Navigating Business Models in Dentistry

Tired of the dental grind? Join us as we dive deep into the world of dental business models. From insurance-heavy practices to fee-for-service, we'll explore the pros and cons of each approach.

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

Jarrod Bridgeman:
Casey, you're looking pretty sharp in your jacket today.

Casey Hiers:
Oh, thanks.

Jarrod Bridgeman:
Nice. Is that new?

Casey Hiers:
New-ish.

Jarrod Bridgeman:
New-ish, okay.

Casey Hiers:
The older I get, I like all the pockets. I can keep a lozenge, I can keep my ChapStick, I can keep a Kleenex-

Jarrod Bridgeman:
Yeah.

Casey Hiers:
... just really anything you want to put in a pocket.

Jarrod Bridgeman:
You can put something on your lapel too.

Casey Hiers:
Ooh.

Jarrod Bridgeman:
That's nice, yeah.

Casey Hiers:
Decorate it up, yeah. Then I did a little Johnny Cash wearing a little black today.

Jarrod Bridgeman:
I love it, yeah.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Casey, I'm pretty excited about today. You and I have a meeting with your team, and I'm just excited that we get to go out and hang out and have some encouraging words and get some, for me, free food. I'm all about that too.

Casey Hiers:
Yeah. Well, our listeners can relate with your team and staff, it's important to do some things along the way. And what we do here is incredibly serious and important and life-changing, but yeah, it's good that we take some time to spend time together to talk big ideas.

Jarrod Bridgeman:
Yep, and break bread and...

Casey Hiers:
Yeah, have a meal of food.

Jarrod Bridgeman:
Yeah. Delicious. That's so nice. And I get to not be at home for a couple of hours.

Casey Hiers:
I like being at home. You don't like being at home?

Jarrod Bridgeman:
Not 24/7.

Casey Hiers:
Busted.

Jarrod Bridgeman:
Busted, dammit! My wife's listening. No. Casey, you and I have been talking recently as we were sitting here when we brainstormed for about five minutes on what our podcast topics will be, and today we-

Casey Hiers:
When you have big brains like us, that's more than enough time.

Jarrod Bridgeman:
Honestly, I get headaches a lot just because my brain's so big. We were talking about excuses that dentists make, and how that can sometimes tie into practice types.

Casey Hiers:
Ooh, like business models-

Jarrod Bridgeman:
Business models.

Casey Hiers:
... and strategy, yeah.

Jarrod Bridgeman:
Right. Right, right. And so, right off the bat, let's go down the list of the different types of business practices there are for that. I would say the first one that always sticks out in my mind is a very insurance-heavy shop.

Casey Hiers:
Oh, yeah, it's the classic "I need to be busier-

Jarrod Bridgeman:
Yeah.

Casey Hiers:
... so I'm going to accept all insurances." We've talked about that a lot, right?

Jarrod Bridgeman:
Right. Well, one of the questions I wanted to ask you is, the psychology of a practice owner who is doing a really successful job running an insurance shop, what is the benefits? What makes them want to be that way and be successful, what's the benefit of that?

Casey Hiers:
Some of them might not want to be successful that way, but sometimes the toothpaste is out of the tooth tube-

Jarrod Bridgeman:
The tooth tube.

Casey Hiers:
The tooth... The tube that the paste for the teeth are in. The toothpaste is out of the tube. There we go. And so, people look up and go, "Ha. Right, this isn't the practice I had dreamed of or necessarily wanted, but it is what it is."
So, you can either just complain non-stop, and look up in 10 years and be in the worst spot, or you can go, "Okay, how can I make this profitable," right?

Jarrod Bridgeman:
Right.

Casey Hiers:
With insurance there's a lot of variables. Do you have the space, do you have the chairs, do you have... A lot of data goes into the insurance shop, but-

Jarrod Bridgeman:
Right.

Casey Hiers:
... you can be profitable with that, but your volume... So, you've got to see a lot of patients-

Jarrod Bridgeman:
Trying to burn them?

Casey Hiers:
In a ethical way, yeah.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
But there's a path to it. And so, when people complain about insurance, I get it. Patients don't like it, practice owners don't like it, insurance is the bad guy.

Jarrod Bridgeman:
Yep.

Casey Hiers:
But are you just going to stand in the mirror at the gym and complain that you're not strong and thin?

