Podcasts about dso

In this episode, Brannon Moncrief returns to the podcast to unpack what's really happening in the DSO market—from tightening deal structures and smarter buyers to the harsh reality that not every recap delivers. With over two decades in the game and 13 years leading McLaren & Associates, Brannon shares what makes a practice desirable in 2025 and why some of the biggest players in the space are hitting walls. Whether you're a mid-career doc holding high EBITDA or just building toward scale, Brannon breaks down how private equity thinks, how deal terms have shifted, and how to avoid being locked into a losing outcome. EPISODE RESOURCES https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!  

The Deadcast cruises down the eastern seaboard, including stops in Hartford, Hampton, Philadelphia, and Landover, featuring touring tips, another police chase, & a visit to the White House.Guests: David Lemieux, Sam Cutler, Dennis Alpert, Tyler Roy-Hart, David Leopold, John Leopold, Rebecca Adams, Brian Schiff, Gary Lambert, Chris Goodspace, Winslow Colwell, Scott Jones, Chad EylerSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Fred Heppner of Arizona Transitions is back for part 2 of his chat with Kiera! Life comes at you fast, and sometimes, it comes in the form of a surprise. Kiera and Fred talk about creating an exit strategy today for your departure from dentistry, as well as what the economics look like for moving on from a practice. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript Kiera Dent (00:01) Hello, Dental A Team listeners. This is Kiera and I am so excited for you to have part two of me and Fred Heppner going through associates, DSOs, how to really grow this. You guys, we had such an incredible first half of this episode. It was so long and so much information that I wanted to break it into two parts. So here's part two. I hope you enjoy. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.   Kiera Dent (00:24) should people be talking   when they're in their 20s 30s or is it something we're like start to think about it I know Ryan and I from Dentist advisors we we talk shop about this quite often of like there I mean there are studies that show that when you retire you actually start to atrophy in life and ⁓ there isn't as much of a purpose and so we talk often of like how can we continue that   mental stamina, the things that are going to fulfill us, whether it's working or something else of philanthropy, like whatever is going to keep you going as a human, whether you're working in the chair or you're not, I think is important. So that's I was curious of like, really probably connecting with you three to five years before we think we might retire, but with the caveat of, hey, if something were to happen to me, what would kind of be my exit strategy? your like death list like I do, like if I die, this is what's going to happen. It's creepy, but it's awesome.   Fred Heppner (01:15) No, it's, it's creepy and it is awesome. And at the same time, it's a really good conversation to have because if we're three to five years out, then one of the first things to do is say, okay, so what's going to happen if you're not here? And that carries on to the discussion we had earlier. So once the discussion about, what do want to do when you, when you retire or you stop practicing dentistry, then the questions start coming up. What about the economics?   Kiera Dent (01:27) Mm-hmm.   Fred Heppner (01:44) So in any... Yep, absolutely.   Kiera Dent (01:44) I was just going to say, like, is it sell? Is it DSO? it? And also, I mean, this   to me also, I think might exponentially accelerate some people's plans because the DSOs are hot and it's like 10x EBITDA. That might accelerate your retirement or your sell because you're on a wave right now that who knows if in the next 20, 30, 40 years we'll be there. Fred, I'm super curious, like, how is this whole DSO model maybe shifting it for transitions? Or is it? I'm curious.   Fred Heppner (02:13) It is, it's shifted quite a bit, but what it's shifted is a real desire for dentists to be able to sell their businesses and release the management responsibility and to have somebody else take that over. 15, 20. Yeah. I just want to do, I just want to do dentistry. I don't want to manage a business. I don't want to manage people. Um, I don't want to run the company. I want to be able to practice my trade. Well,   Kiera Dent (02:22) you   The dream for every business owner. ⁓   Exactly.   Fred Heppner (02:43) I can tell you that in the last 15, 20 years, it's certainly exploded in dentistry and not in a bad way. And here's why. Dentists graduating from dental school today need a place to work. The banks that loan money to dentists to buy dental practices are looking for dentists that have a couple years experience in dentistry. They have a production track record. The banks can see what it is that the dentist can do. Chair aside.   a good credit score and some liquidity, usually 8 to 10 % of the purchase price of the business that they're looking at in cash. So one of the things to consider is graduating dentists should be able to make the minimum payments on their debt, on their student loans, on what debt they have, and begin to put money away as quickly as possible to gain some liquidity. So as we look at the equation of   what DSOs are doing, they're providing them with a place to work. Because as dentists come out, I mean, the majority of dental practices that I work with, maybe you can echo this or discuss it, are just single dentist practices. Right, they don't have a, somebody called it a plus one at some point time, and I thought, okay, that's decent. So you have the dentistry, but there's the ability to bring somebody on maybe one or two days a week. Well, that doesn't,   Kiera Dent (03:44) Mm-hmm.   Totally same.   Mm-hmm.   Fred Heppner (04:09) That doesn't feed a hungry young dentist coming out of dental school who really has a lot of debt and wants to begin to work and develop a way to reduce that debt. They're looking for four days a week, five. They might have a quality of life thing where they just want to work three tens and be off Friday, Saturday, Sunday, Monday. That's okay. But the point is, is that most private practices don't have the capacity to be able to bring on a full-time dentist and feed them right away and keep them very busy. The DSOs, corporate dentistry,   Kiera Dent (04:19) Right.   Fred Heppner (04:39) have offices that can provide that place. So essentially, if a dentist comes out of school and begins to work, they may very well work for one of the corporate DSOs, which gives them experience. It gives them the ability to work five days a week. It gives them the ability to practice in what I call civilian dentistry out of dental school. And it gives them the opportunity to be able to see what it's really like. I can tell you, Kiera, that 15, I think 15 years ago,   Kiera Dent (04:57) Mm-hmm.   Fred Heppner (05:08) the most popular phone call I would get on my phone line was, hey, we just got 50 million from a private equity firm. We're starting a DSO, but we're different. And we want to buy practices from you because we heard you're good. And I just tell them, great, thanks very much. Get in line, register on my website. And when an opportunity comes up, I will email to you like I do everybody else the opportunity. Because most of my clients call and say, I...   Kiera Dent (05:17) you   Fred Heppner (05:34) Hard no to a DSO. I'm a private practitioner. I've got a legacy practice and I want to sell to another private dentist Okay, so that was the most popular second most popular call was I'm sick of working for a company find me a practice to buy Now it's shifted More so do I hear I'm sick of working for somebody else find me a private practice to buy I'm ready to go The the DSO calls have filtered off of it and I don't know that that's a global   Kiera Dent (05:48) Mm-hmm. ⁓   Mm-hmm.   Fred Heppner (06:03) representation of the DSOs starting to slow their buying and really focus on the profitability of the offices they have to really maintain the profitability due to higher interest rates. Maybe they're slowing down their buying. Who knows? The interesting thing about it is that it's somewhat of a closed loop in DSO work. You really can't get into and find out exactly what everybody is doing unless you're member of their organizations, which is fine. And I respect that.   Kiera Dent (06:12) Yeah.   Fred Heppner (06:32) private information, but it begs the question. And ultimately, if a dentist is looking to buy their own practice, eventually they're going to need those one to two years experience, liquidity, good credit score, in order for them to go to one of the commercial banks and say, I want to buy a practice and let me get a practice to buy and then we'll put it together. Okay? So I can tell you that private practice is alive and well.   Kiera Dent (06:55) Mm-hmm.   Fred Heppner (07:02) very bullish on the individual dentist who's out there still practicing and doing quite well. I can also tell you that those kinds of doctor to doctor transitions are extremely successful. The idea is some people who look at a transition like that would think, my gosh, the dentist leaves, all the patients will leave. They'll go somewhere else, they'll go to other practices. Well, if that was true, let's carry that forward. If that was true,   Kiera Dent (07:14) Mm-hmm.   No.   Fred Heppner (07:28) then that would mean that the loans that the dentist used to buy the practice would go in default, would they not? Because if all the patients left, there would be no revenue and they'd have to fold up camp and see you later, right? The default rate on dental practice loans still over the last 15, 20 years and even recently is 40 basis points. 100 basis points is 1%. 40 basis points is four tenths of 1%. So if you follow the math,   Kiera Dent (07:33) Mm-hmm.   Mm-hmm.   Fred Heppner (07:58) The default rate is less than half of 1 % on the billions of dollars that are loaned by banks for dentists to buy practices. They don't fail. Okay.   Kiera Dent (08:08) Totally. They don't and they're such a   good investment. I think that that's why so many people like, that's why I think DSOs are buying up practices. ⁓ And I think that that's where so many private practice owners now, I would say I've watched where it used to be legacy practices and there's still legacy practice doctors who do not want to sell to a DSO. Like when they're there, they want to sell doctor to doctor, they want to bring in an associate, they want to bring in partners. I think   By default, dentistry tends to be a more humanistic, ⁓ very relationship model ⁓ versus I still think though, right now DSOs, you're right. I don't think people are getting as many calls. ⁓ But what I will say is my doctors are probably getting 20 to 30 emails every month from a DSO interested in buying their practice. So they are getting it as private practice owners. And so I think that that's where, ⁓ like I said, some people within the last eight years bought a practice as a private practice.   the DSOs, they were profitable. were within the metrics that the DSO wanted. And it just made sense. was like, I'm going to get 10x EBITDA on this. My EBITDA is great. No private party is going to pay me what this DSO is going to pay me. And while yes, I'd love it to maintain a legacy practice, I'm in my 30s and I could basically have retirement today. mean, there's more risk selling out because they have a lot of it in their stocks and there's a whole ⁓ game around that.   I think that that's where maybe some of the younger generation might be looking at transitions sooner than I think the more senior population of dentistry is. think that they're starting to be the shift and that's where I'm very curious of like, maybe conversations need to be had sooner. Maybe because DSOs are aggressive on the emails to the dentist. Like it is wild and they are sexy offers to them that are not always true. And that creeps me out too, because they're hearing a number. Like I had a doctor and he had a DSO.   Fred Heppner (09:49) Yep. Yep.   Kiera Dent (10:04) come to him and they said, Hey, we're going to give you 5 million. And he's like, here, it seems like a great deal. And I said, yeah, but you're going to do 5 million next year just in your own production. So that's actually a bad deal because you're already going to make that without selling to them and having to work for them for the next five to 10 years or like three to five is usually what their requirement is. So again, I think that this is where it's like, how do we cut through that noise to know when I do transition? Because I think people are getting asked to transition from private practice.   sooner. You're right, they go work at the DSO, they go to some of those bigger corporate practices to get the experience, then they go buy their private practice, and then it really is, or they do a startup. And then it's pretty aggressive because I think Wall Street's pretty hot right now and private equity is very, very luring, but they do have to hit certain requirements to join DSOs.   Fred Heppner (10:53) Yeah. There are tons of verticals that people are getting into, the private equity is getting into, you're right. There's a ton of money at it. You know, I would tell you that the devil is in the details. It may very well be that there are transitions that occur where a DSO or a corporation acquires the assets of a private practice and the dentist stays and works back in the office. And that transition works swimmingly well for the dentist who sells for the DSO.   Kiera Dent (11:02) Mm-hmm.   Fred Heppner (11:21) And ultimately everything works out fine. There are others that don't and they're, they're out there. And I think what you mentioned earlier is, you know, I could get 5 million from my practice. Well, why would you, you will be able to make that in, your earnings in 2.3 years, whatever it might be, whatever the math pencils that be. But if you think about it, if it, if 10 times EBITDA is their offering price, what are, what are the details? How much cash at closing?   Kiera Dent (11:38) Right.   Mm-hmm.   Fred Heppner (11:49) Is there a work back or a work back arrangement where you will be paid to be the dentist? And what is your compensation? What are the benefits that you would receive? And what is the term of that work back arrangement? You're right. It's creeping up now more into five years. 15, 20 years ago, was maybe, you know, stay on one or two years and we're good. There's a claw back. There's a hold back provision that holds back part of the purchase price. And the dentist has to meet the   Kiera Dent (12:04) Mm-hmm.   Yeah.   Fred Heppner (12:17) has to meet certain metrics from the trailing 12 months to be able to get that back. Well, let's pretend. Let's pretend that the DSO comes in and sets up the practice and nothing changes and the business continues to grow and develop because there's more marketing promotion and advertising. There's better cost control. There's just better stuff going on and that works. Well, what if it doesn't? What if all of a sudden the company comes in and says, we're changing these policies?   You were Delta Dental Premier, we're jumping into PPOs because we've got really good reimbursement rates on these 12 PPO contracts. Well, if that reimbursement rate drops from fee for service, does that hinder the doctor to be able to generate the income necessary for that hold back to be acquired in the next two to three years? And then there's equity. You mentioned that they offer a stock in the company to be able to ultimately participate in a   Kiera Dent (13:09) Mm-hmm.   Fred Heppner (13:15) recapitalization should that happen? Well, it'd be really interesting. You're going to love this one. I know you're going to love this one. So for any of your listeners, any of your A-Team clients, if they get approached by a DSO and they look at it and they think it's really, really good, have somebody look at it. What you will hear typically is you really don't need an advisor. You don't need an attorney. We've got all the contracts ready to go. You can come.   Kiera Dent (13:35) Mm-hmm.   Lies. Lies.   Fred Heppner (13:44) Exactly. You can just take all of this and we'll be good. Well, trust but verify. And ultimately a good team would be able to review these. I would be glad to review. I review paperwork all the time from dentists that are looking to transition. And if there's an equity piece in that offer, I turn around and contact the DSO on behalf of the client. And I say, we'd like to see your financials.   Kiera Dent (14:08) Absolutely.   Fred Heppner (14:11) What do you mean? Well, you're asking my client to acquire stock in your company in lieu of cash at closing. yeah, that's part of the deal. I need to see your financials. I need to advise my client on whether or not you have a healthy company and whether or not my client's going to be at risk by taking stock in your company. Well, nobody's ever asked us that. Well, I am. And doesn't it make sense? We've just provided to you tax returns, profit and loss statements, but sing along if you know the words, balance sheets, W-2, production reports, everything on the business.   Kiera Dent (14:21) Yeah.   things.   Mm-hmm.   Fred Heppner (14:39) And yet you're not willing to provide the other. Just provide the other. Show us that your business is solvent. Show it that it is something that my client would like to receive in stock. So, mon bro.   Kiera Dent (14:50) And there's strategy   for tax around that too. there are benefits to having stock rather than all the cash at closing for your total dollar amount when you want to retire, but only if that stock actually is valuable.   Fred Heppner (15:05) Pays back. Correct. Good. And that   is so brilliant. You see, you're good looking, you're smart, and that's a rare combination today. So, so, but think about it. You just mentioned something that people really don't think. If, if I have a practice and they give me 1.5 million chopped up into the ways that we've mentioned, and I have $200,000 worth of equity in the company, what if that $200,000 is half of 1 %? Well, when they recapitalize, I get half of 1 % of what proceeds, right?   Kiera Dent (15:09) Thank you.   Mm-hmm.   I love it. It's such a...   Fred Heppner (15:35) So map it out. Yeah, map it out. mean, can   you sell your practice twice? sometimes yes, sometimes no.   Kiera Dent (15:43) And there's so many sticky pieces around it. And that's where I feel like it's just a, think this is where people get leery to do it. However, I think like there are some, you said, that go really, really well, but agreed. And when I look at this people like Kiera, like I thought about that doctor and I was like, so sweet. You're going to five mil. That's your 10 X. You're going to produce 5 million. Your overhead right now is sitting at a 50 % overhead. So right now you're taking 2.5. Let's say you do get a $5 million check.   you give me 10 taxes, it's barely over your 2.5, which you're already going to get next year. So like, yes, next year, you still have to pay taxes because you're at a 50 % overhead. So you will still get a small amount more of cash to you. But there's a lot of strategy that goes into that 2.5, pending upon what you need when you invest that, like for every million, it's about like on average, if it's in the stock market, about 35,000 right now is like a very, very, very loose number to like estimate your financial future. But I'm like,   you throw 2.5 into the stock market right now, we'll high five, you're making about 100K a year. Like that's just to me, those are the things that I feel you need to be really smart about to make sure that your practices are assets and not liabilities and something that really will provide the retirement for the work you've put in rather than it just feeling good in the moment, but not really giving the life you want.   Fred Heppner (16:59) You know, excellent point. And what you also said earlier, just in passing was, what dentists could buy my practice. can't sell to a private dentist. I've got to sell to a DSO. ⁓ surprise, surprise. That's a myth. There are dentists who would, I can tell you right now, if you could give me your client's number, I'll buy her practice. Well, yeah, well, I mean, that's gonna, that's gonna pencil. So the, the point that I would make is know that   Kiera Dent (17:12) It is a myth.   Right? I know, me too. I'm like, actually, actually I would.   Fred Heppner (17:29) Dentists that are out there who are looking to buy really profitable practices and can meet the production goals. So there's an important aspect there. Your client's doing two and a half million in profit, five million in productivity on her own. If a person coming in to buy that won't be able to quite meet those production numbers, they may hire the client back for a year or two. The bank may want them to make sure that there's some kind of arrangement where they have some help.   But if a bank is looking at a practice that has that kind of liquidity and profitability, they'll gladly loan the money to the dentist if other measures are there because they know it's going to be paid back. So I want to dispel the myth that big practices with large productivity and big profitability are excluded from private practitioners being able to buy them. It's not true. Is it? Yeah.   Kiera Dent (18:10) Mm-hmm.   I agree. They get nervous because of the debt,   but I have somebody that I know that just bought into a $2.5 million is how much they had to bring to the table. Plus they have their student loan debt, plus they have their house debt and they were able to do it to buy into a practice. so I'm like, I think let's not assume that that's the only route. think figure out what you want and there is a buyer based on the outcome you want. I think Fred, I want to switch gears because I want to ask some questions about associates.   because I think we've kind of gone through like private practice. There's so many things like make sure you're taken care of, make sure you know where you're going. But now I want to switch gears because I think this is something I get asked all the time. And so selfishly again, welcome to curious therapy with Fred. I want to know all the pieces. This is my podcast that you get to be a part of. No, it's for all of you. ⁓ we get asked often, how do you set up a great associate buy-in? So like, how do I buy these people and how do I tether them in? I think one of the greatest, I would say   Fred Heppner (19:06) I'm listening.   Kiera Dent (19:19) stressors and like blind spots in practices and the thing that can really hurt a practice is when they have an associate that associate leaving. ⁓ And so they want to like golden handcuff these associates, but they want it to be good for both parties. What are some of those associate transitions to retain associates to get them in as partners? Is it a good idea? Is it not a good idea? And I think like we can wrap on this because I, I'm super curious of like what you recommend to help with that transition.   Fred Heppner (19:45) The   capacity for the business volume has to be there. You've got to have, not only are you working, but there's this phantom practice out there that you can't get to as the provider. And you need somebody to be able to get to that. So bringing on an associate to get to that phantom practice immediately creates incremental income, which is, to the owner of the business, very liquid.   Kiera Dent (20:03) Mm-hmm.   Fred Heppner (20:07) The cost associated with treating extra people during the course of the day is the associate's compensation and variable cost supplies in lab. And if you're ⁓ providing can-to-can technology and your lab costs are very low, but you're producing crowns in a day, for example, and using that kind of technology, then the cost associated with treating every incremental patient and creating that revenue is very low.   we're suggesting that the team in place can handle the extra work. We don't have to hire an extra assistant or hire an extra administrative person. So given those things.   ⁓ One of the best transition plans, in my opinion, is one that has time built into it. The associate has to develop some traction. They have to generate some productivity. They have to show that they can produce the numbers. But more importantly, the outcomes are good. The treatment outcomes are successful. The patients are adapting to them. The team connects with them. This is a good relationship. As an aside, really quick, when you mention relationship business in dentistry,   I think DSOs traditionally are a transactional business. They're really focusing on the transaction, right? Private practice focuses on the relationship. Not to say that corporate dentistry doesn't focus on relationships. They're focused more so on the transactions. I might get ridiculed for that statement, but that's what I see. And that's my opinion.   Kiera Dent (21:19) I would agree.   Sure,   sure.   Fred Heppner (21:36) So back to the associate, need the associate to develop some traction. And essentially that traction comes from being in the office, seeing patients, working with the team, and ultimately getting feedback along the way. And I think that's a one to two year cycle. Will you know as a practitioner and owner of the business within the first one or two months, if the associate is working two or three days a week or four days a week, will you know, do they get along with the patients? Do they get along with the team? Yes. Will you know about treatment outcomes?   Kiera Dent (21:40) Mm-hmm.   Fred Heppner (22:05) To some degree, yes. So early on, you'll know if this is cut bait, this is not going to work. Or yes, this person's fitting in great, primarily because they were vetted. So quick, quick retract back to how do you hire them? Go through a long process of vetting. Don't just take the first one that appears. Get to know them, make sure they're going to integrate well. I see a lot of associate plans.   work real well when the dentist knows the dentist owner knows the associate coming on board from some past experience. Great example is the dentist associate grew up in town, did an internship kind of in the office as a sterilization tech, kind of worked in the office, found out that dentistry was their passion, went to college for undergrad, went to dental school for dental degree and came back to the town to work for that dentist. Right. Okay, good. So somebody you know, ⁓   Kiera Dent (22:38) Mm-hmm.   Totally.   Fred Heppner (23:00) son of doctor, owner's best friend. So there's history there. You know, the quality of the individual. Okay. So once traction is developed during the part of that associate agreement, there's some discussion about ownership and building an understanding of how the practice works so that when time comes to be a partner and buy in, there's already some traction. There's already some traction so that if the person elects to buy the seller out,   in a couple years, then they can switch roles. But there has to be some traction. One of the things that's really perilous is thinking about jumping into a practice and being a partner right away. If you want to practice and you do two million a year, hygiene does 500, you do 1.5. I'm going to come in and I want to be a partner of yours today because I've heard how great your practice is. And you have the physical plant capacity, you have the patient capacity, and I can step right in.   If I pay you half of the value of your practice today to buy in, we can split up the medicine and supplies and drugs. can split up the equipment. We can split up the office equipment. ⁓ we can split up all the operatories, but how do we sort out the patients? Because come Monday morning, say we close tomorrow, Friday, come Monday morning, I need to have in my schedule, the ability to generate half of the revenue in the business so that I can pay myself and I can pay.   to having bought in. that make sense? And that doesn't really happen easily when somebody just freshly wants to buy in as a partner. So fast forwarding to partnerships, which I hope we get a chance to talk a little bit about today, that associate has to be in that process, in that business for a period of time. And that traction needs to get up so that they've got productivity under their belt. And again, going back to what we talked about about banks,   Kiera Dent (24:32) Mm-hmm. Mm-hmm.   I agree.   Fred Heppner (24:59) they wanna see that that productivity is there, that they'll be able to generate it because they wanna make sure that they get the loan paid for. And a really good associate agreement has, in my opinion, good restrictive covenants, not to compete, not to solicit patients or staff. ⁓ In some states, that's not allowed. The FTC voted that associate agreements or employment agreements should not have restrictive covenants, but there's no legislation yet that has actually mandated that.   Kiera Dent (25:05) Totally.   Fred Heppner (25:26) So keep in mind that it's probably not appropriate to think that you'll be able to limit somebody's ability to work. Now for them to essentially buy your practice, for example, and you as a, agreement have a restrictive covenant that you will agree to that's different because somebody paid you good and valuable consideration money for you not to compete against them because they bought your business in an employment agreement. It's a little different.   Kiera Dent (25:49) Mm-hmm.   Great.   Fred Heppner (25:56) So if a dentist comes and works for another dentist who owns the business, and after a couple of months, it's just not gonna work out, they're not gonna have enough connection with the patient base to solicit patients or solicit staff or the team. They won't. So would it matter if there was a restrictive covenant in that initial agreement? Probably not.   because after a couple months, if they've alienated patients and alienated staff and they're not very good at dentistry, you want them out of there anyway, forget about the restrictive covenant, they could go work for somebody else close by. It's probably the same thing that'll happen.   Kiera Dent (26:36) I think it's really wise because I think so many offices hire an associate, but they're so scared to move them along in two months. I think that was wise advice you listed. It is so much easier to move them on in two months than it is to keep them for six months, eight months, 10 months, and then realize their dentistry or their team connection or their patient connections not there. so ⁓ it's, it's be very intentional within those first 90 days and make sure that this will be a long-term fit. ⁓ You can see it in two months.   Fred Heppner (27:01) So how does this,   you can, I'm sure you can. How does this sound? For the first six months of an associate agreement, maybe you don't have quite a good background, deep background about that individual, but you feel that they would be good in the practice. They come recommended by their instructors at university, at dental school. was highly, someone was highly recommended. How about a single page,   six month agreement that says you come to work for me, I will pay you this. And if you want to go, you can go. If I feel you need to go, I'm going to release you. It's an at will agreement, no restrictive covenants, nothing in it that locks anybody down. Because again, what I mentioned earlier is how much traction can you generate really in one or two, three, four months, because you'll know after four or five months that this is somebody really want to lock in at six months, develop a really strong, well-written attorney reviewed.   employment agreement that has restrictive covenants that has specific on how to redo cases in case they need to be done at the end of the employment agreement. Right. What do you think? I mean, does that give that give the opportunity?   Kiera Dent (28:08) Sure.   I think,   I mean, I like it. think that the devil's advocate in me would say, I'm not sure that the ⁓   millennial Gen Z generation coming through would say yes to six months. I think that they're looking for more security. They're looking for more guarantees. They come in with a lot more debt and a lot more risk that I am really curious. As a business, I think it's freaking brilliant. As on the other side, I'm curious, would you be able to get candidates that would want to come or is it too risky of an offer?   Fred Heppner (28:43) You mean,   yeah, do you mean the associate dentist coming on board is thinking more about themselves rather than the practice?   Kiera Dent (28:52) I think with the associate offers that are given currently, ⁓ I think agreed. It does show that they're thinking about it, but I also feel for a practice making sure that they're competitive with offers. I don't love having to be ⁓ like with hygienists. I don't want to have to go chase them, but you have to at least be competitive with other people in the market. So I think I agree with you. I just feel for practices making sure that maybe   Fred Heppner (29:05) ⁓   I understand what you're saying.   Kiera Dent (29:19) you are so competitive with other people and offer. So you do get the candidates, but you can have some of these ideas within like that I think would make you even maybe more attractive. So maybe it's a year that we're offering, but like, Hey, in the first six months, there's no restriction. There's no nothing. We add that in in six months. So that way you are competitive with other people. Cause I think associates, they need that security and I'm watching more and more come through. I mean, they're walking out with one mil plus 2 million in debt. Like, so I think that   I think to be competitive with others, might need to be a possibly. This is my hallucination that could possibly just make sure you're competitive.   Fred Heppner (29:53) Well, well, no, you're   so you're right on you're in a you're in another section of what the employment agreement might look like called compensation and benefits. I'm looking at just the period of time that you would be that a dentist would be employed in the practice to determine if it's a right fit for them and if it's a right fit for the practice and if it's a right fit for the patients and the team. Compensation can say exactly what you were saying. Now,   Kiera Dent (30:16) Right.   Fred Heppner (30:22) Unfortunately, it isn't the responsibility of the practice to provide for somebody who is unproven in their debt or to satisfy their lifestyle requirements. Yes, they're competing with other organizations that are offering salary, health insurance, vision, life insurance policies, all of those benefits that come along with big corporations. However,   It's a private practice. And the sooner I think that dentists who are coming on as associates know the intricacies and the difficulties of running a business and also the rewards that come with it, they would understand better how those arrangements are made. And I've seen compensation programs set up where it's the greater of over two weeks, a compensation per day or a percentage of a certain amount over a certain amount of productivity. So you can meet those requirements. can kind of meet.   Kiera Dent (31:15) Mm-hmm.   Fred Heppner (31:16) Kind of need halfway in between.   Kiera Dent (31:18) Yeah, and I think that that's where I was saying of I feel like making sure that you're meeting in the middle. I love the idea of being able to protect like, you're right, like not being stuck in this with someone who's not working out and getting stuck, I think is actually something that happens all the time with associates. ⁓ And so I think like, Fred, it was such a fun like,   chat about us. I agree, we need to chat more partnerships because now it's like, okay, we've got these associates, we've got some ideas on it. We've heard about figuring out where we want to go and how we're going to be able to get there and needing to think about our future life and how when we need to transition, you said the three to five years, I think looking for like, what do need to do to be able to buy a practice? If I want to buy a practice, what do need to get? Then we talked about like the DSO offers coming for private practices, and how to assess that through Fred.   And then we moved into associates. So Fred, like that was such a like smorgasbord of topics, which I love. And I think definitely reconnecting because I think there's the next step is like, how do we bring in these associates for partners if we want them? How can we build a legacy practice? That's not necessarily just the DSO. So I'd love to get you back on the podcast and chat partnerships and like alternative transitions beyond, but gosh, Fred, such a fun podcast today.   Fred Heppner (32:10) It was fun.   I am   happy to do it anytime. I appreciate what you do for dentistry. So I'll absolutely support you and be glad to do it.   Kiera Dent (32:36) Thank you. Well, Fred, as we wrap up today, were there any last thoughts you had to give to the listeners? And of course, ArizonaTransitions.com, ArizonaTransitions.gmail. If you're looking to transition or associates or what do I do or hey, Fred, I just need help. But any last thoughts you have as we wrap up today?   Fred Heppner (32:52) Yeah, I think   I tell you a funny quip that I think resonates with most people that I talk to. Dentists are excellent at curing dental disease, at diagnosing conditions and recommending treatments and working with patients to get them well. And, ⁓ coming into an event like purchasing a practice or selling a practice where they've never done it before. They don't have the experience or the education.   going in to understand what to do. I would encourage them to get advice and guidance from a great team. ⁓ I have a deal with my dentist. Mike Smith is brilliant. He has a practice called the biting edge here in Phoenix and he's brilliant. And he and I have an agreement. I don't do my own dentistry.   And he doesn't do his own practice transition stuff or practice management stuff. He relies on me to do that because they're in the middle. meet. So I want him to cure my dental conditions and make sure I'm in the optimum dental health that I could be. And I'm to make sure that I provide the services to him so that if he's looking to acquire a practice or merge an office into his, or figure out how the next plan would be for his practice growth or his transition, that he's going to sit down with me because he understands that that's my expertise and he.   he benefits from.   Kiera Dent (34:15) Yeah, I love that. That's such a good way to look at it. Let's sit in our lanes. Let's do what we're really good at and not try to be a one-stop shop. I think that that's brilliant, Fred. And I feel like for all those looking for the transitions for what do we do? How can I do it? Reach out, Fred. I think you're a wealth of knowledge. You've been in it for a long time and just truly so grateful to have you on the podcast today.   Fred Heppner (34:36) It's my pleasure. Absolutely. Have a great day. Talk to you soon. Bye here.   Kiera Dent (34:39) Awesome. Thank you. And thank you,   Fred. Thank you, all of you. And for all of you listening, thanks for listening. And I'll catch you next time on the Dental A Team Podcast.  

