes anymore. I'm not wearing these shirts anymore. I'm not wearing these jackets anymore. Like, let's cut that out so our closets are not overwhelming. I think in businesses, sometimes we actually need to have a cut season. And so this might be the call to you. What can you cut? What can we remove? What can we reduce? What can we repurpose? What do we need to just get rid of? We were looking at it and I'm like, all right, great. We could batch this. We could, we can have these other things so much simpler. But I think sometimes as leaders,

As important as it is to roll new things, it is equally as important to know when it says, cut laser focus my team and let's get focused and dialed in on the things that truly matter and move us forward. That's how you create a culture. That's how you show up as a leader. That's how you're able to grow and innovate and be able to become the leader that your team wants. So in my 90-day comeback challenge, what am I doing? Number one, taking care of myself, getting back to the basics to make sure me as a leader, I'm set up to the highest level to lead and to grow at the level that I know is going to support and sustain my team.

Number two, I'm doing meditations of that future visualization of our company and of my life, of what I want that to be. So I purposely program my mind to look for it, adding in that gratitude bookends constantly. Then I'm writing my journal literally every single morning. Today is day one of my comeback challenge. Today is day two of my 90-day comeback challenge. Today is day three. And what's fascinating is again, I'm a few weeks into this, the momentum's building. And even though things aren't necessarily better.

I see the end. I see that in 90 days, this is where I want to be. These are the core four areas that I'm focused on in our company. Lasered it. And was wild as our leadership team, we walked out of our meeting and they were like, Kiera, thank you for the breath of fresh air. In our marketing department, they were like, Kiera, thank you for the permission that we can cut these items. Now everything doesn't get to be cut, but the things that are just busy work, like we need to get rid of the sweaters and the jackets and the shoes that no longer fit, it's time to do that. So that way your business could elevate because I believe.

Just as much as new items and initiatives are important, eliminating the old cobwebs in your business are equally as important. So if you want to join me on my 90-day, I'd love it. Write me an email, [email protected] and say Kiera, I'm committed to a 90-day comeback challenge as well. Join me. I'd love for you to be a part of it. And for all of you, I would say look at your practices today and see where you can cut. As CEOs and leaders, look to see where are you getting like mucky in the brain because we're not laser focused.

Break it down to the core four if necessary. Simplicity, simplify, simplify, simplify, and really see what truly is necessary and essential in the practice rather than is just busy work that we've always done. And could you cut any of those items as we're headed into winter this year? I would really implore you to do it. I know you and your team will feel so much better from it. And hey, if we can help you, because sometimes I need an outside perspective. I call a lot of coaches and they help me see, Kiera, this is what's really the core of your practice. This is what you need to do.

And sometimes having somebody with that bird's eye view is so invaluable. I can't tell you how much I lean on those coaches, especially when I'm down on myself as a CEO, when I'm down on our business feeling like I'm just not doing a good job. They're there to boost me up, to laser focus me and ensure that we're driving in the correct direction. If we can help you out with that, reach out. [email protected] or click on book a call. We'll just have a free call with you and you're gonna leave with your number one priority, whether you work with us or not, and we will give you a complete practice assessment. So there's no no no stress.

Like, why not? Reach out to someone who's been there, done it, done it so successfully, and also is willing to come on a podcast and tell you what she's doing currently in her business. And I've done this multiple times. I just forgot the season of pruning and how while that might feel painful, it actually is what creates plants and businesses to flourish more because we cut out the mess, we cut out the misses, and we're able to actually grow this into a beautiful build like a blossoming, more healthy business than we've ever had before. So tis the season to cut.

Tis a season to join me on a 90-day comeback challenge, whether you're crushing it or whether you're ready to reset, whatever it is, join me. I'd love to have you be a part of it. We can help you and serve your practice. Reach out, [email protected]. As always, thanks for listening, and I'll catch you next time on the Dental A Team Podcast.

This episode is all about dentistry as a relationship-based field—finding your patients' motivations and blending what they want with what their teeth and mouth needs. Tiff and Kristy provide tips on getting to know the human in the chair (even when you're seeing 30 to 50 patients a day), so they truly feel like their needs are being met.

Episode resources:

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Transcript:

Tiffanie (00:01)

Hello, Dental A Team listeners. We are back here with you on our consultant takeover, is what I like to call it. The consultants here at Dental A Team, myself, Tiff, Tiffanie, Tiff, Spiffy Tiffy, whatever you want to call me, and at least one other consultant every single month will come to you with some actionable, implementable words of wisdom and advice, things that we've seen in offices on the road. We do virtual consulting, we do in-person.

Boots on the ground consulting, and we also do masterminds in person. Right now they are located in Phoenix, where all of our Dental A Team doctors and their mass their office managers can come mastermind together. So a lot of the things that we come to you with are from our experience. We are all experienced in the office. We've had hygiene hygiene or dental assisting, and all of us have had front office and at some point or another have managed a practice, andor some of us.

Kiera have owned practices. So we've got a vast wealth of knowledge here within our company. And then again, also we are still experienced as in we are going into offices and we're helping to innovate. So Dental A Team does it differently because we will smash all the knowledge that we're getting, all of the experience that we're getting, and create new exciting things without completely reinventing the wheel. But again, just putting it out there that we're not stale and stagnant. We are.

constantly in offices and our teams constantly talking about the things that we're doing. And today I bring with he with me to you, Miss Kristy. Kristy, you have been in dentistry for a while, same as me. We've both been in it for what feels like forever. And you did some really cool things in office. And one of my favorite things about your experience is not only like the boots on the ground experience that you have, you've been in

so many practices physically in practices as a dental consultant, but you really work on personal development and leadership as a skill set to layer on top of the dental. And I love that. I I you know I love the same kind of genre of learning. We share books

DAT- Kristy (02:11)

Yeah.

Tiffanie (02:11)

and podcasts all the time. but how do you I'm gonna like just ask you a little snippet how do you feel that that layering in your consulting

as you're working with team members and doctors, how does that layering help you to get them to that space of change where they're ready to implement something new?

DAT- Kristy (02:32)

Yeah, I love that you say that tip because I think truly if if I had to summarize it, it's really investing in the per person, you know. while I think we love to vision our teammates or, you know, even as doctors and employers, we think they're gonna stay forever, right? And that's kind of our goal. But sometimes it's not meant to be that way. And I I truly believe that investing in the person, whether they're

staying there in that practice or moving on or heck, how many go back to school and then come back to you? So I think you know we talked about systems earlier today and there's only so many systems within a dental practice, but when you can layer in and invest in the person on top of teaching systems, it just takes it to a new level. And I I liken it to how we treat our patients, you know?

Tiffanie (03:30)

Yeah.

DAT- Kristy (03:30)

We can

and it ties to our conversation today, I know, but so many times we can just jump in, diagnose, treatment, plan, tell, or we can really get in relationship and figure out what patients want and create a different experience. And I think to your question, Tiff, no different than how we deal with teammates or employees,

Tiffanie (03:50)

Yeah.

DAT- Kristy (03:50)

investing in them for sure.

Tiffanie (03:53)

Yeah, I completely agree. As you were speaking about that, I started thinking, my gosh, yeah, it is it's just that relationship, right? Like you said to the patient experience as well. And being able, I think for our consulting team in general, I think we're all a little bit more inclined towards that like personal development and leadership side. more so than many people I've met in the profession that are very like ready to go, let's just

change this thing like do and i i get that because people get excited for dentistry too and we do as well i think i i love the people aspect of it like dentistry paved my way is what i say i think it's cool i think it's awesome but it's not end all be all it's more to me it's more about the people and like you said investing back into them and i think that's something that Kristy you do really well and i know the rest of our consultants do as well

Of really investing in the human that's on the other side of the screen, or that's standing in front of us when we're in person and really letting them know and understand that we do care. Not even just I was gonna say making them think. That's not even it. Like we're not making people think anything, we're truly investing in them and letting them know that this is the right place. This is where they should be, and they love their jobs, they can love their jobs and inspiring them.

To love what they're doing and love the patients that are coming in. And then I think, Kristy, what you do is create a space of safety for them and then a space of learning. So they get to see, they get to be poured into. And the best part about pouring into someone is the idea that they're going to take that and pour into someone else. So then you're pouring into your teams and your doctors when you're working with them.

And then hoping right that now they're pouring into the patient. And to your point, what we're talking about today is patient like treatment planning and really why we're not getting the yes right away. The patients that are saying, I need to think about this. And I think Kristy, to your statement, to the point of your statement, we've got to make sure that we've poured enough into the relationship to be able to speak to.

treatment plans to issues and problems because like you know you go get your car oil done and then all of a sudden this man you've never seen before he's not even the guy who checked you in comes in he's like Kristy he's like you need and he goes down the list and you're like who are you like

DAT- Kristy (06:19)

Yeah.

Tiffanie (06:19)

why are you like I what are your credentials like how do you know this and and when we're so automated or busy

I fear that we might get in that same space within a dental practice.

DAT- Kristy (06:34)

Yeah, I I agree one hundred percent, Tiff. And I think we do get in that space, right? We get busy and and they do come to us for our knowledge. And you know, don't get me wrong, we have a due diligence to diagnose and and treat and tell them what we see. However, I I I literally like I joke about this, but when I teach like even phone coaching and I say to people, why are they coming in for a cleaning?

They're like a cleaning. And I'm like, but what's a cleaning? Like, why are they

Tiffanie (07:05)

Yeah.

DAT- Kristy (07:06)

literally coming in for a cleaning? What do they it they're coming for what it gives them? N there's nobody that calls on the phone and says, Hey Tiff, will you make sure my hygienist has really sharp instruments so she can scrape my teeth? You

Tiffanie (07:20)

Yeah.

DAT- Kristy (07:20)

know? Like nobody says that ever. They're coming

Tiffanie (07:22)

Yeah.

DAT- Kristy (07:23)

for what it gives them. And if we want,

To really interact and change lives of patients and get them to say yes more often, we really have to figure out what their motivation is. And again, it ties with that diagnose treatment plan and tell them what they need. But in reality, and especially in dentistry, I think patients truly buy what they want, not always what they need, right? And the want

Tiffanie (07:50)

yes.

DAT- Kristy (07:51)

usually has an emotional side to it.

Tiffanie (07:54)

Yeah, that's so funny. Yesterday I went to Target. I went Target's dangerous.

DAT- Kristy (08:02)

Ha ha ha.

Tiffanie (08:03)

I went to Target. So my fiance Aaron and my son Brodie, they decided to it was

I said it looks nice outside. Apparently it was still very hot. But I told them maybe you guys should go, you know, to the driving range and hit some balls. I've been waiting months to be able to go golfing, right? So I'm like, why don't you guys go hit some balls? I'll run to the store. I had to get everything, groceries and stuff. I said I'll do the pickup and I gotta run to Target for a couple of things. So I go to Target with the littles, right? So I've got a 13-year-old boy, 10-year-old girl, and I'm like Roman Target, you know, and I'm just taking my time. And I said, gosh, you know, sometimes Target just

Target needs to tell you what you need. You don't always know what you need going into Target,

DAT- Kristy (08:43)

Yeah.

Tiffanie (08:43)

right? And I'm like, doo-doo doo. And then later that evening, one of the boys, one of the one of the older boys, said something about, I can't remember, something about the my Target experience, right? I think Brodie, Brodie's like unpacking Target, right? And he pulls out this like loaf pan and he's like, What what what is you went to Target for this? And I was like, well.

I didn't, but I know that I needed another loaf pan and it happened to be $2 off. So it made it into the cart. And something Brodie goes, I said, I I told the littles when we were there it was very dangerous that Daddy let me go to Target without a keeper because when Brodie was little, and honestly to this day he's 18, but ever since he was about four, he would be in the cart and we're at wherever Target

DAT- Kristy (09:36)

Mm.

Tiffanie (09:37)

or whatever store it is.

And I'm just going, I'm like, ooh, ooh. And he'd be like, mom, mom, is it a want or is it a need?

