Dental Unscripted | Getting into Ownership and Practice Management Insights

Okay, man.

Welcome to Dental Unscripted,

where Mike Dinsio and Paula Quinn break

down the practice ownership journey,

one episode at a time.

Starting up, buying,

and running a successful dental practice.

Hello, hello.

Welcome back to another episode of Dental

Unscripted.

My name's Michael Dinsio,

and I have my amazing co-host and partner

on the phone.

Hey, Paula, what's going on?

On the phone.

On the phone.

I said on the wire the other day,

and I was like, on the phone,

on the wire.

I'm like, so old.

I know.

I don't even know what this is.

We're live streaming.

We're doing all these things.

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unscripted podcasts.

Here we go.

Today's episode is all about are you ready

to hire an associate dentist?

And some things that you might consider

before you start down this journey.

But, you know,

we get this question a lot and we

help doctors do this.

And there's a lot that goes into it.

Honestly,

I don't think we could cover all the

things that get into that and how you

might approach this topic.

But we got thirty minutes to do it.

And so here we are.

Let's do it.

So, you know,

the first thing that I think of, Paula,

of course,

because I'm the number guy is I know

you like numbers, too,

but that's where my head goes.

You know,

you're probably thinking clinical and

you're thinking capacity and all the

things.

i'm thinking numbers and you know it's

really a vision thing like sometimes i get

these clients that you know i'm good i

don't want to do dentistry i just want

to be the boss and manage a practice

and that's all good and and and well

and it's really about how much money and

procedures and production are you willing

to give up like essentially the question

is is like how much money do you

need to make at home to pay your

bills

let's say it's only a hundred thousand

dollars whatever um and let's say the

business makes you know three hundred

thousand and you only need a hundred so

you've got a lot of room there that

you could just give an associate and just

operate the business um but a lot of

clients of course need every penny right

and they're trying to invest and buy cars

and homes and all the things and so

um it's really a vision thing but by

the numbers if you're the type of person

where it's like look i want to make

as much money as i can out of

this business and until i hit kind of

that threshold where i'm maybe a

borderline just burnt out tired can't do

anymore i have found that a gp doing

ppo work fees you know not fee for

service

um the number usually falls somewhere

between one point two to one point five

uh of course there's bigger uh we have

some clients that are bigger than that but

that's about what i see is like okay

at about one point two i could bring

in another dentist one day a week if

i'm in the one point five maybe it's

two three days a week if i'm beyond

that it might be a full-time doctor and

so

That's really my first KPI on this topic

is, you know,

are you ready to hire a dentist to

help you with all of your success and

all the patients?

So if you haven't even hit one point

two,

I don't even think it's part of the

conversation unless

unless like you just are good with not

making as much as you could.

So Paul,

I know when you ran the practice,

you're not a dentist.

And so you had to give all your

production away,

a hundred percent of it and give your,

your doctors,

thirty or thirty plus percent.

And so,

But, you know, as a hygienist,

it's kind of the same thing.

You had to make that decision as a

hygienist.

You could have been a hygienist the whole

time, but you decided to give that away.

You know,

what are some of the things that like

on that note,

throwing you a curveball or a question,

anything that to really add about like

that decision of hiring someone and giving

them production and how much money I'm

going to lose?

Yeah.

And anything to add really to to that

conversation, I guess,

is what have you heard from clients and

how do they deal with that stress or

that that that answer?

Yeah, I think, you know,

the biggest factor is, like you said,

what do you need in your life?

Obviously,

where I'm in my life is a little

bit different than maybe,

you

a dentist that's been two years out of

school buying a dental practice,

you know what I mean?

Or has a huge loan, right?

Yeah, that's what I mean with the,

you know,

the debt they already have and then the

debt they bring on, you know,

and maybe their lifestyle you know

typically at that age they're getting

married having kids you know so it looks

a little bit different so amount of money

that they may need so i i think

that's number one like you said what how

much do you need to live and quite

frankly to put away because this is going

to be your retirement yes or well it

should be this is your life right so

but i also do think

where you are in your life quality wise.

And I don't necessarily mean always mental

health, although it could be,

it's like some of the,

some of the women that are buying are

in a pregnant, you know,

and they want to have this, but then,

you know,

maybe you have that first baby and you're

like,

I don't know if I, so you,

you also have to decide where your life

is, you know, and, and, you know,

but I, but from a, you know,

so I think for me it was,

I felt I was at a point where

I,

I wanted to actually manage the practice

because I needed that more than anything.