The Bulletproof Dental Podcast Episode 396 HOSTS: Dr. Peter Boulden and Dr. Craig Spodak GUEST: Clifton Cameron, Lightwave Dental DESCRIPTION Clifton Cameron, Chief Dental Officer of LightWave, discusses the dental service organization (DSO) landscape, covering industry challenges like labor inflation, financial strategies, and market consolidation. The conversation explores how dentists should evaluate partnerships, the impact of consumerism on practices, challenges facing solo practitioners, and the importance of strong leadership in navigating the evolving dental industry TAKEAWAYS LightWave is America's only Dental Leadership Organization (DLO). Labor inflation has significantly impacted the dental industry. Dentistry is resilient and can withstand economic fluctuations. The importance of understanding earn-outs and financial risks in DSO agreements. Stability in the market is becoming increasingly important for investors. The majority of dental practices are still solo practitioners. Financial strategies must adapt to current economic conditions. Consolidation in dentistry is ongoing, with a significant percentage of practices under DSO contracts. The need for camaraderie among dental professionals is crucial. Consumerism is reshaping patient expectations in dentistry. Dentists must adapt to changing market dynamics to remain relevant. Investing in leadership and technology is vital for growth. The dental industry is seeing a trend towards consolidation. CHAPTERS 00:00 Introduction to LightWave and Leadership 05:00 The Current State of DSOs 10:01 Understanding Earn-Outs and Financial Risks 14:58 Navigating Labor Inflation and Financial Strategies 20:07 The Future of Dentistry and Market Resilience 25:00 Consolidation in Dentistry: Current Trends and Insights 32:06 The Rise of Startups and DSOs 36:19 Consumerism and the Future of Dental Practices 40:19 The Value of Dental Practices in Transition 44:25 Two Paths for Dentists: Business Owner vs. Employee 53:39 The Future of DSO Consolidation REFERENCES Bulletproof Summit Bulletproof Mastermind  

In today's Part 1 episode, Dr. Mark Costes catches up with longtime friend and powerhouse entrepreneur Dr. Kyle Hale. Kyle opens up about life after selling his DSO, why he took a step back, and how he spent his sabbatical reconnecting with family and rediscovering his passion for racing. He shares his reflections on the stress of clinical dentistry, how his wife Callie's burnout influenced their business decisions, and what it took to prepare their group of practices for a smooth and successful exit.  The conversation also dives into the challenges and lessons learned from scaling quickly, the importance of systems, and how stepping away opened doors to new ventures like the Airway Dentist. This is part one of an inspiring conversation about transition, purpose, and designing a life by intention. EPISODE RESOURCES https://theairwaydentists.com https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

Kiera is joined by Fred Heppner of Arizona Transitions to talk through dental practice transitions. Their conversation includes when you should start thinking about your transition, what the economic outcomes will be any way you go, what a private indemnity group is (and how it can help), and more. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcrpt Kiera Dent (00:01) Hello, Dental A Team listeners. This is Kiera. And today I am so excited to welcome an incredible guest to our podcast, Fred Heppner. He's with Arizona Transitions. And honestly, I feel like right now in today's world, dentists need more than ever guidance and direction of like, what do we do? How do I transition my practice? What am I looking at for retirement? Do I go the DSO route? Do I do the legacy practice route? I just feel like there's so much confusion. And so trying to cut through that noise,   Fred is incredible. We met him and I just said, you know what? He's incredible. And so he said for him, it's whether a person is buying a dental practice or putting a dental practice up for sale, Fred truly can help you successfully navigate through that transition. He deals with complete transitions of dental offices and also practices securing a partner or an associate, which that is such a hard thing. Like, how do we do this? There's a million ways to slice and dice that pie because he's worked with so many different aspects of the dental industry. His experience allows him   to ensure that all parties are satisfied with the transition. So I'm super jazzed. Fred, welcome to the show today. How are you?   Fred Heppner (01:02) I'm   doing great. Thank you, Kiera. I gotta meet this guy. Who is this guy, Fred?   Kiera Dent (01:06) Well,   here he is, if I'm not mistaken. But truly, I'm so honored to have you on the podcast. When our team met you, they were like, Kiera, he's got to get on the podcast. And so just truly excited because like I said, this is a zone that I get excited to geek out on because we deal with it in consulting all the time. Our clients are constantly asking us like, what should we do? They want to bring on partners, they want to bring on associates, they want a retention model. ⁓ They want to know like,   I feel like your dental practice can be your greatest asset or your greatest burden, depending upon how you set it up. And so really being able to just dive in with you. And like I said, I think there's so much noise right now. The dentists are like, it's almost like ostrich in the sand. Like, I just don't want to even think about it. I'm going to put my head in the sand. I'm not going to pay attention. But the reality is like, let's educate, let's learn. Let's bring experts in like yourself. So that way dentists can feel more confident making the decision. I don't think it has to be scary. I don't think it's be daunting. We just need to be educated and.   Fred Heppner (01:41) Yeah, I agree.   No.   Kiera Dent (02:05) and hear wisdom and then do what feels right. So Fred, that was my intro, but anything else you want to add of how you got here or, mean, I'm just excited to riff with you today.   Fred Heppner (02:14) I appreciate the opportunity and I can tell you even from what you just said back in, back in 1983, when I started in the business of dentistry, the interesting thing was I didn't hear very often, Hey, what's your transition plan? Because oftentimes dentists were really just going to build a practice and then that was going to be their retirement and they would sell their practice and retire. Financial planners were, were non-existent to a large degree. And it was early on that I heard somebody and it really resonated with me.   They asked a young dentist who had just taken ownership or started a practice, when are you going to hang up your hand piece? And the dentist kind of, I just got started. What do mean? When am going to hang it up? I got, you know, I got 20, 30 years here. No, no, no. The moment you take ownership of a business, you want to consider what your transition plan out would be early on so that it doesn't spring it on.   Kiera Dent (02:51) Mm-hmm.   Mm-hmm.   Fred Heppner (03:09) We may   talk here later on about, what happens if you're not there? What happens if there's an injury or disability or illness and you can't practice dentistry? Now what? And let's consider talking about that maybe later on. So early in the game, it's appropriate to have some kind of idea of some kind of transition plan. Transition plan doesn't mean I have to value my business. I have to procure a buyer act to make sure that financially qualified. I have to get a contract. I have to get a lease. That's not a transition plan. In simple, think.   Kiera Dent (03:21) Yeah.   Fred Heppner (03:38) The transition plan is what do you want to do when you sell your practice, when you move on from dentistry? And you know, as well as I do, you have clients who have been in dentistry and practice for 25, 30, 35, 40 years. And if they stopped doing something that they've been doing for three decades, what are they going to do with their time? And that's, that's really high on the scale of importance in a transition plan, because ultimately they're going to sit back and say,   Kiera Dent (03:53) Mm hmm. Yeah.   Fred Heppner (04:08) I don't know that I want to be home. I don't know that my spouse wants me to be home all day. And you have to think about these things. So it's much more than I have a practice to sell. I've got a purchase price. I have to figure out how I'm going to sell everything and my staff and my patients and so on. It's more than that. So I think in the initial phases of somebody considering what's my transition plan that can pull their head out of the sand and look at a spot and say, what do I really want to do if I   Kiera Dent (04:12) Totally.   Fred Heppner (04:37) If I don't do this, what will I do? And then feels a whole bunch of other questions into the play. Number one, how much am I going to make from selling my practice? What are the economic outcomes? How much in proceeds will I have after all the fees associated with selling the business and the taxes associated with paying for the proceeds? Now, what have I got left? What is that? What does that number look like? Well, I have no idea. Well, I need to find out. That's why I have a business.   Kiera Dent (05:05) Mm-hmm.   Gosh, Fred, I am so grateful you brought this up because honestly, feel like so I don't know my financial advisor teases me all the time. He's incredible. And he's like, Kiera, you are the person that has every exit strategy. You're like, all right, so what's going to happen if this happens or what happens? And I love to play this game with my husband. I'm like, okay, so if there was a fire in our house in this location, how are we going to get out? Or if we had this, because I feel like when you have almost that North star, especially in your life of   Okay, this is how much I want when I wanna retire. This is when I wanna retire. This is like you said, if I want to, what am I gonna do when this doesn't, like when I'm no longer doing dentistry? Because you're right, I actually, ⁓ working at Midwestern ⁓ University in Arizona, I know a lot of dental students and I know a lot of dentists now. And ⁓ I've been gone from Midwestern for about now, about nine years. And ⁓ in those nine years, which does not seem that long, it's not even been a decade, ⁓   Fred Heppner (05:50) Mm-hmm.   Kiera Dent (06:05) There have been students who have gotten a disability. There have been students who have gotten cancer and can no longer practice dentistry. There are students that have already sold to DSOs. And I'm like, their life looks so different. The student I'm thinking about who ended up getting pretty sick and had to leave, thank goodness he had his ⁓ insurance on him, his disability insurance. But like when I met him,   there was no way that we ever would have thought like four or five years into practice. I went and saw him in his practice and now like he's not doing dentistry anymore. And so I think Fred, it's one of those things where I help him pray every dentist who's listening gets to work until they're 80, 90, however long they want to go that they get to practice their craft. but I think what you're talking about of let's think of what would I do if I couldn't do this anymore, whether by choice or whether by life, ⁓ and then be able to make decisions because I feel like   When you stair step it back, you're able to actually navigate today way more confidently than if you don't have a plan. And I think that gives you more security than anything else. ⁓   Fred Heppner (07:08) Amen. And if your practice   is stable, strong, producing a good profit and you are able to not only retire debt, but start to put away for your own retirement, you are much more in a direction of control also. So retirement may not be a year or a number. It sometimes is an event because injury, disability, illness, sudden death have no discrimination. It can happen to anybody.   And if there isn't a plan in place for that, which I would recommend dentists look into, ⁓ if they don't have them in their community, forming private indemnity groups, disability coverage groups, where if a group of 16, 17 dentists that per oculi are in the same community and know each other and respect each other would agree that if anything were to happen, the group would get activated and it would cover the practice a day at a time on rotation for all the membership.   until the practitioner returns from the injury or disability or the practice is sold because the dentist is incapacitated and can't come back. As a side note, I want to mention to you that I do this for six different groups here in the Valley in Phoenix where I live. And there are anywhere from about 12 to 22 dentists in each of those groups.   So if you're listeners or if anybody in the A team wants to know more about forming groups, I'm happy to pay it forward, provide it for you. It's important. It's really something that dentists, we're invincible. Nothing's going to happen to us, especially when they're 30 years old and they just graduated from Midwestern and they bought their first practice and they're fired up. And it's like, they are looking at nothing other than growth, development, coaching. They're not even thinking if something were to happen to them. So.   Kiera Dent (08:38) Mm-hmm.   hope. Right?   Mm-hmm.   Fred Heppner (08:57) Just as an aside,   let's you and I make sure that we talk more. And for any dentists who want to develop those kinds of groups, it is invaluable. And there are tons of stories that I could impart to you and impart to anybody who's willing to listen about dentists that have a mishap. ⁓ Jim Jorgensen here in Phoenix ⁓ owns Squaw Peak Dental for years. He was in Vegas with his wife, Terry, midnight. They were up in the hotel room and he flatlined. He had a massive heart attack.   Kiera Dent (09:15) Mm-hmm. Yep. Mm-hmm.   Fred Heppner (09:28) She kept him going until the paramedics arrived. He survived. We activated the group. We covered his practice for three months. He came back, continued to practice. A year later, he sold it. So he couldn't have done that. He would have lost that asset and lost the value that that asset has on the open market if that group hadn't been in place. So.   Kiera Dent (09:39) incredible.   Thank   I will. love that. And thank you for sharing that. And that's something I didn't even know existed. And I, I don't, I'm just very pro. Like, I remember when I was filling out our trust and I had to write my will and I was not very old, still like in my thirties, it was really weird. And it made me feel icky. And when you said the phrase earlier of like death, disability, illness, that has no discrimination. It hit me in my core of you're right. Like we do feel like we're invincible, but the reality is those three are hanging   out at any moment and we have no idea when they're going to strike us or our family or someone that we know. As icky as that is. And so I feel like it's like, let's just get, let's get prepared. Like when I had to figure out what's going to happen to me, if I ever am incapacitated and I called my brother, who's my power of attorney. I said, okay, this is what I want. Are you willing to do it? But now I don't like if it happens great. Like he knows, I know there's a plan in place and as much as I would hate for it to happen, there is a plan that's like, and I feel   Gosh, maybe I'm just a selfish egotistical human over here. It does give me a lot of empowerment to know that I know if something were to happen to me, things are good. And I will also say my whole team hates it, but I have an entire death plan of if Kiera Dent dies, I haven't made it so sweet that they want to kill me off. So like, that's my, that's my caveat. Like, let's not make it that good. But there's an entire plan because I realized...   If I don't have this plan in place, if things aren't able to be transferred quickly to people that I trust and that people need to execute on, this company would die and we would not be able to serve all the people that we have. And so as, as weird and as eerie as it is, I feel like Fred, there's so much empowerment that can happen because it's no longer scary. Just like getting an operations manual, just like getting all your systems in your practice in case someone leaves. I feel like it's the same thing for your business in your life. So Fred, like that's a great tip. And I think people should reach out and definitely connect with you.   Fred Heppner (11:42) maybe   for another future podcast. Coming to an A-Team podcast near you,   Kiera Dent (11:44) Like,   I mean, hey, I'm here for it.   Fred Heppner (11:50) I don't know.   It's really important. People take it for granted. And it's interesting because the people that are in the groups that I have and sponsor just sitting back and say to themselves, why wouldn't anybody not be involved in this type of group? So good for future.   Kiera Dent (12:05) That's helpful. Okay. All right. And Fred, just like, mean,   we'll, share it at the end too, but if people are interested, how do they connect with you? We'll just put it in the middle too. So people have the info and then of course we're going to continue on.   Fred Heppner (12:16) ArizonaTransitions.com is my website. ArizonaTransitions@gmail.com is my email. Best way to reach you.   Kiera Dent (12:23) And I'm sure people are   questioning, you work only in Arizona or do you work outside of Arizona just to clear that up for our listeners? Okay.   Fred Heppner (12:29) Good. Time for a little backstory. So   back in 1983, when I started in dentistry, I was a, I was a business coach, similar to how you operate and develop business systems and coaching and training for dentists and their teams to grow and essentially develop profitable and enjoyable practices. I did that for about 20 years. And then about 22 years ago, I really saw a void in Phoenix where I live. moved here in 1995.   of the transition space. just didn't see dental practice transitions being done with integrity, in my opinion. They could have been, but I saw some of the aftermath because dentists would call me and say, hey, I just bought this practice. Can you help me? It's a mess. So I would go in and assist them. Well, slowly but surely, I saw an opportunity to be able to jump into the transitions realm. So I jumped deep into ⁓ classroom study and book work on how to do business evaluations correctly.   Kiera Dent (13:04) Mm-hmm.   Fred Heppner (13:26) the International Society of Business Analysts was my education forum. ⁓ Casey Conrad, who is brilliant, he taught me how to do business valuations correctly. And by the way, he writes the curriculum for the organizations that provide accreditation to people who want to be a business analyst. So I'm learning from the guy who teaches everybody. And then I started studying large contract negotiations.   Kiera Dent (13:45) Mm-hmm. Amazing.   Fred Heppner (13:52) As I developed that understanding and saw that there were things that I could contribute to, I jumped into that realm and became more of ⁓ a transition specialist here in the greater Phoenix area. Well, along the way, I came upon a group called American Dental Sales, which is a large cooperative of 40 dental practice transition specialists, 23 different companies. They cover all 50 states and they had a void in Arizona that they needed to fill. So they approached me and said, we'd like you to come on board.   ⁓ I then met a guy named Hi Smith, who really was one of the preeminent dental practice brokers in the country. ⁓ He was in Naples, Florida. He had a place in Oregon, so he kind of commuted periodically. But Hi was very, very well regarded and still is. He's retired now. Hi was the transition specialist for the Pride Institute, a very well regarded practice management company out of California. And for 35 years.   Kiera Dent (14:44) Mm-hmm.   Fred Heppner (14:50) They referred all the business nationwide to High to develop any kind of transition plan or valuation or partnership or associate ship or practice sale. Well, he was a member of ADS and he actually, I want to say he took me under his wing to some degree because we just became very good friends and he became a really significant mentor of mine.   I fell ill and said, I'm not gonna be able to do this any longer, so you're gonna take over my book of business. and by the way, you're also gonna start doing seminars for the Pride Institute. And I'm gonna introduce you to the people over there so that when they need help, like I've been giving them for the last 30 years, you'll take over. So as a result, we were doing seminars all around the country. So four to five times a year, we'd be in Denver, Boston, Seattle, Orlando, Dallas, Chicago, Philadelphia, you name it.   Kiera Dent (15:30) Mm-hmm.   Fred Heppner (15:43) So people that would come to those meetings were Pride disciples, clients, and they would ask me to help them with their transition. So that became more of a establishing services for dentists that are outside of Arizona, not necessarily creating a footprint in each of those territories. The Pride Institute was purchased by Spear Practice Solutions about 10 or 12 years ago.   Kiera Dent (16:08) Mm-hmm.   Fred Heppner (16:09) So I got dragged kicking and screaming over to Spear and developed a really good relationship with the track practice growth partners at Spear and also Amy Morgan, who was the CEO at Pride out still with Spear. So that's the backstory to tell you that I've done transitions in 26 different States. And it's very easy for me to help provide consultation and guidance for transitions really anywhere.   Kiera Dent (16:12) Thank   Mm-hmm. Mm-hmm.   Awesome.   Fred Heppner (16:39) Florida, as an example, Florida requires a person to be a commercial real estate broker to broker business assets. So I have colleagues in Florida that I refer to. And with my affiliation with ADS, I have boots on the ground in pretty much every territory that if I don't think I can provide value to the client, I simply connect it with the people in my group and everything gets worked right.   Kiera Dent (17:04) That's awesome.   That's amazing. And it's such a fun story.   mean, I think our our paths have crossed on probably several levels. One of my business coaches is former pride. And as soon as you said that, I was like, Oh, my gosh, I bet we both know Liz. I'm sure we and all the different pieces. But I love that because I figured Arizona transitions might some of the listeners might feel like you can't help them and assist them. So I really wanted to clear that up that it's all across the nation in different areas. So all right, Fred, let's dive into like walk us through I know you've got some   Fred Heppner (17:11) Yeah, chances are.   yeah, ⁓ yeah, absolutely.   Kiera Dent (17:36) points.   I know you've got some things of like, what is the transition plan? Like how do doctors get to that level? What do they need to do if they're transitioning? Now again, this doesn't mean you're selling. Right now, I think there's a lot of options to sell, but also like prepping in case life, one of those three mysterious, hopefully never coming to you, like orbs is how feel. I feel like they're like floating around and hopefully they never strike. But what do we do? What are kind of the steps? What are some of the things you have for that?   Fred Heppner (17:56) Yeah, yeah.   Well,   I think the first step in any kind of relationship that I build with a client, it would be a true consultation. And in that sense, it's tell me what your ideal retirement plan or transition plan would look like. You've worked your practice for a number of years. At some point in time, you're going to decide that you will retire from the practice of dentistry. What do you want to do? What does that look like?   What would you be involved with? I'll give you a quick example. Jerry Cox, who's a dentist in Old Scottsdale here in Phoenix, called me and said, I'd like you to help me sell my practice. And I said, I'd be honored, thank you. So I went and saw him and we put together the plan and I asked him the question, what do you want to do? What do you want to do after you retire from practice? says, well, I like to do sculpture. And I said, really, Fred?   Kiera Dent (18:56) you   Fred Heppner (18:57) What have you done? kind of work have you done? He says, well, let me show you. He showed me pictures of the statue of Heather Farr. Heather Farr was an amateur golfer 25, 30 years ago or so, who played at ASU, who was an enormous success, played on the LPGA tour, and ultimately ⁓ developed breast cancer and died. Heather's statue ⁓ was sitting at Karsten Golf Course down near ASU, which they've now plowed.   Kiera Dent (19:20) Wow.   Fred Heppner (19:27) and also at Greyhawk Golf Club. And Jerry sculpted that statue. And I got goosebumps right now. Anyway, so as an example, Jerry has a studio at his house. He said, as soon as I sell, I'm doing that. So the point is in the transition planning phase, know what you want to do. Know what you will occupy your time. If it's turn.   Kiera Dent (19:33) Wow. Yeah.   So Fred, I'm gonna just like ask questions right here because, and   I'm gonna talk for myself. So guys, like this is my own therapy session. So thank you for being a part and a fly on the wall. Like sometimes we don't know. ⁓ So like I feel I'm very much, I know I wanna retire. I know I want more free time, ⁓ but I literally sit here and this, it's like, know how you think about like how time truly never ends. And if you think about like too hard, it actually creeps you out. Like that's kinda how I feel about like retiring of like,   Well, I know I don't want to keep working this hard. Like I don't want to be putting in as many hours, but I still love the impact. I still love the legacy, but I don't quite know what that looks like. And I feel like a lot of times people in their thirties, in their twenties, in their forties, I think as you get later on in life, you probably have more of that clear picture. But what about for those that are very fresh, like that truly maybe some people do, maybe I'm, maybe I'm the only one on my own planet. I don't think I am, but like, what do you do if you don't know what you want to do?   Fred Heppner (20:46) You're not alone. So good. part of the time, what did Chelsea, what did Kelsey Grammer say? I'm listening. So the, the, the idea is that there are portions of people that don't know. There are some that are very clear on what they want to do and there's some that are kind of, well, I'm not sure. My, my recommendation would be, think about it. Then don't answer right now, but think about it because I want you to know what you will be doing when.   Kiera Dent (20:48) Thank you. Thanks for my therapy today, Fred. I appreciate it. Thank you.   Hahaha ⁓   Fred Heppner (21:16) you stop doing this and it may change over time. It may kind of morph into, my God, I didn't know that I really enjoyed painting. Okay. Then, then that's maybe what you might do because as you retire from the proceeds of your sale of your business, you'll, you'll build out a studio in your home or in the Casita or wherever it is. So it, it's okay that you may not know. It's okay that a person may not know what they want to do, but it's important to start thinking about it.   Kiera Dent (21:26) Mm-hmm.   Fred Heppner (21:47) And then we can kind of move into the rest of the, ⁓ the rest of the questions, which I would say, is it a year that you'd like to finish working? Some dentists may want to finish when they're 55. Some may want to work until they're 65. Some may want to finish working when they're 50 or it might be a number. My investment portfolio has to be at $10 million liquid, not including asset hard assets like home.   vacation home, cars, anything like that, boats, whatever, ⁓ but that the liquid assets have a certain number because then I know through my financial planner, because he did a wealth timeline, another side note, right, Kiera? ⁓ He said that if you keep doing what you're doing and you retire at this age and you pull in social security and you have this mandatory required distributions from your portfolio,   Kiera Dent (22:16) Mm-hmm.   Right? Exactly.   Fred Heppner (22:41) you'll be able to have this much money when you're 99. So, and that's just a mathematical spreadsheet that most good financial planners have. And I highly recommend it for anybody who's in business, who's developing a portfolio for retirement. So it may not be, I don't know yet. Okay, good. Well think about it and know that I may circle back during our relationship and ask you, have you given much thought? Do know what you're going to do?   Kiera Dent (22:45) Mm-hmm.   Fred Heppner (23:09) Early on, is it important? Not as much as when it's a three to five year window. When it's a three to five year window from retirement, then we want to talk more significantly about it. Because that will be a good...   Kiera Dent (23:23) got it because that's what I was curious I was like should people be talking   when they're in their 20s 30s or is it something we're like start to think about it I know Ryan and I from Dentist advisors we we talk shop about this quite often of like there I mean there are studies that show that when you retire you actually start to atrophy in life and ⁓ there isn't as much of a purpose and so we talk often of like how can we continue that   mental stamina, the things that are going to fulfill us, whether it's working or something else of philanthropy, like whatever is going to keep you going as a human, whether you're working in the chair or you're not, I think is important. So that's I was curious of like, really probably connecting with you three to five years before we think we might retire, but with the caveat of, hey, if something were to happen to me, what would kind of be my exit strategy? your like death list like I do, like if I die, this is what's going to happen. It's creepy, but it's awesome.   Fred Heppner (24:15) No, it's, it's creepy and it is awesome. And at the same time, it's a really good conversation to have because if we're three to five years out, then one of the first things to do is say, okay, so what's going to happen if you're not here? And that carries on to the discussion we had earlier.   Kiera Dent (24:28) Mm-hmm.   The Dental A Team (24:31) Awesome. Thank you. And thank you, Fred. Thank you, all of you. And for all of you listening, thanks for listening. And I'll catch you next time on the Dental A Team Podcast.  

