Dentistry Demystified: Choosing Your Dream Practice

Unsure if you want to be a solo dentist or run a multi-chair empire? This episode is for you! Casey and Jarrod break down the different types of dental practices, from solo proprietorships to group practices.

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 back at the Millionaire Dentist Podcast in studio with co-host Jarrod Bridgeman.

Jarrod Bridgeman:
Casey, how are you?

Casey Hiers:
Good. Just had a nice lunch of chicken salad from the Chicken Salad Chick.

Jarrod Bridgeman:
Yeah, it's good.

Casey Hiers:
It's a restaurant.

Jarrod Bridgeman:
Yeah, what kind did you get?

Casey Hiers:
Olivia's Old South. They threw in a buttercream cookie. I'm trying to cut out my sweets.

Jarrod Bridgeman:
I came in and I asked for it and you said no, so thanks for that. Casey, you're not there obviously this week but we are there, AGD in Minneapolis, the 2024 AGD event's happening.

Casey Hiers:
Minneapolis.

Jarrod Bridgeman:
Isn't that what I said, Minneapolis?

Casey Hiers:
You kind of slurred it.

Jarrod Bridgeman:
Minneapolis?

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Okay. I'm not drunk.

Casey Hiers:
We're based near Indianapolis. But yes, the Academy of General Dentistry, their annual meeting is in Minneapolis, I think through Saturday, so yeah. We've presented CE at that meeting. We've sent some leadership up there and we like to support that meeting, it's a good one.

Jarrod Bridgeman:
Yep, yep. We've got some folks heading out there really excited to... If you're going to be there, make sure you stop by and say hi and let us wow you with our brains. Just an idea.

Casey Hiers:
Or they can enter a raffle to win a bottle of Camus or $200 tequila.

Jarrod Bridgeman:
That's true. And if you don't enter to win, I get to drink it all. So if you want to help protect my wife-

Casey Hiers:
False.

Jarrod Bridgeman:
... and end fights, no. But when we're at those events, we speak to and we hear every dental practice story in the world. We see every type of practice that's out there. And sometimes folks are just along for the ride, they let their circumstances dictate how their practice and their lives are, you know what I mean about that? And so I wanted to ask you, let's kind of get into it. What are some basic things that people should be able to take control of but may not?

Casey Hiers:
Well, I don't know that we know every scenario, mister big talker but yeah, we see a lot, we hear a lot. Ultimately, been at this for over 20 years, and so every conversation's unique and custom but that being said, you see trends in dentistry. And yeah, like you said, a lot of times people, they're not choosing their own adventure with dentistry. Once they buy a practice, they're being taken for a ride and it's more fun to choose your own adventure and there's a whole bunch of crossroad decisions a practice owner gets to make over their career, which is exciting. Sometimes it's a 50/50 coin flip on what's right or wrong but yeah, we can go over just what some of those are at a high level.

Jarrod Bridgeman:
Yeah, so let's start off the bare-bones, basic, I would say is like a one-practice shop?

Casey Hiers:
Yeah, right? You graduate, maybe you're an associate for a little bit and then boom, you're a practice owner. You've got this practice and really, hopefully this thought process is coming beforehand, but what kind of practice do you want to buy? But if you've got a practice, is this a practice that can get you to where you want to go? Does this one need a lot of work? Does it need a complete 180 change on business model? But really deciding, hey, do I have the right practice and do I just want to make this one practice my cash cow? That's really the first one because a lot of people want their names on the side of buildings, not saying that in a bad way, but they feel the path to the most wealth is multiple locations.

Jarrod Bridgeman:
Which would be the next step. Some people often dive into, "Oh, I'm doing okay at this practice, but I would like more money," wherever the case may be, and so they start branching out into multiple practices. But there are some cons to that, too. Now that's not to say that may not be the answer for you, but it may not be the right time for that answer or you're just complicating your stress levels of adult babysitting, or if you don't have your systems and processes in place in the first practice, you're just repeating that exponentially out there.

Casey Hiers:
Some people get a magic calculator. They don't love where they're at financially with the one practice, so they go, "Well, I'll just do it times two, open a second location, and bada bing bada boom." Well, there's people with multiple locations that are crushing it, that are doing great because for a variety of reasons and variables that were executed correctly, the timing was right, the practice was right, the distance, location, all the...