So that risk reward I felt was going

to be greater with me actually being away

from doing hygiene and bringing in a

couple of hygienists to take my place

financially.

It freed me up to...

But you got to run your business.

You can't just...

You beat me to it.

Yeah, exactly.

If you guys just check out and let

other people run your business,

you're definitely not going to make money.

So you have to strategically give yourself

some time off.

Um,

if you're going to run the world and,

and just run out and let other people

manage it, it's,

it's probably even going to tank somewhat,

you know?

Yeah.

It's all, you know, it's like always a,

a question,

like how much are my hands or is

my time worth my brains?

My time.

Exactly.

Sorry.

I'm going to clean my screen there.

So everyone does.

That's good.

You look, you look so much better now.

Yeah.

clear now.

I was like, Oh my God, blur.

Yeah.

It was very, you know, like I,

I think you're right.

I think there's always just kind of like,

okay, so if I give this up,

what do I gain?

And I think every business owner just in

general, forget dentistry,

every business owner has to ask themselves

those questions is the tasks that I'm

doing, the fillings that I'm,

that I'm putting in or whatever.

Um, is that where this company's,

is that where my time is best spent?

you know,

served for this company's overall health

and, and, and growth.

And I, you know, the,

I guess the question is, is like,

is that where you're at in your career?

And I think you gotta ask yourself that.

And, and like you said, like,

Quitting dentistry sounds great, right?

I don't have to do any of that.

And I could just do the big cases.

And, you know,

there's got to be a strategy there and

how you would roll that out.

Like, okay,

so I'm going to make this decision,

hire somebody.

I'm going to pay them.

My payroll is going to be extra.

But then I need to have some benchmarks,

some goals on how that business then grows

and what that looks like.

for this to be successful.

And guess what?

If it doesn't work,

there's a rollback clawback situation.

But hopefully you focus and you really

tighten up on a lot of other things

in the business does grow.

So for me, again,

my first point was really just the

numbers, you know,

one point two to one point five is

kind of that number that's like, OK,

the average doctor can get to with

hygiene.

I'm not talking

I'm not talking about doctor production.

I'm talking about the whole practices

production, including hygiene, EFTAs,

whatever, without another dentist.

You can get to one point two to

one point five by yourself.

We have a we have a client that's

like one point eight by himself.

Poor thing.

So it's there.

It is possible to be bigger than that.

But I do find that like about one

point two,

you got to start asking yourself that

question.

So the next kind of like to transition

that, Paula, I, you know,

as I as I talk about those doctors

doing one five, one eight,

two million by themselves.

you know i think about that burnout that

burnout that is real for any owner and

when you're burned out you're not

performing right you're you're just not

you're not on your a game you're not

a hundred percent and when you're not a

hundred percent you lose opportunities

And we all could agree, like,

you may think you're, like, killing it.

You may think, oh, gosh, today was today.

But when you're burned out,

you're legitimately missing things out.

And I know that's where your head goes.

I'm thinking about the numbers and the

financials and the profit.

You're probably thinking, gosh,

what's the practice in missing,

losing out on profit?

when you get to some of those,

that volume with just one provider.

So walk me through like where your head

goes with a production situation and what

you might be losing.

I mean,

there's gotta be stuff that's slipping

through the cracks.

Well,

I think with a one point two to

one point five million dollar practice,

you're definitely gonna have more than one

hygienist.

Two to three is typically where those

practices lie.

there's not a dentist in the world that

gets excited about doing three exams an

hour.

So,

and even with one dentist and one

hygienist, um, once it hit, you know,

just, just organically burnout,

what I find is they're missing exams.

Um, so they're not getting in sometimes.

And I know that sounds shocking,

but Michael and I analyze practices all

the time and you'd be shocked if, if,

if they're,

probably fifty sixty percent efficiency

most of the time on getting in on

two exams and you guys can call me

a liar all you want but i if

i get into your practice and you're big

you're you're missing some i also think

that you know one of the complaints i

get because i work with hygiene teams a

lot is their exams are like two seconds

and they

You know, if you say, oh, you know,

Paula has something on the upper left,

they go there and then they forget

everything else.