And that's so true though of everything, right? Target, I will drop two, three hundred dollars because my house needs these things, right? Well, the holidays. I might need this. I want everybody, everything to be the same. And Aaron's like, who's coming for the holidays? Like the kids, right? Like I'm like, I don't know, but what if? Like, what if I and I want it to be aesthetically pleasing, but then when I go into, you know, a practice, I know these patients are the same.

We're gonna go drop two, three hundred dollars on something that makes us feel good in our home. We want it to feel great, but how is it making us feel to have that treatment done? So if we are looking for aesthetically pleasing something, and I come in and I ask for whitening, I ask for you to tell me how to make my teeth look better. And you say, Well, guess what? You've got this gaping issue back here. We can't even touch this. I'm like,

Yeah, well, that's been there for a long time. Like I the holidays are coming and I really want wider teeth. And I'm negated and I'm not paid attention to. And so there's a bunch of different sides, right? But to your point, Kristy, just like Target, I'm gonna be like 24 bucks. That's that's a loaf pan. I need it for the holidays, right? I want it right now, and I'm probably not gonna use it at the holidays. Who knows? I have no clue, but I have it in case I do.

And treatment wise, if we're not feeling tied to the emotional aspect of it, we're gonna think about it. Like, mm, I put something back at target. Cause I was like, honestly, like that's not actually the color I want. I'm not tied emotionally to that color. So like you can keep that target. I'll get this one instead. Not that I didn't buy something, I I replaced it with something, but the emotional aspect to it, I was able to get rid of something because I wasn't emotionally tied to it. I said, that's okay.

But the things that I felt emotionally tied to, I kept in the cart and I paid.

DAT- Kristy (11:46)

Yeah.

Yeah. Agree with you, Tiff, so much. Again, I think we can mesh the two together, but I I'll I always share a little story. I had a friend that was looking for an SUV and

Tiffanie (12:00)

Mm-hmm.

DAT- Kristy (12:01)

she went to the car lot and they were like, my gosh, you're gonna love this car. It has three rows of seats and you can put your kids' friends in here and blah blah blah. And you know, they were really telling all the great features of this SUV, but unfortunately she didn't have kids.

Tiffanie (12:17)

no.

DAT- Kristy (12:16)

So while

it was all true, it wasn't speaking to her why. So she didn't end up buying the SUV. She went down the road and bought a different SUV from somebody else

Tiffanie (12:25)

Yeah.

DAT- Kristy (12:26)

because they figured out her why was to put her surfboard in, not to put kids in. So again,

Tiffanie (12:30)

They asked her the questions.

DAT- Kristy (12:32)

you can you can mesh the two together, but really taking that step back to figure out what are our patients, what do they want? And

Tiffanie (12:40)

Yeah.

DAT- Kristy (12:40)

speak to that thing that we're telling them they need, but speak to it in a way

that

goes ties to their want. Yeah. Yeah.

Tiffanie (12:49)

Yeah, that's a beautiful story because that is

a lack of empathy and a lack of wanting that that that's the connection. So when you have the patients come in that and and Kristy, you're coaching, you ask the questions, you get to know the people so that you're coaching to the people. That's we say we customize our consulting and we do. Dental A Team.

customizes our consulting to your practice. That is an aspect of the customization. It does not mean that we're revamping everything and we'll trial and error everything. Like we have systems that are tried and true that we know work. We've got the systems. We're going to make sure that every practice is working off of these systems and that we if you're already using a version of it, like we manipulate it to make sure that it fits for you. But our customization is I'm going to speak to you in a way that speaks to you. Like I'm not going to

The way I talk to Kristy, even is probably not the way I the same way I talk to Dana, even just in the fact that Kristy's your kids are older. So the conversations

DAT- Kristy (13:53)

Yeah.

Tiffanie (13:54)

I'm gonna have with you about our kids, I'm not gonna talk to you like I can, and I know that you would love nothing

DAT- Kristy (14:00)

Yeah.

Tiffanie (14:00)

more than to hear about the littles, right? But it's like I relate to you on my big because you have bigs. Dana, I can relate to the littles that she's got because

DAT- Kristy (14:11)

Yeah.

Tiffanie (14:11)

there's littles in my life. So

Getting to know the human on the other side is is the key. And coming up with a few questions that can be repeatable. That's not, what did you do last weekend? Or it's Wednesday. So it's either, what did you do last weekend? What are you doing this weekend? Do you have to go back to work? It's like, hey, tell me about work. What do you what do you do? I see like your insurance on here, but like, what do you do for Wells Fargo?

DAT- Kristy (14:39)

Yeah.

Tiffanie (14:40)

Ask a real question. So like.

What are some questions that gets them actually talking? I hate the yes or no. And and fine, like, what did you do last weekend? Like, my gosh, tell me more about that. And I am truly interested in that, but we all ask that question. So maybe our treatment coordinators, our doctors, our dental assistants, hygienists, like come up with one question that you can ask. And maybe you've got three that rotate that like sidelines someone, you know, that.

is out of the ordinary that makes someone be like, Wow, you actually want to know about me. That's cool. Like it's

DAT- Kristy (15:17)

Yeah.

Tiffanie (15:18)

awesome that we remember their kids and the sports and those. And people do feel seen. They feel great because they're coming in for their recalls for it with that. But I think it's that really truly caring and that intentionality that helps a patient say, Yeah, I do, I do want to get this done. Cause to your point, Kristy, it's like

a mom, like do you want you do you want your kids to have healthy teeth? Like let's show them what healthy teeth look like. Like I would hate for you to be on vacation with your kids or at a sporting event and you eat a a nut or a popcorn kernel and this tooth breaks on you in front of the kids. You got this emergency, like I don't know what it needs to look like, but something to that effect where we're really getting to know the human on the other side.

DAT- Kristy (16:02)

Yeah, I agree 100%, Tiff. dentistry is a relationship-based field, period. It just really is. And and even to your point, even with coaching, like we can come in and say, NDTR, you need to do NDTR. But I think we are no different than our patients. And we need to understand the why behind it. And and again, if we're looking to do something that maybe is a little bit foreign to us or a little bit uncomfortable.

knowing the why behind it and and speaking to what we want. I mean, we talked about that earlier. What's working, what's not working, what do we want more of? If we can speak to what we really want or what that patient wants and they feel heard, wow, it just is we're stepping in a forward direction that, you know, people want to feel validated and heard, seen. Yeah.

Tiffanie (16:57)

Yeah. Yeah, I totally agree.

Yeah. Yeah. And those simple intentional questions make all

DAT- Kristy (17:05)

Yes.

Tiffanie (17:05)

the difference. And it doesn't add time. I know we get busy like dentist dentistry is hard because we are a relationship-based field. Hands down.

DAT- Kristy (17:15)

Mm-hmm.

Tiffanie (17:15)

You said it perfectly. We are a relationship-based field and we're really breaking busy.

So we're trying to build relationships with sometimes 30 to 50 patients a day and individualize that care and that attention. And it's hard. So something that helps that and helps patients say, yes, let's do this, rather than, no, I need to think about it, is making sure that we are also communicating with one another, like celebrate.

the knowledge that you have about this patient. So if Kristy's my treatment coordinator and I'm a hygienist or dental assistant and I found out something really cool about this patient, I'm transferring that information to Kristy. I'm like, my gosh, did you know she's a Pilates instructor down the street? Like we've been asking for Pilates or did you know she owns the coffee shop that we go to all the time? Kristy's like,

DAT- Kristy (18:08)

Yeah.

Tiffanie (18:09)

what? Tell me more. How did you even get into that? Because we're genuinely interested. So I don't it we I

We said this on the last podcast we just recorded. You said this, Kristy. You said sometimes we make it more difficult than it needs to be. And this is that space. You can be busy and intentional. Being intentional

DAT- Kristy (18:26)

Mm-hmm.

Tiffanie (18:27)

doesn't add to your busy. You need to be intentional about getting to know the person and intentional about helping the next person save time in their job too and transfer that relationship.

DAT- Kristy (18:43)

Yeah.

What is this saying? We you made me think of it be interested, not interesting, right? Right. So

Tiffanie (18:49)

Yeah, yes, yes.

DAT- Kristy (18:52)

again our ease, but to your point too, Tiff, a lot of times I know we were talking about patients saying they need to think about it. Usually it comes back to two things. In in my opinion, it comes back to one of two things, perceived value, or we didn't find a financial solution.

And so both of those take getting into communication with the patient and figuring out like what is their lifestyle, what is their budget, what are they wanting? And if if a patient walks out and says that, I just challenge you to take a step back and could you answer some of those questions? And if not, let's go back to the root of why are they here? What were their motivators for walking in the door? I mean

I joke about this too. Everybody says they hate. Well, not everybody. I think I'm the opposite, but most patients say

Tiffanie (19:44)

There's a few of you outliers out there.

DAT- Kristy (19:46)

they hate going to the dentist, right?

Tiffanie (19:48)

Yeah.

DAT- Kristy (19:49)

And if that's true, no one's forcing them to walk in the door. So why are they there? They're there for something. And and they're

Tiffanie (19:53)

Yeah. Yeah. Yeah.

DAT- Kristy (19:57)

choosing you. So, number one, be grateful they're choosing you and acknowledge that, but also like figure out.

Why are they looking at this SUV? Why are they coming to our dental practice? Right? What

Tiffanie (20:08)

Mm.

DAT- Kristy (20:10)

is their why? What is their want? And find a way to tie it back to that.

Tiffanie (20:16)

Yeah, you made me think of the car ride this morning with the littles and sis is in like the best mood ever today. It's Monday when we're recording this, you guys. She's in the best mood and she's like and I'm gonna do this and my friends, but then they're both sitting back there saying that they hate school, right? Like they hate school. And I'm like

I think I said that when I was a kid too. And looking back, like school was such a massive part of my life. That's where all my friendships were formed. That's where we had fun, we played, we learned. Like looking back, I'm like, I didn't hate school, but I think we're supposed to hate school. I think

DAT- Kristy (20:54)

Mm-hmm.

Tiffanie (20:54)

we're supposed to be like, I don't want to do this.

But I don't think we actually hate it. Like that's such a strong word. And dentistry, you're supposed to hate dentistry. Nobody likes going to the dentist. We say it all the time. We make it true, right? We do, they do, everyone says. And it is an incredibly invasive space. It's a very intimate situation. You sit your patient in a chair that

you they can't get out of because there's

DAT- Kristy (21:22)

Mm.

Tiffanie (21:22)

so many things in the way. I can barely clean around it, right? And then we lay them back and make them open their mouths and we're hovering over them. They literally are stuck. It's so intimate. And then we're standing there telling them everything that's wrong. No, they they don't like going to the dentist. But if we can make it different, if we can look back at our schooling and see the relationship and the fun and the you know the

playground and the recess and the PE, like all the things that actually made school fun, if we can look back and see that, can't we help them in some way with our relationship see the dentist in a different way too? Because

DAT- Kristy (22:02)

Mm-hmm.

Tiffanie (22:03)

school was about the relationships, even the teachers, like the teachers I loved was because I was in relationship with them, not because of what they taught me. Right. So if we can make sure

that we think of it in that way, like how can we, how can I make you love being here today because you feel seen, you feel valued, you feel heard. And I am, like you said, more interested in you than being interesting. That changes the game. And that could

DAT- Kristy (22:28)

Yeah.

Tiffanie (22:29)

spin how people think about the dentist.

DAT- Kristy (22:32)

I love that Tiff so much because again, we all know the things we have to do or should do.

Tiffanie (22:38)

Yeah.

DAT- Kristy (22:39)

Then how again, how can we sprinkle in something that's just a little bit different and you know gets patients thinking, actually, here's a good one. I heard somebody the other day talk about why do we even call our patients patients? And I was like, I love that. We should be calling them our guests or our clients

Tiffanie (22:59)

Yeah.

DAT- Kristy (22:59)

or our this, right? Patients.

Patience in the word patience means they're sick. And so just by changing

Tiffanie (23:05)

Exactly.