Jarrod Bridgeman:
You got to have the right mindset for it, too. Just because you see somebody else doing it, being successful at it, doesn't mean that you will be.

Casey Hiers:
Ooh, let's dig into that. That is unfortunately, I hear way too often. "Well, I know somebody or they've got this many practices and they have an aircraft and they have a lake house and I want that, so therefore I need two practices." That's not a great business plan.

Jarrod Bridgeman:
No. Yeah.

Casey Hiers:
It's one thing to kind of know what you want and then it's the dig into the details, but yeah. Multiple practices, multiple locations, multiple partners. I mean, we've seen some of that where they look up and they are 50/50 partners in three different practices and they've got a very complicated situation.

Jarrod Bridgeman:
And you're kind of stuck at that point unless you get bought out by somebody.

Casey Hiers:
Well, more times than not, ready, fire, aim. If we want to talk go into the range, they think they want to do it, they do it, they look up and go, "I don't like this either." Now I've got a complicated situation that really hasn't doubled or tripled my income necessarily.

Jarrod Bridgeman:
Right and at that point too, if it's 50/50 or how many other partners are involved, you can't just straight up make a large decision at that point-

Casey Hiers:
You know what the rationalization is for that?

Jarrod Bridgeman:
What's that?

Casey Hiers:
"Well, I'll catch it on the back end because I've got these massive practices and I'm going to get something out of it." And so they put their hope in that they're going to just get this big, perfect check to buy them out when they go to retire and that's going to make up the majority of their retirement. That's the rationalization sometimes for practice three, practice four, partnership here. It's like a complicated crime scene, pictures with yarn with some of the things that we've seen.

Jarrod Bridgeman:
It almost appears as diversifying, but you're not. You know what I mean? You're thinking you're putting all these eggs in different baskets, but it's all really the same basket.

Casey Hiers:
We have general dentists that make a million dollars in general dentistry at one practice because they have figured out the best path for them and roadmap with help from a team to monetize that. And we have others with this complicated situation and they're still not making or saving what they want and they don't really have a ton of certainty with when they can hang it up.

Jarrod Bridgeman:
I mean, this is a much smaller-scale example but years ago, a few buddies and I formed a small board game company between the four of us, and then it was 25% ownership for everybody and so it came down to nothing ever really got done because we could never agree fully to do anything.

Casey Hiers:
Too many cooks in the kitchen. Oh my gosh, that's a big one. So let's say you've got, okay, you've got your either one or two or three or six locations. You've got that one figured out, you feel good about it. And then it's, "Okay, do I need an associate? How many?" That's a huge component to ownership.

Jarrod Bridgeman:
Right you just get more associates, you make more money, right? You're doing more dentistry.

Casey Hiers:
The magic calculator again. It can be incredibly profitable.

Jarrod Bridgeman:
If you've got the numbers to back it up. So let me ask you, I know we've got kind of a rough benchmark as a company of when you should start thinking about looking for an associate. Do you have an average number in your head of when the average dentist might start thinking about, not knowing their numbers fully, are they just thinking, is it based upon time or is it based upon how much they're making? Is it like, "Oh, I'm so busy I need an associate" even if they're not making a lot from it?

Casey Hiers:
That was a lot of words for one question. So there's a lot of variables that go into it but we have people that produce 1.5, 1.6, 1.7, 1.8, 1.9, $2 million by themselves. They're big producers that, it's a non-issue. We have others that at 1.3 they're seemingly to capacity and so stressed out and all those things. So it's custom, there's different things, but yeah, I mean, if your overhead stinks and you're not collecting 1.4, 1.5, 1.6, if you're south of that, you may want to really, really take some time to determine if you want an associate, because while that answers the question of coverage, "Well, I've got somebody to help me out," you got to pay them.

Jarrod Bridgeman:
And unfortunately, we've seen some cases where the associate was making more than the owner.

Casey Hiers:
More than you would think. Once you peel the onion back, yeah, there's, I don't know, 20% of the time, you look apples to apples, the associate is out-earning, not necessarily out-producing, but out-earning the owner of the practice.