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

In the DSO world, as in life, financial disappointment can jeopardize growth, making a strategic and realistic approach to profit-making crucial to secure financial health for your business. And yet, many struggle with the concept. In the latest episode of The Dental Economist Show, host Mike Huffaker welcomes Mike White, Principal at Clifton Larson Allen, to explore why proper financial fundamentals are crucial for practice growth, how to position your group for successful transactions, and key strategies for maximizing practice value. This conversation offers deep insight into the hidden financial leaks plaguing many DSOs today, tried and tested methods to unlock hidden profit and the importance of realism and acceptance in it all, reminding us that it pays (literally) to have your financial house in order!

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

Brad Rourke, President and CEO of Scottie Resources (TSX.V:SCOT – OTCQB:SCTSF), joins me to review the key takeaways from the Maiden Inferred Resource Estimate at the Scottie Gold Mine Project, located in the Golden Triangle of British Columbia.  We also discuss the larger Company strategy of building towards a Preliminary Economic Assessment (PEA) utilizing ore sorting to upgrade ore and then take a Direct-Shipping Ore (DSO) development strategy to metals smelters in Asia.   Maiden Mineral Resource Estimate Highlights:   Inferred Mineral Resource Estimate ("MRE") of 703,000 ounces of gold at an average grade of 6.1 g/t gold and assumes a phased open pit and underground mining scenario. Those metrics consist of 528,000 ounces at 8.7 g/t of underground resources and 174,000 ounces at 3.2 g/t in the shallow pit constrained resource, for its 100% owned Scottie Gold Mine Project, which includes the historic mine and the adjacent Blueberry Contact Zone that are located 35 kilometres north of the town of Stewart, BC, along the Granduc Road. The opportunity to further expand both the open pit and underground resources exists as the deposits are open in several directions.   Optimized for DSO Concept: The MRE was designed around mining a shallow open pit in the initial years, minimizing initial capital and using early cashflows to fund the development of the higher-grade underground resources. The high-quality ounces contained within the MRE will be further leveraged when coupled with the recent excellent ore-sorting study results (NR April 1, 2025). The pit provides a potential short ramp up phase to production, flexibility, and low operational risk. This is complemented by the higher-grade underground resource which commands higher payable terms from Asian smelters, avoiding the need for a processing plant on site. The envisioned project greatly benefits from existing infrastructure, including roads, close proximity to a deep-water shipping port, and nearby power lines. By design the DSO project will be a high-margin, variable cost model with industry leading low initial capital costs resulting in a quick investment payback.   Upside Exploration Potential: During the 2025 exploration drilling campaign Scottie will focus on converting the resources from inferred to indicated with infill drilling as well as expansionary drilling on high quality targets close to the deposits. The company notes a particular benefit in targeting the un-drilled pit-constrained envelope on the siltstone side of the deposit (a high-confidence target), as any additional ounces discovered will convert waste to resources and significantly improve the contained ounces. Exploration around the rest of the project will target zones that offer significant upside potential to provide high-grade resources near infrastructure, for example the newly discovered Wolf Zone (NR December 12, 2024).     When reviewing their direct-ship ore strategy, Brad highlighted that Scottie has one of the closest gold projects to a deep-sea shipping terminal, which based on its location is positioned in one of North America's cheapest commercial shipping lanes to Asia. In addition to the ease of a proposed open-pit mine, which already has an existing mine permit, there is also key external infrastructure in place, such as power lines and hauling roads right to site.     If you have any questions for Brad regarding Scottie Resources, then please email them in to me at  Shad@kereport.com.   Click here to follow the latest news from Scottie Resources

The Deadcast makes a beeline for the northeast, focusing on shows from legendary venues in the Manhattan and Boston areas included on the new Enjoying the Ride box, including ESP experiments, weed smuggling, free jazz titans, multiple police chases, and more.Guests: David Lemieux, Ron Rakow, Sam Cutler, Richie Pechner, Allan Arkush, Ned Lagin, Gary Lambert, Blair Jackson, Stanley Krippner, Rebecca Adams, Johnny Dwork, John Scher, Michael Simmons, Tyler Roy-Hart, Henry K, Howie Levine, Kenny Schiff, Debbie RondeauSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

In this episode, Dustin Burleson sits down with the powerhouse leadership team behind Rock Dental Brands to answer one of the most pressing questions in modern dentistry and orthodontics: How do I avoid choosing the wrong DSO?You'll hear directly from CEO Kristi Casey, Chief Development Officer Spencer Lunghino, and Co-Founder Dr. Mark Dake as they share a transparent look into the origins, philosophy, and strategic direction of Rock Dental Brands. Together, they bust myths around private equity, clinical autonomy, and growth timelines—and reveal what doctors should really be asking before joining a DSO.If you're a dentist, orthodontist, or specialist considering your next move, this episode is a must-listen. What You'll Learn:The real story behind private equity in dentistry—where the money comes from and how it worksWhy not all DSOs (or equity structures) are created equalHow Rock Dental Brands evolved from a doctor-led support model to a nationally respected DSOThe biggest myths around clinical autonomy, ownership, and growthWhy Rock's equity model is designed to treat doctors fairly—and how that differs from joint venturesHow to reverse-engineer a smart partnership decision using Charlie Munger's “invert and avoid” philosophyWhat questions to ask during DSO due diligence (and how to avoid future regret) Key Quotes:“We were built to be proud of the work we're doing 50 years from now." —Dr. Mark Dake“You're not giving up control of your practice. You're gaining part of 110 practices.” —Kristi Casey Connect with Our Guests:Spencer Lunghino – spencer.lunghino@rockdentalbrands.comrockdentalbrands.com Resources Mentioned:GreyFinch Practice Management SoftwareDentiCon by Planet DDSVistria Group – Private equity partner of Rock Dental Brands Subscribe & Review:If you enjoyed this episode, please leave a review and subscribe to The Burleson Box on Apple Podcasts, Spotify, or wherever you listen. Your support helps us bring powerful conversations like this to more listeners in healthcare leadership. ***The Burleson Box is brought to you by Stax Payments:Save Big on Transaction Fees: Boost Your Bottom Line with Stax Payments.Did you know that your practice can start saving thousands of dollars on your monthly processing costs with our preferred payments partner, Stax? Simplify your practice operations and provide a quality patient experience. Healthcare practices like yours need a way to accept payments simply and securely. That's where Stax comes in.Stax helps you manage your entire payments experience from within one platform. You can safely accept touch-free payments in-person, online, or over the phone, securely store and manage patient information with layered security and Level 1 PCI compliance.
Take advantage of a simpler, more transparent way to process your payments with competitive flat-rate pricing, provided exclusively through Stax. No additional fees or contracts required!Power your practice and get paid faster with simple, safe and secure payment solutions. Have questions? Schedule time to speak with a dedicated payment consultant to learn more.Click Below to Lear More Today:StaxPayments.com/burleson-seminars*** Go Premium: Members get early access, ad-free episodes, hand-edited transcripts, exclusive study guides, special edition books each quarter, powerpoint and keynote presentations and two tickets to Dustin Burleson's Annual Leadership Retreat.http://www.theburlesonbox.com/sign-up Stay Up to Date: Sign up for The Burleson Report, our weekly newsletter that is delivered each Sunday with timeless insight for life and private practice. Sign up here:http://www.theburlesonreport.com Follow Dustin Burleson, DDS, MBA at:http://www.burlesonseminars.com

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!  

May has arrived, and with it comes warmer evenings, vibrant landscapes in full bloom, and a night sky packed with incredible sights to enjoy. Whether you're setting up a telescope, grabbing a pair of binoculars, or simply stepping outside to look up, there's plenty to see this month.In this episode, we'll explore some of the highlights of the May night sky: Which planets are visible this month, when and where to look for them.  We'll spotlight one of the Moon's most breathtaking and detailed features, examine a meteor shower, a comet and then we'll take a tour through one of the sky's most underrated, but rich constellations.Whether you're an experienced astronomer who's been observing for years, or you're just starting your journey into the night sky, this episode is packed with tips, background information, and observing advice to help you make the most of your nights under the stars.Make sure to subscribe to the AstroGuy Podcast for monthly sky tours, deep dives into celestial phenomena, and tips to enhance your observing experience. If you enjoy the episode, please subscribe, comment, and share, and leave a review on your favorite podcast platform. Carpe Noctem!Links:Feel free to buy us a cup of coffee or two! We really appreciate it! https://tinyurl.com/AstroGuyCoffeeOur Facebook group page: https://www.facebook.com/groups/astroguypodCranford TV-35: https://www.cranfordnj.org/tv-35Clark TV-36: https://www.ourclark.com/194/Clark-News---Our-Clark-MediaOur “Astronomy Basics” episode: https://youtu.be/MtUkLVneNYs Comet SWAN information: https://theskylive.com/c2025f2-infoMay 2025 Episode Guide: https://tinyurl.com/AGMay2025GuideThe Full Episode Guide of DSO's sorted by Catalog Name: http://tinyurl.com/AGFullGuideAffiliate LinksHigh Point Scientific: https://www.highpointscientific.com/?rfsn=7714880.bb6129Amazon: https://amzn.to/4gFQmOG Music Credits:Spring Flowers by Keys of Moonhttps://soundcloud.com/keysofmoonEvening Improvisation by Spheriáhttps://soundcloud.com/spheriamusicAdrift Among Infinite Stars by Scott Buckleywww.scottbuckley.com.auRelaxing Chill MusicARNOR by Alex-Productionshttps://onsound.eu/ Music promoted by https://www.chosic.com/free-music/all/Creative Commons CC BY 4.0https://creativecommons.org/licenses/by/4.0/

On today's Part 2 episode of Dr. Mark Costes' interview with Matt Mulcock, CFP, managing partner at Dentist Advisors, they break down the evolving financial landscape for dentists. They discuss the rise of private equity and DSOs, how practice valuations have shifted from collections-based to EBITDA multiples, and the critical decision-making process when considering a sale.   Matt also emphasizes the importance of financial organization, understanding incentive structures in wealth management, and assembling a “personal board of directors” to navigate major career and investment decisions. If you've ever wondered whether selling to a DSO is the right move or how to maximize your long-term financial health, this episode is packed with insights to help you make informed, strategic choices. EPISODE RESOURCES https://dentistadvisors.com https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

The Deadcast's tour of Enjoying the Ride trucks all the way to the East Bay, exploring beloved venues including the Greek Theater & Kaiser Auditorium, with tales of the Hog Farm's Skeleton Crew & vintage field recordings from Oakland Coliseum Arena's parking lot. Guests: David Lemieux, Ron Rakow, Kevin Schmevin, Mark Pinkus, Blair Jackson, Steve Silberman, Rebecca Adams, David Gans, Johnny Dwork, Tyler Roy-Hart, Steven Bernstein, Robert Nyberg, Chad KroegerSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

On this episode of the Dentist Money Show, Kyle Francis, founder of Professional Transition Strategies joins Matt to break down the evolving landscape of dental practice transitions. He emphasizes the importance of education, preparation, and strategic decision-making. They talk about some of the common misconceptions about DSOs and highlight the benefits of joint ventures. Tune in to hear insights on how to maximize your practice's value and better understand the consolidation trends in the dental industry. Check out our Dental Practice Valuation Calculator to get an estimate of your practice's worth. Use this easy tool if you're considering selling your dental practice, merging with a DSO, or planning your financial future! Book a free consultation with a CFP® advisor who only works with dentists. Get an objective financial assessment and learn how Dentist Advisors can help you live your rich life.

In this episode, we welcome back Brian Colao, the Director of the DSO Industry Group at Dykema, for an insightful discussion on the current state of the DSO market as we move through 2025. Join us as we dive into: The challenges and opportunities now in the DSO space The impact of economic factors on mergers and acquisitions The rise of same-store growth strategies Updates on the upcoming Dykema DSO Conference, including exciting workshops and networking events Special highlights include the Glo Lounge and keynote speaker, John McEnroe Brian shares his extensive experience in the industry, providing valuable insights for both newcomers and seasoned professionals. Don't miss out on this informative episode packed with expert analysis and practical advice! Key Details: Dykema DSO Conference Dates: August 6-8, 2025 Location: Gaylord Rockies, Aurora, Colorado Discount Code: Use GDN25 to save $250 on registration! For more information, visit https://dykemadso.com/ and be sure to subscribe to our DSO Weekly e-newsletter at https://www.groupdentistrynow.com/. Don't forget to like, comment, and subscribe for more episodes!

On today's episode, Dr. Mark Costes sits down with dental attorney Matthew Odgers, founder of Odgers Law Group, to break down the legal essentials every dentist needs to know. Whether you're buying, selling, or entering a partnership, Matthew shares expert insights on avoiding costly mistakes, negotiating lease agreements, and structuring airtight contracts.  They also discuss the importance of due diligence when purchasing a practice, navigating lease challenges, and why well-defined partnership agreements are crucial for long-term success. Plus, they dive into the pros and cons of selling to a private buyer versus a DSO.  EPISODE RESOURCES https://odgerslawgroup.com https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

In this episode, Dr. Tehaum Saood shares his journey as a new dentist, discussing the challenges and experiences he faced transitioning from dental school to practice. He emphasizes the importance of finding the right job, seeking mentorship, and being intentional about career choices. Dr. Tehaum also provides practical advice for new graduates on job searching, interviewing, and navigating the early stages of their careers in dentistry.Dr. Tehaum's page: https://www.instagram.com/onemissiondmd/Engage with the podcast on Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/dentaldownloadpodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Haley's Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/dr.haley.dds⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Keywordsdentistry, dental school, career advice, mentorship, job search, Aspen Dental, new dentist, dental practice, professional growth, dental education, DSO, dental support organization jobs, DSO jobs, reality of dentist, dentist life, associate dentist

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!  

