What does it take to go from a Private Practice to 26 locations DSO
Happy Wednesday everybody! I would like to start a tradition and dedicate Wednesday to being a DSO day. As I travel around the country and meet with fascinating dentists I always wonder what makes one person grow and expand? What pushes someone to go outside of the comfort zone and disregard traditional wisdom? What are the personality traits of dentists who are expanding to two, three, five, or 26 locations? So let’s dive into this.
Mindset. Any obstacle or a challenge is first conquered in the mind of a person and while interviewing; I have found that most dentists formulate the mindset before setting their goals. My friend Dr. Scott Goldman, with United Dental Partners now a 26 locations DSO, didn’t set out to accomplish impossible, but once forced to the corner of life had to neglect naysayers and focus on what he thought his destiny was. He has been through so much in life to the point where most could’ve said “I’m done”. But not Dr. Goldman. Perseverance, grid, humbleness, and most importantly believe in yourself is the foundation to it all. In the beginning life will throw all kinds of obstacles at you just to test if you really are going to do what you said your are about to do. And honestly, that’s the way it should be. Once I heard a saying “The bigger the problem, the bigger the hero”. Welcome problems, acknowledge that they suck, but keep pushing forward just like through a test in school.
Dr. Scott Goldman and Tiger at the headquarters of United Dental Partners, Chicago, Illinois
Systems. Most of the dentists I meet are eager to grow and build dental empires. Right or wrong, life will tell. However, before that, you need to become a businessperson and realize you are working for yourself. This is where the greatest responsibility lies. A good friend of mine Dr. Mark Costes talks a lot about building operational systems to make your office grow and ride in autopilot. When you expand, that’s when you start to set up your own systems. If you have three locations and have no systems in place, you cannot run all three practices at the same time. The systematization of your practices is going to be the big, big, big first step.
Flagship Practice. Most of my successful clients and friends who are expanding into multiple locations always have the flagship office up and running, with overhead under 60%, so that they can expand into the next office. That’s going to be very critical. Dr. Dave Bender, with Village Dental at Saxony and total of 3 locations, mastered flagship practice way before branching out to another location. From marketing, working late hours, placing his own orders, all of it! First year he couldn’t even take a salary. But again, that flagship practice had to be “flagship” like a trailblazer where you earn your stripes!
Dr. Dave Bender and his team at Village Dental at Saxony, Fisher, Indiana
Being selfless. The fourth component, which is really interesting to me, is being very selfless. What that means is, as you scale up the business, you actually take less and less from the business. If you are in a position where you can’t allow yourself to work without a salary, work extra hours, without extra pay, then you’re probably not in the position to go to multiple locations. Cash is crucial and at the early stage you’ll need every single dollar to be going towards that new location and use for things like marketing budget, purchasing supplies, equipment and furniture, in addition to hiring team members. One mistake I see people make over and over is when you need to hire an associate and you start comparing yourself to a younger dentist. From compensation (by saying “when I was an associate I was getting paid…”) to the effort that associate is putting in. Remember the times have changed, now young dentists have more debt and to be honest they may not want to work as hard as you did. You greatest opportunity is to adopt and make things work within the constraints. My friend Dr. Summer Kassmel, with 2 locations in Colorado, is a great example of being successful within given constraints when it comes to growing a practice. When her health declined and she had to make drastic changes, she brought an associate, which is not easy in the tourist town, put a plan for a smooth transition, took the paycut and essentially had to leave for a period of time to have a procedure done. Most impressive part about her story is the attitude Dr. Summer had towards it. Always-positive and giving all she got to the team. I have to mention a book that covers more on this subject (see the book)
Dr. Summer Kassmel and her awesome lead dental assistant Brittany. Eagle, Colorado
Long term thinkers. We are so tempted to “have it all” and “now”. You’ve been working really hard since 1st grade and now you can feel it, it’s just around the corner. However people that I personally interviewed and mentioned in this article all had huge setbacks. Therefore the only force that carried them forward was thinking long term and not being obsessed with short-term gains. Prepare yourself for all of it, from taking the pay cut, driving old Honda Civic, not having medical insurance at the most vulnerable moment, or even moving in back with your in-laws. For once it will make a great story and most importantly will test you for the future. This may never happen to you, however being ready for it and thinking long term will set you apart.
It’s your entire fault. Many doctors that I meet would like to blame somebody for some of the mistakes and shortfalls. Yet, the most consistent trait I see among dentists who are very successful is that they take 100% responsibility. My suggestion would be to get “Extreme Ownership” book by Jocko Willink (see the book) and use it as your guiding compass for opening more practices and taking full ownership of anything that happens. It’s actually a good thing. You’ll see that you sleep much better if you take 100% responsibility, when everything is your fault. Things go well, great! Things go poorly, also okay! You’re at fault, you are in charge, you’re responsible, you don’t blame anybody, you have lower expectations, and you just get after it and have fun. One person that comes to my mind thinking about this subject is my good friend Dr. Joseph Lee with Normandy Dentistry/Lakewood Dentistry that now combined has 40 treatment rooms between 2 locations. Dr. Lee went from 6 chairs to 20 and then doubled that in no time. And it didn’t work the way he planned, not even close. With a huge mortgage on 2 buildings, family, and big dreams who did he have to blame? The person in the mirror and most importantly he went right back to work. You can watch full 20 minutes of greatness with Dr. Lee here
Dr. Joseph Lee and Tiger during the interview, link above. Jacksonville, Florida
Let’s make your story alive. As you see all the stories above might be different, but they all have one thing in common – EXECUTION. I believe every dentist in the country has a shot at building his or her own dental group or the dental service organization and when it happens, please share your story with us.
P.S – Mega important!
I have to say if you feel that it would be too much pressure to operate and manage multiple offices, then just have one! Today group practices is a buzz word and there’s so much going on and so much pressure to get more efficient and open up multiple locations, but you don’t have. Trust yourself and listen to your gut. If you are a single-practice owner and you enjoy focusing on dentistry and don’t like to be under stress, just stay on your course. Life is too short. Make sure you are doing it for the right reasons. If you are being forced into multiple locations by financial reasons or by ambitions of other people, that’s not the right way to do it. With the right intentions and being true to yourself, you will make good choices.