DAT- Kristy (23:06)

and reframing that, it gives you a different outlook and different, you know, you you just show up differently. So I

Tiffanie (23:13)

Yeah.

DAT- Kristy (23:14)

I think little tweaks like that, but but really being in relationship and figuring out their why is huge.

Tiffanie (23:21)

I agree. I love that you said that because Kiera actually, she spoke at an event this past weekend and the keynote speaker on Friday was talking about all of this stuff, very similar to what we're talking about today. And that's something he said. He said, I don't call my patient, and this is just like a tidbit, you guys take it, whatever. We're this is not a Dental

DAT- Kristy (23:40)

Yeah.

Tiffanie (23:40)

A Team, we're changing everything, but this is us talking today. He said, I don't call my patients patients, because when you think of patient, you think of an ill.

Or an elderly, someone who's going to the doctor because there's something wrong. He calls them his clients because they are a client of his dental practice. And sometimes he finds something that they need to invest in. So if you go to the financial advisor, to your bank, to you anywhere, you're investing in something. You're a client of that person's. You're not a patient of theirs.

DAT- Kristy (24:12)

Yeah.

Tiffanie (24:13)

So I I

I found that very interesting in in mimicking what you just said, Kristy. I do think it changed everything is mindset. Everything is mindset. And if you can help the other person's mindset be different, then no, then I need to think about that. That's then you've done your job because now you've allowed the patient to see the path to health. Otherwise, they're stuck and not able to get out of their own way.

DAT- Kristy (24:39)

Yeah,

I love that tip. It's funny because we didn't we didn't know I didn't know you heard that, but it tied right in. And and I

Tiffanie (24:47)

Yeah.

DAT- Kristy (24:47)

truly think even just saying it, like when we say it, we present different when we say the words. So

Tiffanie (24:53)

Mm-hmm. Mm-hmm.

DAT- Kristy (24:55)

yeah. this is a good one. This is fun. Yeah. Yeah.

Tiffanie (24:58)

I agree. I agree. Thanks, Kristy.

I would say action item would be to think about how you are intentional with your patients. And is there a handful of questions that you can keep on the tip of your tongue that really allow you to open up space of communication with your patients? Think you chat GPT it, I don't care, but what can you ask your patients to really get that communication? And remember, communication flows, it doesn't stop.

You're either talking to someone or communicating with them. Kristy, thank you so much. This was so cool.

DAT- Kristy (25:34)

Yeah.

Tiffanie (25:35)

I love it. do you have anything last minute, any action items you feel they need to go run away and paint the town red with?

DAT- Kristy (25:45)

No, just I challenge everybody to figure out on a day-to-day basis what is why are they choosing here and what are they looking for today? If you can answer those questions, you probably already have started a good relationship with them. So that's it.

Tiffanie (26:00)

Mm.

I love it. Okay. Go do

the things, you guys. Go take a look. Go dig in deep and know that you're doing wonderful things. You're out there helping people become their healthiest, most beautiful selves in whatever way that can possibly be. And it is your job to make sure that you pave that path for them to get healthier. So do everything you can. drop us a five-star review below. Please leave a comment if you have any tips, tricks, anything that you're doing that you know is working, or any feedback you have for us, we do love to see those come up. Make sure you share this with a friend.

Anyone outside of dentistry too, I know we work with a lot of businesses. I know there's a lot of other healthcare at least companies and practices that listen to us. So let us know how those work as well. And as always, [email protected]. We are here to help serve you in the best ways possible. Thanks, and we'll catch you next time.

Part two of Kiera's conversation with Brannon Moncrief, principal and CEO of McLerran and Associates, is about common misconceptions with private buyers and DSOs. These include which tends to have more patient and/or staff turnover, types of equity that matter more than others, when deals tend to go south, and a ton more.

Episode resources:

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Transcript:

Kiera (00:23)

Can you walk me through private buyer versus DSO? Like what is the dark? What's in the shadows? What are like the horror stories? And I don't want to freak people out. I feel like it's just a good way to educate of like what things can go wrong instead of just looking for all the things that can go right. And then we're able to make the most educated decisions.

Brannon Moncrief (00:39)

absolutely. So let's talk about private buyer deals first. So couple of things that we see in the private buyer world. One, I think a lot of sellers are under the misconception that selling to a private buyer means protecting their legacy and less change for their practice post sale compared to selling to a DSO. I would tell you that as long as you're selling to a good DSO.

And there are good and bad players out there, no doubt. We'll talk about that in just a minute. As long as you're selling to a good DSO that is in the business of buying great practices, partnering with great clinicians, and wanting to just perpetuate what you've built, more change will actually occur in your practice post sale with a private buyer than a DSO. And the reason being is that a private buyer is going to show up every day. They have bought 100%

Kiera (01:30)

For sure.

Brannon Moncrief (01:31)

of your business. They're going to physically show up to your practice every day.

They're likely from a different generation. They were trained differently. And they will have different ideas and different motivations clinically and personally, professionally, financially, about where they want to take the business. Therefore, you're going to see more change faster when you sell to a private buyer than selling to a DSO. And because they physically show up to your office every day, they have a different personality than you. You have these long-term relationships with your staff and patients. They might not click.

Kiera (02:05)

Mm-hmm.

Brannon Moncrief (02:05)

So you might see

more patient turnover, you might see more staff turnover with a private buyer than a DSO. A DSO is not gonna plant somebody in your office that's going to, you know, wear the DSO cap all day and transform your business into something that it's not. They're gonna rely on you to continue doing what you do well and then outsource all the administrative and operational tasks that you're not ultimately good at to them.

And behind the veil, they'll help make your business operate more smoothly and more profitably. So I think that's a big misconception that, if I sell to a DSO, they're gonna destroy my legacy, they're gonna change my practice. If I sell to a private buyer, that's the perpetuation of of what I've built over the past 30 years. That is not necessarily the case. from a private buyer, you know, perspective, I think dealing with associate to purchase and partnerships.

It is a big thing to talk about. The partnership failure rate is extremely high. It's higher than the divorce rate. Partnerships

Kiera (03:07)

Mm-hmm. Yes.

Brannon Moncrief (03:09)

are very easy to get into and very hard to get out of. So you need to make damn sure that you're ready to get married to somebody from a professional perspective and have an ironclad partnership agreement

Kiera (03:24)

Anyway.

Brannon Moncrief (03:24)

where you address everything that could go wrong on a go-forward basis because

Kiera (03:28)

Yep.

Brannon Moncrief (03:30)

there is a high probability.

That there are going to be, whether it's life events or disagreements within the business, that you're gonna have to get through. And if you don't have

Kiera (03:38)

Mm-hmm.

Brannon Moncrief (03:39)

the right partner, communication is going to break down and the business is going to suffer, you know, as a result. We've also seen a lot of situations where an associate will join the practice with the intent of eventually becoming the successor and the owner, but the associate and the seller don't work out the details on the front end. And oftentimes when

They're ready to consummate the transaction. They have very different ideas about what the business is worth or how the deal is going to be structured. Sometimes the timing doesn't align. You know, sellers said that they were going to sell the practice in two years. Two years comes around

Kiera (04:14)

Okay.

Brannon Moncrief (04:14)

and they're like, you know what? Life's pretty good. You know, I'm only working two days a

Kiera (04:17)

Yeah.

Brannon Moncrief (04:18)

week now. I'm playing a lot of golf. You're working your ass off. You know, I'd like to wait another two years. And you're going to continue, you know, supplementing my production and helping create this lifestyle practice for me.

And then the associate's got to go, crap, do I wait two more years or do I bounce and try to find another opportunity? Or vice versa, where seller said,

Kiera (04:39)

Mm-hmm.

Brannon Moncrief (04:39)

Hey, I want to be ready to sell in two years, you get there and you know, associate just started a family, right? Or decided they don't want to pursue

Kiera (04:46)

Yeah.

Brannon Moncrief (04:47)

practice ownership. And now seller's going, do I wait for this person to mature and turn into my successor? Or do I need to start over with somebody

Kiera (04:57)

Mm-hmm.

Brannon Moncrief (04:58)

else? So if you're gonna go down that path.

My advice is to have those conversations on the front end and establish the rules of the game

Kiera (05:05)

Great.

Brannon Moncrief (05:06)

and do it in a formal framework in writing.

Kiera (05:09)

Mm-hmm.

Brannon Moncrief (05:10)

don't wait until the day you're ready to sell to sit down and have serious discussions about when that's going to happen, how it's going to be done structurally, how the practice is going to be valued. Do it on the front end. And then from a private buyer perspective, I would just say like a lot of these deals can go south post sale.

Kiera (05:31)

Yeah.

Brannon Moncrief (05:31)

As a

result of a breakdown in communication between buyer and seller and arguments over petty, petty stuff. Right.

Kiera (05:38)

Yep. Yep.

Brannon Moncrief (05:40)

And I will tell you that the number one way that buyers and sellers get sideways in a private buyer deal is over accounts receivable and credit balances. so y yeah, you you you know I'm speaking your language here.

Kiera (05:51)

You're not wrong. I do.

Brannon Moncrief (05:56)

Making sure that your AR and credit balances are as clean as possible when you go to sell, and

Kiera (05:58)

Mm-hmm.

Brannon Moncrief (06:01)

ideally selling the AR to the buyer and writing them a check for the credit balances at close so that the day

Kiera (06:10)

You're done.

Brannon Moncrief (06:11)

after the sale, every dollar of revenue that comes in it belongs to the buyer. And there's no

Kiera (06:16)

Yep.

Brannon Moncrief (06:17)

weird conversations about, for instance, patient patient comes in.

Kiera (06:21)

These make me laugh.

They're a mess.

Brannon Moncrief (06:24)

We see these things all the time. So a patient comes in post sale, seller's no longer there, but seller did not sell the receivables. So the buyer is collecting the seller's receivables and remitting them to the seller post sale. Patient

Kiera (06:36)

Yep.

Brannon Moncrief (06:38)

comes in that has a previous balance with the seller, gets work done by the buyer, the new owner, writes one check at the front desk. What do you think the front office person does? They don't, they just deposit the check into the buyer's

Kiera (06:50)

They deposit it. Exactly.

Brannon Moncrief (06:52)

bank account.

And now the buyer has some of the seller's money sitting in their bank account and it hasn't been properly accounted for at the front desk. Eventually, especially if that happens multiple times, there's going to be a problem. And even if there was no malice, right, involved, the seller's going to get pissed off that the buyer is not abiding by their word and collecting those receivables and remitting them to them properly, even though the buyer didn't mean to.

End up with some of the sellers money in their bank account. So these are the types of things that one, if you can plan for it on the front end and make it as clean as possible, you know, in regards to how you structure the deal, how you how you navigate the agreements. But two, on the back end, just communicate and be calm and behave

Kiera (07:40)

Mm-hmm.

Brannon Moncrief (07:42)

like normal people and do the right thing. And as long

Kiera (07:46)

Yeah.

Brannon Moncrief (07:46)

as everybody does that, everything's gonna be fine.

But we have seen people get in lawsuits over 300 bucks. I mean, just crazy,

Kiera (07:54)

Yep.

Brannon Moncrief (07:55)

crazy stuff. And unfortunately, we haven't talked about this yet. It's a very emotional process, especially doctor to doctor. For the seller, they're selling their identity. They're they're dealing with talking about their own mortality, right? And it's their baby. it's been their life's work, you know, for the past 30 years. It's not just a financially impactful.

Transaction. It's very emotionally impactful. And for the buyer, you know, they're five years out of school. They've got a significant amount of student loan debt. They're about to triple the amount of debt they have when they go and buy your practice and borrow another million bucks to do so. They're starting a family. They're buying their first house. Like they got a lot of balls in the air. They're at a completely different stage in their life than the seller.

Kiera (08:47)

Yeah.

Brannon Moncrief (08:48)

it's a lot.

