When it comes to scaling smarter, not scattered, there are three mistakes owners make that hurt efficiency, profitability, and leadership. Kiera talks about how Dental A-Team helps practices simplify methods so that success is humming across all locations.

Episode resources:

Subscribe to The Dental A-Team podcast

Schedule a Practice Assessment

Leave us a review

Transcript:

The Dental A Team (00:00)

Hello, Dental A Team listeners. This is Kiera and I hope you are having such an amazing day. Today is podcasting day and I actually did a little reel for you guys to come and enjoy getting ready for me on podcasting day. My husband and I, we did this funny thing when I got like amped myself up and we're like, I love my life. I love my job. I love podcasting. And I don't know if you guys have seen that little girl.

who does that where she gets so excited about life and it's like, I love my bed, I love my hot tub, I love my view. And truly I love all of you. And I'm just super excited to be here with you podcasting, to be talking about great things in dentistry. And today I think that this one's going out to our multi-practice owners. And these are three costly gaps that I've noticed within multi-practice ownership that really try to highlight some of the gaps because at the end of the day, the podcast was created

to help all dentists elevate, to help all of us rise, to positively impact the world of dentistry in the greatest way possible. And that's what we're about. That's what our mission is. That's what I'm about. And so today going out to those multi-practice owners, or for those of you thinking about multi-practice ownership and do you want to do this? do you want to like, what are some of these gaps that maybe could also impact solo practice owners? So at Dental A Team, do work with solo practice owners, multi-practice owners. We work with...

like from basically one million, you know, you're maybe at that 650, one million range, all the way up to that 10, 15, $20 million range as well for practices. And there is a no one size fits all in Dental A Team I'm very, very, very, very big on who we hire and who the people are within our company. And with our clients that this is your life. This is your dream. There is no ultimate destination that we're trying to get all of our practices to. There is no final

You've got to hit this in order to be excellent within Dental A Team. is what is your life? We have some owners that are working at two or three days a week. We have some owners that are working six days a week. We have some that want multi-practice ownership. have others that want solo practice ownership. We have some that are solo practitioners doing 4 million in one location of about six to seven operatories. We have others that are in multi-locations doing 2 million. So really there is a no one size fits all. It's more what do you want to be? And we call this the yes model. So where do you

personally and professionally want to be. stands for earnings to make sure you're profitable and S stands for systems and teams to support that. So really making sure that way you can say yes to your life, yes to the things you want in life. That's what we're about. So with that, like when you look at multi-practice ownership, it does not necessarily mean adding more profit. I've talked to several multi-practice owners that are actually making less money in multi-practice ownership than they are.

prior to expanding to multi locations. Think about it. You've got one location that's doing really well, the other one's not doing so well, well, your good one has to then support your not so cash flowing one. So sometimes it actually can be a lot more costly for you. And so for you to just realize that some of the ways that we can do this will actually impact solo practitioners. ⁓ And so the three things that we're gonna work on today are like,

things that hurt efficiency, they hurt profitability and they hurt leadership. So when we look at this, doing a deep dive on that, that's really what I want you to look at of like how you can scale smarter and not scattered because really with multi-practice ownership, I remember the day we opened our second location. Our first practice was doing, it was 500,000 to 2.4 million in nine months. And then we opened our second location and you better believe that it was like just adding more fuel to this already burning chaos fire. I think that's really, really clear. And I hope you heard that it was adding more fuel.

to the chaos fire, not to the profitable fire, but to the chaos fire. ⁓ And that was really, really, really struggling. ⁓ It was hard on me. It was hard on our practice. It was hard on the team. I was not showing up as a great manager. I was not showing up as a great ⁓ leader. I was not showing up as a great partner. ⁓ I was not showing up great in my marriage. It was like literally just trying to swim through and feel like I was trying to survive rather than doing it smart. And so that's something really big that we've been wanting to do for all of you is

to give you this smarter way. Dental A Team was really here for you. It was built by people who are just like you, who have been in your shoes, they don't just understand you, but have actually been in your shoes, who's walked the walk, talked the talk, and we've done it very successfully. So I love to help offices. Hopefully we're helping you. ⁓ And if you love this podcast, please be sure to like it, start, share it, because that's how we're able to help and influence more people. number one, the biggest number one miss is no centralized operations. So that means ⁓ we don't...

we don't have a central plan and instead our practices are individual islands. This was very much my practices. We had our one and it was doing certain things and we had our second one and it was not doing certain things. And so going from each practice felt like I was going to multiple different locations, multi different pieces and that really gets hard. And so we have inconsistent systems which means we have unpredictable outcomes. And then on that, like we did not have a set way that we'd schedule. So we'd schedule one way at our first location another way at our second location.