Kiera talks about the numerous shifts on the horizon in dentistry, what your practice can do to embrace the changes, and how Dental A-Team can help. Episode resources: Sign up for Dental A-Team's Virtual Summit 2025! Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: Kiera Dent (00:01) Hello, Dental A Team listeners. This is Kiera and I am so excited to have you on the podcast today. I hope today is just an incredible day for you. And I hope you remember you are in the greatest industry possible. And today I'm really excited because I feel like there's some opportunities to discuss and challenges that I think offices are gonna be facing in the next five to 10 years. I wanted to pop on and just say like, hey, dentistry is changing fast. And my question is, are you and your practice gonna be ready to seize the opportunity or?   Honestly, are you going to be struggling and hanging out in the back? I think that there will be a lot of shifts. I think we've seen a lot of shifts in dentistry. And so really just popping on to help you look for different things for technology, patient experience, different things within the practice, and really be able to help you guys prepare and get your practice there. Do you guys know Dental A Team? We are here to serve. We are here to help you and your practice have the best experience. I truly do believe that running a dental practice that's profitable and successful does not need to be hard. It does not have to be crazy.   and it can actually be fun and we can get doctors and team members aligned to be able to work in tandem together. And so that's why we're here today. I'm super excited because honestly, staying ahead of these trends is going to help you have long-term practice success. I've really been watching in the offices that we consult, the ones that are adapting and early adapters to technology, I think are going to be in the forefront. And so really just looking at where you are in the life cycle of your practice, looking to see where you want to be in the next five to 10 years.   and not making decisions to sell or to go to a DSO or to stay in a legacy practice out of necessity, but actually out of choice. So number one, I think that AI is coming in. AI is coming in pretty popular. There's a lot of different things. So we're having it in diagnostics. So like Pearl and Overjet, they're able to help co-diagnose with you. There's 3D printing that's coming in. I know offices are using AI and creating bots. We have an office.   where they've created an actual 24 hour a day bot for their practice. And I really think right now is a time for you to be learning. So whether it's 3D printing within your practice, automating our patient communication, looking into AI like this practice where they have a bot, using chat GPT for other things, utilizing AI, think helping practices with case acceptance. We've talked with Pearl, I've had Pearl on the podcast before, but what's crazy cool about that is offices are utilizing it.   actually you're seeing like a 30 to 50 % increase in case acceptance just by using this AI assisted technology. And I prefer Pearl over Overjet. Honestly, I think that there's no wrong choice on it. But the reality is like, I think you've got to get these things in motion. You've got to start looking for them. Otherwise, I really am concerned for you as a practice that you will accidentally become outdated. So really making sure that you are, you're working through this, that you are adding these things in because I think   AI is going to rapidly take off. And if you're not prepared, I think you will be outdated. So that's opportunity number one. So I'd say get involved in some sort of AI, whatever it is, even if you just start dabbling in chat GPT every single day, whatever it is, but really starting to utilize that. Opportunity number two. Now these are the opportunities that I see in the next five to 10 years. I think they're hitting this now. But number two is going to be like looking at membership plans, fee-per-service.   looking at some of those things. Now I'm not here to say drop insurance plans. I've actually been, think a consultant who's been pretty adamant about hanging onto insurance plans for as long as you can, pending upon what you want to do for marketing. If you're an incredible marketer, rock on, you might not need it. But insurance is just going to be something where I feel over time, it's going to get a little bit funkier. I don't think you're going to see a huge increase in insurance funds. I could be totally off on this. I'm not stamping my like everything that I am, but I think like, let's pay attention to it and let's see.   costs are rising in dentistry, but insurance plans are not paying a lot. And so could we start to shift our patient base? Could we start to retain our patients and actually build this fee for service model in? Now you've got to be super careful and I'm going to put like huge asterisks and exclamation points and pieces around it because if you do not transition out of insurances correctly and have a plan and a process and a patient experience in place, you will get like, I've seen it be so bad for practices. So really I think like,   One, if you don't have an in-house membership plan, let's get that started. I'm very pro these. It allows you to have options in the future. It allows you to have different marketing strategies. I think a lot of people are just looking at benefits at a different way now. And I think it just helps you to not be as dependent upon insurance in the future. Then number two is assess your insurance plans. And let's see, are there maybe any insurance plans that we could drop that aren't really going to hurt your production? You really got to do this strategically. Otherwise it will burn you in the booty.   and I do not want you to be at that practice. I've had too many of those offices, so let's make sure you're not there. And then make sure that we're like really getting people sticky to our practice. I think this will be a really, really, really big change for people. And then also it's something where even as fee for service patients, if you can get them on membership plans, I can speak for myself. Being on a membership plan, I actually came in for my two cleanings as opposed to a fee for service patient who often will only come in one time.   So I think it's just another way for you to have more patient flow, more opportunities to diagnose by having that membership plan. I have a practice where they were, this is me as a patient, I was going to them and they had a membership program. The doctor left, branched off, opened up their own practice and they don't have a membership program. And I was like, well, sweet, maybe I'll just go to you once a year. This is as a consultant. I know I need to go in twice a year. I know I have amazing teeth, but I don't need to go twice a year. Like honestly, if I only go once a year, my teeth are probably fine.   but if they had put me on a membership plan, there are other opportunities. For example, you could offer me a night guard, you could do whitening on me, you could do fluoride treatments on me, but because they're not putting into place a membership plan, odds are I probably won't be going back. So look to see how can we actually get our patients to be retained in our practice, not dependent upon insurance. So when we start to trickle that down, we start to convert more and more of our patient base. And what I will say is a lot of practices have transitioned say,   30 % of their patient base over to a membership plan. They start practicing on this, they start getting used to it. So when they want to drop insurance plans, they have a solution that's been really ingrained into their practice. The team's really good. I'm obsessed with companies like Dental Menu. I think that they do a great job for membership programs. I think that they've got a great one built. BoomCloud Clear. So you can just take a look to see who you like the most for it. And then I'm really obsessed with Moola. Moola, I think is a great credit card processor for you.   that actually helps you with your membership programs in-house so you can actually save on your credit card fees. I'm really pro them. Any of these companies that I'm recommending today, be sure to tell them, Denali team, you heard it on the podcast because they actually have a referral pricing for you. So that's what I negotiate. We don't do hardly any affiliates within our company. I just negotiate the lowest fees for you. but really I think looking to see, I think it's an opportunity for you with insurance plans and the economy to start adding in a membership.   Opportunity number three for you is looking into, tell the dentistry I don't think like hot, hot, but I do think virtual consult and online payments. So how can we make things easier for people? So can we get a virtual consultation? Can we start to have, I know there's like, we've had other people on our podcast before where they do virtual, like your smile, what is it? Your virtual smile consult. And what you can do is you can actually do treatment planning. You can have new patients meet you.   You can have videos on your website where it's like, hey, I'm the doctor. They can actually ask questions to the doctor. I have seen a lot of this with bigger cases come into pretty strong effect. Also, if you're wanting to do say consultations where maybe we're doing bigger treatment plans or even like full mouth cosmetic, there's a lot of those that I think are out there to help virtually. I have a doctor and they do a lot of what's called hybrid. So all on X cases and there's a software they can literally use and show the patient their new smile sitting in the chair.   So I think whether you're having patients virtually meet you or if you're using that technology within the chair to help present your cases better, having online options, so online scheduling, online payments, those types of things I really think we need to get more into the virtual world. I think dentistry is a smidgey dated. So I would strongly recommend for you on this to see how can you actually add these pieces into your practice because I do think these are going to like enhance you and just be something patients are expecting. Right now patients are expecting online.   patient scheduling, they're looking for online payments. They're looking for, mean, think about it. If I want to have a consult, my husband and I, we've done IVF. I've talked about it a couple of times on the podcast. I did a virtual consultation with my IVF doctor in another state and we went and we went, now, if you know IVF, IVF's around a 20 to $25,000 process per cycle. And so thinking about that in comparison to dentistry, they literally did virtual consults with me so I could be out of state, I could fly in.   I didn't have to actually be there. And so looking to see, that's what modern medicine is doing. What things could we actually do in dentistry that might be able to help us out as well? So I really think looking for that, that's where I mentioned Moolah, they're great for online, your smile, your virtual, gosh, I'm like botching it. I think it's your smile virtual consult, virtual smile consult. Look it up, that one I'm not as strong on. But just see how can we incorporate some of these items within our practice.   And I would really say that when you do this, you're able to get those high case acceptance. You're able to have more patient acceptance. Think about it. We're paying bills online at night. We are also scheduling appointments. I am constantly on my phone in the middle of the day, at night, on the weekends, moving appointments around, looking to see. And I think if we're not offering that for our patients, we're actually gonna get left behind because patients might accidentally leave you to go to a practice that's actually more up to date. So definitely.   Let's get into how can we become more virtual online. I think it's a huge, huge, huge opportunity for practices. Like I said, I think those are the top three opportunities right now. So we've got AI, membership programs, and then getting more virtual. So virtual consults, virtual like having more available online options. And then I think two of the big challenges in the next five to 10 years, which I think we're seeing it, which I think tie into the opportunities are,   We know it's expensive to run a dental practice. And I think dentistry has had this like nice run for quite a few years, decades where they've been able to stay in a very profitable margin. Hence why DSOs have entered the playing field. And so I think with inflation, higher payroll, supply costs, I think that there's some things in there to pay attention. And number one is you've got to know your number. So I'm really pro overhead calculators, looking at it, having your team involved with you, making sure that all of you are on the same page.   Those are gonna be some really good ways for you guys to stay on top of it, not falling out behind the scenes and figuring it out. Then utilizing buying group things. So for example, Synergy is a great buying group. You buy from your own preferred vendor, but you just get a discount on your supplies. Why not do things like that? How can we actually look to see, can we hire hygienists in and then have a base plus commission? and I were on the podcast.   a couple of weeks ago talking about how we can incentivize hygienists and not have to have as high of payroll, but really looking to see what are the ways that we can do this, looking to see how we can increase our fees, doing a 5 % fee increase, negotiating with insurances or possibly dropping some of those lower paying ones. What are some of these pieces? And what I will say is When you watch your numbers and you analyze your overhead, I promise you, you will be more profitable. So right now we're like, gosh, it's so expensive, which I'm not here to say it's not.   But there's offices out there that are running at a 35% overhead. So that means there's 65% profit margin for them. So looking at that and knowing that there's practices that are able to do that, that means once we know it's possible, then we can look for how you can do it in your practice as well. Now I understand that there's different areas. California is expensive. Hawaii is expensive. Like I hear you, but that doesn't mean that it's impossible. And I think being a wise steward over your numbers is actually something that I really would implore you to do.   to make sure that as costs rise, you know what you're actually spending money on. So you can actually make better decisions. look to see, can we hire this person? Are we paying within the realm? What do we need to do? Could we add on other services within our practice? all on X cases, ortho cases, things like that. But I really think like it's a huge challenge that I think you've got to stay on top of. Otherwise, before you know it, you're gonna just be like inundated and not be able to hire team members because we weren't watching it. We didn't know our numbers. We didn't know what we needed to be producing.   We didn't build block schedules to make sure that our practice could actually run lean and efficiently. And then challenge two, which I think has been hitting hard, which we'll just kind of address, is like staffing shortages and team retention. But I will say that this is like an if. Like there's so many offices out there that I know have incredible cultures. And so what I really feel like needs to happen in this realm is you've got to be an office that in a place that people want to work for. I started noticing that the new currency is time.   Time is the new currency, I think, in where we're at right now. Time and compensation and being happy. But I don't think it's as high on compensation as people think it is. Yes, it's a piece, but I see team members that are getting paid less, but for great cultures are saying because they want this work-life balance. They want more time. They want to be able to be with their kids. They want to be able to feel appreciated with their boss. They want to feel like they're doing a great job. And that is more the currency of today. And so how can you build this culture where   We attract a bunch of people to our practice. We have team members that want to stay with us and that we actually know that, like, we're looking to see how can we maximize this. I am seeing a trend, I'm not saying this is how you have to be, but I am seeing a trend where there is a four-day work week of employees actually tends to lead to less burnout and less team turnover. I don't know what it is. My five-day practices tend to have a bit more of that, but the four-day, and again, they, so they're not,   just open four days or open five days, but they have these rotating shifts and rotating days where they're off. I have seen that that's helping. And so I really feel that when you can build this amazing culture, build it to be a place where you're excited about, add fun things in, watch your overhead, watch those costs. But I really think it's something that's possible. think back to why you started to practice. You wanted to change, you wanted to do things differently. You want to have a team where you were so excited. I know that's what I get excited about. love, I love having a team. love.   loving on them. I love giving them opportunities. I love seeing them flourish in their lives. I love being excited for the growth they're having and so really trying hard to build this incredible team culture to cut the team turnover, to keep it to where you're this like raved about practice where everybody wants to work for you. I think would really, really be an incredible thing for you to just take on. And I know we've heard about it, but I think like, look at your culture, look at the things. I had to do a deep dive of this last year.   Britt and I, sat there and we're like, all right, what is the team saying? What are the issues that we know we're seeing consistently? And what do we want to do to change to make this a better environment and a better space? And I feel that only teams in incredible culture, but there were things that we were struggling with. were things of that we needed to change. There were things that had shifted since I started the company. And I think you've got to stay on top of that. Otherwise, I think you can easily get outdated. So that's a quick wrap.   I think the biggest opportunities are definitely AI membership programs and then also getting virtual, like getting everything up to date and online. And then challenges of course are going to be higher costs and then staff shortages and team retention. But I honestly believe that those who adapt, those who innovate, those who listen to this and they don't just passively listen but actively implement are going to flourish. They say a lot of times the biggest millionaires and billionaires are born during times of hardship and harder times. And so I think   Instead of looking at this like, my gosh, the world is falling apart. Look at this. I'm like, this is the greatest time in dentistry. This is where you get to rise to the top. This is where adding customer service or doing unreasonable hospitality or being a different work culture will actually set you apart. Like you have a chance, like it's not all just set anymore. You have a chance to shuffle and ruffle and make your way to the top. And I honestly believe that you can future-proof your practice. You can get ahead of these trends. You can look ahead and   You can be the practice who is proactive and looked and saw where to get the worm and how to navigate your practice rather than being the one who wished that they would have innovated sooner. And so really just to call the action and truly if you want to future proof your practice, you want to get ahead of these, us. We're on Instagram, DentalATeam or email us, Hello@TheDentalATeam.com I'm happy to pop on a strategy session with you, give you a free practice assessment for your practice to look at maybe where the gaps are, maybe where your blind spots are, maybe we can help you out.   And honestly check out our newsletter. We have a newsletter that goes out so you can always subscribe go to our website TheDentalATeam.com We try to keep you guys on top of this of just insights and knowledge to where we can really help you and your practice thrive And so really this is truly what the Denali team does. This is who we are This is what we love to do and if you're ready to take on opportunities and overcome your challenges reach out Now's the time I do not believe that having a practice should be hard. I do not believe that these things are just   Let me talk about it. It's time to implement. time to take action. And it's time for you to be the elite practice that you were destined to be. And as always, thanks so much for listening and I'll catch you next time on the Dental A Team podcast.  

In this week's episode, we discuss the month's news items we've found most interesting and relevant to making machinima, including more great projects to be inspired by, genAIs we've spotted, Steam's rip off, inZOI's challenge to Sims and the phenomenon known as the 'Minecraft Movie'.  Check out our discussion and do add comments on our YT or blog posts.1:18 Projects: a zombie film in GTA5, Trillo's Cuco, NeuralViz' Tigg Talk – an alternative perspective on tariffs3:33 The speed of a creative and production process – efficiencies and pivoting to topical content a la South Park!6:25 Anomidae's game explainer, Platinum WoW's documentary about early days of World of Warcraft, GTA6 mAIchinima9:00 GenAI updates: Sesame, ElevenLabs Actor Mode, Runway's gen 4, ChatGPT's image generator, Studio Ghibli's backlash, DSO physical generator, Recammaster tool, Phil's examples of how the tools can be used, volumetric capture, vtubing WarpTuber, Animes and Facerig, 26:28 Reallusion and Apple Arts Studio's Animation Shopee28:00 Steam's share of revenue and algorithmic bias29:41 Nintendo's Switch 231:09 Mocap studio at a comicon – who were they?32:45 John Robertson's show The Dark Room35:40 InZOI release – more photorealistic than the Sims, and an intriguing looking engine – what will happen to Sims now?45:30 The Minecraft movie – a renewed interest in machinima (or not!) and the Rocky Horror Picture ShowCredits -Speakers: Damien Valentine, Phil Rice, Tracy HarwoodProducer: Damien ValentineEditor: Phil RiceMusic: Animo Domini Beats