They just kind of like, they're,

they're just,

they got to get back to the filling

or the crown.

They just already checked one other

hygienist, if not two there, you know,

somebody wants to chit chat and be friends

with you.

Now don't get me wrong.

I don't think we've worked with a dentist.

That's rude.

I'm not saying that these doctors are

just.

you know, dismissing.

They're trying their best.

Yeah, they're not.

But they'll admit it and the hygienists

complain.

They're just...

And out and missing things,

missing things, not being super thorough.

Quite frankly,

what that also does is not cause you

to require things of your employees,

your team.

You know, if they don't, let's say,

do a great handoff,

you almost don't care because you just

like want to get through the motion and

get back to what you're doing.

Totally.

So I think there's just a lot of

missed opportunity.

I think there's missed opportunity on the

exams alone.

I think there's missed opportunity during

the exams because we're doing them a

little bit quicker.

Yeah.

I was just thinking like patient impact,

like that relationship building, maybe.

Usually the X-ray protocol gets off.

So we're losing money.

on just the frequency of the radiographs.

Just a lot of things.

It's just domino effect of being burnout,

being busy, whatever you want to call it.

So what are some things,

just to double down on that,

what are some things they can track?

If you were looking at this as somebody's

consultant, how would you approach...

Because you're right.

They're, they're, they're,

they're going to say a hundred percent of

the exam, right?

Like you said, and I've heard it too.

And it's like, no way, dude.

That's like, yeah, that's like me saying,

I've never missed a call, a sales call.

Like it happens all the time.

Busy.

Yeah.

Do I want it?

Do I want to admit it?

No, but it absolutely happens.

And so like, uh, so,

so what are some things,

how do you track, uh,

for those dentists that feel like they're

the bee's knees and they miss it,

they don't miss anything.

Okay guys, start tracking it.

This is how you would do that.

Yeah,

I think the first thing and super simple

is your act of patience.

You should have at minimum,

to exams per active patient per year.

That's not even limited exams.

That's just periodic exams,

new patient exams.

It should be multiplied by two.

So like visits and exams or just active

patients and exams?

Well, I mean, technically visits for sure.

But then if you do active patients,

that means you're also not getting active

patients.

And that's a whole nother story.

Yeah.

Yeah.

I mean, however many visits came in.

Well, you couldn't really just do visits,

though, Michael, because.

Some of those are, yeah.

Active patients are the last eighteen

months.

So I think you're safe doing active

patients because they've been in the door

in the last eighteen months.

So if you just take that and multiply

it by two,

it should be about how many exams you've

done.

You could just add up your pro fees

and multiply by two,

add up your perio-maintenances,

your pro fees and perio-maintenances and

multiply by two.

There you go.

There you go.

I like that.

That's a little bit more and then

you know, I think you look at that.

I think you look at your case acceptance.

Yeah.

Are people, you know,

are you spending enough time creating

enough value that people are picking up

what you're putting down?

And I think another one would just be

either annual patient value or the value

per exam.

You know, like, are you, you know,

if you're,

if you're in there and you have two

hundred dollars per exam yeah probably

going pretty quick maybe not you know

that's a filling yeah and we've had a

lot of podcasts about like kpis and what's

a healthy case acceptance so go back to

the archives and watch uh dental intel

episodes we've done that but yeah

Well, in fact,

we're actually going to have a couple of

podcasts coming up soon with some doctors

that can discuss kind of how they approach

and case acceptance.

But yeah,

what are those just key percentages,

KPIs that you would watch for that?

Well,

case acceptance is average is thirty nine

percent except the dollar amount.

So if you diagnosed my mask,

it'd be horrible.

Pick an easy number.

A thousand, right?

Yeah.

Three hundred and ninety dollars would

accept before they walk out the door.

That's average.

OK.

Top is sixty five percent.

Sixty three.

Sixty five percent.

It changes kind of oscillates right in

that area.

I think right now it's like sixty three

percent.

So, yeah, you know, that's one thing.

And your patient value.

should be between eight hundred and twelve

hundred.

I mean,

most practices we get in there or five

hundred, maybe six.

I'd say that's really good.

So I think most people in the journey

of of their mouth have a lot of

things going on.

And I do find when busy offices not

only

We talked about getting in for the exam.