Our billing was not the same. The way we were insurance verifying, our fee schedules weren't even the same because we were in two different cities. And so we had different fee schedules. ⁓ Reporting was not the same. We did not have leaders in both practices. We did not have SOPs that could scale. Like truly our operations manual was not done and we just thought buy another practice and let's go through this. Rather than having a set standard, and this is something I'm really big on when people want to go to multi-practice ownership or they're already in multi-practice ownership. This is really where we start. There's a practice that we're working with and

I think about them, were, the solo doctor was running around to every single location, trying to out-produce the problems instead of fixing the problems at the base level. And that's going to be through this of like centralized systems and getting systems in place and like having our scheduling and our billing and our cashflow consistent and looking at each of the individual practices ⁓ to make sure that they are centralized. And so when we work with multi-locations,

What we do is we actually simplify it down. So you don't necessarily have to have centralized billing or scheduling like right away. Once you get to that four or five, usually it's very recommended to have centralized billing or I've got some practices that are multi like it's one location, but they have about 15 to 17 operatories. Well, that does count in my opinion as multi ops, multi practices, cause a lot of times multi practices are like five ops or more. So you think about a 15 op practice that's like three practices, but just under one roof.

So even in this larger practice, I often recommend we start to centralizing. So we have a set standard of how we're doing billing. We have different reporting metrics. You've got to have the KPIs. We've got to have the set system. So what we started to do is we standardized the operatories. So all ops are the same. We standardized how we're scheduling. We're all in the same softwares. We have an SOP. So we've got our front office, our back office teams, and we do the exact same way. So how we're doing it. We had both practices auditing each other so that we standards were not getting missed and it wasn't.

Well, this practice does it this way and this one does it this way. No, we're trying to make these standardized. that way, again, it's not so that way we can't have our own flare and variety at the different locations, but it's so that way when practices show up and doctors show up, we're actually able to be efficient and effective because we're able to have it be the same. It's like, could you imagine ⁓ if your practices were like everybody's varying different houses? So the way I put my silverware in my house might be very different than where you put your silverware in your house.

So just imagine we've got five different houses, how much easier it would be if we all walk in and we all agree that silverware goes to the right of the dishwasher. Well, now, no matter where the dishwasher is placed in a house, we know silverware will always be to the right of the dishwasher. Just like when we walk into an operatory, we always know that the ⁓ disposable, so our gauze, our cotton, is always to the right of X. It all practices. So as much as we can get them similar, so that way it's just more efficient, it's more streamlined, everything is working together rather than against each other.

but truly getting centralized operations in multi-operatories or multi-locations is going to be one of the biggest ways to cut costs, to save time, and to make it more efficient for a better patient care all the way around the board. So really look at your practice and see, do we have inconsistent systems? Are we doing things differently? Do we have different flares and flavors? Do we have like five different houses within our multi-practice ownership? And what could we do to unify it across all of the practices this quarter? And usually when I'm starting with an office,

I'm going to look for the scheduling because that's usually the fastest. Then the operatories will be my next piece that I'm going to go for. And then after that, we're going to go into our billing tactics and making sure that goes into it, which leads me right into point number two. And this is gap number two and it's profit per location is not being tracked. A lot of times when people get multipractices, what they do is they just keep it all under one tax ID number. I understand your reasoning. I did that when I started my multiple businesses. It actually gets really hairy scary. And so ⁓

Yes, like let's untangle this. I'm not a CPA. My job is not to be giving you financial advice. My job is just to help you as a consultant. We pair really well with CPAs. And so miss number two is when we don't have profit being tracked per location, but overall as total revenue, but not knowing which practice is profitable and which practice is struggling. That's a really, really, really big miss as a practice. So helping you just understand that you've got to a hundred percent.

make sure we're looking at the profitability and breaking it apart. So each practice has its own tax ID number. Yes, this is annoying. Yes, you have to fix the billing pieces for it, but each practice needs to be treated like its own individual business unit. within the bigger whole. So it's like we have the same standards, we have the same operatory setup, we have the same softwares, we have the same billing tactics, but what we have is we make sure each practice is profitable.