Kiera is a guest on the Dentalligenstia Podcast, hosted by Nick Zagar and Remy Isdaner. She talks about the connection between success and knowing your practice's numbers for the following: Production Overhead Collection New patients Case acceptance Kiera also gives tips on streamlining workflow, working through scratch starts, startup versus seasoned practice needs, and more. Episode resources: Sign up for Dental A-Team's Virtual Summit 2025! Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript: The Dental A Team (00:00.16) Hello Dental A Team listeners, this is Kiera and today I am so excited. I did an incredible podcast and I just thought it'd be fun for you guys to hear it, to listen to it. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast. Welcome to the Dentalligentsia podcast. I'm Nick Zager and we have Remy Isdaner, my partner, and we are Mirlo Real Estate Partners. Today we have a special guest, Kiera Dent from the Dental A Team. Welcome Kiera. Thanks guys. I'm super excited to be here.   I love what you guys are doing. I'm just jazz. And I'm glad that I didn't have to say the name of your podcast because I would have totally botched that. So thank you for taking that on for me. I love what you guys are doing. And I'm just super, super excited to be here. I love geeking about dentistry and business and all things. So thank you guys. I'm really honored to be here. We appreciate that. you know, our favorite clients are typically early to mid-career dentists. And we love what you do to support.   our mutual clients and really want to know a little bit more about you and why you do what you do. How did you get into this? Yeah, for sure. Well, luckily for both of us, we love the same type of clients. So it's really fun. I actually started my career in dentistry in high school. I was offered an opportunity to either go into nursing or dentistry. And I thought, hmm, I want to wear scrubs. Like that was my end goal. And I thought, learn the whole body or learn the mouth. I'm surely going dental route. So that was honest to goodness. The reason why I got into dentistry.   I was a dental assistant for years and then became office manager, treatment coordinator, scheduler, biller, you name it. I have not been a hygienist and I'm not a dentist, but my husband, he went to pharmacy school at Midwestern Arizona. And during that time, I'm a little hustler. I found out if I could work at the college, I'd get a discount on his tuition. And so I knew there was a dental college and so I found out, got a job at the dental college.   And I was super blessed, super fortunate. And I worked there for three years with dental students. And one of the students asked me while we were in school, she said, hey, Kiera, do you want to come help me open my practice in Colorado? And I was like, heck yeah. Dental assistant to practice owner. Like, this is a great plan. I never knew how I'd be able to do this. I'm not a dentist. And I'm like, I see what you guys do in dental school. Yes, I want to say yes to this. So I went and helped her open the practice in Colorado. And we took our office from 500,000 to 2.4 million.   The Dental A Team (02:25.773) in nine months and opened our second location. And what I found from that was I learned a lot. We built a pretty big group of practices and I learned so much from that of what not to do. My marriage was about in shambles. Her marriage was about in shambles. My health was deteriorating. I was working from 2 a.m. till 10 p.m. trying to make these practices grow and I thought, well, shoot, one, if I could help her grow a practice, I wonder all my other students that I love.   Could I help them grow their practices and give them the confidence as well? And two, there's got to be a better way to do this than what I've been doing and what she's been doing. Like, yes, we have success on paper, but behind the scenes, we're deteriorating as human beings. And so that's really what spurred my passion. I never worked with a consulting company. Everything that Dental A Team's consulting is are things that I wish I would have had when I was a practice owner, things that I wish I would have known.   things to help all of my dental students. It's fun because it's becoming full circle. A lot of those students are now buying practices and coming and working with me, which is super fun. But really the passion comes from how can I help these dentists live their best lives, get the profitability they want, but also get their team bought in because most consulting companies work with just the dentist or just the team. And I thought, but if I can get the team on board, these dentists lives become a lot easier. And so it's really fun to talk about both sides of the coin.   And shoot my last name is Dent. So I think I was destined for this career path. It's not a stage name It's just the third fiance finally like I didn't get married I just took three fiancees to get a better last name So that's kind of my story and how I got into it and truly just love love this industry and love helping dentists Flourish and succeed and help more people But nursing never had a chance Yeah, I mean the scrubs if it would if they would have cuter scrubs than maybe but   The fact that I had the short path didn't just the mouth, but it's funny. I don't even get to wear scrubs anymore. like, man, that was a short lived moment. yeah, nursing. don't think I could do rectal trumpets. That's just like, I mean, I'll take the mouth all day long versus that. I don't think I could. I have such a gag reflex. I don't think I could honestly do it. Well, talk to us about some of your favorite client stories. gosh.   The Dental A Team (04:39.725) So knowing that like the startup to the mid range are kind of the ideal clients, I was thinking of a couple and one comes to mind. He attended one of our summits. We have one in April every year for doctors and teams. And so he attended it. And I remember he had like a really funny name on his screen because I see all the participants. I really try to make our summits really engaging and active. And I remember it was iPhone. And so I just kept calling this person out. was like, hey, iPhone, how you doing over there?   just kept kind of like razz and I had no clue there's no camera on it just says iPhone and lo and behold iPhone decides to sign up with us and he had just bought his practice and paid in full for consulting which I was always like man that's a pretty like gutsy move you just bought a practice but I also like people that are gutsy and this committed to it and what was interesting is we'll call him iPhone if you listen to this you'll know exactly who I'm talking about but over the course it's been about two years now iPhone has gone from   Being a practice owner who literally knew nothing about ownership had a pretty seasoned team when they bought their practice And went through all these hard transitions like I'm telling you this was a labor of love on both sides the consulting side and his side from needing to transition out his office manager who was really really causing a lot of like Shakes within the practice and and driving the team in a direction. He didn't want to go   So learning how to hire, learning how to lead, learning how to present treatment plans, learning how to put KPIs into the practice. Like you want to talk about a jumpstart to business ownership. And I remember he's like, Kiera, I'm not even taking home a paycheck. And those moments always rock me because this is real life for a lot of dentists. And my goal is to help them get to taking home their paychecks quickly. And so about six months, he was taking a little bit, but we started like at six months, he was able to take his full paycheck and then fast forward to   I just saw him actually last weekend and he was sharing that now he's producing over 250,000 a month in his practice, collecting home a paycheck, has a new office manager that was sitting next to him. They've shifted the culture. This office manager said that this doctor like makes for Phil Seen, Heard and appreciated. He understands his KPIs. He's got a profitability margin of 60%, which makes me so proud.   The Dental A Team (06:59.629) excuse me, his overhead 60 % profit margin of 40%. He knows his numbers. He knows how to look at it, getting ready to possibly expand his practice. But he said, we were just meeting last week and he said, Kiera, I want to give back because Dental A Team's given me so much. so having him help coach other practices now of things that he's learned really just inspires me. But I think about this man of...   like the rocky road he went on to get there. And I think that his journey is not unique. I think this is so common for so many owners who buy practices two, three, four years in, but to be able to have him be an example of what can happen and for him to be going from about 150,000 when he first bought the practice to now doing 250,000 a month, just to give him the confidence, I think as a leader, as a dentist, to get a team bought in and on board.   the fact that he knew his numbers and it's been, it'll be two years in April since he bought his practice and joined. And I think that is one of my most favorite stories because to see him excited about life, to see him excited about his practice when there were some dark days, I remember like his name, we'll just say iPhone was on our schedule a lot of times to give more support and to review resumes and to teach him how to hire for culture and to build a culture.   That is a magical experience. And there's, like I said, so many things from KPIs to numbers to culture to hiring to diagnosing and getting patients to accept you when the other dentist was still a part of the practice and moving on. He's honestly one of my favorite clients because I think his story is so relatable to how so many other people feel. And to see him now on the other side of it, truly beaming, I think is honestly one of my favorite stories. I have so many favorite stories.   But I think he's a really recent telling one that is just a fun success story to share with people. That's super cool. And he's got a great name. I know, right? iPhone. I'm like, it's easy because I was like, who is this? Who shows up? Like, I hate it on meetings. Like, get your name of who you really are because I want to call you. There's another, she's now a client. And I was speaking in person and, you know, front row, was like, hey, what's your name? And she's like, I'm going to be anonymous.   The Dental A Team (09:13.803) So we have a running joke now that she's just anonymous, even though she's a client now. And she's like, I'm so glad. But now she's like, secretly optimistic anonymous. So, you know, we've kind of changed that around, but yeah, it's fun to have clients show their personalities. But yeah, if you're on an event, put your dang name on there. Otherwise, maybe you'll be iPhone forever. Fair enough. I'd rather be iPhone than anonymous, but point taken. I've got a serious question.   for you based on that great story, but first I'm gonna joke. So it's on record in our company, there's a iPhone, Samsung battle and I'm on the iPhone side and Nick's on the other side. And we have it on record here on this podcast that Nick said something to the effect of, that sounds awesome being iPhone or iPhones are awesome.   So just just want to make sure that that we're all in the same page there, you know, Remy I'm happy in our company. It's the same. It's like Apple versus HP I'm diehard Apple everything connects in so seamlessly. So Remy we're on the same. Yep. I phone over here It's definitely definitely for the Samsung. I'm sick of the green bubbles, but they are getting better now I can see that you're writing I can see that it's been read. So I mean, hey, they are making some progress, but that's been like, you know decades in the making speaking the same language   Okay, as promised, I'd start with jokes and then, you know, that was a great success story and your passion is clear. Let's talk about those KPIs. So what are some of the KPIs that young dentists, newer dentists should be looking for? And I asked that question and then also add a preface. We talk to doctors all the time who have no, it's clear they have no...   connection to what the business side of dentistry is doing in their own practice. And I get it, we get it, that they didn't set out to run a business necessarily. They set out to provide the best oral health to their community. But it is a business after all. And so what are some of the things that those young dentists should be looking for? Remy, I'm so grateful you asked this question. It was not pre-planned.   The Dental A Team (11:36.073) My passion came actually from teaching people how to run successful businesses because as a business owner myself, profits seemed elusive. I remember like, what the heck is a freaking KPI? I didn't even know what that meant. And I really love in dental hygiene, there's no judgment. And I just want people to feel safe and confident to ask those questions. And I think dentists really feel this need to know everything because you are a doctor. And I just want to highlight that, guess what? None of them know it. Like 99 % of dentists that we work with   don't understand the business, but yet understanding the business and the numbers, I feel is like your treasure map to success. It helps you see where are broken systems in your practice to fix. So rather than just trying to pump a bunch of systems, let's look at the numbers to see which system we really can impact. Also, when you know your numbers, you can make smarter decisions of who to hire, when to hire, things like that. And so for people who don't understand KPIs, like I said, someone told me that I was a Dr. Seuss of systems. So I take that.   as a huge compliment to try and make it so simple for people. I believe KPIs are like the vitals of your practice. It's like when you go to the doctor, they always check your like height, weight, your blood pressure, your temperature. They're gonna check those things because if any of those things are out of whack, we're gonna have like an immediate plan. And I feel like that's similar to KPIs within a practice and KPIs can get a little extensive. So if we're talking about a brand new practice, things I start small and then we get bigger.   And so like main things that are really going to give you a nice suck on your business, if you're not careful are going to be your cashflow. So that's going to be your overhead. I'm watching your production and your collections because oftentimes the practice is producing enough, but your team's not collecting that money. So we want to make sure we have a 98 % collections ratio. I'm also going to watch your AR. So AR is your accounts receivable, checking from patient portion and insurance portion, because a lot of times practices actually have the money in their practice.   but they're not collecting, it's just kind of sitting there in overdue payments that are due to you, whether that's from patient or insurance. If we can look at those, we can figure out where's our collection problem. it we don't have clean claims sending to insurance or we're not collecting from patients and we're sending statements or we're not even calling. So I'm really gonna watch those super, super tight. And then if you want to go, excuse me, further down the line and things that I'll watch are gonna be like your lab costs, your supply costs, marketing can come into place.   The Dental A Team (14:00.685) scheduling, we can look at your scheduling and see like number of new patients coming in. That's a big one that I really like to watch because if we're not getting enough new patients or on the flip side, we're attritioning, AKA we're not keeping them in for re-care and reappointment percentages. We can get a leaky bucket and just keep filling with new patients but not retaining the ones that we have. So I like to watch your attrition rate. I also like to look at your case acceptance. So what are you diagnosing and what's being accepted to see is it a diagnosis problem?   or is it an acceptance problem? Whatever doctors wanna make, there is a study and a standard of three times what you wanna produce is what you need to be diagnosing. So if you're not watching this diagnosis amount, you might not be diagnosing enough to be able to get what you want on your schedule for your production. So I like to watch that. And I like to watch your case acceptance of dollar for dollar. So if you're presenting a thousand dollar treatment plan, how much of that thousand is actually being accepted? Are we accepting 100 % of that? Are we accepting 50 % of that?   and then asking questions of why, because case acceptance is usually one or two words from our exam to our treatment coordinator. And then I like to watch your hygiene percentages. So what's your hygienist producing per hour? I like three times pay for PPO practices, and I like four times pay for fee for service practices, and that's on adjusted production. So let's not go off of gross, let's go off of adjusted. Gross feeds the ego, net feeds the family.   So let's not be feeding our egos. I know it feels really good to say you're producing 260, but if you can only collect 150 of that, let's live in real life world. So those would be some zones. And then like, again, if you want to go like next level, you're already doing that. Some things we found over the last year of tracking hundreds of offices were open time in a schedule and your dollar per hour production, because a lot of times just open time in schedules, we found you could actually hit your goal.   if we could fill those spaces and then figuring out protocols for your team just to keep that schedule full. So I said a lot of KPIs for you, but really your main ones, you've got to be watching our production, collection, overhead, new patients and case acceptance. If I could only pick five, those would be my top five that I would start with. And I'm going to give six, like your reappointment percentages. Cause if we're not reappointing, that's really going to kick you down later on. And it's going to make a lot more work for you. And I think those are some pretty easy ones to watch pretty quickly.   The Dental A Team (16:18.733) but then also hopefully giving a lot of other ones for you to be able to watch in addition to that, that depending upon where you are in the journey of your practice, things to be looking at and doctors, you don't have to track all this. You get your team to track this for you. And then you get this lovely report that comes to your desk every week or every month. You review it, you assess it, and then you make the changes accordingly.   How do you help the practices that you're working with refine their systems to streamline their workflows to ultimately maximize their productivity? So Nick, on that, I'm just going to sound like a broken record. I literally look at their numbers, because whatever their numbers are looking at, these KPIs, that's going to tell us where the system's broken in addition to what your team is saying is a problem. So usually it's like communication or it's   low case acceptance or overhead or cashflow issues. And so what we're gonna do from there is we're gonna look to see what is the system in place. So if we're having an overhead issue and cashflow issue, well, I'm gonna look at the billing system. Like, let's look there, because that's where the money's at. So let's figure out what is our process, who's doing what, and where is the breakdown, and then we're gonna refine the system. I don't believe teams like to do hard things, and I don't like to do hard things, and so.   everything we implement should be easy because teams will gravitate towards ease and also not making someone remember things. So that's a true system. So we'll put in things like we can put automated notes or we can change our note templates if we're consistently missing something on our claims, we're gonna fix and adjust that system. We're also gonna look to see running certain reports that we put on an automated system for them. It's on a sheet for them. That way they don't have to remember to do this.   We create handoffs where it's on their route slip. So no one has to remember, like just with your memory, it's already built as a true system. And I think a lot about like McDonald's or Chick-fil-A or some of these companies that are able to mass produce and give you the same experience wherever you go. Well, let's build that and let's make a very simple system that everybody can follow rather than hoping and praying our team members remember and they don't drop the ball. So I'm going to look at those numbers. I'm going to look to see where the gap is and then dig deeper to find   The Dental A Team (18:33.461) root problem and then add an automatic system as much as we can to fix that problem forever. Are you dealing, how much of your business are startups, scratch startups versus acquisitions, also new practice owners through acquisition versus, you know, I guess that's the question, those two paths.   I tend, and I think it's just due to who I am and the things I did, I tend to attract more acquisitions in our company. So we're probably 75 % acquisitions, 25 % scratch start. We've worked with a lot of scratch starts. We've done a lot of pieces with scratch starts. But for me, I'm of the opinion, it's already there. My job is just to come and be the miracle girl on a practice that's already there. I know that I can successfully add hundreds of thousands to a practice very quickly.   adjust their overhead and make them profitable within just a couple of months. Scratch starts, we can do the same thing, but there is more of building that base to get more people in to build it. However, you don't buy someone else's problems when you do a scratch start. So in Dental A team, again, I think it's due to my experience, the things I've done. Like I said, I took a practice from 500,000 to 2.4 million in nine months. I know which systems to quickly shift and adjust. I like to say that we're...   We're a miracle girl for practices. You just sprinkle us on and we watch it bloom. Scratch starts, like I said, usually I'm about six months to a year before we're gonna start to see that churn and burn. And it's just due to building that patient base, which doesn't exist in the scratch start typically. But again, we've had several scratch starts. We've had several be a very successful, but that would be the reason I think why. But again, I don't shy away from scratch starts. I've done plenty of scratch starts and I do love that you get to build everything that you want and it's brand new.   You get to set the systems up from day one. I just think I like to. It's already in place and now my job's just to optimize and magnify it and make it even stronger for them very quickly. But I'm a fast results person. I like to see results quickly. Scratch starts long term have amazing results. Short term they're a little bit harder to get that churn on. Sure. Are people, are dentists typically onboarding you during the acquisition process so you're already known to them and their, you know, their,   The Dental A Team (20:55.281) They're acquiring with you on board versus an acquisition where things are just not, things don't feel right and they're not turning out the way the doctor planned or not as fast as they had hoped and then they're onboarding. So I think the doctors who do the best are the ones who bring us on usually month one or two before they open a practice. And I always say when you open a practice, it's like having a baby.   people nest the two months before they have the baby and then baby comes in, it's like screaming mayhem for about six months until you figure this out. And I really do believe that that's how practice ownership is. So the offices who I found do really, really, really well are the ones who bring us in one to two months before they actually add us into their loan of their additional cashflow that they need. So it's part of their purchase. That makes sense. Versus the ones that are like, Hey, I don't have cash, but I need help.   because every office does this, literally every single one of them they're in and I call it the six months shakeout. As soon as you buy a practice, it is bananas for six months. Like you have high costs, you have high expenses, nothing shaking out. You're trying to win over all these patients or bring in new patients. Like it's mayhem. And that's actually when you need consulting the most. Like you need someone to pull your head out of the sand, tell you do step one, step two, step three. This is where you actually need to focus rather than just being psycho and trying to like do all the things, but never getting anything done.   So I really love when they come. Otherwise, and I'll say, I'm really pro, of course, being a consultant, I'm pro this, I'm really pro hiring a consultant that can actually like put money on your books. So a lot of things people buy when they're buying a startup, they actually don't add revenue for them. So it's just a lot of cost without a lot of adding to it. And so there's lots of great consultants out there, but I'm really pro find someone who's done what you need to do successfully multiple times.   and bring them in because a consultant for us, our fee is guaranteed covered every single month. Like I'm never worried about that, but we tend to do two, three, four, five times our fee, adding that in in production and reduction of overhead for a practice very quickly. So I never worry about, I understand the owners do worry about fees because it can feel scary with everything you're adding on, but be intentional with what you're purchasing, what can add money to your books rather than just taking money off of your books.   The Dental A Team (23:19.462) Go ahead, Nick. Well, I was going to switch gears into talking about building and developing a strong team, since you just mentioned that. And I wanted to start by actually saying that when we're working with a client and they're looking for, you know, to a relocation option or they're looking to buy a building or just a general lease, mean, these are all super negotiable things inside, you know, inside of their   you know their business world but you know the the You know the highest expense that they likely have is payroll and so they can't really That's not something you're not gonna retain high-level talent by you know negotiating like a like like a madman like you would with a landlord for example, and so I wanted to talk to you about what are key qualities that a you know a dental practice owner should look for when hiring   key team members. For sure. I'm so glad that you said that rented landlords are negotiable because I think people feel like it's fixed. And I'm like, no, listen, listen, this is why you need Nick and Remy. Talk to them. They'll help me negotiate this down. Agreed teams are a bit trickier to negotiate down here. You're not going to probably get the best people. No one wants to feel like they're being bought on sale to come onto your practice. but as a landlord, yeah, I want the best deal. My labs and my supplies, I want the best deal.   But for teams, so I'm gonna kind of give two different answers because I think startup practices versus maybe a little bit more seasoned in their career actually have two different needs typically. As a startup, I'm really pro them hiring basically an office manager that knows how to do a lot of the things that they don't know how to do. So we need someone who's strong with case acceptance, strong with billing, strong with leadership, strong with hiring, and it's going to be an expensive hire. But what that...   that expensive hire is going to do is going to exponentially grow your practice for you. While dentists are in the back doing dentistry, you have someone who's really your yin to yang in the front office for you. So I'm really pro and I'm really pro not hiring just one person, but two people in the front office. I've seen a lot of embezzlement in my time. I've seen a lot of just funny things going on in the front office. And also if you only have one person up front, you're literally like SOL, which stands for so out of luck.   The Dental A Team (25:38.758) Um, in my opinion, like you really will be S O L if that one person leaves because you know nothing in the front office. So I'm super pro hiring those people and hiring really good talent when you're a startup. Now, if you're a little more seasoned, figure out what's going to be your yin and yang. If you've got a good biller or you can outsource your billing, um, maybe you don't need as high quality of, or as expensive of an hire that way. But what I have found is typically I like to see payroll around 30 % of your collection. So we're collecting a hundred thousand.   about is going to be spent for payroll costs, not including doctors. And so for that, that's also your fringe benefits, your 401k. And what I've seen with a lot of doctors is team members are only listening to their dollar per hour, but doctors, you're paying a lot more than just a dollar per hour. So we've actually created a really beautiful form for our offices that's kind of like their total compensation package that we recommend giving like once or twice a year to your team so they actually see what they're producing.   Now, hygienists are coming in as a really hot topic, depending upon the area you're in. And a lot of those are like, they're kicking that overhead, the payroll amount really high, but you need a hygienist because they're a producer. And so what's happening, we have a couple of hygienists on our team as consultants. And what they're recommending is let's have a really good base, base plus commission. And then looking back at your hygiene schedule to show this hygienist based on what we've already done. I don't like to live in like theories.   because no one wants to live in theories. They want to feel confident. So if I can hire hygienists for X amount that is fair within the market rate, but give them a commission, so anything they produce over that, showing on historical trends of what my practice has been doing, that's gonna help me keep my payroll costs lower, but I'm gonna be able to pay this hygienist more and be able to actually offset my payroll costs because they're producing more, but I can keep my payroll lower. So that's where I do think you can quote unquote negotiate.   But I really feel strongly, you've got to show them with confidence that they can do this and you've got to have an incredible culture. Culture and time tend to be the currency of hiring great team members right now. And so if you don't have a great culture, if you're not a great boss, you're not gonna hire great talent. I've seen offices paying their employees less than other people in the market, but they have such a great culture that team members want to stay. And then also looking at this time off, PTO is becoming a really hot topic and I feel like since 2020,   The Dental A Team (27:57.872) We're seeing more of this lifestyle that people want to be living more so than like the 401k traditional benefits, depending upon the age of the person you're hiring. Cause I do think there's two different age groups that want two different things. And so being aware of that and cognitive, think you can get creative with what you're doing. So I think that's a lot of great ways to bring it on, but you've also got to be clear on what your culture is and what your tip is. And you've got to be careful not to hold onto those sour apples that are truly destroying your practice.   One of the best quotes I heard is, the worst thing you can do to your best employees is tolerate the poor performance of your worst employee. And so really being cognitive, and I know that's hard, but trusting and believing that you can bring these great people in. So we put awesome ads out. I tell people to write to their ideal person, figure out who they want of their ideal person, and then posting those ads consistently and following up can be really good ways to get it. And then like,   Great culture does not mean you give everything to your team. It also means that we hold them accountable, that we have structure, that we have systems in place, but giving them the autonomy within that to create what they want to. I think are some hopefully simple pieces based on where you are, of who to hire, how to keep those costs lower. Also, what a good framework of what your payroll should be. And then also realizing the amount of payroll you've got, that should be producing. So make sure that you're.   payroll dollars are actually giving you the production that you should be getting from it. And if not, maybe it's time to make a couple of changes that way too. Yeah, one, one always is, is trying to kind of create a culture that promotes accountability and collaboration and continuous improvement. And you can probably, you know, inside the mission statement of the, of the, of the practice kind of address some of those things so that you have some ground rules. But ultimately at the end of the day, it's about   the leadership and also needs to live those values as well. Yeah. And on that Nick, am really pro core values. When I first started, I heard a explanation of core values and they said, usually when you start a practice, you have three core things that really were the core of why you started this practice. So think back to what those three, those are like your true core. And when I thought back, I was like, yeah, for me it was do the right thing.   The Dental A Team (30:16.272) have a ton of fun and make it easy for clients. So like those are my three. it's do the right thing, fun and ease. And then we have aspirational ones in addition to that, but really truly like our core values go on our job board. So like when we're hiring people, we say these are our core values, this is our company. Every Wednesday we're highlighting out team members that have been exhibiting core values within our company. So each team member shouts someone out about the core values. And I really have found that   That's how you build culture. Culture is a slow burn, but it's a consistent burn. And so if you have that and you really live, breathe and bring that in, your culture, it will take a little bit of time. say it's kind of like moving the Titanic, but the consistency piece will start to shift it to where you have that incredible culture. And then if you have someone who's not, have the one-on-one conversations rather than the full team conversation. Get really, really good at having uncomfortable conversations. I love the quote. I've added my own little.   sprinkles to it. I say your success and happiness that's care is added is directly proportional to the number of uncomfortable conversations you're willing to have. And I like adding happiness to it because I think like my success is one thing, but my success and my happiness, I want to be happy when I go to work. I want to have a great time. And so just getting really good with those uncomfortable conversations. And I say, it's a conversation. It's not a confrontation. And like, let's get to the root cause. Let's solve the problem rather than the person.   and let's move that forward. I think those are some hopeful quick tips for people to start to change that culture because it can be done and it's paramount for bringing in great team members as well. Well, that's a really important piece of the puzzle is communication, especially since everybody has a different communication style. you know, I wonder what your guidance is about how somebody who owns a practice can, you know,   can become a better communicator or overcome some of those challenges to be able to kind of understand how to communicate to different members of their staff or what have you. For sure. I'll give a couple of books. I believe there's so much wisdom found in the minds of men and authors. And so The Five Dysfunctions of a Team by Patrick Lanzione I think is a great one to figure out how to build that trust and healthy debate between you and your team members. so encouraging that.   The Dental A Team (32:43.974) and digging down deep into that. Also, there's a lot of personality traits, tests that are out there. I really am pro disc. There's also a company called Culture Index, and I think they teach you a lot of how to communicate. And something I learned early in my career that I try to pass on to our clients is hire people who are complimentary to you, not necessarily the same as you. Your biller is going to have a very different personality than your scheduler.   I want a bubbly outgoing scheduler who just makes my patients feel incredible. And my biller, do not want them being the party scene. I want them to be the person who's so detailed on every single number. Well, those two personalities are also going to be different communication styles. My biller, can probably be a bit more direct with. My scheduler, might need to have a little more finesse with. The five love languages at work is another great way to see how do people prefer to be communicated with. And then also just asking. I think asking people of,   hey, like some people really wanna be direct and just told directly, other people need like the sandwich, the compliment, here's what we need to work on, the compliment, because otherwise they're gonna feel like they're an utter failure. And so I think as leaders learning, I used to always communicate the way I like to be communicated too. And I feel like that was so naive on my part, because that's how I prefer, does not mean that's how other people prefer. we have, when we hire new hires and we recommend this for our offices,   We actually have them take a quiz within our practice and it tells me their favorite things for appreciation. What is it? If I was to get them a gift, what would be something very meaningful to them? How do they prefer to be communicated with? Is it direct? Is it collaborative? And then we have them read the same book so that way we can speak in the same communication language with each other. And then coming in to when it's an uncomfortable conversation, owning that and saying, hey, like this is uncomfortable for me to say.   We address the root problem and then we ask for feedback of, Remy, how did that land? I want to make sure that what I was trying to convey is actually how you heard it. Then Remy can come back and say, Kiera, I felt like you thought I was a jerk and that I'm not working. And I'm like, my gosh, thank you for saying that. That's not at all how I was saying it. What did you hear? That way I can change this to make sure we're on the same page. That communication takes finesse, takes time, but I will say I would rather invest in that skill than having the constant turnover.   The Dental A Team (35:06.96) train that's going on. And if you're in maybe a bad culture right now and you don't know how to fix it, anonymous surveys, we send them out for a lot of our clients when they're in this particular spot and start to ask honest feedback of what does this doctor or team need to do to change? What's causing the turnover? What's causing the breaks in the practice from the team members perspective? And then adjusting our communication styles accordingly to really try and help that communication. But I really love asking for feedback of how that landed.   I think that's one of the easiest ways to get that feedback very quickly on communication. So we've talked a bit about communication, I guess, with your own staff, but paramount to any successful dental practice, they need to have strong communication with their patients because enhancing a patient experience, I think, really kind of goes hand in hand with growth and all the other   types of things you need to consider to raise the, do better, I guess, for lack of better word. So. I think patient communication, you're right, it's paramount. And learning, I think that's handoffs. I think that's having everybody speaking the same thing, doctors giving good exams on that. But then also finding out what your patient drivers are similar to a team driver. What is ultimately their number one objective? Is it cosmetic?   Is it function, is it cost, or is it longevity? I said those in a very important order. believe order matters. Because if I put cost first, I'm highlighting cost. But if I put these in a very strategic way, I've done this with hundreds of offices, and we've asked thousands of patients, I will tell you 99 % the time it's not cost. It's usually function, it's longevity, cosmetic, how it looks. And then of course, figuring out within cost. But if you can figure that out from your patients and learn to communicate with them in their style, utilizing disc profiles as well.   You're exactly right, Nick. You'll get higher case acceptance, you'll have a better patient exam. If you have handoffs where everybody's speaking the same language and we're passing the baton off from person to person so that way nothing gets dropped, you will be shocked. We've increased case acceptance. I had a practice, they were getting about 25 to 30 % case acceptance and we literally got 100 % case acceptance that day just by changing a little bit of how we communicate in our handoffs.   The Dental A Team (37:27.462) The patients would walk up to the front and say, doctor wants to see me back in two weeks for a crown for an hour, I need to get that scheduled. And if your patient is that clear and your communication is that clear, you can only imagine what that does for your practice and your production and your reviews, because that patient's not confused anymore, they literally know what to do.   The Dental A Team (37:50.822) Can you share any practical tips on how dental teams can educate their patients more effectively about their oral health and treatment plans? Yeah. So I'm really pro hygiene. The hygienists have hopefully an hour with them. And so I'm really big on visuals. And so we work with our practices to build kind of like explaining it helping these patients see like on x-rays where you can use, there's a lot of AI softwares out there. I love Pearl. I love Overjet. They can help educate the patients of what's going on in their mouth.   And what I found for patients is there's a lot of mistrust. And I know dentists hate this analogy, but it is kind of like a mechanic. And so we're looking under the hood and the patient's like, I see nothing but black and white up on there, but you're telling me to like squint my eyes and there's a little cavity right here. So I think also helping train your patients of like, this is a good tooth. And this is a tooth where there is decay, showing intraoral photos for them, helping them so that way when they're going through their teeth, it's like, okay, tell me what you see on this tooth.   the more the patient can actually grasp it and understand it, the more they're going to actually accept that treatment. But in addition to that, one of my hygienists that's a consultant on our team, she gave me some really good advice and she said, never ever, ever use little league words for major league problems. I think oftentimes we don't want to offend the patient or want to make it feel better. And so we're like, well, there's this like little cavity. The tooth is bombed out. Like, why are we saying it's a little cavity rather than telling them like, this is what's going on now.   Yes, they're still finessed, so we don't wanna make them feel bad about it, but we also need to help them see the severity. And what I found is when you're confident in your diagnosis, when you're confident in how you're presenting treatment, your patients are actually buying your confidence, they're not buying the treatment. And so you being confident, and I've helped hundreds of them practice, I literally have an office and we've added multiple millions to their five locations by simply helping them present treatment better and stronger and more confidently, because truly the patient is buying your confidence. And so now, never over diagnosing.   but getting that patient to see it and truly telling them what's going on. And then I always love to say like, here's a comprehensive exam and the good news is, this is how we're going to get you like great back to great oral health and using the good news is, or the great news is that way the patient feels like there's hope and optimism and then giving them a really clear plan of where you want them to start. That way it doesn't feel overwhelming or daunting. Cause you can teach a patient all these things.   The Dental A Team (40:14.448) They just need to know where to start and how you're gonna be able to help them get the success that they're looking for and to get back to oral health. Not all patients have it. And I say that not like these problems did not happen overnight. So it's not gonna get fixed overnight. Our bodies are always decaying. Like we're always like aging is as fun and thrilling as that is. Same thing with our teeth. And the great news is this is how we're gonna get you healthy.   We've talked a bit about, you know, communication and creating a strong relationship, I guess, with your patients. Talk to us a little bit about how dental practices can develop a strong presence inside their local community to build trust and attract more patients. Yeah, there's an office that I really love. We were just chatting with them and something that I think this office did so well is they have the goal to be   the hometown dentist in their city. That's the vision of their practice. They want all of their patients to feel that way. So it's a very large practice. They have 15 operatories and they've still been able to maintain that hometown feel and they're very connected to their community. Another practice they said that our goal is to change the way people feel about going to the dentist within our community. And so I think the way that you can get this like stamp in your community is one, having that be part of your vision where you want to be   that local dentist to your patients where it's that hometown dentist feel in your practice, then your practice, your patient experience will feel that way. But then these offices, the two that I explained, they're very involved in the Chamber of Commerce. They're very involved in the little league sports. They're very involved in giving back and providing for these communities. I have another dentist and she created what's called the Thrive Home, where it's literally being able to give back to the community with all the different specialties like OT.   PT, dentistry, to give back within the community. And I really think if that is something that is your MO, treating your patients that way, asking for their referrals and their reviews, and then also being able to have that presence. I know growing up, for me, our chiropractor was so well known, that chiropractor was everywhere. They were at all the football games, they were all the high school events, they were at the town hall, the chamber of commerce, like.   The Dental A Team (42:30.106) Everybody knows that Ellison Chiropractic is the number one chiropractor in the area. And I will say it's because this family was so involved in the community. We saw them everywhere. And so I think how can you also do that and giving back to it? But I think my biggest recommendation, if you want to grow patients based on your community, I think it comes from genuine care and genuine authenticity that you actually love this community that you want to give back. If it's just to pull new patients in, there's other ways to do it.   But I think really, truly, you want to give back to that community you want to serve. I think patients will feel that when it's true and genuine and authentic. We understand how important marketing is to a practice and how it gets teeth through the door. And it's expensive, and it's money we're spending. But I think you hit the nail on the head. In addition to traditional marketing, there's so much more you can be doing in   involvement really is the key. The more involved you can be in your community, the better. Whether you want that hometown feel or you're focusing on productivity and efficiency and I think getting yourself out there and being a part of something is invaluable. That's great advice. When our clients hire us, it's normally because they   They feel totally lost. They're beginning the journey of practice ownership or real estate ownership. They have a lot of student debt. They are about to borrow a lot more money. And it's really scary. we try to really hold their hand through that process to kind of give them those tools so that they can ultimately make the right decisions.   for their practices real estate. And so it's really cool to hear you and how infectious your energy is and you have really good support systems for your clients to really ensure that they're not missing anything and are really maximizing their potential. And so that's really cool to...   The Dental A Team (44:54.078) to hear from you. Switching gears a little bit, I want to talk about the future and industry trends to see if there's anything that you're seeing or anything that you think your clients are going to face in the next five to 10 years that they should be preparing for. Yeah. And Nick, thank you. I just wanted to highlight what you said because you're right, it's terrifying. It's terrifying to go into that much debt.   I remember I used to call my dentist 2.5 because we were 2.5 million debt. And I was like, that back straight because you need to keep these hands and that back good. And I would just always say like 2.5, 2.5 because we were 2.5 million debt. And I think that that's where my passion comes from profitability overhead systems because I know how daunting it can be to be an incredible clinician, to be an incredible business, to be an amazing practice, but not to have the cashflow to support what you just went into debt for.   And so that's really where I'm pro like know your numbers, use the systems, utilize your team because, and I will say this again and again and again, a dentist who is financially successful and secure is the best boss to have. And health health teams, want your dentist to be successful and profitable because they're more solid, they're more stable and they're not stressed out, which is going to make a better boss for you. And so agreed. It's very daunting. It feels very scary, but I will promise you if you know your numbers,   It can feel awful at the beginning, but it can actually make it so much better for you. So thank you for highlighting that Nick, because I think I've just seen so many students so stressed about cash and staying up at night. I've had it myself. And so speaking from real life experience, giving you the tools out of that dark hole, I think is one of the greatest gifts we can give to these dentists who are already giving the gift of smiles and confidence to all their patients. Being able to do that same for dentists is such an amazing thing. And now,   Speaking of like what's in the future, shoot, DSOs are on the horizon. I think an AI, like these are two hot conversations. My doctors tell me that they are probably getting a DSO offer at least three to four times a day. And that is ratcheting up. They're getting so many offers constantly from DSOs. They're finding them. And I don't blame them. I think Wall Street is smart. They've realized that dentistry is a great business to invest in. mean, we're hearing 50 % overhead. So we've got exponential profit within.   The Dental A Team (47:19.474) Dental practices are profitable, typically speaking. And so I think that these are some things for doctors to be aware of. And I think educating yourself on making sure that you're selling or you're living your life the way you want to, rather than like just getting an offer on a bad day. So I think the DSO offers are dangerous because when you have a bad day in dentistry, it's very easy to look at that EBITDA number and say, I just want to sell. I want to get rid of all my problems, but I want to also caution and advise.   to know exactly what you're getting into because I've had some dentists sell. I think DSOs can be great for a lot of practices. I think MSOs can be great. I can see legacy practice and partnerships being great. There's so many amazing things and I don't think there's really a wrong route to go in dentistry. The wrong route I think is when you make an emotional decision that's not going to impact your life the way you want to. And so being very cautious, I think of when do I wanna sell and also what really is a good deal because I had a doctor and their epita,   They talked to some DSOs and he's like, cure it. It's going to be great. I'm going to get five mil for this. And I said, we'll call this one hometown. Like he's not the hometown, but like, we'll just call him. I got iPhone anonymous hometown now. So I was like hometown. I just want to point out that next year you're going to produce 5 million based on our block scheduling and also on the expansion of your practice that we just did. You are going to produce 5 million and they did. So I said, you're going to actually get short changed on this DSO deal. If you're like.   But if you're done with dentistry, it's a great deal. But also you're going to have to work for this person as an associate when you're going to make five mil next year, just in producing on your own and you don't even need to sell. This hometown does not want to be done with dentistry for about 10 years. So I said, you are shortchanging yourself where you can build this. You can exponentially expand into this, but you've got to make the decision of where you want to go and what you want to do. But the five million sounded so attractive to this doctor.   when they didn't realize that their practice was already producing that and would produce that with ease the next year. So I think like being really cautious of that, that you're not making, I feel like I'm so passionate because I feel like your business not only is providing for your life right now, but it's a long-term asset. And like what you guys do with the real estate, these are long-term assets that are building their wealth portfolios. Let's not, let's not do botchy investments, kind of like stocks, right? The stocks we all know just like dropped like, shoot, if you're watching that, you're going to freak out and you're going to want to sell everything.   The Dental A Team (49:40.68) but they know be stable through your investments, stay steady and not make those irrational decisions I think is so paramount because the DSO offer seem very appealing right now, especially on those like hard dental days. So that's one that I think dentists really need to be cognitive and aware of and knowing what your end goal is, what your retirement goal is, what you ultimately wanna sell out for. So that way when these offers come through, you can be educated and educating yourself more because I promise you.   I do not believe DSOs are going away. think in the next decade to two decades, we will see dentistry become more similar to healthcare. I know I'm like very hated about this. I've had this opinion for several years. My husband works in standard medicine. He works for hospitals and I'm like, gosh, like what was going on in the hospital scene is now what we're starting to see in dentistry. It's not gonna be too long before they're all bought up, but I'm also watching standardized healthcare now trying to shift into private practices and get out of the DSO.   like with air quotes around it. So I think just being cognitive of what you want to do and what you want your legacy to be. But also I don't fault you. I mean, a lot of these dentists are going to be able to get incredible retirements that they may never have been able to get similar to people buying homes in COVID. Like they're getting insane value, insane interest rates. it can be a very wise financial investment deal for you, but just do your homework. Cause I've seen some DSOs go under and people have lost pretty much their entire retirement. So that would be something I definitely highlight on. And then also watching AI.   The doctors are not into AI, they've got to get into AI. That's where I mentioned Pearl and Overjet, they're helping with diagnosis. I can already see they're riding on the wall that insurance companies, guarantee you, are probably already using AI. And so making sure that you are staying at least up to par with insurance companies, if not further ahead. Utilizing virtual assistance, think staffing costs are going to continue to be skyrocketing. And so for that, what other things can we do? like...   Opportunities force innovation. And I think we're in an opportunity zone to force some innovation and to be on the cutting edge of that. I do think right now, doctors who are not online, depending upon where you are in your career, if you're not online, having a presence on social media, if you're not getting involved in AI, I am going to caution that I think those practices very easily could get left behind unintentionally to where it might be hard for them to come back. So just even dabbling in it, getting some team members that could help you with that, I think is super important. And I would say this year,   The Dental A Team (52:04.51) I would add some sort of AI to your practice. Whatever you choose to do, just so you start to experience it, use it. There's so many things and I think honest in the next five years, I think AI is going to radically disrupt how practices are operating that I think it's important to like at least be dabbling so you're not completely left behind on accident.   You think the AI is, I mean, it's mind blowing and the applications just seem endless and hard to keep up with. you, so are you, if I hear you correctly, you're talking about AI integrations on like the practice management side of things versus patient care, right? Like patient care, so yeah. Yeah.   I think patient care is going to be tricky. I think until they get robots who are amazing, do think like the clinical side of dentistry probably will maintain pretty accurate. But I do think your front office and a lot of your systems will get changed. And I'll just highlight, there's a practice that we work with and she has, it's a pediatric practice. She's got incredible- call them? Sorry, what? What are we gonna call them? this one, we're gonna call this one, we'll just say jammin'.   so this one's jammin. I do like that we're naming all my offices. right. So jammin jammin has a pediatric practice. She's got an entire amazing team, but she has like eight support virtual assistants behind the scene for this practice. In addition, she has made her own AI bot called Amy and Amy. That's actual name of the AI bots. That one's real. didn't change it. mean, I should have called it like Joker, but like that's not really going to work jammin and Joker. This was actually called Amy. but Amy.   responds to to Jammin's practices day in and day out to make sure patients are happy. Now they live in a very affluent area, so it's very fast paced. But what I love about this doctor is she realized in order for me to keep my patients happy and to meet their demands, there's AI and I can create an AI bot that responds exactly how our practice would, but I'm actually not having to pay a team member, an actual human being to do this. And they're able to get all the needs met. That's what I mean by.   The Dental A Team (54:13.37) looking to see where can AI integrate. And I think it's going to hit your front office faster. But I think like software is meh, like that one's tricky. Software's are tricky to me, but I'm like billing. I guarantee you AI is going to take that over for sure. Hands down. It's going to take it over. I think answering phones and scheduling phones, I think are, the way we send out claims for sure. Like that's all within your billing realm. there's some softwares that are trying to act as office managers. think reading X-rays are going to definitely be taken over by AI.   hands down and I am curious and I don't have an answer for it, but I'm super curious. How is that going to impact diagnosis? I work with some practices in Canada and Australia and they're more streamlined. There's not really a lot of change. Like it is what it is. It's standardized healthcare over there. And I'm curious with AI coming in and I know I'm going to be like, I might get ripped on this. I'm welcoming the reviews because I think it's worthwhile to talk about. I'm curious how AI is going to impact diagnosis.   And what can be diagnosed and what can be actually built out which leads me to believe similar to medicine That's why there's bill like they bill out every single possible code that they can't I mean for the gauze for the cotton and I'm super curious that I don't know I think it's worthwhile to look into is that gonna impact our diagnosis and how we're billing should I maybe be looking and knowing those codes more thoroughly? Depending upon how it's gonna be. I don't know. I think that that's huge speculation on my part, but I   I can't help but think that AI is going to impact our diagnosis in a big way. We're insurance companies, which then leads me to think companies might be leaving insurance. right, like we might be going more fee for service. So then you got to ramp up your marketing. But I think that's going to be a big spin that's probably going to be hitting us in the next couple of years.   The Dental A Team (56:02.27) It's scary and exciting. don't know what else to Scary and exciting. It feels wild, right? But I'm like, don't think dentistry itself is going to change much. I still think we're going to have our craft. It's a very, very humanistic, very crafting. But I'm super intrigued. And I think for me, I'd rather take it on as like, let's be excited about it. Let's get into it. Let's see. How can we dabble? How can we influence it rather than being told like, is what's going to happen now?   I would prefer to be a pioneer through it and I think first office is to innovate. I I prefer to be like second, third, like I'm not gonna be like right on the first in case everything botches, but like second, third, get in there because these things, I don't think it's going to go away. I think it will adapt and morph, but I think it's here for a while. I hate that I didn't ask you this way earlier, but are you also, are you working with all different specialties or are you strictly general?   That's a great question. We actually work with all. So we have pediatric, GP, oral surgery. The only one we don't dabble in is ortho. I think there are some incredible consultants out there that do ortho. Ortho has its own software. It's its own beast. It's its own animal. I do work with ortho and GP, so we're very familiar with it. But ortho, I just think there's consultants that rock the ortho world, but all other specialties. We have clients within all of those and really love them in all their areas. We tend to specialize GP and pediatric, but we have clients of all.   all specialties minus ortho. Yeah, I The reason I asked is that I was speaking to, you know, an endo group who was actually starting to transition to fee for service. And I don't know, maybe that'd be a good introduction. Yeah. The fee for service world is weird. I really, offices want to cut. They want to just cut the insurance right now. And I'm like, hold please, before you do that, realize it's a retention piece for your patients. And if you don't have a great experience and you also don't have great systems in place,   and you also don't know how to maintain these patients, I had a practice to do this and they almost lost 50 % of their entire practice. So I'm really pro, like you can drop insurance and I'm not here to say not to, but I want you to be very thorough and educated on it and know worst case scenario, best case scenario. I think fee-for-service is gonna dip in a lot more, but if you're not careful, fee-for-service patients are free agents and never forget that. So they can go anywhere at any time. They're not tethered to you like they are with insurance. So making sure.   The Dental A Team (58:25.202) before you start cutting and get all excited about fee-for-service, I'm here to say do it, but do it correctly. Because I think there's a right way and a wrong way to do it. And I've seen it hit practices really hard if they don't do it correctly. Good to know. The time we spend with people like you is meant to help dentists and really end support staff all around. And they all offer different types of great information and fe

