THE MILLIONAIRE DENTIST PODCAST

Episode 39: A Practice Owner's And Growth Through Acquisition

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EPISODE 39: A Practice Owner's Path and Growth Through Acquisition

On today’s episode of the Millionaire Dentist podcast, Casey Hiers welcomes special guest Dr. Ashly Cothern from Dallas, Texas to discuss not only Ashly's career path but how growing her practice by acquisition was the right fit for her.

 

EPISODE 39 TRANSCRIPTION

Announcer:
Hello, everyone. Welcome to the Millionaire Dentist podcast brought to you by Four Quadrants Advisory. On this podcast, we break down the world of dentistry finances and business practices to help you become the millionaire dentist you deserve to be. Please be advised, we do speak with an honest tongue and may not be safe for work.

Casey Hiers:
Hello and welcome. This is Casey Hiers, and today's topic on the Millionaire Dentist Podcast is titled Growing Your Practice Through Acquisition. Dr. Ashly Cothern joins us from Dallas, Texas today. Ashley, thank you for spending some time with us.

Dr. Ashly Cothern:
You bet. Happy to be here.

Casey Hiers:
Before we dive in, let's just start at the beginning. I love things to be chronological. And so walk our listeners through life after graduating from the Baylor College of Dentistry with your Doctor of Dental Surgery degree. What was your first job? Were you an associate? Or what did that look like?

Dr. Ashly Cothern:
So I actually was not. I was the one graduate from my class to purchase a practice right out of school. And it really fell in my lap. My fourth year, like many fourth year soon to be grads, passed out my resume all over town, and visited with several dentists. And one day on the way home from dental school on my way to my apartment, I stopped by where I saw this sign, Dentist, and the folks weren't there. They were already gone. And so I called and left a message on the voicemail, or the answering machine at the time, and said, "Hey there, my name's Ashley. I'm a fourth year dental student, and would love to visit with your dentist."

Dr. Ashly Cothern:
Well, I didn't hear back, but we tried a new church that Sunday, three days later, and it ends up that this man stands up, he was a guest speaker, and he stands up and shares his story. Well, it ends up that that was the dentist. So I'm tugging on my husband's shirt saying, "That's the dentist. I just dropped my resume off at his office right by our apartment." So I run down to the front of the church afterwards and introduce myself, and long story short, we got to know each other, and at 42 years old, he was independently wealthy, and he decided to retire from dentistry, and sold the practice to me. So inside three months I graduated, bought the practice, and he was gone.

Casey Hiers:
How serendipitous is that? The gentleman stood up at a church service you were at, and kumbaya, it all worked out.

Dr. Ashly Cothern:
Absolutely. Ignorance is bliss. I just jumped in with two feet and bought a practice that had two operatories. So it was pretty small, but it was very manageable for me at the time. And so we quickly grew the practice. I kept the staff, and they would joke that their last dentist would take two and three hour lunches. And I quickly said, "Okay, we're not taking lunches. We're working through. Let's be efficient. Let's get in and out." And so we grew the practice, and I still have a relatively small practice. I'm still in the same space, but we now have four operatories with two hygienists, two assistants, and two front office gals. And so that's really how it started.

Dr. Ashly Cothern:
And my first five years out, I did the best I could do, and I think it was pretty good. I have always wanted to be a dentist. I have no idea why. We have no dentists in our family. I tease and say I was hit with a lightning bolt and said, "You're going to be a dentist." But early on, in high school, I started visiting with my dentist and ask them questions such as, "If you could do it over again, what degree would you get in undergraduate to help you run your business, to help you be a better dentist?" Things like that. And so I feel like I had some pretty good tools. I interned through high school and in college at a general dentist office, a periodontist office, and an orthodontist office. So I got to know some different realms of dentistry. And so anyhow, I'm out of school running this practice by myself, and on one hand-

Casey Hiers:
Yeah, sorry to interrupt you. So you knew you wanted to be an owner. There was never a question. You're in dental school, and just logical next step buy a practice. Is that how that went down?

Dr. Ashly Cothern:
Yeah. I think logical next step is to become associate. It's what all my counterparts were doing. everybody else was looking to be an associate. That's what I was trying to do. And he said, "I like you so much. I want you to buy the practice, and I'm out of here." So it just happened. But yeah, ownership was definitely part of the plan.