Jarrod Bridgeman:
And that's not why you open a business. I mean, having employees is great and all, but usually your main focus is to make money yourself. I don't know about you.

Casey Hiers:
Well, and I mean, I talked to an oral surgeon the other day, he works five days a week, and that's the other thing. Okay, do you want to work five days a week, four days a week, three days a week? What's that look like? What's each option look like? What needs to occur? Let's quantify it. There are so many crossroads that a dentist has, but then unfortunately, they'll look up without much strategy, without much guidance, and they look up and they're like, "How did I get here? I like dentistry, but I don't love all these details."
Or let's talk about insurance. Insurance is one of the biggest frustrations ever where if you're a young dentist, maybe target fee-for-service practices to purchase and you'll eliminate decades of stress. But then there's others that do a startup and they accept some insurances. Well, that's basically marketing costs and they've had a path to be successful doing it that way.

Jarrod Bridgeman:
Sure, sure.

Casey Hiers:
And so like you said earlier, "Well, somebody else did it and did it well." I mean, we have examples of every scenario almost where somebody has crushed it in a good way and where somebody has... Dentistry is not what they wanted and they're considering getting out. So it's not necessarily which decision do you do, because there's not a cookie-cutter answer. It's your situation, your preference, your practice, your geography, so many things that go into these decisions yet these practice owners make decisions on emotion.

Jarrod Bridgeman:
Right, instead of looking at all those things and then aiming that towards, "Here's my end goal. What can I do? What can I tweak? What can I do to come close to that?"

Casey Hiers:
I mean, emotion should be the first one. It's good and bad. What do you want? Then you need some professionals or some consultants or a team to then get into the nitty-gritty of all the numbers, all the variables, all the details to determine is that a good idea?

Jarrod Bridgeman:
Right. They don't have one of those Dental Practice Businesses for Dummies books out there?

Casey Hiers:
Oh, I'm sure there are. And the cliff notes version is just produce more.

Jarrod Bridgeman:
That's right. It's two pages, just real big across the top.

Casey Hiers:
Yeah. Well, and practice owners, they know this. When they consider adding a location then, again, a bunch of cheerleaders, everybody thinks that's a great idea. "Oh, that sounds great. Oh, that sounds neat. Oh, yeah. Lots of bankers want to give you money and equipment. Companies want to fill up your practice." But really taking control of the business side of dentistry and if you don't, it's going to take care of you, you don't really get to just sit it out. Either you're going to take control of it or it's going to take control of you. Those are your options. And unfortunately so many people are like, "Well, I'll just keep practicing." I had a guy tell me the other day, "I'm going to practice till my arms fall off." The hell is that?

Jarrod Bridgeman:
That sounds awful.

Casey Hiers:
I mean, what is that? That's not a lot of strategy.

Jarrod Bridgeman:
No, and I also don't want to be in the chair when that happens. Sounds gruesome.

Casey Hiers:
As a patient, yeah. Yeah, no kidding. And then kind of like what I was just talking about. Hey, do you want to retire at 55? Do you want to retire at 60 or 62 or maybe 65? Being really clear on that is important and the percentage of practice owners that can't answer that question because they just don't know. They don't know how much, if they have enough money, but they don't want to admit that so then they just kind of have this general, "Well, I don't know." Have a surgical and clear path and plan with your retirement or again, you're going to look up and your 70th birthday, you're going to be coming home from work-

Jarrod Bridgeman:
Bad back.

Casey Hiers:
... to blow out your candles because you're still practicing. Because you just thought it was going to take care of itself. Very little does.

Jarrod Bridgeman:
Very little. And it's just one of those things. One of the things I wanted to mention, too, was don't just think about what you want. Think about how different things in your practice make you feel and why it makes you feel that way. Like okay, having one practice, I'm stressed about staff. Do you think adding another location is going to alleviate that stress if that's one of your biggest stressors? Boil it down to the actual issues and I think that's a good place to start. And it might hurt. It might hurt you to kind of really voice that out there, even if it's pen to paper.