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

Wondering how AI is reshaping dentistry—for real? If you've heard the buzz but haven't seen how it translates to your day-to-day practice, this episode is for you. I'm joined by Wardah Inam, the brilliant mind behind Overjet, the AI platform that's helping dentists diagnose with more confidence, improve case acceptance, and finally bring consistency to treatment planning. Whether you're part of a DSO or running your own practice, this conversation will change how you think about tech in the operatory. I sit down with Wardah Inam, CEO and co-founder of Overjet, one of the leading AI companies transforming dental care. With a PhD from MIT and a deep background in AI and healthcare innovation, Wardah shares her journey from being a curious dental patient to pioneering real-time AI solutions for dentists, DSOs, and insurers alike. In this insightful conversation, you'll learn how AI isn't just hype—it's becoming a game changer in diagnostics, treatment planning, and administrative efficiency. Wardah explains how Overjet is making diagnosis more quantitative, improving consistency across providers, and boosting case acceptance with powerful visuals that speak to patients in a way they can understand. Whether you're a solo practitioner, DSO leader, or simply curious about how AI fits into your workflow, this episode is packed with practical insights, future-forward thinking, and compelling reasons to consider the power of AI in your dental practice. What You'll Learn: How Overjet's AI technology is improving diagnostic precision and patient trust Why AI is a powerful tool for increasing case acceptance The surprising story that inspired Wardah to enter the dental field The role of AI in streamlining insurance claims and reducing administrative burden What sets Overjet apart from other dental AI companies The future of AI in dentistry—from auto-charting to real-time claim approvals — Key Takeaways 00:40 Introduction to AI in Dentistry 03:17 Overjet's Role in Dental Care 04:00 Wardah's Journey into Dentistry 06:44 The Importance of Consistent Diagnosis 07:53 AI's Impact on Insurance Claims 10:53 Enhancing Case Acceptance with AI 14:53 The Future of AI in Dental Practices 20:00 Overjet's Unique Features 25:23 Real-Time Insurance Approvals 25:20 Adoption Trends: DSOs vs. Solo Practitioners 28:12 Final Thoughts and Lightning Round — Learn proven dental marketing strategies and online reputation management techniques at: https://www.drlentau.com This podcast is sponsored by Dental Intelligence. Learn more at: https://www.dentalintel.com/ This podcast is sponsored by The Doc Sites, the leading provider of websites and online marketing for dentists. Find out more at: https://www.docsites.com/ Raving Patients Podcast is your go-to place for the latest and best dental marketing strategies that will help you skyrocket your practice. Follow us for more!

The Deadcast begins our virtual tour of the new Enjoying the Ride box, visiting the cradle of the Dead in Palo Alto/Menlo Park (with a detour to visit the Warlocks' earliest shows) before heading to San Francisco with stops at the Fillmore West and Winterland.Guests: Connie Bonner Mosley, Ron Rakow, Ned Lagin, Ron Pietrowski, Tyler Roy-Hart, Les Earnest, Doug Oade, Eric Schwartz, Blair Jackson, Michael Parrish, Dominic Stefano, David LemieuxSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

The equation seems simple - quality patient care is driven by quality administration. And yet, too many DSOs underestimate the importance of the quality assurance department and its process. Why is that? Tune in to the latest episode of The Dental Economist Show as host, Mike Huffaker, welcomes Dr. Mariz Tanious aka Dr. T, Chief Dental Officer at Affinity Dental Management, to explore the criticality of robust quality assurance processes, how a quality-first approach can elevate organizational culture and operations, and the profound impact it can have on levels of patient care at your practice. From implementing effective documentation protocols to leveraging AI technology for better patient outcomes, Dr. T shares invaluable insights from her two decades of experience, reminding us all that the only thing more important than the numbers your business is bringing in, is the quality of those numbers.

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In this episode, we dive deep into the transformative power of AI in dental practices and how Bola AI is revolutionizing workflows, enhancing patient engagement, and improving accuracy in clinical documentation. Rushi Ganmukhi, CEO of Bola AI & Cassie Tallon, CEO of The Fractional Match discuss: The rapid evolution of AI technology in dentistry How Bola AI is streamlining dental workflows and saving time for both dentists and staff The importance of accurate clinical notes and its impact on insurance claims and patient care Whether you're a dental professional, part of a DSO, or simply interested in the intersection of technology and healthcare, this episode is packed with valuable insights and practical advice. Links: Learn more about Bola AI - https://bola.ai/?ref_id=GDN Schedule a demo: https://bola.ai/demo/?ref_id=GDN Connect with Cassie Tallon: https://thefractionalmatch.com/

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

For the 50th anniversary reissue of Tiger Rose, we explore the lost story of Robert Hunter & Jerry Garcia's only full-length studio collaboration, the Dead lyricist's 2nd solo album, produced by Garcia & performed by an all-star cast including Garcia, Mickey Hart, & Donna Jean Godchaux.Guests: Kathy Veda Vaughan Bogert, Mickey Hart, Barry Melton, Ron Rakow, Howie LevineSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

"You need a coach, and you need a mentor" Connect With Our Sponsors -GreyFinch - https://greyfinch.com/jillallen/MyOrthoVA - https://www.myorthova.com/get-startedSmileSuite - http://getsmilesuite.com/ RSVP for the Provide AAO  Happy Hour - https://docs.google.com/forms/d/e/1FAIpQLSc5SXhZalSUVDY421Af7TcmOBiiECec4OIOIjRjyQJAX1qW8Q/viewform Summary -In this conversation, Shannon Patterson discusses the evolving landscape of orthodontic practice transitions, emphasizing the importance of mentorship, ownership, and financial stability. The discussion covers market trends, the significance of partnerships, and critical steps for buying or selling a practice. Shannon also highlights the need for proper preparation and professional guidance in navigating transitions, as well as reflections on trends observed in 2024. In this conversation, Shannon Patterson and Jill discuss the intricacies of practice transitions, focusing on the importance of avoiding common mistakes, understanding the evolving landscape of DSOs and OSOs, and the necessity of investing in oneself and one's team. They emphasize the significance of having a senior doctor involved during transitions, the shift in the DSO model towards partnerships, and the need for doctors to outline their personal and professional goals to achieve a balanced and fulfilling career. Connect With Our Guest -Bentson, Copple, Patterson & Associates- https://bcp-advisors.com/ Takeaways - Shannon Patterson emphasizes the importance of mentorship in the orthodontic field.The market has shifted to a buyer's market post-COVID, affecting practice sales.Young doctors are increasingly interested in ownership for long-term wealth.Partnerships are becoming a predominant model in the orthodontic industry.Financial stability is crucial for doctors considering selling their practices.Preparation for practice transitions involves cleaning up financial records.Observation buckets in orthodontics are essential for future patient leads.Professional help is necessary for successful practice transitions.Banks are now more stringent in their requirements for practice purchases.Understanding market demand is key for sellers in the orthodontic field. Avoid costly mistakes in practice transitions.Senior doctors should remain involved during transitions.The DSO model has shifted towards partnerships.Investing in yourself and your team is crucial.Outline personal and professional goals for success.Burnout is a real issue in the dental profession.Younger doctors need support in practice management.Change should be gradual to ease team anxiety.Utilizing consultants can improve practice performance.Work-life balance is essential for long-term satisfaction.Chapters - 00:00 Introduction to Practice Transitions02:52 Rebranding and Transitioning at Benson Copple Patterson05:50 Market Trends in Orthodontics08:57 The Importance of Ownership in Dentistry11:59 Critical Steps for Buying or Selling a Practice18:03 Preparing for Practice Transitions25:03 Reflections on 2024 Trends25:55 Avoiding Costly Mistakes in Practice Transitions34:11 Understanding DSOs and OSOs42:01 Investing in Yourself and Your Team Are you ready to start a practice of your own? Do you need a fresh set of eyes or some advice in your existing practice? Reach out to me- www.practiceresults.com.    If you like what we are doing here on Hey Docs! and want to hear more of this awesome content, give us a 5-star Rating on your preferred listening platform and subscribe to our show so you never miss an episode.    New episodes drop every Thursday!    Episode Credits - Hosted by Jill AllenProduced by Jordann KillionAudio Engineering by Garrett Lucero

In this episode of Medsider Radio, we sat down with Kirk Huntsman, CEO of Vivos, a company commercializing a non-invasive, FDA-cleared oral appliance designed to treat obstructive sleep apnea (OSA). Kirk is a seasoned healthcare entrepreneur with a track record for scaling and exiting successful businesses. He founded Dental One, growing it into one of the largest dental service organizations (DSO) in the U.S., with over 165 practices across 15 states. After selling the company to MSD Capital, he led ReachOut Healthcare America, a Morgan Stanley Private Equity portfolio company. He later built and exited Xenith Practices, another DSO, and founded Ortho Ventures, focusing on pediatric oral appliances. Now as CEO of Vivos, Kirk and his team are developing and commercializing proprietary treatments for sleep-related breathing disorders, offering patients an FDA-cleared alternative to CPAP therapy.In this interview, Kirk talks about his go-to-market strategy, the importance of credibility markers, the complexity of industry partnerships, and the challenges he faced pursuing an IPO.Before we dive into the discussion, I wanted to mention a few things:First, if you're into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You'll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and 3 packages that will help you make use of our database of 750+ life science investors more efficiently for your fundraise and help you discover your next medical device or health technology investor!In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost, including the latest Medsider Mentors Volume VII. If you're interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Kirk Huntsman.

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

Keywords dentistry, corporate dentistry, private practice, dental associates, student debt, dental contracts, work-life balance, dental consolidation, patient care, dental referrals, DSO, Dental support organization, Dr Wahan, Dr Gallagher, drwahan, Brendan Gallagher, dental podcast, oral surgery podcast   summary This conversation explores the evolving landscape of dentistry, focusing on the competition between corporate and private practices. The speakers discuss the challenges of finding associates, the impact of corporate consolidation, financial realities, and the burden of student debt. They also delve into the appeal of corporate contracts, work-life balance, and the importance of patient relationships in the context of personalized care versus corporate efficiency.   takeaways Corporate dentistry is on the rise, affecting private practices. Finding associates for private practices is increasingly challenging. Student debt is a significant burden for new dentists. Corporate contracts often offer higher starting salaries but come with hidden costs. Work-life balance varies significantly between corporate and private practices. The consolidation of dental practices is driven by financial backing from private equity. Patient relationships are crucial for personalized care in dentistry. The financial realities of running a dental practice have changed post-COVID. Dentists need to be aware of the terms in their contracts with corporate entities. The future of dentistry may lean more towards corporate models, impacting patient care.   titles Navigating the Dental Landscape: Corporate vs. Private The Challenges of Finding Dental Associates   Sound Bites "There's always a need for it." "You need to look at all your options now." "It's a weird time in dentistry."   Chapters 00:00 The Landscape of Dentistry: Private vs. Corporate 01:51 Challenges in Finding Associates 03:49 The Rise of Dental Support Organizations (DSOs) 06:22 Financial Dynamics in Dentistry 08:33 The Burden of Student Debt 09:51 Navigating Career Choices in Dentistry 11:47 The Reality of Corporate Dentistry 14:27 Work-Life Balance in Dental Careers 16:03 Future Trends in Dental Practice 17:51 The Corporate Dentistry Dilemma 18:46 Navigating Employment Contracts and Covenants 19:17 The Shift Towards Corporate Practices 20:31 Patient-Centered Care vs. Corporate Efficiency 23:09 The Importance of Personal Relationships in Dentistry 25:38 The Future of Private Practice vs. Corporate Dentistry

In this episode, host Bill Neumann sits down with Jake Berry, Chief Development Officer at MB2 Dental, to discuss the evolution of the DSO landscape and the unique partnership model that MB2 has pioneered. Join us as we explore: The history and founding of MB2 Dental, starting from a single practice in Dallas in 2007 to nearly 800 locations today. The differences between traditional DSOs and MB2's Dental Partnership Organization (DPO) model, emphasizing shared ownership and alignment of interests. Insights into the current state of the DSO market, including challenges and opportunities for consolidation. The recent recapitalization event and what it means for MB2 partners and the future of the organization. The importance of doctor retention and how MB2 supports its partners in achieving long-term success. To learn more about MB2 Dental visit https://mb2dental.com/ Thank you to OSDental for sponsoring this podcast. Find out more about a unified operating system for growing dental practices. Visit https://osdental.io Subscribe to our channel for more episodes and stay updated on the latest DSO news, insights, and events!  

This week, the Dental Amigos welcome Brannon Moncrief, the Principal and CEO of McLerran & Associates, who specializes in providing sell-side advisory to large dental practice owners seeking to monetize their businesses in private buyer sales or DSO transactions. Brannon has personally facilitated the sale of over 1,000 dental practices and is widely considered to be an expert on DSO affiliations. In this episode, Brannon offers his insight on the “DSO vs. private doctor buyer” debate, emphasizing the importance of defining personal, professional, and financial goals before making a decision. Brannon draws on his extensive experience to help listeners understand concepts like EBITDA and the different types of equity to help listeners understand highly complex and often confusing DSO offers. Finally, Brannon discusses the challenges of internal succession planning and his long term strategies for facilitating a smooth transition into retirement. To get in touch with Brannon and his team, schedule a free, confidential discovery call here: https://dentaltransitions.com/contact-us/. Brannon can also be reached directly at brannon@dentaltransitions.com or (512) 660-8505. Listeners who want to reach Paul can do so at Paul@DentalNachos.com and those who want to reach Rob can do so at Rob@RMontgomery-law.com.