It's a lot of stress, it's a lot of pressure. So you've got high emotions on both sides of the transaction. And that's why you normally see erratic and poor behavior and poor communication and things go off the rails over very, very small issues. And that's where hopefully you've got a good broker involved. You know, they're helping, you know, hold hands on both sides and serve as that buffer and manage those emotions, both during the transaction and and afterwards. So

Those are some of the dark paths that that you can go down from a a a

Kiera (09:18)

Yeah.

Brannon Moncrief (09:20)

private buyer perspective. You know, from a DSO perspective. Yeah, absolutely. Please.

Kiera (09:23)

Can I jump in? I'm gonna jump in real quick on some of the because I agree

with you. And I'm always let's talk about the credits in the AR real quick. there's a piece of me that's like, as a buyer of this, do you really want to be paying your front office girl to go collect money for this person that you now have to pay back? The answer is a hard no. So when I think about that, of like, let's just think through the logistics of how this AR is going to get collected. Cause I did this on my first practice purchases when I giggled and it was a freaking nightmare and I had a

have all the writing down and I had to say like, my gosh, like we owe this guy this much money. And it was just dumb. I was like, I wish we would have gotten it for a lesser deal. Whatever we collected, we gotta keep. We're motivated to collect it. I'm not trying to pay my front office girl to go hustle her booty while she's on my dime to go collect for this seller. So that was a big zone. I don't disagree with you. And the credits get a check up front because you're going to be redoing their work and you're going to be so annoyed with how much redo dentistry you're

Having to do or all those credits sitting out there that you're like, my gosh, I paid for this and I'm doing it for free. So absolutely agree with you on that. And I've been through two partnerships myself. I've been on dental practices. So speaking of that partnership, I always say plan the divorce from the day one. Like, what's gonna happen? How are we gonna separate? What are the things like what's gonna happen if I don't want to keep working? How does that look? And when you said that, Brannon, like again, speaking from real life cura, I've gone through this a few times. if I would have known what the outcomes were going to be from the seller.

Coming in as a buyer, because I always put money in. I was annoyed. Someone sold it out from under me. And I was like, what the heck? Like, how did I not even know this was selling? Like they're like, sorry, you lost money. And I'm like, but I didn't even get to see the books and I put money in to purchase this. It was like, hey, I want to go in, like you said, start a family, or I want to go be with my husband, or like these different things. And I was like, no, you can't. Like you're part of this deal. And I was like, I didn't even know I was part of this deal. So really talking about like what are those big things, what's going to happen.

Because when everybody has the rules of the game before we start the game, we can play the game way more fairly with each other. And agreed, when I look at the life cycle of the seller and the buyer, the buyer, like you said, is coming in at a very young early stage. Like imagine them as like toddlers in their professional career. And you are like ready to go off and play pickleball in retirement. You're on very opposite sides. Your team is at a very opposite side. So recognizing, I love that you said that people are going to feel this way of

my gosh. Like I never thought about the legacy changing so much with selling to a private buyer. I am curious before you head to DSO, I have this opinion and I really am curious if you can back it with facts. So many dentists feel like they're doing the right thing by selling to a younger buyer to keep their legacy alive. However, what I have seen is they do and they feel good. They brush their shoulders, they've sold it to their associate that's gonna take care of the legacy.

Well, that associate, like we just said, about the life cycle of them, they're young, they got debt, they got a lot of debt on them, they've got a lot of things. And these DSOs are chirping in their ear left and right. That I've seen a lot of those younger buyers actually sell to a DSO. So it's a few years after they did the legacy. So the reason I bring that up is because I think a lot of legacy dentists are wanting that legacy and they're not even looking at the DSO route because they think they're doing the right thing. But then that younger buyer then just flips around and sells it to the DSO for a higher multiple. So I'm curious, like.

Is that true from your perspective and what you've seen? Because I just think it's important for dentists to not feel like they're being the good old boys or the good old girls and like doing the right thing. But then the next dentist is just selling it for the higher multiples that they could have gotten.

Brannon Moncrief (12:50)

Think it's it's noble in principle, but in reality, it's kind of a falsehood, right? We have

Kiera (12:56)

That's how I feel.

Brannon Moncrief (12:57)

we have had multiple clients on the DSO side that were those associates that bought the practice. And as soon as the seller walked out the door, right? So

Kiera (13:07)

Yep.

Brannon Moncrief (13:07)

and a lot of those deals, the seller actually stayed on for a year or two, and the practice grew substantially post-sale, or

Kiera (13:13)

Mm-hmm. Yep.

Brannon Moncrief (13:14)

was already in the position to be a candidate for a DSO sale.

But the seller chose to go the private buyer route to protect private practice dentistry and their legacy. And then right when they walked out the door, I got the phone call. Hey, I bought this practice two years ago. I've doubled it. You know, my EBITDA is sitting at 700,000. I want to sell it and then go back to being an associate. And,

Kiera (13:38)

Exactly.

Brannon Moncrief (13:39)

you know, they they basically triple what the seller could have gotten. You know,

Kiera (13:43)

Absolutely.

Brannon Moncrief (13:44)

if the seller had

waited, put in the same amount of energy, and then sold it to a DSO, they would have been way better off economically. So it's noble, but I do think that if you have a practice of the caliber and size that a DSO would be interested in purchasing, you need to at least explore it. Don't just discount

Kiera (14:04)

Feel the same.

Brannon Moncrief (14:05)

it and say, hey, that's not the right path. That's not good for dentistry. You need to do ultimately what's right for you. Because

Kiera (14:13)

Mm-hmm.

Brannon Moncrief (14:15)

Whether you like it or not, private equity is here to stay. DSOs

Kiera (14:18)

I agree.

Brannon Moncrief (14:18)

are here to stay. Your stand is ultimately not going to matter in the big picture of how private practice evolves.

Kiera (14:29)

Mm-hmm.

Brannon Moncrief (14:29)

so I I agree with you. You at least should look at it. It may not make any sense, right? We may go through it and hey, at least you looked under that rock. but to completely ignore it based on principle, I don't think is a good idea.

Kiera (14:43)

I agree. I just wanted to like throw that out there because I feel like so many legacy dentists are really trying to do the right thing in their minds. And yet these younger doctors, and I'm not here to like throw shade at the younger doctors, it's just the different lifestyle that they're in. It's the different I mean, shoot, how can any of us, if we had that much debt and loans on us, not explore a DSO when I have a way to get out of that debt and I don't have to work for the next thirty years of my life? It's just a different style that they're living in. So okay.

Let's do let's do a quick wrap of the dark side of DSOs. Thank you for like going a little longer with me. I definitely want to have the part two of this because I feel like people are just always curious about what's under the hood on both sides.

Brannon Moncrief (15:20)

No, I I love it. I do want to check one more thing on partnerships, because we've actually had this conversation on with some of your clients, large practices with with

Kiera (15:27)

Mm-hmm. Yep.

Brannon Moncrief (15:30)

multiple associates that are DSO targets, where a the founder is contemplating do I s do I partner with a DSO or do I I give or or sell minority own equity to my associate doctors? And a lot of them have decided to go the minority equity route to their associate doctors.

I want to make the point that if you're going to give or sell minority equity to an associate, one, even if they're minority partners, they're they're going to want to say in what happens with the business on a go-forward basis. They're going to want to see it at the table, even if you're not equal partners, especially if they're paying for the equity. And two, they are not likely going to step up and help you run the business. So I think what

Kiera (16:13)

So true.

Brannon Moncrief (16:14)

you should look at it as is it's a retention tool, not

Kiera (16:18)

I would agree.

Brannon Moncrief (16:18)

a

Not a tool to offload the operational and management responsibilities where you know you're gonna be able to be on a yacht most of the time while your associate that's got 15% equity not only works chair side but also runs the business for you. And that's where, if that's what you're looking for, like less operational and management responsibility, I think the DSO makes more sense because they're gonna pay two or three times the price.

That a private buyer is going to pay. And they are designed to provide you with support from an operational perspective. So just be careful about your mindset. And if you're gonna sell minority equity to associates, understand that's a retention tool, not a tool to offload your operational and management responsibilities. And therefore, again, you may wanna look at the DSO route.

As opposed to selling minority equity to your associates, at least, at least look at it. And sometimes

Kiera (17:23)

Mm-hmm.

Brannon Moncrief (17:23)

that helps put you in the right frame of mind, at least, should you proceed with your associates, as opposed to selling, pursuing a sale to a DSO. The other thing is also just thinking about the back end. What happens when you go to sell the majority of your equity? Are your associates

Kiera (17:40)

Mm-hmm.

Brannon Moncrief (17:41)

your buyer? What happens if they don't want to buy? Right.

Kiera (17:43)

Right.

Brannon Moncrief (17:44)

Now you're stuck where you own 60% of the practice and you've got two associates that both have minority equity ownership and they're like, hey, I'm happy. I don't want to buy your 60%. by the way, I'm the future of this practice. I'm gonna block a DSO sale. And

Kiera (17:58)

Mm-hmm.

Brannon Moncrief (17:59)

now it's like, well, what the hell do I do with the remainder of my equity? Right? If I can't

Kiera (18:01)

Yeah.

Brannon Moncrief (18:03)

sell to a DSO and my associates don't want to buy it, what happens now? So we've seen that.

Kiera (18:08)

Yeah, 'cause I have heard

I've heard a rumor that if you have minor minority partners with associates that it is actually harder to sell to a DSO. Is it because of this or is it also on the DSO side because now they got multi partners that they're having to convince and sell to?

Brannon Moncrief (18:22)

ESO actually loves it. That option is still

Kiera (18:23)

Okay.

Brannon Moncrief (18:24)

available to you. However, those minority partners have to be on board and complicit with the sale.

Kiera (18:29)

And I know you think

because all the owners are like, Yeah, but I put it in our agreement that they can't do this. And I'm like, but they're an owner. Like they own. You can't just override them. And they o don't own just I mean, I had like a five percent in one and they overrid me hard and it was sold before I even knew. And I was like, Got it. Like, but it was five percent. I was very, very, very tiny. I still don't think that that was legal, but it did happen. So like there was one. But

Like most of the time you're giving them like fifteen to twenty percent equity in your business. That's not a small five percent. And they're also working in the business day in and day out. I was a five percent quiet minority, like wasn't even in the business. There's different ways that these deals are done. So that's good to hear that it doesn't block you on the DSO, but I do agree on the associates. Make sure they're really bought. And I think owners feel like, no, they're gonna be on board with me. And I'm like, you have to realize they have like 10 more years, 20 more years they want to work. They don't want to sell their business and go be an associate somewhere else.

And you're like, but they're gonna get a big payout. And I'm like, but they don't because they're in so much freaking debt because they just bought your practice. So there are different pieces that I think you need to consider of that minority partner that's very different than you in your OG years of like, this is your retirement. They're not there to retire. They're they're still hungry and they still want to work. And so I I agree with you. Those minority partners feel really good, but I sometimes see them as more golden handcuffs on the seller, like the legacy doctor, than they are on the associate. It's a great retention piece.

But it also puts you in like less options in the future too.

Brannon Moncrief (19:54)

And like you said, you can design the legal agreement in a way that you have a drag-along right, a unilateral right to legally

Kiera (19:59)

Mm-hmm.

Brannon Moncrief (19:59)

do whatever you want. However, if they're now the primary producers, they're the youth, they're the future of the business, the DSO is going be super sensitive to making

Kiera (20:09)

Mm-hmm.

Brannon Moncrief (20:09)

sure that they're complicit in the sale. And if they're not, regardless of what your legal agreements say, if the key providers in the future of the business are not on board, the buyer is going to back away from the deal.

Kiera (20:21)

Right.

Brannon Moncrief (20:21)

And

that's where these deals go south. So you just need to think through all of this. And these are some of the roadblocks, some the challenges that we see in the private buyer world, especially as it pertains to partnerships and, you know, associates.

Kiera (20:35)

Awesome. Okay. flip side DSO. Tell me about the dark side of DSO.