So we know how much are we paying for all the fixed versus variable costs and we're tracking those within each location. When team members travel between each location, they're actually paid out of two separate entities. So they could be technically putting in more than 40 hours, but if they're only putting 20 hours here and 30 hours here, technically that's not over time. It's like working two different jobs. Now you have to be careful with that to make sure that those employees are not overworked.

But making sure that like when I've got team members going to multi locations, I am tracking it per location. I am tracking it per practice. When I've got regional managers separating out that regional manager salary amongst all the locations to make sure is this practical profitable? And if not, what are the underperformers? What are the root causes? How can I get this profitable? Can we do block scheduling in there? Can I work on my costs? I've got two practices right now and their rent is much higher in one location. Well, if I've got higher rent over there and higher costs,

I have to produce more in that practice than I do. So I can't have the exact same block scheduling in both locations. I can still block schedule similarly, but I have to make sure that I'm hitting my correct overhead percentages and that each practice is profitable. We have separate credit cards for each location. So we're ordering on those separate credit cards. So it is per location. We have different bank accounts for each location. So the money's coming in so we can see what it is. And what's crazy is when offices actually do this, what they find is

they're actually able to quickly identify what the root causes of that practice. They're able to bring it up to par. like one practice, they're losing money due to not having hygiene reappointments in there. So like the hygiene team is not as profitable as they should be. So we laser focus in on that. We fix the systems across the board, but we laser focus on the practice that's struggling. And we're actually able to boost them by 400,000 per year just by fixing that one small problem, because we're not looking at the organization as a whole. Yes, you do need to look at the organization as a whole.

but you do need to like scope it down to how each practice is performing. And this should be weekly, monthly, quarterly to then assess how we're doing. ⁓ When people get into multi level DSOs, you better believe they're looking at their top performers and their lower performance. And a lot of times they cut those lower performing offices out because that's hurting their overall profitability of the business. So many offices have really high producing practices and they're dumping it to go save the other ones. Just like thinking about a real estate portfolio.

they're looking and rebalancing those portfolios, but for you to rebalance it is to make sure you're tracking the profit per location and we're fixing the issues at the base root problem. ⁓ And so really what it should be is you should A, make sure you're running them individually, B, do a P &L by location and let's figure out where our gaps are within the finances to see how can I make each location profitable and set that as the target as the goal for your regional, for your office managers.

This is the goal per location. I work with an office and we have six locations that we go to quarterly. And we are looking at their scorecards every single week, every single practice. And then we look collectively at the whole to make sure organization as a whole is profitable. Yes, when we started new and of course we're going to be dumping money into it. But the goal is for that new practice to be profitable. Six months to one year max is when they need to start breaking profit. And so when teams know this, when office managers know this, what happens is the whole

portfolio actually does better and the businesses are running much more effectively, efficiently with better patient care, better team awareness all around. So that's miss number two, ⁓ gap number two. Miss number three is not having consistent accountability. So when you have it, oftentimes it's just this chaos. Like I said, like we're adding more fuel to a chaos burning fire. And so ⁓ when we have that there's no roles, there's no structured check-ins, there's...

It just feels like hope and pray. And then we're trying to like get the profitability margins. We're trying to do all those pieces. So we've got to have cadences in there of weekly calls, having weekly scorecards and quarterly reviews. ⁓ And so when you have leaders at each location, what they do is they, get all office managers together on a weekly call. They look at the scorecards for their practices. They look cross company so they can look at all the other offices. So if I'm struggling with a profitability, but this office over here is doing really well.

office managers sync up, let's have you two work together, let's have you see what you're doing differently. That way everybody's able to be profitable. So that really helps. And then you empower all the leaders to own their KPIs and report back. So they're owning their teams, they're owning their departments, they're owning the profitability of their practice. And then this way we're able to have metrics that are the same across all locations. So having a set scorecard that's used, when we do it within our company, we have practice A, practice B, practice C.