Casey Hiers:
Yeah. Well, and then there's the, "I want to get out of the mouth and be a entrepreneurial CEO practice owner." Again, if that's your goal, there's a path to it, but it's really, really difficult to achieve on your own. And we know that because a lot of practice owners have come to us and said, "I've tried this. I've really messed this up. Can you unwrap it?" Well, we're not a rescue firm, so let's look at the numbers and see. We take successful people and make them more successful, but that's another one of those where their whole goal is to not practice dentistry. Again, it can be done, but it's not easy.

Jarrod Bridgeman:
No, and that's a very particular personality trait, too.

Casey Hiers:
Yeah. Well, I mean it's like...

Jarrod Bridgeman:
It's a motivational speaker type fellow.

Casey Hiers:
I mean, just because I get complimented for making a good meal doesn't mean I'm going to go open a restaurant tomorrow. I can be a good cook, but opening a restaurant probably isn't the best use of my time or my strengths.

Jarrod Bridgeman:
Nah, I don't see you doing that. So we've talked fee-for-service, we've talked insurances, which the insurance is like the devil in the details almost kind of thing. When I recently attended one of our events where we presented and once the insurance conversation came up, you could see every practice owner in the room just shaking their heads.

Casey Hiers:
A couple of them got red in the face, I think mainly because of anger of insurance. But no, it's a big topic and again, too many people don't really have a strategy around it.

Jarrod Bridgeman:
No, and I can see that one being a little tougher to tackle just because there's a lot more things involved than numbers.

Casey Hiers:
I mean, listen, if we have a client with a great practice and a great attitude and who's coachable and all those things that we've helped them on, insurance is still going to be a 12-to-24-month pretty hardcore deep dive to get it right.

Jarrod Bridgeman:
Right. And that's with an entire team of people.

Casey Hiers:
Yeah, yeah. I mean, these knee-jerk reactions don't cut the mustard.

Jarrod Bridgeman:
Casey, any final points on this topic? To me, it's really-

Casey Hiers:
Don't go chasing waterfalls. I mean, really, TLC, you can just...

Jarrod Bridgeman:
Left Eye Lopes, yeah.

Casey Hiers:
Yeah. No, I mean, determine what you want and then strategize to do it. Don't just have emotion drive your thoughts. Because all these things we mentioned, either side of the aisle can be massively successful. Your chance of success is increased when you have a team of dental experts that are looking at everything comprehensively in your situation to get you to the end goal. If you don't have an end goal or it's just kind of wishy-washy, how the hell are you going to get there and how's somebody going to help you get there?

Jarrod Bridgeman:
You got to have a map. When we were going out west, you take a map, otherwise you end up like the Donner Party.

Casey Hiers:
I like to have a map and a driver, and so again, for our clients, that's the experience we try to give them. We have the roadmap and we also have a driver to drive you down that path so that you can enjoy practicing dentistry or the things you enjoy. But now if you're listening and you've pondered some of these things, again, they're not light. These are all big, heavy crossroads done right, can propel you, done wrong, can set you back, and all of a sudden dentist's not what you want it to be, but instead retire on your own terms because you've taken control of it. You've not been controlled.

Jarrod Bridgeman:
Casey, I love that. We're going to be in several new cities coming up this year. We're going to be in Cincinnati and Cleveland, Ohio doing our own events there. We're doing a bourbon tasting and a lunch, so make sure to check those out. We're going to be in the Washington DC area. That's going to be in Tyson's in Virginia.

Casey Hiers:
Tyson's Corner.

Jarrod Bridgeman:
Yep. And Chevy Chase, Maryland. I just launched a couple of spots for our Los Angeles areas. We're going to be in Huntington Beach, California as well as Calabasas.

Casey Hiers:
Calabasas.

Jarrod Bridgeman:
Calabasas.

Casey Hiers:
Yeah, those are good areas.

Jarrod Bridgeman:
So we're going to be there. And then we're looking at San Francisco as well this year. So we're going to be in a lot of cool places and new places that we haven't normally reached out and done our own events. We've gone, we spoke at different places, but I'm really excited about getting out there into some new spots and meeting some new dentists and then seeing what we can do.

Casey Hiers:
I love when practice owners tell me, "Where have you been all my life?"

Jarrod Bridgeman:
That's right.

Casey Hiers:
So that's why we go to new areas.

Jarrod Bridgeman:
That's right. Thank you so much, Casey.

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.