Brannon Moncrief (20:41)

I would say there's there's several. So first and foremost, the reason that we exist as sell side advisors is DSOs and private equity from a buying perspective are relatively predatory. Their goal is to buy low and sell high. And they have created an entire ecosystem of trying to get in front of sellers without them having proper representation, without

Kiera (21:08)

Mm-hmm.

Brannon Moncrief (21:08)

having competition at the table.

Because they know if they have a conversation in the dark and do a deal without the seller having proper representation, without being in a multiple offer situation, they can pay less for the asset. So

Kiera (21:25)

Mm-hmm.

Brannon Moncrief (21:26)

many DSOs have built huge marketing machines that push out a lot of direct mail. They have business development teams where their only job is to bird dog potential sellers and they pay, oftentimes, both.

You know, advisors and doctors to introduce them to potential sellers. If you're gonna go down that path, those are shark-infested waters. You've got

Kiera (21:50)

Mm-hmm.

Brannon Moncrief (21:51)

to make sure you have proper representation, whether it's us or somebody else, you've got to have a sell-side advisor at the table. You have to be in a multiple offer situation to create the leverage that you need to maximize the economic outcome. And I would say, even more importantly, the optionality you need to find the right buyer.

Because not all DSOs are created equal. And if you've talked to one, you've talked to one. They're all different. So you need to shop around, you need to date around to find the right fit, because fit and deal structure are the two things that are gonna impact your long-term happiness if you go down

Kiera (22:25)

Mm-hmm.

Brannon Moncrief (22:26)

the DSO path. Yes, the valuation matters. Yes, the cash at close matters. But the type of equity you hold, the rights you have

Kiera (22:34)

Yeah.

Brannon Moncrief (22:34)

with that equity.

Who you partner with from an operational perspective and from a financial perspective is going to dictate your long-term outcome. So

Kiera (22:43)

Mm-hmm.

Brannon Moncrief (22:44)

that's first and foremost is DSOs are predatory. Don't do this on your own. Thinking that you're going to save a commission, you will cost yourself millions and a lot of heartache down the road. Secondly, again, kind of going back to the DSO's going to change my business. You know, they're going to destroy my legacy.

I will say there are DSOs out there where the suits think they're smarter than the doctors. And

Kiera (23:10)

Mm-hmm.

Brannon Moncrief (23:11)

I would argue that long term those DSOs are going to crash and burn. So you

Kiera (23:15)

Agree.

Brannon Moncrief (23:15)

do not want to be sitting at the table with one of those buyers, right? And that's also why you need to fill that table in a competitive process so that those buyers stand out in a bad way. So that you know, hey.

Kiera (23:30)

Mm-hmm.

Brannon Moncrief (23:31)

Based on all these interviews that I've done with all these potential buyers, I don't like those two people. I don't like what they had to say, how they answered my questions, comparatively speaking, to the other buyers at the table. They're good actors and bad actors. You want to make sure that you stay away from the bad actors. Again, big part of what we do, vetting these DSOs and making sure we only bring the best of the best options to the table because they're continue to be bad actors in the marketplace.

You will also hear some horror stories about how a DSO came in and tried to change my business and ruined my business. I will say that a lot of those stories are not completely truthful. You don't have context.

Kiera (24:15)

It's true.

Brannon Moncrief (24:16)

Oftentimes, what happens is the seller takes their foot off the gas. The seller takes

Kiera (24:21)

Mm-hmm.

Brannon Moncrief (24:21)

5 million, 10 million cash at close, and then loses the motivation.

continue to work hard and manage the business and the business suffers as a result. Well if I'm the DSO that bought that business and my partner completely checked out post sale because they hit their retirement goal, my only option is to lean in, put my hands on the business and try to write the ship. So oftentimes when you hear those horror stories, there's a precursor there that is not explained. Bad behavior on behalf of the doctor post sale

cause the DSO to have to have a heavy hand from an operational perspective. So there are those bad actors out there, but there are also stories online that I see all the time where I'm like, what's the truth here? Because I actually

Kiera (25:10)

Mm.

Brannon Moncrief (25:12)

know that potential that actual DSO, I've done 20 deals with them and I've never heard that story from one of my clients. So you either weren't ready to take on a partner, right? Emotionally or financially. Some doctors

Kiera (25:25)

Mm-hmm.

Brannon Moncrief (25:26)

Can't make that shift, right? You need really think about that. If you haven't been an employee for 30 years, are you employable? Right. Are you gonna do you play nice with others if you've

Kiera (25:36)

Mm-hmm.

Brannon Moncrief (25:37)

been, you know, king of the hill for the past 30 years, right? You need to think about that as well. So that's that's another nuance. The biggest one is the equity, right?

Kiera (25:48)

Mm-hmm, mm-hmm.

Brannon Moncrief (25:49)

For a long time, nobody talked about the downside in the equity because.

Private equity is making money hand over fist for about a decade previous to 2024. there were many recaps from 2018 to 2023 at really great returns. I mean, some BSOs hit multiple recaps at a three to five X return on invested capital. Those are amazing financial outcomes. But the game changed in 2023 when interest rates increased rapidly. And

The capital markets tightened up, along with the fact that we were mid-consolidation, meaning that any industry that's being consolidated by private equity, you're gonna have winners and losers. But it takes time for that to play out. It takes five to ten years to figure out who are the winners and losers. They're not all going to be successful. When you layer on a rapid increase in interest rates, and these are heavily levered businesses where

The carrying cost of the debt is substantial, along with significant inflationary pressure on overhead, along with being mid-consolidation cycle where the winners and losers start to separate themselves from each other. It accelerated the the path of the losers, right? And you can get several casualties, multiple DSOs fail. Now, that doesn't mean that the practice is all closed. It just means that they're kind of zombie companies from an equity perspective. And

The doctors likely are not going to have a good outcome on their equity long term. And then you've had other DSOs that were built on a strong foundation, the winners of the game that have done remarkably well, despite the more challenging macroeconomic environment that we've been up against the past few years. So anytime you're talking about private equity, there's winners and losers. And all other outcomes are going to be somewhere in between. They're going to be people that go to zero. They're going to be people that get a unicorn outcome, a 5X return on equity with three recaps.

And then there's going to be people that get a more modest return. We want to keep you away from the losers. And I'm happy to say it was relatively easy for us to identify who the losers were going to be. You know, you play in the sandbox enough. You stand at the water cooler and listen to the the talk. You meet the management teams, you hear the investment thesis, you watch their buying behavior. It's relatively easy to figure out like whose house of cards versus

Who's built on a strong foundation and who's going be successful? So of those DSOs that have been, you know, pure casualties, gone bankrupt, we haven't sold a single practice to them. I'm proud to say that. now, will there be more casualties in the future? Yeah. Yeah, there will be. but I will say the reckoning that we've been through over the past few years has caused private equity and DSOs, for lack of a better phrase, excuse my language, to get their shit together.

Kiera (28:52)

Mm.

Brannon Moncrief (28:53)

So long term, it's been good for the industry because DSOs have had to become operators, not aggregators. They've had to learn how to integrate and operate the businesses that have acquired and grow those businesses post-sale. As

Kiera (29:06)

Mm-hmm.

Brannon Moncrief (29:06)

a result, they become much better operators and much more astute and much more disciplined about what they buy, what they pay

Kiera (29:13)

Mm-hmm.

Brannon Moncrief (29:13)

for it, and how they structure deals. So they've just gotten a lot smarter. So you're going to see less casualties on a go-forward basis than you've seen over the past few years.

And I do think that you're going to see more recaps and modest but positive results on the equity with some DSOs, not all, over the next few years. So the reckoning's been painful for some, you might say many, but I think it was a needed reset. and it's a natural progression of any private equity backed industry. But be careful because

There are plenty of DSOs out there today that are actively buying practices that will put a letter of intent in front of you and show you that your equity is going to see a 20x return over the next

Kiera (30:02)

Yeah.

Brannon Moncrief (30:02)

15 years through multiple recap events. I can tell you that some of those DSOs I am 100% confident are going to go bankrupt. We do

Kiera (30:10)

Mm-hmm.

Brannon Moncrief (30:11)

not allow those DSOs to sit at the table with our clients. But that doesn't mean that they won't give you some crazy financial projection that's never going to come true. So

Kiera (30:20)

Mm-hmm.

Brannon Moncrief (30:21)

Again, having proper representation, people that know the lay of the land, that know who to bet on and who not to bet on, that's extremely important because yes, the equity does have a potential wealth creation opportunity, but it does have risk. And that risk

Kiera (30:38)

Yeah.

Brannon Moncrief (30:39)

has been illustrated, you know, over the past few years in a major way.

Kiera (30:43)

Totally. And Brannon, I I love how you talked about to me, I feel like if you're going into a DSO cell, make sure your cash at close of whatever it is you're good with. Like if you never see your or your recap or your any of that investment, like again, this is how I live. So please live how you want. Brannon might absolutely radically disagree with me. I've always felt like if I'm good with how much I'm getting at cash at close, fanfreakantastic and anything I get beyond that is gonna make me exponentially.

Like wealthy, like it's the stock market. We have no clue which stocks we're betting on. And you have a very small pool, you can do better. But like you are betting in a very like volatile, like to me, it's very volatile. I think about Bitcoin. People who got in early on Bitcoin, they're freaking living their life in the best way. Those who went through the really, really, really bad hit, they're not living their best life. I watched this like multi, multi, multi-million, almost billionaire in Bitcoin go from like kingpin to popper. Like

Literally overnight. I watched him go in like his life and he had everything in Bitcoin and he was one of the top people and it dropped. And I feel like that's the same thing in dentistry. Like you said, you're betting on a a company and you have no idea to know what the future of that business is going to do. So I agree with you. I think that people get their shorts burned when they're banking on all those like huge, huge recaps and all of this equity being worth so much. It's like I don't really want to be with them and I don't really want to be with the lowest end.

I want to be in that middle of the pack and I hope I choose the right one to bet on. But again, the

way Kiera Dent lives, I live very modest. I live very conservative. And I would rather like, am I good at my cash on

close? So if nothing else happens, fantastic. And if something else does happen, I'm going to surely pick my best one. But then I'm really happy no matter what the outcome is. And I'm hoping that I bet on the right one that does give me a great recap. But at the same time, I'm really happy whether it does that or doesn't. I also love that you talked about like they are not planning to come in to take over.

But you do have to accept that you're working for a new boss. And I don't think people realize that. Like you do. You are now an associate. You are not making the same as what you were making before as an owner. That is the price you've got paid when you've got that check up front. And I think sometimes people forget that check up front, whether you're a seller on a private side and you're getting a check there, and now you're getting an associate pay, or you're selling to a DSO and your paycheck is not as much. That's something else that I recommend you look at. Like, what does my life look like post sell? Like I did get that big check, but now I'm gonna live on a much lower income.

Let me maybe practice that for a year before I actually sell. I did that with a doctor and he did much better. He's like, This is all I get. And I was like, Yeah, that's your future life. I think that's that's it. But you're also gonna get a very large payout, but that becomes your day in, day out, and make sure that you're comfortable with that. So Brannon, thanks for like digging into this. I really appreciate the part one, part two today. Are there any last thoughts you have as we're wrapping up today?

Brannon Moncrief (33:23)

Just a couple of things that I'll speak on. I think that was well said. Your approach to, hey, you got to be happy with a cash at close, that I would say is the most conservative approach, but that's a no-brainer, right? If the cash at close gets you where you need to be and everything else is gravy, great. I would argue that the type of equity matters a lot. So,

Kiera (33:40)

I would agree with that.

Brannon Moncrief (33:41)

so the private equity has gotten wise to the fact that this is a provider-centric business. And the way you create alignment with providers is joint venture equity.

retained practice level equity. That is real ongoing equity in your business post sale that has EBITDA distributions. So

Kiera (34:00)

Mm-hmm.

Brannon Moncrief (34:00)

it helps soften the blow as far as your your you know the cut and your take home pay on an annual basis. And it's real equity in your business that has real value and is going to throw off EBITDA distributions along the way. So I would argue that that equity is a lot safer than than

Kiera (34:17)

I would agree with you completely.