Jarrod Bridgeman:
Right.

Casey Hiers:
You can.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
It's kind of a miserable existence.

Jarrod Bridgeman:
It doesn't work for me. I don't even go to the gym to look in the mirror, I just do it at home and cry.

Casey Hiers:
But no, obviously, a heavy insurance... Now, some people are truly stuck because maybe they don't have the capacity of the room, the square footage, the chairs, whatever that might be. But that certainly is one of the business models that you have, it's the insurance one. What's the opposite? Fee-for-service.

Jarrod Bridgeman:
Right.

Casey Hiers:
There's a lot of them out there. They're quiet at meetings because they almost feel guilty. I'm producing 155 and collecting 15.

Jarrod Bridgeman:
Now, let's compare the two. Fee-for-service sounds less stressful on the side of, you don't need as many patients to bring in that money. What are some stressors that a fee-for-service practice may face that an insurance shop may not?

Casey Hiers:
If your new patients per month is down for a period of time, that's going to sting a little more.

Jarrod Bridgeman:
Right.

Casey Hiers:
If there's more profit but less patient room for "Yeah, screw them, let's get rid of these bottom-feeder patients that I can't stand and the staff can't stand." When you're fee-for-service, a little less margin for just-

Jarrod Bridgeman:
But I feel the benefits of it seem to outweigh, at least how I would work, outweigh the-

Casey Hiers:
Yeah, money-in can be better. If people aren't good with money or planning or tax planning, that can be all for naught.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Right?

Jarrod Bridgeman:
Yeah.

Casey Hiers:
There's ways to screw up a fee-for-service practice too.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
And listen, we have a lot of clients with both. We have clients with fee-for-service practices. And guess what, they have a whole bunch of things that need fixed-

Jarrod Bridgeman:
Right.

Casey Hiers:
... to ultimately take that money home instead of it just falling through the cracks.

Jarrod Bridgeman:
And then, of course, we've got the people who balance both.

Casey Hiers:
Kind of a hybrid.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Yeah, that's probably the most common, "Yeah, I accept some insurances. I've cut one or two, I'm negotiating a couple, you know, I'm trying to head towards fee-for-service." But you've got a foot in both sides. Maybe it's space, maybe there's different variables or logistics that cause that, or maybe it's just a fear of leap of faith.

Jarrod Bridgeman:
Right.

Casey Hiers:
So that hybrid model of, yeah, maybe 35% fee-for-service, 65%, that math adds up, right?

Jarrod Bridgeman:
Sure.

Casey Hiers:
65% insurance.

Jarrod Bridgeman:
Sure. I'm not an accountant.

Casey Hiers:
You've get the hybrid, so you've got some options. You can get a feel for each one, and if you have a good external team, do a true assessment of, where is my time best spent?

Jarrod Bridgeman:
Right. And it's nice because it gives you that feeling of a safety net.

Casey Hiers:
A little bit.

Jarrod Bridgeman:
Just a bit. Just-

Casey Hiers:
Even for marketing, "Yeah, I've taken a couple of insurances, sure, yeah.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Come see me." Well, when they come see you and your staff and your space and everything is top-notch, well, people... What I talked with a dentist the other day, if you have an emergency, the same person that's going to pay $350 to get that tooth fixed is going to pay $600.

Jarrod Bridgeman:
Right.

Casey Hiers:
Right?

Jarrod Bridgeman:
Right.

Casey Hiers:
Other times it's preventative, somebody can't pay hardly anything.

Jarrod Bridgeman:
Well, speaking of emergency, you were recently chatted up with an emergency dentist who owned a practice that was an emergency practice.

Casey Hiers:
Yeah, I had a nice sit down with somebody who, they've helped people open a lot of practices, get into the more emergency dental pros and cons. Well, a lot of them don't have hygiene.

Jarrod Bridgeman:
Right.

Casey Hiers:
Right? You're doing extractions, you're doing implants, you're doing emergency dentistry, but with no hygiene department, the opportunity for lower overhead is there.

Jarrod Bridgeman:
Yep.

Casey Hiers:
Typically, you need to work the weekends-

Jarrod Bridgeman:
Yep.

Casey Hiers:
... but my gosh, you can produce a lot, and you can-

Jarrod Bridgeman:
Because I don't know if you know this, but emergencies don't always happen 9:00 to 5:00, Monday through Thursday.