Casey Hiers:
That was the plan, that's what you wanted. Now in your mind, you probably had a vision of ownership and what that looked like and what that was going to be. What surprised you about ownership? Once you get in, and the honeymoon period is over, what surprised you about ownership that you weren't expecting?

Dr. Ashly Cothern:
Wow, that's a great question. So, I think that I have several friends who own several different businesses other than dental offices. And I think it's interesting how closely they parallel. I think there's so many situations it's managing people, it's relationships, it's the hot water heater breaking down, it's the software exploding. It's things like that that are the headaches. The dentistry I love and can do with my eyes closed all day long, but it's all that other stuff, whether you own a dry cleaner, or an insurance company, or a dental practice, there's just stuff that has to be done, the overhead stuff. And so that initially I was like, "Oh, it's not real fun. I don't love that part." So that was surprising to me just because I've never done it before, but I think something else that was surprising to me is I initially thought, "Okay, if I'm a good practice owner, I can do everything on my own. I can do everything by myself. I can be great at all things."

Dr. Ashly Cothern:
And I now know that the true sign of a great leader is surrounding yourself by other leaders, and equipping other folks to be the best that they can be. And so together we move forward at a greater rate. And so I think my definition of leadership then and now is very, very different. And I think something else that really surprised me is my mentors were dentists in the eighties. And that was a very different time in dentistry, as we all know. And so I came out, and I was not making as much money as I anticipated I would. And I think one of the reasons that I wanted to become a dentist is to have some financial security. I didn't necessarily grow up with that. We had some divorce in our family, and I just never wanted to not be able to provide for myself and my family. And so I think a big piece of that was I wanted financial security. And I saw very early on that if times were tough, I didn't get a paycheck, or I'm paying my staff, and I'm not getting one. So, that was surprising.

Casey Hiers:
That is a fascinating point. So, as you know, we travel the country, at least pre-pandemic, and present continuing education and get to talk to a lot of practice owners, and a lot of practice owners happy to admit, "Listen, a big part of why I got into dentistry is because I wanted to make good money, be financially free," whatever you want to call it. And then they put on all this hard work, and they don't feel like their income is quite being reflected by all their hard work, and it certainly wasn't what they thought it would be early on. It sounds like you experienced that a little bit early on yourself.

Dr. Ashly Cothern:
Absolutely, absolutely. And I think my definition not only of leadership has changed, but I think success has changed, where initially I thought success would be I was making tons of money, and I, again, now know that being a wife and a mom of four, in my world success is simplicity. And my success is having flexibility to... We start at 7:00 AM and we're done at 2:30 or 3:30 three days a week, and that's successful to me. I get to go home and be a mom four days, and I get to be a dentist three days each week. And so that has changed. That has evolved. Now, when I first got out and I said I did the best I knew to do, I hit it about five years and I thought, "Okay, I need some help. I feel like I've maxed out at what I can and know to do."

Dr. Ashly Cothern:
And so at that time, I brought on management consulting, brought in Jamison, and they did a wonderful job of managing systems. They did a great job of refining us, helping us just with relationships and just loving on people and serving them well. They did a great job of that, but I still had to pay them a big chunk of money each month. And my husband and I are both going, "Okay, they're not looking at our bank account, and they're not seeing how much is not there." And so that's actually when we got referred over to you guys to say, "We need somebody to look at the big picture. Not just a piece of the pie, but the entire pie, all of the pieces of the puzzle." And that's where Four Quadrants came in. And my husband nor do I, either of us, have a financial background. Our parents did not gift us with that at all.

Dr. Ashly Cothern:
And so, again, we knew we needed to surround ourselves by people that we could trust, and that could help us grow because to your point, we've worked our tails off, and we want to reap the benefits. And so Four Quadrants came in, and quite honestly, I think I was at the low end of the spectrum that you guys were accepting clients, but there was something that about us that you said "Yes," and let us in. And I think we're pretty coachable. whatever you guys say is gospel, and we're going to do it. We're going to make it happen. Because since being with you guys, we have saved consistently, which we never did before. It was paycheck to paycheck. It was survival mode. It was we're having a baby, save up, have a baby, spend the money, save up, have another baby, spend the money.