Brannon Moncrief (34:19)

than holding company equity.

If you own equity in the DSO, the outcome could be amazing. It could be terrible, right?

Kiera (34:27)

Agreed.

Brannon Moncrief (34:27)

Could be somewhere in between. So you do need to think about like what is your annual burn rate? What is your postclosing compensation going to look like? How does your chair side wage versus the joint venture equity distributions play into that? And understanding that holding company equity has significantly more risk than joint venture retained equity in your practice.

you've got to look at it, you know, in a holistic way.

Kiera (34:54)

Mm-hmm.

Brannon Moncrief (34:55)

but I I I think a lot of your comments were were spot on. And yeah, look, you got to talk about the good and bad, right? And there

Kiera (35:01)

Mm-hmm, mm-hmm.

Brannon Moncrief (35:02)

is nothing in life that is typically a no-brainer with nothing but good. I would also argue that nothing that we've talked about today has all bad, you know, associated

Kiera (35:12)

Mm-hmm.

Brannon Moncrief (35:13)

with it. So it's a balanced equation. You gotta take a holistic approach, you gotta get educated.

And I appreciate you having me here to help do that.

Kiera (35:21)

Yeah, Brannon. Thank you so much for that and agreed. The varying types of equity. Thank you for that correction because you're right. There are safer equity that you've got in the holding one. That's a full-blown like bet on it and good luck. I really agree with you on like know what it's going to be post-close what's your day in, day out burn rate and like what you need to survive on. I feel like that answers so many questions. And Brannon, I I appreciate you doing this. And I hope everybody listening, like, let's do pen to paper. Reach out to Brannon. I know, Brannon, you guys do free valuations for.

Any client that comes through zero pressure, that's why I really love you guys, you will talk to them. I feel like you're very highly educated. You're one of the biggest brokers in the industry where you're doing the most transactions of most. And so you're seeing more and more deals. And I feel like having somebody who does more and more deals, like when I've talked to other people, I'm like, what's your average deal size? Like, am I your higher deal? Am I your lower deal? When I'm talking to financial advisors, I want to know what their average portfolio size is. I don't want to be the largest and I don't want to be the smallest. And I need to make sure that who I am at my size of practice.

You've done it multiple times and you're very, very proficient with it because Brannon, you just see, like you said, you've 1500 deals. That's a lot of deals to sit at the table to know the good, the bad, the ugly. You're not going to be perfect at it, but you're going to have a lot more at bats that are going to be more congruent. So, Brannon, if people are interested, they kind of want to put pen to paper, start to look to see what it is. Again, I hope you're not ready to sell. Like Brannon said, and I say, Let's catch you a few years before you're ready to do that. That way we can start to make it the best it can be. My side included, we want to catch you before you want to sell. I don't want to have to like do.

Like Hail Mary moves for a whole year trying to get you to your buy and your EBITDA that you're looking for. but Brannon, if people want to reach out to you, how can they connect with you?

Brannon Moncrief (36:55)

One of best ways to reach me, I give my cell phone number is to text me and schedule a discovery call. Every conversation we have with a potential client always starts with a 30-minute, confidential, casual discovery call just to get to know each other and figure out does it make sense to move on to the next step and do a thorough evaluation and start that education process? You can text me at 512-660-8505.

Or you can email me, Brannon, that's B R A N N O N @DentalTransitions.com. But yeah, anybody listening would love to carve out thirty minutes just to get to know you and talk about your why and and what's next.

Kiera (37:37)

Absolutely. And Brannon, anyone who comes from Dental A Team, be sure to let them know you heard them on the podcast. Brannon does an amazing job taking care of our clients and our listeners. So be sure to let them know. And Brannon, thanks for your time. I feel highly educated. I hope everybody did. I hope you guys enjoyed part one, part two of this today. Brannon, thank you for being such a wealth of knowledge in the industry. We adore you. Our clients adore you. And I'm just grateful for you today. So thank you. Yeah, likewise.

Brannon Moncrief (37:58)

See you. Good to see you. Bye everybody.

Kiera (38:00)

And for everyone listening, thank you for listening. And as always, thanks for listening. And I'll catch you next time on the Dental A Team podcast.

Kiera is joined by Brannon Moncrief, principal and CEO of McLerran and Associates and expert on dental practice sales and DSO affiliates. The two talk about running your practice with a mindset to sell (maybe not today or tomorrow, but eventually). That means thinking about your business as it is and preparing it for a private buyer or DSO or associate transition; "keeping your foot on the gas" when it comes to finances; knowing what those sale numbers can look like depending on how successful your practice is; and more.

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Transcript:

Kiera (00:00)

Hello, Dental A Team listeners. This is Kiera. And today I have one of my favorite people in the industry on the podcast today. He and I have podcasted multiple times. I just think he's a wealth of knowledge. And today I'm really excited because I think that the landscape of what to do with our practices, whether I have a private buy, whether I have an associate legacy transition, whether I go to a DSO, like what do I do? And how do I make my practice like a viable asset as opposed to just a job for me for the rest of time?

I feel like Brannon Moncrief is one of the best of the best in the industry to answer these questions. He and I chat shop often and he is a wealth of knowledge for me. So Brannon, welcome to the podcast today. How are you?

Brannon Moncrief (00:38)

Thanks for having me. Appreciate the kind words.

Kiera (00:41)

Of course. you and I were just chatting. I think you and I have talked like, what, this is our third time in less than a week. So it's kind of fun to have this in a a real podcast setting. but Brannon, for those who don't know you and don't know about your business and what you do, just give the listeners a little bit of background of who Brannon Moncroep is, and then we're gonna dive into how people can valuate their practices and kind of like what do I do in this choose your own adventure landscape that they're living in.

Brannon Moncrief (01:05)

Appreciate that. I am the principal and CEO of McLaren and Associates. And I've spent pretty much my entire professional career on the business side of dentistry, about 25 years now. I can't believe it's already been that long. I I wish. I wish. That's the filter on my camera.

Kiera (01:17)

It's okay. You're not a day over 25, Brannon. You just started this from a baby. it's a nice one.

Brannon Moncrief (01:27)

thank you. So I spent the first 10 or so years of my career as a dental lender, lending money to dentists all across the country to

Buy and start practices. And then I purchased McLaren 15 years ago. The legacy business that I acquired was a small mom and pop practice brokerage firm focused on traditional practice sales, doctor-to-doctor, practice transitions, specifically in Texas. Scaled that business significantly over the past five, six years, expanded it nationwide. So now we have offices all across the country handling doctor-to-doctor deals.

In general dentistry and across all different dental specialties. And then a lot of your audience has probably seen me on different podcasts, webinars talking about DSO affiliations. We got heavily involved in the DSO and private equity space about seven years ago, really out of necessity. We were watching a lot of doctors that we thought would engage us to sell their business to another clinician choose to go down the DSO path for one reason or the other.

And we knew that private equity was likely here to stay and gonna consolidate our industry rapidly. So we evolved. We built out a team, built out a process to provide cell set advisory to large practice owners who, for one reason or the other, are gonna choose to affiliate with a DSO or private equity as opposed to sell in a traditional sense to another doctor. So we've done about 250 DSO affiliations across the country, general dentistry and all dental specialties.

And

then we've been involved in about 1500 private practice sales. So have really seen everything that can go right and wrong in monetizing your business. But I look at my job first and foremost to educate doctors regarding what is your business worth, private buyer versus DSO? What are the pros and cons? What are the nuances of each of those options? Get you educated, and then you get to choose your own adventure from there. And we help you execute. We help you take the practice to market and monetize it.

at the highest possible outcome and also ensure that we find the right fit for your practice, the right buyer to protect your legacy.

Kiera (03:33)

No, Brannon, I think that you guys do so much in the industry and you've helped the industry. And I've learned a lot working with you, working with several of our clients. And I feel like this is just something as a business owner, whether you are thinking of selling today or selling in the future. I remember when I first started Dental A Team, people were like, Kiera, you're gonna sell it. And I was like, always. Like I'm always building this to be sold. That doesn't mean that I want to sell it today or tomorrow or the next day.

But I would be an absolute rookie if I didn't think about selling this at some point in time. I think you build businesses better when you have that exit in mind. Again, that doesn't mean like I have no intentions of rapidly firing this off. I've been here for quite some time. I feel like I'm getting cozy in this chair, just like I'm sure Brannon and you are in your business. but it's constantly building it, innovating it, creating systems, creating EBITDA, creating those profit margins that are necessary. So when the day comes, because I don't believe that any of us are probably going to really know.

The day we want to sell. I've seen plenty of doctors who have had divorce hit, they've had death hit, they've had accidents. I had a dentist get hit by a bike. Like he was on his bike and he got hit by a car, so he didn't get hit by a bike. He was on a bike getting hit. And I'm like, I promise you that day leaving the office, it wasn't like, I'm on a bucket list to get hit by a car today. Like that just surely was not there. But he had built his practice to where if he wanted to sell, he could, or we had the systems and processes in place to give him the options. And I think that just preparing for this gives optionality long term.

So you're doing it on your terms as opposed to being forced to make a rash decision unexpectedly. So going into that with that mindset, and I hope people, and I know Brannon, you agree with that. Otherwise, we wouldn't be podcasting. You and I have very aligned interests in the industry. But I am really curious, like helping people to kind of have that mindset. Like, what are some of the things that DSOs versus private buyers versus like just transitioning to an associate? What are some of the things? Because I know that there's different flavors and factors. Like, I don't like mint chips.

But I definitely like a grasshopper shake. Like I like both, but don't give me the little chips in it. It's disgusting. Like I prefer the like Oreo mashed up with the mint flavoring. So like I'm gonna prefer different things. And I guarantee you that while both might like the same flavor with air quotes around it, there's nuances that both of those buyers are going to want differently. So how do people, when they're looking at this, thinking about that future sell? again, not tomorrow, but when they're when the time comes, whether planned or unplanned, what should they be preparing for for both of those different types of buyers?

Brannon Moncrief (05:57)

Love

what you said about like being prepared to sell at any moment in time. Because if you take the steps to prepare your practice to be marketable, valuable, and sellable, those are the same steps you need to take to make your business hum, you know, on a daily basis, right?

Kiera (06:12)

Exactly.

Brannon Moncrief (06:13)

but you never know what life's gonna throw at you. So you always want to be prepared, whether you're looking two years down the road or 20 years down the road. we'll kind of bifurcate our conversation today in a flip-flopping back and forth between private buyer versus DSO because they're really.

know two different worlds. So when

Kiera (06:27)

Mm-hmm.

Brannon Moncrief (06:28)

we talk about the private buyer world, you want to do check as many boxes as possible as far as what private buyers are looking for when they call somebody like McLaren and say, hey, I'm looking to buy a practice. And we ask, okay, great, tell me about what you're looking for. Because the answer is pretty consistent. Typically private buyers are looking for a practice within 60 miles of a major metro area. So urban, suburban markets.

Those practices are going to see higher valuations and more demand than practices in tertiary or rural markets. Doesn't mean that if you're in a tertiary market, you can't sell your practice. It just means that all things equal, it might take a little bit longer and it might trade for a lower valuation. they're looking for five plus operatories. Most young dentists these days are relatively entrepreneurial.

And eventually want to grow into a multi-doctor practice for one reason or the other. A lot of that is lifestyle driven. Some of that may be value driven, the fact that they eventually want to sell the practice for a premium to a DSO or private equity. They're looking for PPO and fee for service practices. So if you have an HMO component or a Medicaid component, that's definitely going to impact demand and valuation. They're looking at technology, equipment, facility, curb appeal.