Right now I've got an office I'm thinking of and practice A is super profitable and practice B is not. And they're just looking at it collectively as a whole versus saying, my gosh, we've got to get like practice B profitable. Practice B is not producing and it's not collecting what it should be. A lot of times also that profitability margin is hurting because we're not collecting. And so one practice is very much collecting, paying for the other practice, but it's just due to broken systems and not having that O-M responsible. And it's because we're spread across trying to be

⁓ efficient, which is true, but we have to have individualized centralized accountability frameworks in each location. So it reports up. People know who's ultimately responsible for that practice for the different pieces, rather than it being we're all responsible for everything. That means nothing is actually truly being tracked. So ⁓ when we've implemented these scorecards across practices, usually what you start to see is you see an increase in profitability, an increase in collections, an increase in case acceptance, because everybody's looking

Like we're looking side to side, it's like Sudoku. I'm looking to see how am I comparing with my other practices and how can I get the support where I'm struggling? And then you also start to create cohesiveness as a unity. You start to create cross collaboration. And this is a huge, huge, huge mess in multi-practice ownership and even in bigger practices. So when you look at this and you have that weekly reporting rhythm, you have this weekly accountability, and then you start to empower your leaders to meet with their team members once a month.

and then have quarterly cadences where we're looking to see how we're doing, you start to see teams rise up. Because now it's like, great, we know what the scoreboard is. We know what we're aiming for. know everybody knows what they're accountable for. There's no more of this confusion of what should we be doing or should my practice do this, but your practice doesn't. You try to get them as standardized as possible. And what I will tell you is working with multiple multi-practice owners, this is not a dream. This is a reality that you should be striving for and that you can do. I love to work with Mac.

multi-practice owners because I love to take the chaos and turn it into simplicity. I love to help you see which like it's like a ball of yarn and you're like, my gosh, like pull this string or pull this string or pull that string. And like, we don't know how to untangle what we've created. And so doing these three misses of not having centralized operations. So making sure we're centralized across the board, making sure each practice is profitable and then having accountability across the board. When you streamline those across all your locations,

instantly things get better. Scaling is not great when it's chaos. Scaling is great when it's tightened, when it's predictable, and when it's consistent. That's when it becomes fun. That's when it becomes fun to be multi-practice honored, but it is not fun when it is the chaos. And so when we do this, this is something that I'm obsessed with. This is something I love to help offices. This is where I love to help regional managers figure out how to do this because a lot of times they don't even know. They've never done it before. They've just been a great office manager and doing one baby versus five babies.

We all know as parents and siblings and aunts and uncles, we know that one baby is a lot easier than five babies. However, five babies can actually be easier on certain levels when we have set standards and we have set processes and we have set things in place and we've got rhythms and we've got routines that actually sometimes can be easier than just one because it forces you to actually rise up. It forces you to be better than what you've been. And so with this, just know these are some of the three big gaps that we see in multi-practice ownership or large practice ownership.

These are some of the areas that we really expert help. And hopefully for you to just have a quick like checklist of like, where am I doing on my standardized ops? How am I doing on profitability of each location? And how am I doing on accountability, KPI tracking, scorecard accountability, weekly check-ins, implementing just a few of these things will radically help you. But sometimes it's so hard to lift your head up out of the bubble when you're living in the bubble. And so if you're struggling with that, reach out.

Like let's just have a conversation. Let's see if we're a right fit. If nothing else, we'll give you a lot of gaps, a lot of tools, a lot of tips and help you out. reach out, [email protected]. Go to our website, TheDentalATeam.com and click on the book of call. This is what we do. We create structure for scale, clarity for leaders and profit for every location. Like that is what our obsession is. And so I'd love to help you out. As always, just know dentistry is the greatest place we could ever possibly be in. We are so blessed to be a part of dentistry.

And I just want you to remember like if multi-practice ownership or larger practice ownerships on the horizon, these are things to do. If you're already in the weeds of it, you know, it's a lot harder to actually do than you thought it was. And so reach out. There's no reason to do this alone. The industry is hard as it is. So there's no reason to do this alone. Reach out. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.