We talked about spending enough time in

the exam to catch things and diagnose.

But I've had doctors admit if it is

a small filling,

they might hold off because there's really

no place to put the patient either.

Yes.

So when you're looking at the schedule and

there's just, yeah, no opportunity.

They'll start waiting.

Not saying,

I don't want anyone to think that

there's a doctor out there thinking i'm

just letting this tooth rot out of their

mouth to like a crown but what i'm

saying is if it's something they feel you

know isn't a ticking time bomb and and

probably is going to grow slow um they'll

tend to watch a little bit longer than

they normally would i've had people admit

it to me um you know it's it's

just not worth

Throwing it in this schedule,

there's no time.

I have hygienists say that to me about

periodontal disease.

They don't diagnose because they have

nowhere to put it.

Yeah.

I think anytime that you're having those

conversations about schedule and we don't

have anybody to put anybody anywhere,

it could be a new hygienist or it

could be another doctor, that's clear.

Let's be super clear, folks.

It's only when you hit big enough to

where you're going to need help.

But then that discussion within your head

is like, well,

is this going to pay off?

Is the ROI going to be there?

So now I'm giving production.

That's how you feel like I'm giving my

business to them and they should be

grateful and I got to pay them to

do it and all that.

Like all of the things apologists kind of

exposed here is like,

what's your exam efficiency and case

acceptance and annual patient value that

all should go up.

When you bring in people,

other dentists to help you with the

demand.

Right.

So like if you need to work on

that yourself, that's one thing.

But if you're too busy,

the way to ROI that and get all

those numbers up is to bring another

dentist.

helper in and so like i just want

to make sure that we're clear because you

could have terrible numbers of all the

things that paula just said and only be

doing five hundred thousand you don't need

another associate i promise you so like

that's the conversation we're having is

that's how you get the roi out of

your associate is really just deep diving

deep into some of these kpis um

One thing before we move off on tracking

and whatnot on missed opportunity is just

what you're diagnosing.

That's my favorite.

You know it is, Paula.

I think doctors get burned out and they

stop diagnosing and then they get

refreshed and then they start diagnosing.

And we have a client right now that...

kind of self-admittedly had her had her

head in the sand for years and she's

back and we're tracking her uh her

diagnosing just simply tracking that uh

bam she's diagnosing more more is getting

accepted and her business is doing

fantastic so just tracking yourself

On what you're diagnosing and you could be

conservative, you could be aggressive.

It doesn't really matter.

You get that baseline and then you hold

yourself to that baseline.

And if you're below the baseline, OK,

maybe I'm tired.

And if you're finding that you're always

tired,

maybe it's time to get an associate

dentist.

OK, so.

Moving on,

I wanted to chat a little bit more

about like, OK,

so maybe we haven't hit one point to

maybe we're sitting at eight hundred,

Paula.

But you've got great relationships with

your patients and you know that there is

procedures that you refer out consistently

and it's pretty low hanging fruit.

how easy would it be to pull in

someone that does implants how easy would

it be to pull those molars and do

some fun endo and whatever you're into

ortho um you know that's a part of

this conversation too right like so maybe

it's not a I'm exhausted I can't take

all these patients maybe it's just you

want to cherry pick and I know you

did that in your office why did that

make sense

Well,

fifty percent of an implant placement is

better than zero.

You know, when she says it like that,

it's like, duh.

But yeah, of course.

So, you know, whatever of an ortho case.

So, yeah, I mean, when, well, for me,

it was a little bit easier decision.

I'm not a dentist,

so I can't do any of it.

You know,

but when I see some limitations on an

associate that I had, and I'm watching,

you know,

Savani and I teach all the time,

track your referrals out,

track your referrals out.

And when you start seeing that you're

sending out X amount of ortho X amount

of endo X amount of implants,

it's time to say, Hey, you know, I,

you know,

you gotta make it worth somebody's time.

So that's to me,

getting someone in to just do those

specialties is a no brainer.

Now bringing in an associate that can do

those specialties is a little bit

different because they're going to,

they're gonna want everyday stuff too,

because they gotta make a living.

If they're sitting around waiting on an

implant or an ortho case or an extraction

or endo,

they're gonna come and they're gonna make

good money when it does,

but then they're gonna also,

so if they're not just popping in your

office

once a week and doing just those

procedures or once a month and doing those

procedures, you know,

that's an easy decision when they're,

you just have to have enough that it's

worth their while.