In the 2nd part of the Deadcast's Phil Lesh tribute, we get deep into his singular bass playing with Phil's son & bandmate Grahame, Phish's Mike Gordon, & musicologist Rob Collier, while touring Phil's high adventures with Ned Lagin, radio co-host Gary Lambert, & other friends.Guests: Grahame Lesh, Mike Gordon, Ned Lagin, David Crosby, David Lemieux, Gary Lambert, Rob CollierSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Kiera is joined by Dr. Robert DiPilla to talk about his world of dentistry, including the transition from cosmetic to holistic services, how he educated his patients, lessons learned during his multi-practice ownership, and more.   About Dr. DiPilla: Dr. Robert DiPilla studied dentistry at the University of Detroit-Mercy, and then went on to attain a Fellowship for Dental Implants at the Harvard Club. He was quickly recruited to Manhattan, where he honed his dentistry techniques, and had the opportunity to work on many high-profile clients. Dr. DiPilla became a partner at the renowned Rosenthal Dental Group on Madison Avenue, and earned the title “the dentist's dentist” by his peers in the industry. Dr. DiPilla has had the privilege of perfecting the smiles of celebrity clientele such as Kathie Lee Gifford, Wayne Gretzky, Steve Duchesne, and Sarah Ferguson among others. While Dr. DiPilla maintains a Manhattan office, he now focuses on the location where his career began in the Detroit Metropolitan area. He contributes regularly to nationally circulated trade publications, and continues to be recognized as a leader and expert resource in aesthetic dentistry. Episode resources: Sign up for Dental A-Team's Virtual Summit 2025! Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Transcript Kiera Dent (00:00.768) Hello, Dental A Team listeners. This is Kiera And today I am so jazzed to have an incredible guest. We have been following this man. We've been wanting him on our podcast. He is incredible. And I feel like what he's doing is changing the way dentists are doing dentistry. I think he's kind of in this new age, new era, adapting with the times. And so was so excited to bring him on and have his knowledge. So welcome to the show, Dr. Robert DiPilla. How are you today?   Dr Robert DiPilla (00:25.484) I'm doing well. Thank you very much. I'm excited to be on your show. There are so many great things about you and your show. I I once again, I went back to some of your podcasts and you some great, great guests on.   Kiera Dent (00:37.376) Well, thank you. am quite shocked. Dental A Team is about to release their thousandth episode. And I was thinking, I cannot believe I've been on this microphone a thousand times. So I'm super honored that you are a part of that journey. And really everyone who listens to the podcast knows our ultimate goal at Dental A Team is to positively impact the world of dentistry in the greatest way possible. so bringing guests on like yourself, people who are passionate about dentistry, making sure that we keep the passion alive in dentistry, making sure that people realize   I believe we're in the best industry we possibly could ever be in. And so I'm super excited because I feel like you're taking a new edge spin to some things in dentistry. So before we get into some of these fun topics, Dr. DiPilla, why don't you take us through kind of your journey? I know you have a pretty interesting route of how you were able to go from where you were and where you started in dentistry to where you are today. So if you kind of want to take us on your journey, that way the audience gets to know you as well.   Dr Robert DiPilla (01:31.854) That journey starts 36 years ago. I graduated at the University of Detroit, Mercy in 1989, and I did a residency at Harvard at the Harvard Club for doing implants. And from that, I really was interested in the cosmetic realm. So you got to think about in the early 90s. And it was kind of like touched upon. And I was very fortunate.   to take a course with Bill Dickerson and Larry Rosenthal. And this is the first time they were together in doing these particular courses. And my first patient for my aesthetic course was my sister, believe it or not. when I mentioned this, it was an amazing journey. She was very appreciative. It was a great case. And from that, one interesting point.   Kiera Dent (02:16.68) Wow, that's brave, an aesthetic course.   Dr Robert DiPilla (02:30.828) when I was in the lecture and they were talking about different materials, different processes, the way to do things. I know once again, I just graduated, I did like a little surgical residency and I thought to myself, mean, the auditorium was packed, there's probably like a hundred students. And I'm like looking around and I'm thinking myself, am I the only dumb one here that doesn't know this?   I said, this is insane. And they're going over these seven different steps to do bonding and veneers. I'm like, my gosh, did I learn this in school? you   Kiera Dent (03:05.28) Did I skip that day? I promise I didn't miss too many, right? That's what you're probably thinking, like I was there.   Dr Robert DiPilla (03:10.237) I would promise I was there. But I promised myself since then, it was like a real, not say a low point in my life, but it was a low point in the sense of how come I didn't know this? And I kind of pride myself in understanding things and certain process and procedures. And I said, from that day, this will never happen again. So that journey led into teaching with Bill Dickerson before it was LVI and also   aesthetic advantage with Larry Rosenthal. And as you know, there were two separate groups and I had to make a decision on what camp was I going to go into. Was I going to do the LVI camp in Vegas? And mind you, I'm in Michigan. Or do I go to New York route? And my decision was New York was closer. So I went with Larry Rosenthal. So I was an instructor with him for about three or four years. And then I was invited to be a doctor in his office.   And I was there for a good 10 years. that journey right there was probably the highest point of my life in that particular aesthetic office. There was a lot of great contacts, a lot of great people that we met. And I always say everything is a blessing for me. I don't hold anything back as far as this was a disappointment. This didn't happen for me because I think everything is a growing experience.   So for me, being in Larry's office was really, truly, truly, like I said, a blessing. It was a great thing for my career. And then I knew that when I started having a family and kids, New York for me personally wasn't the place for me. Coming from the Midwest, Midwest values, I wanted to have the family where I grew up because my mom is still here and my extended family is here as well. So once again, from that, I left New York.   Kiera Dent (04:51.21) You   Dr Robert DiPilla (05:01.806) And then, but I kept a practice in New York as well, because I had a lot of patients to see. And I started my own practice in Birmingham, Michigan. And that was in 2000, probably 2003, 2004. And then from that, you know, we grew to five different practices. So it's been a really challenging once again, but it's been a great journey for us.   Kiera Dent (05:15.338) Wow.   Kiera Dent (05:25.706) That's incredible. And so I'm curious because when I first started as a dental assistant, one of the doctors that I worked for had a practice in California and Utah. And so every Thursday or Wednesday, I think it was, we would close out in California and he'd catch a flight and he'd go to his practice in Utah. He'd be there Thursday, Friday, fly home, and we do Monday, Tuesday, Wednesday. So did you fly back and forth between your two practices?   Dr Robert DiPilla (05:45.93) I did the same thing. When I moved back to Michigan, I would work in Michigan Monday, Tuesday, Wednesday, would fly out to New York and work Thursday and Friday. And then plus New York's a great city and I stayed for the weekend and I flew back the first flight out 6 a.m. on Monday morning to make it to my practice at 9 a.m. So I did that for seven years. So back and forth. then once again,   Kiera Dent (05:56.106) Yeah.   Kiera Dent (06:02.806) sure.   you   Dr Robert DiPilla (06:12.462) It was great. To me, people, how did you do that? Why did you do that? It was just my routine and it worked out really, really well. And then there was some point where I kind of have to slow down and kind of give that up a little bit because I wanted to build more practices in Michigan.   Kiera Dent (06:27.414) Sure. No, that makes sense. And I was just curious because when that Dennis would do it, I thought like it was so wild, but it made sense of how he was able to have the two practices. So it's either you fly back and forth for a while or you get associates. Did you end up keeping that practice in New York or did you have an associate running it or did you end up selling it and then focus in Michigan?   Dr Robert DiPilla (06:45.186) Yeah, no, I actually, believe it or not, a lot of my New York patients actually will fly to Michigan to have their work done. And then the rest is I gave it to a really good friend of mine, Dr. Michael Krause, that's in the city on 49th and Madison. So, you know, basically a lot of my patients just kind of ended up with him.   Kiera Dent (06:52.564) Incredible.   Kiera Dent (07:06.728) Amazing. And that's great to know. And I hope dentists heard that of when you are really great at your craft, they will fly, they will come to see you. And I think that that's something that's different in today's world. I think that it's very common for patients to fly other places rather than just going to their dentist down the street. I think people fly for different surgeries to different places. Now I think for your day in day out routine dental care, you'll probably stay closer to home. But also we only go six, like two times a year. So it's really not that much to travel if you want to.   Dr Robert DiPilla (07:25.919) percent. Yeah.   Yeah.   Dr Robert DiPilla (07:34.798) Yeah, there's a lot, know, as you know, there's a lot of patients that will seek out plastic surgeons and they will go to a certain destination if it's New York, LA or Miami. And that's the same thing with dentistry. I mean, I've been very fortunate. I've had a of patients from Miami that will fly up and for me to do their work, their veneers, New York, of course, all the way even from LA. So it's been it's been a wonderful thing. I'm very humbled, you know, to do that. I don't take that take that lightly.   Kiera Dent (07:40.214) Mm-hmm.   Kiera Dent (08:02.812) No, and I think that there's when you love what you do and you're really great at what you do, people fly. I mean, I am a dental snob. think being in dentistry, it makes me one of the worst patients. And so I'm always nervous. And so I do travel to dentists out of the state. And I think it's something of the world has changed. And so I love your journey. I love the passion you have. I love that you've built multiple practices. I think you bring an interesting perspective. And so I'm super curious because you've kind of gone into a holistic route as well. So   I'm curious, how do you go from dental implants, veneers, which feels very cosmetic, into holistic? Like what's kind of the bridge? How have you done that? Because I think people feel like I'm either traditional dentistry or I'm holistic dentistry. And I feel like you're bridging this gap. And I think the world is bridging this gap as well. I don't think it's as polarized as it used to be, but what's kind of your take on that and how did you transition? What got you excited about that? Give some insights.   Dr Robert DiPilla (08:53.684) I mean, you   You know, for you as you know, being a hygienist, know, to me, for our patients, we want to make sure that they have a healthy foundation. a healthy foundation is the bone and also the gingival tissue. And, you know, it doesn't matter how great of a cosmetic dentist you are, how great of an implantologist you are, the tissue has to be stable. It has to be making sure that, you know, the oral microbiome is sufficient.   Kiera Dent (09:05.299) Mm-hmm.   Dr Robert DiPilla (09:25.774) You got to make sure that the biofilm is eliminated. And one of the biggest things that, I mentor 22 doctors here in Michigan, from guys who've just, guys or gals who've just been out a year and guys like myself that been out for 36 years. One of the things that I try to impress upon them is that don't be a mechanic of the mouth. And my feelings,   is that dental schools right now, and once again, different than my era, is just really, they're really teaching you how to pass the board exams. And then the real age of dentistry is what you get after as far as continued education. And I think it's really important, as you know, even being a hygienist, is that you have a patient that comes back, yet you did scaling and root planning.   Kiera Dent (10:01.694) Right.   Dr Robert DiPilla (10:17.15) and you see him back in three months and they're saying, yeah, I brush every day, I floss every day, I have the water pick that you recommended, I'm doing the oral care, I'm doing this. And they come back and it's like, my God, are you really flossing? Are you really brushing your teeth? No, no, I am. But why is that? Why are we doing maybe supervised neglect or super profis? The question comes in is that we have to understand why, my biggest thing is the why, why is that happening?   You know, we incorporated now we're doing genetic testing, we're doing saliva testing for our patients because as we know, a lot of, you know, reintroduction of refractory periodontitis that happens. So even the same thing with my hygienist, you know, we're very strong in continuing education. We're very strong in not just scaling and root planing teeth, just for the matter of fact of doing it. And one of the things that, you know, my hygienist, they all know,   is that if you're doing Scanlan Root Planning, what type of attachment do you want back? So I think you have to have a strong foundation in histology. You have to know the periodontium very, very well. And a lot of times in school, yeah, yeah, that was that class. I had it, but this is what I want to do. So I think for us in dentistry, you have to move away from being that mechanic of the mouth, because I can teach my assistant to prep a tooth, easy. But you have to understand the diagnosis and the   Kiera Dent (11:26.774) you   Kiera Dent (11:38.368) you   Dr Robert DiPilla (11:42.094) And it also goes back to different materials. The whole rage now is zirconia, crowns, and it's a lot stronger. But is it really? Is it lithium disilicate, or is it philospathic porcelain? So I think there has to be an understanding of where to place those materials in the proper patients and proper occlusion. So because a salesperson comes in, oh, this is the latest and greatest, doesn't mean that you should buy it. So I think.   Kiera Dent (12:09.824) for sure.   Dr Robert DiPilla (12:10.894) For me, it's kind of taking a step back and understanding dental materials, understanding the periodontium, understanding all that. I the classes that we hated in school, believe it not, I've been doing this for 36, are probably the most important now than anything else.   Kiera Dent (12:25.67) No, for sure. And I'm so grateful you talked about that because agreed like the healthy foundations, I think it's so easily overlooked. So I'm curious, how did you start to incorporate this with your patients? Because you didn't come out of school having this, you didn't learn all these things right away, you started incorporating it. I think people are oftentimes afraid to add this into their practices due to patient pushback. So how did you, how did you educate your patient base?   Dr Robert DiPilla (12:48.702) Well, yeah, I think it's just having a good communication with your patient and being authentic. with our patients, we're there for them in a sense of we don't push anything, we don't sell anything, we just educate our patients. And a lot of times, if I've seen a patient for 10, 15, 20 years and I'm watching them get worse,   And, you know, I'll just have that, you know, that radical candor with them saying, hey, listen, you know, where do you want to go with this? What do you, how can I help you? You know, do you, mean, for some reason I'm watching you getting worse and I don't want that. So what can I do to help? And then we kind of castor them in that, in that direction as much as possible. You know, there's, we'll do a lot of like nutritional counseling and we see a lot of patients that, as you know, they come in, you know, they're not, they're not healthy. And I have the,   Kiera Dent (13:39.51) All right.   Dr Robert DiPilla (13:42.21) I guess the personality to talk to my patients and say, listen, I want you to see this person. I care about you. I've seen you for many, many times. And I just, you know, I see some things that I don't like. So what I want you to do, here's a referral. I want you to see them. And then nine out of 10 times they'll come back and say, my God, thank you so much. I didn't know I had this underlying condition.   Kiera Dent (14:07.84) That's incredible. And I agree that education, I think is the new age of communication. I think a lot of patients want to understand more. think we live in this digital era where people are consuming so much more information rapidly and they want to be educated and they want to know what's going on. And I do think social media has, has ramped this up exponentially for people to want more education rather than just blindly following. And so I really love that you took it that way. I want to ask you a couple of questions about   growth of practices because I think so many people grow practices or they feel that they need to grow practices or they need to expand their practices. I'm curious after having done that, you've had practices in multiple states, you've grown your, like walk me through, like when do you grow as a dentist? When do you not grow as a dentist? What are some things that you learned through that growth of multi-practice ownership, especially with dentists that are in today's world? I think that there are some that are brand new.   There's the DSO on the radar and on the horizon for people. Walk me through some of your thoughts around this practice growth, multi-location, when do I grow, what do I do with DSOs? I'm super curious because you've done it and you've done it for a long time. What are some of your thoughts around that?   Dr Robert DiPilla (15:08.718) 100%.   Dr Robert DiPilla (15:17.582) I'm going to let's go back when I was like I said, very fortunate to be in Larry Rosenthal's office in New York City. And everyone knows Larry Rosenthal is the premier, know, veneer office to go to. So I was once again, I was very, very fortunate to go there. But well, my dismay, I was the young kid.   Kiera Dent (15:37.364) It's incredible, by the way. like, like, let's just stop for a second. Like, that's incredible that you got to work there with him.   Dr Robert DiPilla (15:44.622) So think of a patient that's there, know, we had celebrity CEOs, we had every mogul you could imagine we had. And you got this young kid walking in and they're like, well, kid, move away, where's Larry? Where's Larry? So what I had to do, I had to kind of reinvent myself. And, you know, and I had to figure out what type of avatar patient, you know, do I want? And I think that it doesn't matter if I'm in New York, if I'm in Birmingham, Michigan.   Kiera Dent (15:44.947) Yeah.   Kiera Dent (15:57.715) Yeah.   Dr Robert DiPilla (16:11.274) I'm if in Salt Lake City, Atlanta, doesn't matter. You just have to figure out what avatar do you want. And then you kind of go where that avatar is. So an example, this is what I did. So in New York City, I need to get a haircut. So for me, I went to the biggest celebrity hairstylist you can get. And it was Orbe in New York City. And why did I do   Kiera Dent (16:37.556) Yeah. Okay. I mean, you do have great hair, by the way. So, I mean, it must have worked out for you. I like it. It looks great.   Dr Robert DiPilla (16:41.582) Well, thank you so No way. It's not what it Well, thank you. So I went to Orbe and why did I go to see him? Because Orbe has what a lot of celebrity clientele. And for me, it was building a relationship with Orbe. You come in, your first appointment, who are you? What do you do? Oh my God, yeah, I have a dentist and that, that, that. As you know, when you say you're a dentist or a hygienist, oh, by the way, can you look at this?   Kiera Dent (17:10.633) haha   Dr Robert DiPilla (17:11.758) So what that does is that it kind of opens up the dialogue as much as possible. So from him, I've been seeing him for two to three years. And once again, it's something that you always have to continue going. If you do it once or twice and it doesn't work, well, that's not going to happen. So they go into the gym, you work out once or twice, you're not going to be in shape. it's of those things that you perpetually just have to do. So I was very fortunate seeing him for years. And from that,   Kiera Dent (17:32.083) Right.   Dr Robert DiPilla (17:39.49) I had my own celebrity clientele that came into Larry's office. It was great. All right, how about another one? So I was fortunate they had the LA Reebok Club where I used to live on the Upper West Side. And then joined a gym, of course. And I wanted to find out who was the best trainer who trained all the celebrities. And then once again, the same thing. So I think it's important.   Kiera Dent (17:44.308) Mm-hmm.   Dr Robert DiPilla (18:06.818) you know, to find out because I'm going tell you a lot of the celebrities and a lot of moguls, they're not calling to make the appointment. They have someone as an assistant to make their appointments for them. So I'll give you an example. I was working out in East Hampton for a little bit because I bought a house in in Amiganza. And as I was doing this renovation, I never really worked on Fridays, but in East Hampton, I worked some Fridays and I was fortunate   that I had a logistics manager for the Rolling Stones that came in. Built a relationship with her. And then from that, because she's a logistics manager, she does everything for the Stones. So I was very fortunate. She called me up, hey, Mick has a concert tonight at Madison Square Garden. He wants his teeth cleaned. He wants them checked out. Can you do it? Sure. What time? Nine o'clock at night. What?   Kiera Dent (18:39.082) Well.   Kiera Dent (19:01.735) I'm   Dr Robert DiPilla (19:03.342) So those are the things that you have to do. If you want that type of avatar, you want that type of clientele, then you kind have to do whatever it takes to go above and beyond to make sure that that happens. So don't think that if you want that type of practice, there's going to be some sacrifices that you're going to have to do. So for me, my personal story, for me being in New York, I was so driven, driven, driven. That's all I did. That's all I did. And I was married at the...   at the time. you know, looking back in retrospect, it affected my marriage. So, you know, my ex-wife, we're great, we're still great friends, but it affected because I just, for me, I was driven. This is what I wanted to do. I was out. I was going to opening of galleries. I was opening up to restaurants and because I wanted to be successful. But with that, there are some consequences that come with it.   So you have to kind of be prepared. You they always say, you know, the balance of life, you know, what to do as far as your career and work. I mean, there is, but you're going to sacrifice, you know, somewhere. You can't have it all, as they say. So you're going to have to kind of give up some.   Kiera Dent (20:12.853) Great.   Do you, looking back, are you grateful that you've made the decisions you've made or do you wish you would have done things differently? Like knowing what you know now. Walk me through because I think people people often wonder this.   Dr Robert DiPilla (20:26.466) Yeah, there's no, for me, there's no regrets because even if there was a regret, I always look at it as something that will make me better down the road. mean, listen, we're all gonna have failures. Things are gonna happen, but you have to learn from that. I mean, for someone to say, this has never happened to me and da, da, da, either they're lying or they have not, they've just graduated yesterday. I didn't tell my associates the same thing and that they had a bad day.   Kiera Dent (20:49.724) Yeah.   Dr Robert DiPilla (20:56.046) patient was complaining or something, I said, listen, it's going to happen. As long as you know in your heart you did the right thing, that's all you can do.   Kiera Dent (21:05.593) I that. And I appreciate that because I think so many times people feel like I should have known this right from the get go. But I think a lot of learning is experiencing too. And so going through it and making different decisions. And like you said, what's the type of life? What's the type of avatar do I want? And then crafting your practice around that. I really love that you highlight. I feel like you crafted your practice and your craft around the avatar, patient and life that you wanted.   I think at the beginning you probably hustled a lot more than you thought you would need to, but I think that that's the beginning of practice ownership. I think that's the beginning of any career. And then you're able to then start to curate it into what you wanted it to be. And I think so many dentists don't realize that that is a possibility for you if you want it to craft it for what you want.   Dr Robert DiPilla (21:50.486) No, listen, mean, there's many different practices, as you know. There's the elite practices that are doing, know, veneers and an example who took over Larry Rosenthal's office is Mike Appa. Mike Appa is a great dentist. When I was leaving Larry's office, he was coming in and he took it to the next level. And I missed, from my era, we didn't really have Facebook or Instagram or anything like that. So I'm kind of like the, know, the lagger in that particular point.   But he took that and made it to a different level as far as his career going to Dubai. And now he has multiple, multiple practices. But once again, there is some sacrifices. I'm sure it has not come easy to him. He has put in a lot of work, a lot of time, a lot of dedication to craft that for him. I look at it as, man, that's amazing. Good for him. Other people can get jealous of that.   but they don't understand the hard work what it takes to get there. It's like the basketball player, like, my God, he's making all this, how did he get that? But he forgot all the thousands and thousands of hours being in the gym and also practicing. Sometimes we forget that.   Kiera Dent (22:58.037) Yeah.   Kiera Dent (23:03.55) Right. Right. I think that it's been so just I love I love your passion. I love the life that you've lived. I love the I love that you were so committed to never being that person and then look at how that that drive and that determination took you from where you were to where you are today. I'm curious speaking to dentists who are maybe I don't know two three four years out.   What advice would you give them from all your years of practicing of the things you've been able to do, the clientele you've had, the team you had? What would be advice you'd give to that population of dentists right now? Knowing everything you know, knowing the climate, knowing the, like I said, DSOs are on the horizon. Do I become a private practice owner? Do I work corporate? Do I own multi-practices? What would you give? Again, we're talking four or five years out. I feel like this is right where they're starting to get that itch. They've got their, they figured a lot of things out.   Well, what advice would you have for that dentist?   Dr Robert DiPilla (23:57.454) So it's funny that you say that because three of my associates, I have been out four to five years. And we get together, which is great, which I love is we get together once a month at my house over here and we kind of go over some kids' education things and just kind of talking to them as far as what their successes are, what their stresses are, and also what they're stuck. We call that three S's. And I always tell them, listen, I don't want you to be me.   Kiera Dent (24:03.528) Mm-hmm.   Dr Robert DiPilla (24:27.5) I want you to be you. If you're interested in Invisalign, then go for it. And I think that a lot of younger dentists feel that, my God, I have to do that endo. I have to do that extraction. I have to do that filling. I have to do this because there's so much money and debt from dental school and you can't do everything because something's gonna, you're gonna get hurt on one perspective.   My advice, I've been doing this, like I said, for 36 years, find out what you really, really love to do and then do that. Is it gonna pan off the next day? No, it's gonna take time. And I think we live in a world that it's instant gratification and everyone wants everything done yesterday. It's just the law of averages. You're just gonna have to do it, do it, do it, do it and keep it until you get there. For me, like I said, I was going for the implant route.   Kiera Dent (25:16.519) Right.   Dr Robert DiPilla (25:26.474) I loved surgery. And then I found that niche that I wanted to do was the aesthetic world. And then, okay, I'm doing some aesthetics. We're at Larry's office. We're doing 10 veneers on the bottom, 10 veneers on the top and the bottom. And I'm thinking to myself, yeah, the bite doesn't look that great. I said, well, there's something more to this. And then I went down to Rabbit Hole. I did Pete Dawson's chorus.   Kiera Dent (25:47.568) I'm   Dr Robert DiPilla (25:55.746) I remember at Panky. So I went another route as far as now doing full mouth rehabilitation. Going back to, you know, Facebook, Centric Relation, doing everything that needs to be done. How am supposed to get back to that? Right? And then, you know, getting there. So, you know, for me, that is my niche now. And from, you know, I'm building a bigger office in Birmingham. I think I'm crazy what I'm doing right now.   Kiera Dent (26:08.108) The baseball, that's a throwback.   Dr Robert DiPilla (26:25.016) but I still have passion for what I do. feel like, you when someone said, you've been out for 36 years, I feel like I've only been out for five years. I still love this profession. I love what it's given me, the opportunity, but sometimes I don't like the direction where it's going in. And that kind of goes back to what you mentioned about the DSOs. Don't get me wrong, I'm not popo-ing DSOs. I mean, I think there's a place for everyone.   Kiera Dent (26:33.611) Yeah.   Kiera Dent (26:47.198) Yeah, I'm curious on your take. You've been in this for a long time.   Dr Robert DiPilla (26:55.24) I mean, know dentists are in Medicaid offices, great. We know that patients are in PPO offices, great. Fee for service, better. And then also group practices that, you know, my associates are in. And then there's DSOs. Once again, I'm fortunate to be part of Dicama's group, and it's one of the premier law firms that have put all the DSOs together.   Kiera Dent (27:06.698) Yeah.   Kiera Dent (27:18.805) Mm-hmm.   Dr Robert DiPilla (27:25.358) And some are great, some are amazing, but some have failed. And I think one of the problems I feel that corporate has is that if you do the CEO, you're looking at what? You're looking at the numbers, you're looking at the metrics, right? You're looking at the KPIs. But if you're in the trenches, you can't treat every office as the same. It's different. The hygienist has a different personality. dentist has a personality. You have different patients, demographic of patients.   Kiera Dent (27:31.04) Right.   Dr Robert DiPilla (27:54.648) So I think for dentists, we're just a different animal as far as the field that we're in. It's very, very personal that we have as far as our offices. And like I said, I have five offices. All five are completely different. If I try to implement every single detail thing in Birmingham to do it in Detroit, no. Same thing in Detroit to do at Sinclair Shores, no. It has to be customized to that particular practice.   Kiera Dent (28:22.782) Yeah, no, and I think that's such wise wisdom because working with hundreds of offices, I don't have an A to Z cookbook. I don't tell them like implement this. I know systems that will work, but we customize it to your area because the patient base, like you said in New York compared to Birmingham, Michigan, they're going to be very different patients. They're going to have different needs, different like all of it is different. The pace of it is going to be different. Your attrition rates will probably look differently. And so I agree with you completely that   Dr Robert DiPilla (28:36.046) That's great.   Kiera Dent (28:52.52) Everything is not apples to apples. I'm curious, how do you lead all five of those practices? Do you have, like, what does your team structure look like? Because so many people do get stressed out with multi-practice ownership. What have you done to reduce that stress level for yourself and make sure that they're all successful?   Dr Robert DiPilla (29:06.262) Yeah. No, it's, we just had our all company meeting. I call it the summit meeting. And, you know, it's amazing that, you know, 10 years ago, I had one office and maybe four employees. Now I   Kiera Dent (29:13.672) Thank you.   Kiera Dent (29:20.928) Did you hear that everyone? 10 years ago. So this is something that in his 36 years of dentistry, he did 26 years. I also think people need to realize they sometimes feel like they're too old to open up multiple practices. They feel they're too far in their career. They needed to do this earlier. So I hope people are hearing your timeline of 26 years solo practice and now 10 years making five practices, but also there is a timeline around that. So continue please. But I just want to highlight, this was not an overnight thing for you either.   Dr Robert DiPilla (29:23.5) Years ago, Yeah. Single practice.   Dr Robert DiPilla (29:51.054) It's not. I'll go back and I'll tell you the reason why for that. And for me, like I said, going to New York, I wanted to be the best. I wanted to be that celebrity dentist. And when I came back to Michigan, I centered everything around me. People came, they flew in from out of state to see me. And one of the things, I can't scale me. And one of the things that I have to open up   Kiera Dent (30:12.63) Yeah.   Dr Robert DiPilla (30:20.174) the offices and kind of passed the baton to my other associates. So, you for me, that was like the biggest thing is the key is letting go. And like I said, we had a summit meeting two weeks ago. And like I said, I had five employees in one practice. Now I have five practices with close to 70 employees. You may say, my God, how do you do that? I hire smart people smarter than me.   Kiera Dent (30:43.082) Yeah   Dr Robert DiPilla (30:49.79) to do that. I have a great CFO. I have a great regional manager and I have great office managers. And one of the biggest things that we, we constant, constant role play a lot of the things that we do in the office. And why is that important? One of the things that we did when COVID happened, before we opened up, we had a month where we did Zoom calls.   like this, and we did a role play because when patients come back, they're gonna have questions. And what are we doing to protect them and ourselves? And it was really important for the front desk, it was really important for our managers, hygienists and assistants to make sure we're getting our message across. One of the things that I never wanna hear on the phone is if a patient asked a question,   and our front desk, our personal, I don't know. I don't know what we're doing. So, you to me, it's just having those questions answered. And what we did is I call it the kind of the soft opening, like what a restaurant would do before they opened up fully, they would kind of, you know, bring in some of their guests or their family members to have a soft opening. So that's what we usually do from that. But the main thing, you for me,   Kiera Dent (31:51.997) That's   Dr Robert DiPilla (32:15.112) is I just hire great people that are around me that will integrate the vision that I have. So there's a great book and I highly, highly recommend for dentists. And I know Gina Whitman very well, it's called Traction. I don't know if you've heard the book or. And it's amazing. And then the follow-up book is Rocket Fuel.   Kiera Dent (32:33.75) We are diehard traction people. We help offices with it. It is incredible. Yes.   Kiera Dent (32:41.903) Amen. When you were talking about integrator, was like, he's a visionary needs the integrator. Did you, did you hire?   Dr Robert DiPilla (32:45.198) I'm the 100%. I mean, for me, I'm definitely the visionary. know what I want to see. And then my CFL is the integrator. I have so bad ADD, I'm like, don't squirrel. Okay, what happened over here? No, no, no, no, get on track. We gotta do this. So for me, like.   Kiera Dent (32:57.848) you   Kiera Dent (33:03.382) How did you find your CFO integrator? you go through one of Traction's hiring things? Did you find them through? How did you find that integrator? Because I think that's such a key piece in growth. How did you find yours?   Dr Robert DiPilla (33:14.572) Well, luckily she was with us and within the company and we just hired up for her. She just went from low level to higher hiring and she got it. She understood the whole process. mean, when she read the book, she, I mean, my God, this is the missing piece for us. And I love that, that passion that she has for that and then just kind of put everything together. So I was very fortunate in that respect. But when we do our hiring,   Kiera Dent (33:21.462) amazing.   Kiera Dent (33:32.118) Yeah.   Dr Robert DiPilla (33:43.746) We hire within our culture and who we are. And sometimes it's difficult to do that. We did that right after COVID because some people didn't feel like they wanted to come back or didn't feel safe to come back as far as some employees, which is fine. And there was a shortage of dental assistants and hygienists wasn't an issue for us. It was more assistance. And I hate to say that we hired people that weren't the right fit.   Kiera Dent (34:08.97) Mm-hmm.   Dr Robert DiPilla (34:13.71) And I'm going to tell you that was a big mistake because it's going to take you longer to find another person. So I'd have no one. do it myself compared to not have the same, the right person that would fit in our culture.   Kiera Dent (34:29.974) I agree. That's wise wisdom. And I think so many people get desperate. And I mean, I've done it. I think we've all done it, right? We've all made those hires and we're like, agreed with you. We'd rather wait it out till the right person comes through rather than doing those desperate hires. And I think it's   Dr Robert DiPilla (34:41.966) Yeah, it works out. And really works out. I'm a true believer that, I mean, there is a plan and you just kind of have to wait it out and it comes in because the same thing in our downtown Detroit office, we were waiting for someone and we thought someone, oh my God, she's going to be great. Oh my God, she's moving from Boston. She's going to come here. She's ran a periodontal office. Oh my God, we love her. And then got ghosted. Like what the hell happened? And then the next day,   Kiera Dent (35:07.38) Mm-hmm.   Dr Robert DiPilla (35:10.85) We got another resume. Lauren, I mean, amazing. I mean, just that blessing that comes through. So I think the best thing to do is just wait it out, hire within your culture. And if they don't fit, they're not the right team member for you.   Kiera Dent (35:28.916) I love that. Dr. DiPilla, something I have found so fascinating with our podcast today, just so appreciative. I feel you have wisdom. And I think wisdom oftentimes lacks. And I think it comes from experience. I think you've learned from the things that you've done. I'm not saying you're old. I'm saying that I hear wisdom from you. And I think you had this wisdom even when you first started your career. I think you learned things. But I feel you lived your own.   Dr Robert DiPilla (35:42.114) You're saying I'm   Kiera Dent (35:56.438) I feel like you grew because you wanted to grow, not because you felt like you needed to. I feel like you waited when I'm sure a lot of your other colleagues were building multi-practices and you're like, this is what I'm enjoying doing. And what I've heard is as you've shifted and morphed throughout your career and the way you've presented it, it sounds like you've done it based on intrigue and curiosity and things that still keep the passion within you. And I feel like...   You're a great example of someone who can be practicing dentistry for 36 years and still have passion, fire and fuel behind it, rather than the what I see a lot of right now of burnout. And I was trying to put the pieces together as we were chatting and I'm like, I think honest to goodness, you've done everything because it was a passion and a curiosity and it fueled you rather than drained you. And I also really love that   you believe that there's a higher path for you. Like you said, it's just because one door is closing, it means the other door is opening, but that door is not quite ready yet. So be okay with this door closing. But that would how I would summarize you. Obviously, please fill in any gaps I may have missed. But I think that that's so refreshing to hear that I think a lot of us can take stock in and learn from you as well.   Dr Robert DiPilla (36:49.806) 100%.   Dr Robert DiPilla (37:05.474) Wow, well, thank you for that. That's, thank you. But for me, right now, I think it's important to, like I said, pass the baton to my other dentist and kind of elevate them as much as possible. And I think if you're in a group practice or if you're in a single practice, sometimes we live on our own little island and you don't know where to do. would...   Kiera Dent (37:10.197) You're welcome.   Dr Robert DiPilla (37:31.66) get a couple of your friends, colleagues, whatever, just go out to a restaurant, hang out and kind of talk your story. Because we're all in it and we all go through the same things. And maybe I'm blessed with mental resiliency, I don't know. I mean, there's a lot of things that are kind of thrown at you. But for me, for my upbringing, mean, things bother me, don't get me wrong, I am human.   But I know that my purpose is stronger than the noise that hear that's behind me. And for me, where am I going to go from here? What's the next 10 years look like? And For me, my legacy and what I want to hear is that when I'm long gone and a patient goes to another dentist and says, hey, who's your other dentist? And I say, well, I went to DiPilla All I want to hear is that, you know what?   Yes, I heard great people. That's all I want to hear. You went to one of the best. That's it. That's all I want to hear. I mean, I that's my legacy is that make sure that we as a group, as a team or organization, we've done the right thing by you and also by the the patients and also our team too. We got to take care of our the team that supports us very,   Kiera Dent (38:54.25) That's beautiful. And I think as you said that I think maybe a takeaway from today would be figure out the legacy that you want to leave. think that that legacy, just did a mastermind group with some people in person and I had them write when they were, you know, I didn't give them an age. I just said, when you're sitting back looking at your life, what do want to feel? What do you want to experience? And what do you want it to be said about you?   And it was crazy because people started making different decisions in that moment because the legacy of who they want to be and what they want to leave behind radically shifts what you're doing today. And I think that that's a beautiful takeaway from today. I have loved our conversation. I thoroughly enjoy you as a human. I think you're just doing a beautiful work, an example of keeping the passion alive in dentistry and doing great things no matter what's going on. any last thoughts you have, how can people connect with you?   Dr Robert DiPilla (39:34.926) Thank you.   Dr Robert DiPilla (39:44.238) I think for anyone guys who have been graduating, this is like the best time to be a dentist. I mean, I'm so excited. mean, the technology is amazing. Things that we used to do before and we can do now, digital workflow, 3D printing, AI, it's amazing. So, for me, I go into work every day. I'm very passionate what we need to do. But for me,   It's time for me to kind of like maybe work maybe in the chair once or twice a week and then work on the business. And that's where I'm more passionate about as well. And then kind of like I said, elevating everybody else. But once again, this has been a real, real pleasure and I can see your passion as well and much, success for yourself.   Kiera Dent (40:28.682) Likewise, thank you so much for joining today, Dr. Tafilla. I hope everybody who's listened takes away a few golden nuggets and gems because I really do believe there was so much value and wisdom in this podcast today. I think that there's so much beauty. love podcasting with people like yourself that are just so optimistic of the future. So thank you for joining us and for all of you listening. Yes.   Dr Robert DiPilla (40:49.816) My pleasure.   Kiera Dent (40:53.78) All of you listening, thank you for joining us. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.  