All of that matters when you go to monetize your business, but you also want to be evaluating what is your runway to selling the business and are you going to get the ROI on that investment at sale, right? If you're six months away from selling, probably doesn't make a lot of sense to pour a lot of money into technology and equipment and updating your practice. But if you're five years away, seven years away, 10 years away, you're going to get the benefit, the ROI of that investment along the way. And it's going to make your practice more valuable and more sellable when you go to sell.

you want to make sure that your financials are updated and clean. You want to make sure that you're working with, you know, a dental CPA. we see a lot of messy financials, and that becomes a serious problem when advisors step in on the buy side and are trying to figure out, you know, what is the true overhead of this practice? What does the cash flow actually look like after removing all those personal and discretionary expenses you're writing off to the business? And a lot of the private buyer deals are going to be contingent on financing. So lenders are looking, you know, through that.

That same, you know, lens as well. I would say keeping your foot on the gas, you know, that's one of the biggest issues that we see where we start looking at financials for a client that's ready to go to market. And I'm like, damn, I wish you

would have called me three years ago. And there's always an

Kiera (08:56)

Yes.

Brannon Moncrief (08:58)

explanation. No, I'm spending more time with the grandkids, I'm playing more golf, you know, I'm traveling more, the patients are still there. The reality is buyers care about the most recent couple of years of performance.

So you want to keep your foot on the gas leading up to a sale. You want to sell at a peak, not a valley. Otherwise, you just need to be conscious of the fact that you might be transitioning your practice without being aware of it. What we call sunsetting an office. And that's a strategy, but

Kiera (09:25)

Mm-hmm.

Brannon Moncrief (09:25)

we want it to be a conscious strategy, not an unconscious strategy where you sunset the practice from a cash flow perspective and then you call me and you want to sell it for what it would have been worth three years ago. Right. So keeping your foot on the gas.

is a big one. And the earlier you start planning, the more optionality you're gonna have. So

Kiera (09:45)

Mm-hmm.

Brannon Moncrief (09:45)

if you wait until the day you're ready to sell, you got one option, right? It's a it's a short-term transition. Sell tomorrow, you're likely out the door within four to six weeks, unless you have a large multi-doctor practice. So the earlier you start planning, you can think about, you know, does a DSO make sense? Is it does it make sense to do some type of internal succession planning? You know, bring associates on as minority partners and then step out.

you know, over a period of time or do some type of associate to purchase. So start planning, I would say at least three to five years in advance. That's that's really key. Start having these conversations, learn what drives value, get a feel for what type of transition strategy you ultimately want to deploy and what you can do in the meantime, you know, what levers you can pull to increase profitability, increased demand and marketability leading up to a sale. And that's where you know somebody like you comes into play, right? You can help pull those levers

And help the doctor increase the value of the practice leading up to the sale. So that's really what matters in the private buyer world. Now, the DSO world is going to mirror a lot of that. what I would layer in there is DSOs care a lot about EBITDA profitability and making sure that, you know, your practice is generating at least, let's say, two million dollars in top line revenue, four hundred thousand dollars or more in EBITDA.

That's really the size practices that they're looking for. And I would say if you fall below that metric, you might have some DSOs interested. But in my opinion, makes no sense to consider a DSO affiliation if you're doing less than $2 million in top-wind revenue. It's just not, in my opinion, economically motivating comparative to hanging on to the practice for a little while and then eventually selling it to a private buyer. But key-man risk is a big deal. Engineering the practice in a way that it's not.

solely dependent upon you both from an operational perspective and

Kiera (11:37)

Yeah.

Brannon Moncrief (11:38)

from a productivity perspective. So, you know, becoming a multi-doctor practice that is not solely contingent upon you clinically. And then, you know, building out your team to where it's not so dependent on you operationally on the day-to-day as well. So I think in the DSO world, it's really about profitability, it's about that key man risk. And then it's about having enough runway

To

exit to fulfill the post-closing requirement that the DSO is going to require. So the industry has moved towards a norm of five years. That doesn't mean you working five years full-time, chair side. It just means they want you to have a vested interest in the business for five years post-sale. So if you wait until the day you're ready to exit, DSO is off the table. So

Kiera (12:23)

Yeah.

Brannon Moncrief (12:26)

those are the three things I think that make DSO a little bit different than private buyer. But ultimately,

All of those things, I think, are smart business, even if you're five, 10, 15, 20 years away from a sale.

Kiera (12:41)

Yeah. And Brannon, I love that you talk about this because you're exactly right. Like these things are what you actually want your business to be as a business owner. You want it to be profitable. You want it to not be dependent upon yourself. You want to have less key people like reporting up to you. You want to have it where there's a team in place. Like those are the things that actually make dentists happier in the long run, too. And makes them not want to sell just in like a bad day flash sell. We all have bad days, every single one of us listening.

I promise you, Brannon, if someone walked by on the wrong day and was I'll give you a buck for your business, you're like, Yeah, take it today. Like I've surely had those days. but it's like just I think also having that peace of mind of knowing what it is. You said a few things, and I don't want to get like I understand you and I both kind of play Switzerland in the industry, but I also know we do know some key players. You talked about CPAs that you really love because I agree, having clean financials as a business owner and also as somebody who's looking to sell.

Who are some of your favorite dental CPA specifics? Like and again, I'm not here to say like these are the only ones. I know you and I both have some of our faves. Are there any that you're finding that are really good to prep for sales and to help people just see their financials better from your opinion?

Brannon Moncrief (13:49)

Typically, if you're, you know, a smaller practice, you know, let's say one to two locations under three million dollars in top line revenue, you know, AD CPA is a great place to start, right? that's the Academy of dental CPAs. So I think that's a great place to start. That is a group of DSA individual CPA firms that specialize in working with dentists, and each of them has a geographical focus, right? So you can find that member that

works in your area. we also do, you know, a decent amount of work with Profy.

Kiera (14:24)

Mm-hmm.

Brannon Moncrief (14:25)

Profile works with a lot of large, you know, multi-location practices. So if you are a little bit more sophisticated, a little bit larger, that would be a good place to start. And then I'm sure, you know, you have a handful as well here that you would recommend.

Kiera (14:41)

Yeah, absolutely. Yeah, I found agreed profile. We do a lot of work with a lot of their clients, agreed on that smaller and like please take that we're not talking smaller, like I know this business is large for you. I think when Brannon and I are speaking, dollars are what's going to get evaluated on. So if you're in that one to three, that's what you're being evaluated. It doesn't mean that it's a small business and you're not going to get a great multiple. It just means like certain CPAs have different tax strategies based on the size of revenue that's coming through your business. So

Really getting somebody, I remember I I remembered calling my this is funny, Brannon. I called my processor, my lending processor, and I was like, I think I need a better deal. Like I'm such a big client. I'm transacting 10 grand a month, and you should definitely give me a better deal. And I giggled today because I can only imagine the person on the other side of my gear like that's such a small transaction amount compared to half of our other people on there.

But for me, that was a large amount and that didn't change my lifestyle of believing that $10,000 a month of transaction was so much that I felt like I deserved it. But when I go into these ranks of talking to buyers and talking to people, I think knowing yourself and being comfortable with the business that you've got and the ROI you're going to get from it, it doesn't matter. It matters on what your life and your end goals are. It doesn't matter on the dollar amount. Now, if you're looking for a different lifestyle, like if I wanted a $10 million sell and I'm transactioning $10,000.

Well, we can see that clearly the math's not going to math. So I just want you guys to realize like picking these CPAs, I do think it is pivotal and paramount to choose a CPA that knows your size of business and then recognize you will probably outgrow that CPA. A CPA who's transacting one to three million is not going to be your best CPA when you're transacting five to ten million. There's different strategies involved. And I have seen it multiple times where my clients who have been with somebody for so long, because that's who they needed when they started.

You've got to make sure that CPA is growing with you at the same size and they're able like, and you don't wanna be the big fish in their pond. You wanna be the small fish in their pond, knowing that they've done a lot more. But again, not being so small that the the people can't help you because sometimes those larger firms, they are gonna charge a lot more when you're at one to three million. It does not financially make sense for your profitability to be paying that much because you don't need that much. So I do like I'd Bailey. I found I'd Bailey, especially for some of those large DSOs.

Scott Haberman is somebody I really love and recommend a lot. I think he does a lot of DSO transactions, a lot of multi-locations, a lot of that higher level. If you're that one to three to even four, I would definitely not recommend calling him. Fees are too high for that size of business that you're at. So that was helpful, Brannon. On that, I also was curious when you were talking about this. I think you did a really good job of of listing it of the things that are going to make it more valuable. I'm also curious, like, what are you seeing of multiples when they do sell? So, like if I'm selling to a legacy, like what's my benefit?

versus my con, like pro and con me of selling to a a private buyer versus a DSO buyer. Like what does my life look like on both of those scenarios?

Brannon Moncrief (17:36)

Okay. This is a this is an in-depth conversation, but I love the question. So let's let's let's

Kiera (17:40)

I know, me too.

Brannon Moncrief (17:43)

juxtapose, like you said, private buyer versus DSO. Let's start with valuation first, and then we can start with with some of the more qualitative factors involved. So from a valuation perspective, most of the time when you're looking at valuation through the lens of a private buyer, we're talking about the age-old benchmark.

of

a percentage of revenue or a multiple of net cash flow before doctor compensation and debt service. We'll also talk about an EBITDA multiple, although most private buyers don't look at valuation through the lens of an EBITDA multiple. So you're

Kiera (18:20)

Why is that,

Brannon? This like is a piece I genuinely don't understand.

Brannon Moncrief (18:26)

Primary reason is that most private buyers are going to buy your practice and it's going to be their baby. They're going to step into your shoes. They're going to take over all the production. And therefore, the profit that they're going to realize from the business is a product not only of the EBITDA, but also the clinical chair side wage. So they do

Kiera (18:45)

I see.

Brannon Moncrief (18:46)

look at it differently comparative to multi-location practice owners or, you know, DSOs. Not to say that that's correct.

But the reality is that, and again, I'm sorry for using this terminology, but a smaller practice, right? Look, it's all relative, right? A million

Kiera (19:02)

I think it's fine. Mm-hmm.

Brannon Moncrief (19:05)

dollar one-doctor practice is a very, very successful one doctor practice. But most practices doing less than, let's call it 1.5 million in top line revenue are not generating any amount of meaningful EBITDA. It's just impossible given the overhead structure, you know, of a dental business. But there's still

profitable businesses that have value for the owner operator. And that is what most private buyers are looking at. They're looking at it through the lens of the owner operator, the chairside clinician that's going to not only take home that EBITDA, but also that chairside wage. So they're

Kiera (19:39)

Got it.

Brannon Moncrief (19:40)

typically going to pay somewhere in the range of 70 to 90% of annual revenue. And that is the most current year's annual revenue. Now you'll see outliers, right?

If you're located in a tertiary market, if you have an antiquated office, a smaller office, you know, let's say sub $700,000 in revenue, you might trade on the lower end or below that 70% of revenue range. If you're in a really sexy market, you know, like in Austin, Texas, a Phoenix, Arizona, a Charlotte, North Carolina, where there's a tremendous amount of demand, you might trade for 100% of revenue, especially if you have.

you know, a fully updated high-tech office with six operatories and your, you know, fee for service and you're, you know, netting, you know, 50% profitability, right? That so you have outliers on both ends

Kiera (20:32)

Mm-hmm.

Brannon Moncrief (20:32)

of the spectrum there. practices often trade for anywhere from, let's call it two times to two and a half times net cash flow before doctor compensation and debt service. So if the average general dentistry practice nets 38%,

Before doctor compensation debt service, multiply that by two. That practice is trading for 76% of revenue.

Kiera (20:57)

Mm-hmm.

Brannon Moncrief (20:58)

And then from an EBITDA perspective, although we just talked about the fact that most private buyers don't look at valuation through the lens of a multiple of EBITDA, most private deals are trading for some that have EBITDA, right? That have meaningful EBITDA. They're trading for somewhere in the range of four to four and a half times EBITDA.

But that would be a larger private buyer deal. A practice with EBITDA of three or four hundred thousand may trade, you know, for anywhere between 1.2 to 1.5 million. And that practice likely has top line revenue of anywhere from 1.2 to 1.8 million.