Dr. Ashly Cothern:
So we did that for a decade. And with Four Quadrants in the picture, it has been consistency. It has been growth. It has been saving. It has been thinking about the future, and it's that financial security that I've always wanted. Now, could I make more money? Sure, if I worked four days a week or five days a week. There's always that opportunity. But Four Quadrants has listened to us and to my desire to be a wife and a mom first, and a really great dentist third, and how to be successful at it. So they didn't just come in. You guys didn't just say, "Hey, you got to work eight days a week," but you said, "What do you need? How can we help?"

Casey Hiers:
I love that you pointed that out. We typically say our results are consistent. How we get there is very different. We want to listen to people we work with. What do they want out of their life? What do they want out of their personal life and their practice? And that vision is very custom, and I appreciate you bringing that up. So you're working with us, you've got a comprehensive view of things, you're feeling better. Did you hit any roadblocks along the way? Obviously this is Growing Your Practice Through Acquisition, and so I guess talk about where you maybe did some marketing, but you were just at a place where you wanted and needed to grow.

Dr. Ashly Cothern:
Yeah. So I think that's always our desire is to better ourselves and grow and change. I think it's hilarious that people ask, "Are you accepting new patients?" We're always accepting new patients. Yes, absolutely. And how do we go about doing that? How do we continue to grow the practice? Because our practice is a very comprehensive practice, as I'm sure many of yours are. I like to believe that we see the patient for all that they are, we recommend all that they need, and we move forward because of education and communication, and we move forward with that treatment. So in theory, we're completing lots of patients' treatments, their comprehensive restorative treatment. And so yes, we need new patients to continue to grow. So, yes. We've done marketing, I don't know, a decade or so, I guess, when websites were the thing. I drug my feet on that. I literally took out a page in the yellow pages when I first started.

Dr. Ashly Cothern:
And then now it's very, very different. And so yes, we started a website, and we advertised. We're in Dallas,. And so we advertise in a prominent magazine called D Magazine, and things like that. Now we definitely hit roadblocks along the way, and one of the reasons that I love you guys so much is each time I would hit a roadblock, meaning cashflow is low or things have slowed down for whatever reason, y'all will always say, "Okay, let's figure out how we can reconvene. How do we need to be flexible here, or just change direction for a bit? Let's decrease the amount that we might be saving or contributing for a small period of time." And y'all always come back, whether it's a month or six months later, "Okay, let's revisit that. Now where are we? What do we need to do to get us back on track?"

Dr. Ashly Cothern:
So we did... About two years ago, two and a half years ago, there was a retiring dentist across the street, and he was looking to sell his practice. He wanted me to buy the space and to move in. It was a very old practice that needed a big facelift, and it was just going to be too big of an undertaking. And so I told him, "Thank you, appreciate it, but I'm not interested. But if you ever need a place for your patients, give me a call." So I pursued him for about six months. He couldn't find a buyer, and so I continued to tell him, "If you need a place, I'm happy to take care of your patients." Long story short, he came back to me and said, "Hey, I'd love for you to buy my chart."

Dr. Ashly Cothern:
So that's basically what we did. We purchased his charts, and his patients came over to our practice. And that just gave us a great boom in production and collection. And we throw him a retirement party with all of his staff, and we invited his whole practice and it was just a great goodwill thing to do. But that boosted our practice. I'm looking to do it again any old day. But every time, good or bad, something new comes along, you guys were there to help guide us on how to handle it.

Casey Hiers:
Well, you just hit on a real important point, and I'm speaking with a couple of folks, and they want to grow, grow, grow. They want to have four practices, five practices, six practices, and...

Dr. Ashly Cothern:
God love him.

Casey Hiers:
Well, it's interesting. I ask why, and as we start peeling the onion back, it's because they're not making the money that they want, and they think that's the only way. And they're buying multiple locations. They've got a whole bunch of associates. And so what happens is without the right systems and processes in place, it magnifies the areas that they're not executing, and it just makes the problem worse. But yeah, you really hit on that, and to just grow to hope and pray that you're going to make more, that doesn't always happen. Sometimes it can just magnify issues.