Casey Hiers:
Not planned, not planned, yeah. Yeah, Monday, 9:00 AM through Thursday at noon.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Yeah.

Jarrod Bridgeman:
Yeah. So, walk us through the differences even with that. So, that's usually because of the emergency style of it, weekend working, even nights, sometimes they put almost a premium on the cost for that, on the cost of the patient?

Casey Hiers:
They can, but there's some heavy insurance involved with some of that too.

Jarrod Bridgeman:
True, yeah.

Casey Hiers:
So, there's pros and cons to each business model. Here's the thing, and we haven't hit on the last business model yet, but here is the thing. What is your path, what is your strategy, what is your vision, what business model do you want, and how are you going to be profitable?
Those are basic questions. If you can't answer, you need to get them answered, or you're going to look up and be what? The next business model.

Jarrod Bridgeman:
All grumpy and-

Casey Hiers:
You stay where you are.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
You stay where you are, dentistry is not exactly what you thought it would be or hoped it would be, you're doing okay, but you're still frustrated. So many people are in that business model of, "I don't know..."

Jarrod Bridgeman:
The B&M.

Casey Hiers:
What's that stand for?

Jarrod Bridgeman:
Bitch and moan.

Casey Hiers:
Bitch and moan. A little bit. And then, it's easy to deflect blame, right?

Jarrod Bridgeman:
Right.

Casey Hiers:
So I hear things like, "Well, COVID..." Did that have an impact? Absolutely. We're four years removed.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
At some point you can't hang your hat on and just say COVID for every mess-up, screw-up, or thing you're not happy with.

Jarrod Bridgeman:
Yep.

Casey Hiers:
Staff, not going away. Always going to be challenging and frustrating. Easy to hide behind.

Jarrod Bridgeman:
And staffing, that's across the board, not just-

Casey Hiers:
Name your industry.

Jarrod Bridgeman:
Yeah, everybody-

Casey Hiers:
Hiring is hard-

Jarrod Bridgeman:
Yeah.

Casey Hiers:
... right? I mean, what old people said when we were younger, "This next generation, they don't know how to work." Same thing-

Jarrod Bridgeman:
Yeah, yeah.

Casey Hiers:
... different evidence to back it up.

Jarrod Bridgeman:
Yep.

Casey Hiers:
But yeah, it's not going away. So, you can just decide to live in this COVID, my staff stinks, there's no tooth decay-

Jarrod Bridgeman:
Wait, What? No tooth decay?

Casey Hiers:
Yeah. I mean, there's less tooth decay.

Jarrod Bridgeman:
Oh.

Casey Hiers:
I've heard that recently. Is there facts, is there evidence? Maybe. Maybe in certain affluent areas there is less tooth decay, I don't know. I just have heard that excuse a little bit more and more and more, or just, "It can't be done," or, "My geography," right?

Jarrod Bridgeman:
Right, right.

Casey Hiers:
Those five or six excuses, sometimes realities-

Jarrod Bridgeman:
Yep.

Casey Hiers:
... but if you hide behind them month after month, year after year, decade after decade, guess what, you're not going to have been all you can be and been a good steward of your talents and your platform-

Jarrod Bridgeman:
And just grow angry-

Casey Hiers:
... at being a practice owner.

Jarrod Bridgeman:
... and bitter and...

Casey Hiers:
Yeah. Unfortunately we see that. But choose your model. Stay where you are and complain. Emergency dentistry, that's not for everybody.

Jarrod Bridgeman:
Right.

Casey Hiers:
But you can make a lot of money. I mean, if you're just broke doing dentistry and your overhead's 95%, maybe you need a change, right? My gosh, maybe you look into a different option, or a hybrid or fee-for-service or insurance shop. But not knowing isn't good enough, hope is a terrible business strategy. The excuses I've mentioned, they are factors.

Jarrod Bridgeman:
Yeah.

Casey Hiers:
Don't buy into the boogeyman and just, "Can't be done," and just live in that-

Jarrod Bridgeman:
No, you're right, because if these things don't get to a point where you're happier with your practice and it's time for you to retire, if your practice isn't all that appealing, you're going to have a hard time selling.

Casey Hiers:
Yeah, if a younger dentist was looking to buy a practice to an older, cynical, jaded, defeated, excuse-riddled owner, I don't know that that's the most attractive practice.