Kiera (21:36)

Mm hmm.

Brannon Moncrief (21:37)

When we look at valuation through the lens of a DSO, and when DSOs are looking at practices, they don't really care about revenue. It's all about profitability. It's all about EBITDA. And I know most of your viewers understand what EBITDA is, but think of EBITDA as absentee owner profit, the profit that's available for the investor. EBITDA stands for Earnings Before Interest, Taxes, Depreciation, Amortization. What it really means is after all the true overhead of the business is paid.

After the doctors are paid a market wage to work chair side, including the seller, what is the passive absentee owner profit left for the investor? And DSOs are paying anywhere from five on the very, very low end to let's call it nine times EBITDA. Nine times EBITDA would be a platform investment, probably five or more locations with EBITDA of 5 million or more.

Five times EBITDA would be a much smaller practice. Let's call it $1.5 million in top line revenue with $250,000 in EBITDA. Where, in my opinion, a practice that size that's trading for five times EBITDA, why sell to a DSO? Just hang on to it and eventually sell it to a private buyer. You're gonna get around the same valuation from a private buyer that you would from a DSO in that particular situation. Most practices are selling for

Somewhere around seven times EBITDA practices that we take to market. And most of the time we're talking about a one to three location practice with revenue in the three to ten million range, with EBITDA in the 700,000 to let's call it two million range. Most of those practices are going to trade for somewhere around seven times EBITDA, might be a half a turn lower, might be a half a turn higher, depending upon.

The geography and the other characteristics that we talked about, you know, previously. So when you're talking about, let's say a $2 million practice, let's just take an example, right? Private

Kiera (23:39)

Mm-hmm.

Brannon Moncrief (23:39)

buyer valuation versus DSO valuation. So $2 million top line Rev practice with $400,000 in EBITDA. In the private buyer world, you're gonna have to find a relatively confident, sophisticated private buyer with some experience and a pretty good personal financial statement that can knock down a practice of that caliber.

On a good day, that practice probably trades for somewhere in the 1.5 to 1.8 million range from a private buyer perspective. In the DSO world, let's say that practice trades for seven times EBITDA, it's trading for 2.8 million, right? Seven times 400,000. So pretty big gap. You know, you're talking about at least a million-dollar gap. And as the practice gets larger and as the EBITDA number gets larger,

It gets harder and harder to sell from a private buyer perspective, just because there's only so many private buyers that have the confidence, the skill set, the financial backing to buy a practice with top line revenue of five million. And in the DSO world, DSOs start to get really, really excited about the larger and larger the practice gets. So that gap between the private buyer valuation and DSO valuation, it increases exponentially as the practice grows in size from a revenue.

and EBITDA perspective. But in the example that we just outlined, while the gap is a million bucks, right? Let's just call it 1.8 million versus 2.8 million, there's a lot of nuance regarding

Kiera (25:04)

Mm-hmm.

Brannon Moncrief (25:05)

what happens with that gap, right? And the commitment on behalf of the seller post-closing, the private buyer deal, you're probably going to get 100% or very close to 100% cash at close. And you're likely going to be able to exit the business in relatively short order.

Let's say six months or less.

Kiera (25:23)

Right.

Brannon Moncrief (25:24)

In the DSO world, yes, you're getting a higher valuation, but it comes with structure. You might only get 60 or 65% cash at closing. So the cash at closing is actually going to look similar to the private buyer deal. And then there's likely gonna be an earnout component and some type of equity component where you have upside and the ability to get to that 2.8 million number or higher, you know, post sale.

It is going to come with that post-closing commitment of three to five years. So a lot more structure involved, a lot more nuance involved. You've got the post-closing commitment of the DSO deal. You've got the equity component that has a risk reward proposition. So it's not as cut and dry as saying, DSO's going to pay me 2.8 million versus private buyer is going pay me 1.8 million. That's a million dollar gap. DSO all day long. No, you got to look at the details. The details

Kiera (26:15)

Mm-hmm.

Brannon Moncrief (26:16)

match.

But I would say as you cross that four million, five million top line revenue mark, it's a lot more compelling to go the DSO route than it is to go the private buyer route. As you move down from that two million top line revenue mark, it's a lot more compelling to go the private buyer route versus the DSO route. That gap in between that two to five million dollars in top line revenue, you know, $400,000 to a million dollars in EBITDA, it's debatable. It it depends.

Kiera (26:46)

Mm-hmm.

Brannon Moncrief (26:46)

Right. On your specific situation, your goals, the characteristics of your practice, and really, yeah, what you're trying to accomplish. And that's where we spend a lot of time with clients, educating them regarding, hey, let's do evaluation through both lenses. And then let's unpack the gap, the economic value gap. And then let's unpack the nuances. And then most importantly, let's unpack your why. Right. Like what is your

Kiera (27:09)

Mm-hmm, mm-hmm.

Brannon Moncrief (27:11)

runway to exiting the business? Why are you looking to monetize it? And then we'll lay over.

you know, all of that qualitative and quantitative information to decide what is the right route for you to go down.

Kiera (27:22)

Yeah. And Brannon, I love that you talked about it because they're I think when people hear just dollars, right? Like 1.8 versus 2.8, like of course I'm going that. But like you said, I think the big pieces I've watched with people selling in both realms, like you said, your lifestyle of selling to a private buyer is usually a lot easier. You're done. Like I cash out, I'm out, like I'm done, and I can put that money into, and I'm getting almost a hundred percent of that close. Just like you said, both of them you're getting about the same of money at close.

And I think people need to realize like the DSO is still a gamble. Like there are pieces when you're investing and there's buybacks and different pieces. And it's based on you performing, you might not get all of that additional amount. You also might get it. And so just being comfortable and like, could you put these into investments? What are you planning to do with this money when you close? Looking at some of those things of what because like we were looking at a deal structure the other day. And I was like, well, dang, if they took the money now and invested it over the next 10 years, as opposed to working for 10 more years and probably not being able to get that.

Would they get the same type of returns if it was invested properly versus continuing to work? And so this is, I think, where for me, I get obsessed with this psychotic puzzle of like, you know, the pictures where it's like got lines everywhere and they're like overlapping and crossing and there's no like rhyme or reason. That's how I feel like it is when you're going to sell because there's so many different scenarios that you could play. Like, do I want to invest it now? And like, what's my run rate? And do I have spousal or partner support that we wouldn't even need to touch that if we were to sell now?

Am I the primary provider of this? So if I were to sell now, like this is it, game over. I need to live on this now. Is it that if I work for a few more years and get it up to five million? But like me working for three to four more years to get it to that five million mark and then needing to work for a DSO for three to five years, do I have eight to 10 years left in me that I want to continue working? Because that's the realism if I were to sell it that way. So I agree with you. I think it's really like, what's my why? What number do I actually need to make? That's why I feel like having a good.

CPA, having a good financial advisor, knowing like what your your target end day is, if you know that number of what you would ideally like to get, I think it's so much easier to work backwards and then also lifestyle of what you want to do. So, and as you said it, it finally made sense for me, Brannon, because I'm always like, why does one care about top line and one care about EBITDA? But putting it in simple terms, like please tell me if I got it right. I feel like I'm your student today. I took a bunch of notes. My learning today was the reason that a private buyer would be buying it at

A number and a multiple based on revenue, like top line production number, and that's adjusted production, everybody. So don't get excited. They're gonna be looking at that. They're not going at your 1.9 when you're only collecting one. They're for sure going off that collection amount. Like, don't get excited about that. But they're gonna do that is because they're coming in and they're the they're a a dentist. So they can remake that money. That's what they're able to do. Yes, they're taking home profitability versus a DSO as a legitimate investor. They're not coming in as a dentist, they're not working as a dentist, they don't care about that top number.

They care about what's my passive pro profitability in there because that makes it a good like no investor that I've found comes in and wants to take over and become an employee. They want just the passive money. They're gonna put people in place and they're just gonna run this and it's gonna be part of their bigger portfolio. They're looking for the amount of cash of passive profit to make them larger to private equity. Is that did I get that? Or is there anything that I missed in my understanding today?

Brannon Moncrief (30:37)

I I I think that is very well said. That that is the difference between the perspective of a private buyer and DSO. They're they're very different. I understand how sometimes people are like, why doesn't a private buyer care about EBITDA? Like you should. You should care about profit, but it's just a different perspective if you're gonna step into the shoes of the seller and the clinician and you're gonna take home that clinical, you know, chair side

Kiera (30:59)

Sure.

Brannon Moncrief (31:00)

wage. You know, one point I I wanna make in regards to this whole discussion, like private buyer versus DSO.

Is you hear a lot of talking heads out there that are really pro-DSO

Kiera (31:11)

Just

Brannon Moncrief (31:12)

that are like, it's a no-brainer, like 2.8 million versus 1.8 million. You go DSO all day long. They don't even want to talk about the difference and and the nuance involved. And then you have other people, whether it's CPAs, whether it is brokers that don't do DSO deals, that are like, no, DSOs are the devil. You know, you you should only sell to a private buyer, you should never sell to a DSO. And I I think

You have to look at those people's perspective and their business and why they may be saying certain things, right? Because

Kiera (31:45)

Mm-hmm, mm-hmm.

Brannon Moncrief (31:47)

ultimately there is often an ulterior motive. And that is to protect

Kiera (31:51)

You would agree.

Brannon Moncrief (31:52)

their own business and their own pocketbook. And that's really where I love, where we come at this conversation is we do private deals all day long across the country.

Kiera (32:00)

Mm-hmm.

Brannon Moncrief (32:01)

We do DSO deals all day long, all across the country.

We excel in both of those worlds. I don't know that there's another practice brokerage firm that does, right? Most of them are siloed into either doing private deals or DSO deals. They don't excel in both worlds. They're not highly educated in both worlds. So I love that we kind of sit in that objective seat. Hey, let's talk about all of it. And I don't really care

Kiera (32:23)

Mm-hmm, mm-hmm.

Brannon Moncrief (32:24)

what path you want to go down, but get an education and then make the decision that makes the most sense for you. And then we'll help you crush the outcome, whether it's today or

Five years from now, whether it's private buyer or DSO.

Kiera (32:36)

I and I feel the same. Like in the consulting world for us, I don't care what route you go. We tell everyone like what's your life and what you want this business to do. That's our ultimate goal and end goal of what we're going to be doing. Like if you want to go to a DSO, rock on. If you want to go towards private sell, rock on. My job as your consultant and as our consulting firm is to make you the most profitable, like the most sellable business that you can possibly do. And like we're a miracle grow for practices. So I love working with people like Brannon because it's like great, you're not ready to sell or it's not quite to the level we want. Here's like

three or four levers that we're going to instantly push to drive that amount up for you, knowing we're headed for a seller. We want to get it there. So Brannon, I kind of want to pivot gears and do almost like our part two of today's episode. and that part two is I want to talk about the dark side of both of these because like there's elephants in the room on both. And I feel like if we can talk about that dark side, I feel like it'd be a very beneficial because I've heard the DSOs go bankrupt. And so that additional 40% that I was working my last five to eight years.

I actually don't cash out on that. Or they go under and then I don't even have a business. I also know with private buyers, people get annoyed because they're sitting there, sitting next to their associate. They bring on a partner, the partnership is sinking ships. So can we just like do a part two? And I want to just go a little dark. Like I think we had the light. Let's now go dark on part two of this episode.

Can you walk me through private buyer versus DSO? Like what is the dark? What's in the shadows? What are like the horror stories? And I don't want to freak people out. I feel like it's just a good way to educate of like what things can go wrong instead of just looking for all the things that can go right. And then we're able to make the most educated decisions.

Brannon, thank you for being such a wealth of knowledge in the industry. We adore you. Our clients adore you. And I'm just grateful for you today. So thank you. Yeah, likewise.

Brannon Moncrief (34:17)

See you. Good to see you. Bye everybody.

Kiera (34:19)

And for everyone listening, thank you for listening. And as always, thanks for listening. And I'll catch you next time on the Dental A Team podcast.