Well,

that's what I was going to ask is

like, you know,

I tend to find that doctors think in

extremes.

It's like, okay, well,

I'm going to bring an associate and

they're going to work full time.

It doesn't have to be full time.

Or I'm going to bring in a specialist

and they're going to work one day a

week.

It doesn't have to be.

It could just be one Saturday a month.

So depending on the size of your practice,

of course you don't want to get somebody

and then they have an empty schedule.

I remember when you owned your practice

and you'd be like,

know i don't have that schedule full and

so you would go and try to fill

that sucker i think i think i walked

the streets it was like i was in

hygiene school again trying to find

patients to work on you'd be like anybody

need a root canal i'm on the corner

flipping this literally and so and so like

yeah like it all has to like make

sense and how you do that but um

Cause you want them to come back.

Now,

if they're an associate and they just

happen to have those skills,

still a little bit easier decision.

Cause now you can keep that all in

house and you can weigh that,

but you are also going to have to

share new patients or share exams and

other things.

Yeah.

Yeah.

And I think it's pretty easy.

I mean, like, you know, for me,

what I tell docs,

when we were ready to bring some specialty

in house, um,

You know,

obviously a root canal is a root canal.

I can't wait too long on that.

Replacing an implant, orthodontics,

sometimes oral surgery,

most of the time oral surgery,

wisdom teeth.

You can pre-plan that stuff out a month

and you just start filling that day.

And then you say, hey, you know,

ready for it.

So, yeah.

Yeah,

I think what I think is pretty cool

about doing something like that is,

is like you said,

if you are paying fifty percent and

there's contracts that you can put

together that protect you from risk and

and then they bring their team or not

or your supplies or not or whatever.

Right.

Those are the little granular things that

need to be worked out.

But man,

can it really beef up your financials and

help your growth?

And quite frankly, Paula,

a patient doesn't want to go to another

office, do they?

They want to do it at your office.

They trust your office.

They feel comfortable with your team.

And quite frankly,

you get a little upset when you refer

them out.

Yeah, yeah, exactly.

So so it does a lot for you

financially.

It does a lot for the patients.

And so, yeah,

I think I think that that makes a

ton of sense.

So the last thing that I that I

want to kind of touch on before we

close this episode down is is kind of

like.

the potential partnership or you thinking

about exit strategy and so again we're

just to bring you back we're on the

topic of are you ready to hire an

associate dentist and so there are of

course a lot of case studies or cases

here where

you're you are um you're full but you

could be you could be busier sure and

you're asking yourself like okay i've got

five years to go three years to go

whatever there's nothing better than

selling your practice to your associate

there's nothing better than that um and

it's great for the associate too and so

Bringing in an associate to get them

familiar with the patients and team and

you feel great about handing it off

because the protege has been with you.

What's the right amount of time there,

you might ask?

I've seen it less than a year.

I've seen it three years.

You don't need five years.

You probably don't even need three years

to really know what you've got there.

But if it's not all about money,

even though I made it about money on

the first point today on the episode,

if it's not about money and you're

thinking exit, gosh,

that's a great way to do that.

Give away some of your production and

really just make sure it's going to be

a smooth transition.

I will say folks that sell their practice

to the associate typically get a higher

value for their business because it is a

true goodwill transfer.

There's way less risk.

So buyers are usually willing to pay a

little bit more than just a random

practice that they don't know anything

about.

I would.

Why wouldn't you?

It's worth more to you than it is

the rest of the world.

So all things to consider.

Did we talk about every...

single opportunity or every scenario about

hiring as an associate and what all goes

into that no if you'd like to discuss

this more or think about it or want

to put some math down or pencil or

paper or whatever you want to say

Give us a call.

We're happy to talk to you about it.

There's a lot of benefits to it.

It's a lot of downsides to financially.

But I think in in a lot of

situations, it makes a ton of sense.

And we help doctors do it every single

day.

So with without really going down another

rabbit hole that paula needs to pull me

out of let's end this episode on a

high note thank you so much for uh

responding and or watching subscribing all

the things we really appreciate it and um

we'll see on the next one thanks again

thank you take care guys bye

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