Casey Hiers:
And so for you, it's been incredibly helpful, incredibly beneficial. And I guess, compared to this, to the traditional marketing and all the other efforts you do to grow patients, this was a very efficient thing for you to do. And like you just said, you would do it again. Right?

Dr. Ashly Cothern:
Absolutely. 100%.

Casey Hiers:
Are there any, for our listeners out there that are hearing this and saying, "Wow, that's interesting," any tips or tricks you give? Obviously you did the legwork. You were hustling. You saw this practice. You pursued the person. You were persistent. But I guess what areas would you tell somebody, "Hey, keep in mind this or that," or "I wasn't expecting this." Any surprises, any tips or tricks you would tell our listeners in going through that process?

Dr. Ashly Cothern:
If they're acquiring?

Casey Hiers:
Yeah. If they're like, "Hey, I'm going to look around my area and potentially do that."

Dr. Ashly Cothern:
Yeah. So, I've always heard this, and I've never done it, and I've put it on my to-do list to do, and I haven't done it, but certainly just networking. just your natural relationships that you have just to get the word out, "Hey, I'm trying to grow my practice. If you guys know of anybody who's looking to retire, let me know." especially after this COVID issue, there's a lot of dentists who aren't wanting to go back. It's hard to practice. It's frustrating to practice. It's different to practice. And some of these folks that are near retirement age, they may just say, "Forget it. I'm not willing to do all this."

Dr. Ashly Cothern:
So, I think networking, I think visiting with folks that you already know in your circle. I have a really good relationship with some head hunters here in Dallas who know every dental practice and they know every dental graduate, and they know the folks who were ready to get out and retire, and then the folks that are graduating dental school and looking for jobs. And about every six months, I call them and say, "Hey, don't forget me, anybody out there looking to sell their practice? I'm happy to snatch them up." And just got off the phone with them yesterday, and there actually was an opportunity, but it wasn't the right opportunity. But just staying in constant conversation with those folks, I think, is key.

Casey Hiers:
Now, you had mentioned you were able to buy the charts, and not have to worry about the physical building. I would imagine that could be a bugaboo for some people, if they own the building and all those things, and that's part of their plan for retirement. That could be challenging. You had mentioned they weren't having any buyers. And so that worked out. But I think for some folks out there, having another location may fit into their personal life and goals. For others, it doesn't. So it truly has to be the right fit.

Dr. Ashly Cothern:
Yeah, it does. And I'm not opposed to it. I'm just about to... I lease my space, and I'm just about to sign another three-year lease. I'm not going to sign a 10 year lease because something may come up, and I'm not married to the space like I once was. But I'm not married to the space because if the right situation comes up, you bet. I think it could be great to just pick up my practice and walk over and plop it in something maybe a little bit larger if I'm wanting to grow it and combine it with that dentist's practice.

Casey Hiers:
Well, Ashly, I've known your story, and I knew growing through acquisition, I've had more conversations probably in the last year and a half with people around that, simply because they're not where they want to be, or traditional marketing is less effective for whatever reason. And so I found it prudent to invite you on today. I wanted to hear your story. I'm sure our listeners out there are hearing things that are percolating and get the wheels turning. There's more than one way to grow. Growing the right way is important, and buying the right practice.

Casey Hiers:
Some people have their heart set on a plan, they'll find the wrong practice, and they'll go through a horrible situation before they find the right one. And your persistence and diligence has paid off, and again, you mentioned it earlier, your coachability is so good. And those characteristics really drive success. I want to thank you for joining us today. And again, this is just one example of a successful dentist in Dallas, Texas that wasn't going to settle, and she wanted to grow. And for her, growing through acquisition was the right move for her, and she had a comprehensive team to help her look at some of those details, and it was the right fit for you. I appreciate you sharing your story with our listeners, and appreciate you being on today.

Dr. Ashly Cothern:
Absolutely. So happy to do it.

Casey Hiers:
Thank you.

Announcer:
That's all the time we have today. Thank you to our guests for their insight and for sharing some really great information. And thank you to you, the listener, for tuning in. The Millionaire Dentist podcast is brought to you by Four Quadrants Advisory. To see if they might be a good fit for you and your practice, go on over to fourquadrantsadvisory.com and see why year after year, they retain over 95% of their clients. Thank you again for joining us and we'll see you next time.