Jarrod Bridgeman:
Correct.

Casey Hiers:
And while you're not going to lead with all your excuses as a practice owner trying to sell, that stuff stinks on you, it comes off of you. I've been in rooms with them. Unfortunately I can see. But guess what? While you're complaining about your practice and not having any proactive vision-

Jarrod Bridgeman:
Yep.

Casey Hiers:
... there's a lot of dentists out there making a lot of damn money-

Jarrod Bridgeman:
And having a happy life doing it.

Casey Hiers:
... and they're okay, and they like dentistry, because they've answered these questions, they know what their business model is. So, while you're complaining, somebody else is out making money. Guess what, it can be done.

Jarrod Bridgeman:
Yep.

Casey Hiers:
And we have the advantage of seeing numbers and data from practices all over the country. So, when I hear these excuses for the 200th time, I have to bite through my tongue sometimes-

Jarrod Bridgeman:
Right.

Casey Hiers:
... because it's real, the struggle is real, it is challenging. But just staying in your excuses, it's a terrible place to be. Make a decision, pick a business model, be profitable, find a team that can help you, do something. But just... Maybe I just need to take a break from the road.

Jarrod Bridgeman:
Casey, let me ask-

Casey Hiers:
Because as you can tell, I hear a lot of bitching and moaning, and the loudest cries come from the cheap seats, and there's people crushing it that go, "Yeah, I could get better in these areas."

Jarrod Bridgeman:
Every time you hear one of these excuses, do you have to treat it as if it's the first time you've heard it when you're talking to somebody in-person?

Casey Hiers:
Well, toothy decay has been recent.

Jarrod Bridgeman:
That's been the recent one?

Casey Hiers:
They asked me, and I'm like, "I'm sorry, what?"

Jarrod Bridgeman:
I was just thinking about back in my retail days, if something didn't ring up right away, people are like, "Oh, it's free, isn't it?" And you had to act like... and laugh as if it was the first time you ever heard that joke.

Casey Hiers:
No, I mean, I'm pretty straightforward, try to be pretty genuine. And if people tell me something I've heard, I just say, "Hey, would you be shocked if this isn't the first time I've heard this?" The choice is, what are you going to do with it?

Jarrod Bridgeman:
Right.

Casey Hiers:
Well, we've been talking about, choose your hard. It can be hard, meaning, you fix it, or it can be hard that you live in this reality for, hopefully not decades, but-

Jarrod Bridgeman:
Sometimes it happens.

Casey Hiers:
... we see it.

Jarrod Bridgeman:
Casey, if someone wanted to come and listen to us more, do you and your team often go out and speak around the country? I know we're going to be outside Detroit, Michigan, we're going to be in Grand Rapids, Michigan this-

Casey Hiers:
Bloomfield Hills, Detroit.

Jarrod Bridgeman:
Bloomfield Hills, that's right.

Casey Hiers:
Very nice area.

Jarrod Bridgeman:
These are both-

Casey Hiers:
Probably less tooth decay, more affluent.

Jarrod Bridgeman:
That's right.

Casey Hiers:
I'm sure there's something to it. Let's not hang our hat on it. Yeah, we'll be in Grand Rapids, we'll be in Bloomfield, Hills. We're doing a couple of large study clubs.

Jarrod Bridgeman:
Oh, we're going to be in New Orleans the night before SmileCon.

Casey Hiers:
That's right.

Jarrod Bridgeman:
And we'll be at SmileCon as well.

Casey Hiers:
That's right.

Jarrod Bridgeman:
Yep. So, look out for those. Austin, Texas, and Dallas, Texas, keep an eye out, we're coming to you in November as well. If you need anything, if you have questions, if you want to schedule a call, anything like that, go to ForQuartetsAdvisory.com

Casey Hiers:
Let's not "If you need anything."

Jarrod Bridgeman:
Well, true. Yeah?

Casey Hiers:
Let's limit this.

Jarrod Bridgeman:
If you need someone to talk to and have a shoulder to cry on, I'm your guy. No, I'm just kidding about that. But feel free to visit our site. There's an events tab you can check out where we're going to be. You can listen to older episodes of the podcasts. So, please, check us out. Thank you, Casey, so much for joining me today, and I hope you have a great day.

Casey Hiers:
Thanks.

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.