On today's episode, we're back with part two of our live panel from the Women in DSO event, featuring Dr. Mark Costes and his powerhouse executive team—Ashlee Hirschfeld, Kay Lange, Sydney Robinson, and Mary Lafferty. This conversation dives deeper into the key operational strategies and leadership principles that drive growth and efficiency in DSOs. The team explores the importance of accountability in systemization, how to form a strong internal "board of directors," and the role of marketing in patient acquisition and retention. They also discuss strategies for reducing staff turnover, overcoming resistance to change, and leveraging AI for smarter business decisions. Plus, Mary shares game-changing insights on optimizing marketing efforts for real impact. EPISODE RESOURCES https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

On this episode of the Dentist Money Show, Chip Fichtner from Large Practice Sales joins Matt to discuss the complexities of large dental practices and explain what an invisible DSO is. He highlights the importance of selecting the right DSO partner and how to avoid common pitfalls in these transactions. Whether you're a dentist considering a partnership or just looking to understand how these organizations work, tune in to hear some valuable insights of the current market landscape, the factors that can help maximize practice value, and the future dynamics of DSOs. Book a free consultation with a CFP® advisor who only works with dentists. Get an objective financial assessment and learn how Dentist Advisors can help you live your rich life.

In today's Part 1 episode, Dr. Mark Costes takes the stage at the Women in DSO event, sharing insights into the incredible growth of Dental Success Companies and the lessons learned from scaling multiple businesses. He's joined by his powerhouse executive team, including Ashlee Hirschfeld, Kay Lange, Sydney Robinson, and Mary Lafferty, who break down key strategies for running a thriving DSO. They discuss everything from the operational bottlenecks that prevent growth to how AI is reshaping the dental industry. The conversation dives into the importance of standardizing care, creating a solid hiring process, and leveraging technology to streamline operations. Plus, they share practical tips on making job postings more attractive, retaining top talent, and building a culture that fosters innovation. EPISODE RESOURCES https://www.truedentalsuccess.com Dental Success Network Subscribe to The Dentalpreneur Podcast

In this episode, Dr. Nikita shares her journey from dental training in India to becoming a clinical lead dentist at a DSO in the US. She discusses the challenges and experiences of applying to US dental schools, the rigorous training at the University of Michigan School of Dentistry, and the differences in dental practices between India and the US. She emphasizes the importance of resilience, continuous learning, and building relationships with patients and team members in her professional journey. She shares advice for others looking to apply to ITDP programs. Dr. Nikita's Instagram: https://www.instagram.com/nikitarungta7/Engage with the podcast on Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/dentaldownloadpodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Haley's Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/dr.haley.dds⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Keywordsdental journey, international dentist, dental school, US dental education, dental training, career advice, resilience, job search, DSO, patient management

Join dental entrepreneurs George Hariri, Matt Guarino, and Matt Ford as they break down the realities of running their national DSO, Shared Practices Group. They tackle the triumphs and tribulations of scaling a business, answer your burning questions (submit yours at bdppod.com), and delve into life's other adventures - from health and parenting to sports and politics. It's business, banter, and everything in between. Tune in and join the BDP community today!

Meagan welcomes Dr. Nicole Calloway Rankins, a board-certified OB/GYN, to discuss everything related to pregnancy, childbirth, and the VBAC experience. With over 23 years of experience and more than 1,000 deliveries, Dr. Rankins shares her insights on common questions and concerns from expectant mothers. From the importance of mindset during labor to understanding the implications of the word “allow” in provider-patient relationships, this episode is packed with valuable information. Don't miss out on Dr. Rankins' tips for a calm and confident birth, and learn how to advocate for yourself in the birthing process!Dr. Nicole Rankins' WebsiteNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Hello, Women of Strength, It's Meagan, and I am so excited to be joining you today with our friend, Nicole Calloway Rankins. Dr. Nicole Calloway Rankins is incredible. We've been following her for a long time and have collaborated with her in the past and are so excited to be having her on the podcast today. Dr. Rankins is a board-certified practicing OB/GYN, wife, mom and podcast host here to help you get calm, confident, and empower you to have a beautiful birth you deserve. She was born into a family of educators, and she felt a pull to medical school the day she looked in the mirror and saw a vision of herself in a white coat. And get this, it all happened while she was studying to be an engineer. She says, "I know that sounds crazy, but that vision has led me to exactly where I am supposed to be today- serving pregnant women." She's delivered more than 1,000 babies and has de-mystified childbirth for thousands more through her 5-star rated All About Pregnancy and Birth Podcast which she's going be talking about a little bit more today. I'm so excited for her. She has over 2 million downloads and her online birth plan and childbirth education classes. You guys, she is really changing so much about the birth world. She's incredible. You're going to hear it today. I love chatting with her. You can find her at drnicolrankins.com and of course, we'll have all of her other podcasts and Instagram and all that in the show notes. So get ready, we're excited. We're going to be talking a little bit more about common questions for an OB/GYN, but then we're also going to be diving into questions from you personally. I reached out on Instagram and said, "Hey, what are your questions for this doctor?" She is so excited to answer them, and she did. We went through every single question that was asked on our Instagram community. I'm so excited. I'm going to get to the intro, and then we are going to start with Dr. Rankins. You guys, Dr. Rankins is back with us today and I'm so excited. Funny enough, I keep saying that you're back, but you've never done the podcast with us.Dr. Nicole Rankins: I don't think so. Yeah, I think we did a class.m: We did a class which was phenomenal and everyone ranted and raved about it. So we're back together ,but we have you for the first time on the podcast. So welcome. Dr. Nicole Rankins: Well, thank you. I'm excited to be here.Meagan: We just adore you and I love getting your opinion on things. I think from doulas, from midwives to OBs, we all have different opinions and experiences, and if there's anyone that has hands-on experience, it is you and a midwife, like someone who is physically handling.Dr. Nicole Rankins: Yep. I've done this a couple thousand times. Yes.Meagan: Versus my 300 and something verse.Dr. Nicole Rankins: Don't discount it. That's very excellent.Meagan: It's still super great, but when it comes to thousands and an understanding on an even deeper level, it's just so fun and it's a compliment to the podcast to have your expertise.Dr. Nicole Rankins: Yeah, I've been at this 23 years, so it's a long time.Meagan: And still going. It's still going.Dr. Nicole Rankins: Still going. Yes.Meagan: And okay, tell me we can edit this if you want, but you have a new podcast coming out. I do know it's not going to be by the time this airs. It's not going to be out just yet. But can you tell us a little bit more about it and where people can find this?Dr. Nicole Rankins: Yeah. So it's still going to be in the same feed. So if you subscribe to the old podcast, it's just going to change, keep the same feed, but it's going to have a new name and a bit of a new focus still related to pregnancy and birth, but it's just a bit tighter. I want to say the name so bad, but I'm not going to.Meagan: Okay. Don't let it out. We will find out it is released.Dr. Nicole Rankins: Yes.Meagan: Tell them where to follow right now.Dr. Nicole Rankins: Right now? Yeah, if you follow me on Instagram, even though I'm taking a Little break now, you'll get it there. But the podcast is called All About Pregnancy and Birth. Go ahead and subscribe, and you can be the first one to know when the first episodes come out. I just have lots of new ways to present information about pregnancy and birth and frameworks and things. Okay, I'll give a little hint. One of the first things I'm talking about is one thing that's so important to pregnancy and your birth experience is your mindset. So one of the things I created is this MAMA mindset framework. MAMA stands for meditation, affirmations, move your body, attitude of gratitudes. I have practices, exercises, and things we're going to talk about. That's just one little, tiny sliver of the things that I've been working on and writing, so it's just good, great stuff.Meagan: Yay. Oh my gosh. I'm so excited. That is even more applied with just birth in general. But VBAC, I feel like mindset attitude, and all these things that you were just saying, is so important because even though we're just moms going and having babies, we have some extra things that some extra barriers that sometimes we have to either break through or we run into.Dr. Nicole Rankins: Absolutely. Yeah. I mean, a calm mind creates a confident birth. So when you have that calm mind, that is the first step to helping you create a confident birth experience. So mindset is really important.Meagan: Yeah, it really is. Well, I'm excited to chat with you today, and I'm excited to listen to that sometime here in the near future and listen to more of what you are bringing to the table. Okay, so one of the questions that I would like to go over is the word "allow".What does the word "allow" mean? How does someone navigate something that maybe doesn't feel right for them? And on both sides-- Dr. Fox and I have talked about how sometimes it's not right for the provider. You're not the right patient for that provider because what you want is not comfortable with the provider and vice versa.But we often hear or actually more see it on The VBAC Link Community on Facebook. There are comments of, "My doctor said they will allow" or "My midwife said they'll allow me to." If so when you are saying that or maybe have you said that, what does that mean?Dr. Nicole Rankins: Yeah, I don't say that word.Meagan: Okay.Dr. Nicole Rankins: It's a word that should not be in the discussion about birth because allow implies a hierarchal relationship where I get to make the decisions about what does or does not happen in someone's pregnancy, birth, labor, body, and that is not true. You as the person giving birth are the one who ultimately makes the decisions, not your doctor or your midwife. We can't really allow anything. We're not your parents. Do you know what I mean? So "allow" shouldn't be part of the conversation. It's a left overturn from just a general patriarchal foundation of OB/GYN, particularly when men took over into the specialty and banished midwives is how that language came about is that we need to tell folks and we need to control. So it really shouldn't be the case, but it still hangs around. Words matter, and it's important. Even though people don't necessarily mean it with any sort of ill-intent or that they mean that they're trying to control you, and inherently sort of subconsciously implies that. So I strongly dislike the word "allow".Meagan: Yeah, I am with you too. As someone who has had that word happen to me, it made me feel like I had to do something to meet their standard quota to get that allowance.Dr. Nicole Rankins: Right.Meagan: That just didn't feel great.Dr. Nicole Rankins: Yeah. Yeah.Meagan: So if someone is saying that, are there any tips of advice that you would give?Dr. Nicole Rankins: Yeah, I mean, first off, if you hear it, that's a little notch of a red flag potentially that it's not going to be a shared decision-making process because really, it should be that my role is to give you information and share my expertise with you to help you come up with the best decision for yourself. That looks like various things for different people. Some people want tons of information. They want to think about it and then talk about it. Some people are like, "Just tell me what to do," which if that's what you want me to do, then I can do that too. So if you hear "allowed", then it's concerning that there may not be that shared decision-making. So that's a little bit of a red flag to know.But then to open it up for discussion, it kind of depends on what the situation is. So is it we don't allow you to eat or drink during labor or we don't allow TOLAC? Then the next question is really, why? Especially if it's something that's important for you, why? If you want to use the language back, you can even use it back. "But why is that not allowed? Why is that the case?" And then kind of take the discussion from there.Meagan: Yeah. I think asking the question just in general, "Why?" or "Okay, I hear you. Can you explain to me?"Dr. Nicole Rankins: Yes.Meagan: It really helps there be a discussion like you were saying. I feel like when it comes to birth, like you're saying, I'm not your parent, but it needs to be collaborative effort here. We're trusting you to help us with this really amazing event in our life, but at the same time, we have to have equal trust from you. It's this collaboration of like, let's talk about what we want this to look like.Dr. Nicole Rankins: Yeah. Definitely, tust and collaboration are key in order to have a great birth experience. And ideally, you want to try to work on that foundation during your prenatal appointments so that by the time you get to the hospital, you know that you're going to have that relationship actually, regardless of what doctors there or nurses say. You create this environment of trust and collaboration. So when you ask the question why, don't necessarily start off-- and this is part of the psychology of human behavior. You don't necessarily have to start off with, "Well, why?" attitude because advocacy is not about creating conflict or creating chaos. Advocacy is really about creating that collaboration and creating that trust. It's the end result. So start from a place of trying to connect. Ask, learn information, and then kind of go from there.Meagan: Yeah. Love that. Well, thank you. Okay. Fetal monitoring. I know this is actually going to be a question down the line, or maybe it's a little different, but fetal monitoring with VBAC in hospitals is typically required. Can we talk about the evidence on that of why? Why? Again, here's the question, why? Why is that done? Dive in deeper. We talk about that in our course. But I think it's so great to talk directly to an OB/GYN like you to understand your point of view.Dr. Nicole Rankins: Yeah. The reason that's the case is that one of the first signs of uterine rupture is going to be a change in the fetal heart rate. So that's why we always want to see the fetal heart rate because it's going to be the first indication that there's potentially an issue. So it's really that simple. It may even be potentially before you start having pain. Some people may or may not have bleeding, but fetal heart rate changes and pain are going to be the things that will clue us in and we don't want to miss that if it happens.Meagan: Yeah, so when a fetal heart changes, we know, through labor-- this is a spin-off of the question. We know babies' heart rates fluctuate up and down. Sometimes they might have a compression in the cord that causes the heart rate to go really down during the uterine contraction and that goes up, but it goes really down. It's like, oh, that's low, and then it goes right back up to its baseline. So what is a concerning fetal trace in this scenario?Dr. Nicole Rankins: Right, yeah. So this is the part where I have to say, this is the reason we do four years of OB/GYN residency, why we have to get take fetal heart rate monitoring training every couple of years to stay up on it. This isn't something that can be had in a subtle conversation because it's not just what you see in the moment, it's what you see in the moment. The things we look for in general are a baseline of the heart rate between 110 and 150, 160, roughly. We look for things called accelerations, decelerations, and the variability, which is like the squiggliness of it, that's the big picture. But when we look at it, it's like, okay. We assess it, and then we try to do some things to improve the heart rate. We look at how the heart rate looks over time. Has it gotten worse over time? If we do some things to get it better, then that's considered good. So we can't really say if you see this specific snapshot of a fetal heart rate, then that's going to be the thing that triggers things. It really just depends.Meagan: Makes total sense.Dr. Nicole Rankins: And it can also be contractions because sometimes if you're having too many contractions back to back and there's no time to get a break, so the baby's like, "Can I just have a minute to breathe in between these contractions, please?" So maybe we need to slow down the contractions. So really, it's a lot of things that go into it, and that's where our expertise comes in.Meagan: Yeah, it's a big math equation in a lot of ways when it comes to tracings and things like that. Okay.Dr. Nicole Rankins: I do want to say that a lot of times people think monitoring equals no movement. But more and more, hospitals these days have wireless monitoring so you're able to move. That's definitely a question you want to ask ahead of time if wireless monitoring options are available so that you're able to move around.Meagan: Yeah, yeah. Because they've got, at least I don't know if it's what it's called there, but we call it the Monica.It's just that little sandpaper on your belly and that's kind of nice. Sandpaper sounds harsh. It's a light little scrub so it gets the oils off your skin. So that's a really nice thing.Awesome. Okay. And then scar thickness. This is a really big one, and we've talked a little bit about it with Dr. Fox in the past. But scar thickness and double versus single stitch closure is a very, very common question that we are getting wondering about the evidence that shows that someone maybe shouldn't TOLAC or the evidence on thinner scars because it seems like it's becoming a new standard. It's coming in with the VBAC calculator. That is what we're seeing. It's like we're doing the VBAC calculator and we're measuring the scar and those kind of two things are becoming routine. And then of course, once we review OP reports. Double versus single.Dr. Nicole Rankins: Yeah. So the double versus single doesn't make a difference. So whether you had a double layer closure or a single layer closure, you're still a candidate for a VBAC. So that one is pretty easy. I don't even look at OP notes for double versus single layer. It really just needs to be a low transverse incision on the low part of the uterus. So that's that. As far as the scar thickness, the rationale behind that is that when the uterus ruptures, it literally just thins out. Thins out and thins out until it ruptures open generally. So when we're measuring this scar thickness, the physiology of it makes sense that if it's really thin and then you start to put the pressure of contractions on it, there may be a higher chance of it rupturing. Now, is there hard data that if it's this amount that is definitely going to rupture or you should or shouldn't TOLAC? Not necessarily. In our area, it's not routinely measured or talked about. It's not anything that we discuss, so it's not a routine part of practice, but that's the thought behind it. And typically it may come up if it's noticed, or if it's very noticeable. If the ultrasound, the maternal fetal medicine specialist or whoever does the ultrasound says, "This uterine scar, where it is, is really, really thin," and then it may come up. But in general, I don't see that come up very often.Meagan: Yeah, well, that's good. That's good to know. Yeah, it just seems. Yeah. Like, oh my goodness. Are you hearing that ding?Dr. Nicole Rankins: No.Meagan: Okay, good. I hope you're not hearing it. On my end, my computer keeps dinging, but it's on mute, so I'm not really sure what's going on. I'm having all the technical issues today.Anyway, that's really, really good to know though, because it is something that so many people are hyper-focusing on. Sometimes I think there are other things to hyper-focus on like our nutrition and finding that supportive provider and getting the education and really understanding the choice that we're making when we VBAC.Dr. Nicole Rankins: Yeah, definitely. I'm not focusing on it, so I don't think you should focus on it.Meagan:Yes, yes. But it is. I think it is probably hard for these people when they go to these visits. They're so excited. They want to have a TOLAC or a VBAC, and then they're like, "Oh well, we have to do these things first to see if you qualify."Dr. Nicole Rankins: And scar thickness is just not part of ACOG's recommendation. It's not part of what determines whether or not you can have VBAC.Meagan: I know. It shouldn't be anyway. Yes, yes, yes. But for some reason, we're still seeing it. So I think it's good to know that you guys, if you're having that, maybe just think twice about it.Dr. Nicole Rankins: Or get a second opinion.Meagan: Yeah, I was going to say, get a second opinion.Dr. Nicole Rankins: Yes.Meagan: Okay. So our community asked questions. I went on and said that we were going to have you on. And they were so excited and kind of just asked all of the questions. So one of the questions was, if you don't get an epidural for a VBAC and you need a C-section, will you have to be put fully out, so under general anesthesia?Dr. Nicole Rankins: Yeah, no. Not necessarily, and most likely not. Generally, as long as it's not an emergency, there's time to do a spinal. The difference between an epidural and spinal, the epidural is a catheter that stays in place and medicine continually gets fed through the catheter where a spinal is a one-shot dose of medicine that lasts for two to three hours. So as long as there's time and you can sit up for the spinal or they can lay you on your side for the spinal, then they can do the spinal for the C-section, and you don't have to do general. General anesthesia is only reserved for if it's truly an emergency and there's not enough time to do the spinal.Meagan: Right. And for this is another, I'm adding this. But epidural versus spinal longevity of effectiveness meaning like you're numb enough for them to perform the surgery.Dr. Nicole Rankins: Yeah. The spinal's going wear off.Meagan: Yeah. Quickly, but it's going to go on quicker. Right or no? Or deeper?Dr. Nicole Rankins: Yeah, it's a denser numbing than what you get with an epidural. When you get an epidural before, if you have an epidural and then you go to a C-section, then you just get a bigger dose of medicine that kind of mimics what you get through the spinal. So the thing about the spinal is that it's meant to cover a surgery, so it's going to be a larger dose of medicine, so you're going to be more numb because we don't actually want you to be completely numb during labor. The spinal is really just to make sure you're nice and is numb and don't feel the surgery.Meagan: And how long does it take to kick in to be numb enough? Like 20 minutes? 30?Dr. Nicole Rankins: Yeah, yeah. I would say it's actually pretty quickly. So yes, you're right. It can kick in a little bit faster than epidural because it's a lot more medicine. So typically, I would say within 5-10 minutes, you're going to start feeling numbness pretty quickly. But by the time we've laid you down, washed your belly, put in the catheter, done those things, then you're numb.Meagan: Yeah. So in that non-emergency situation, you're going to have plenty of time to be numb and not have to be put under general anesthesia. In an emergent situation, we have minutes. We have minutes to work with. How many minutes if we're having fetal distress? And obviously, it could vary for a lot of patients, I'm sure, but major fetal distress emergent like true emergent under general anesthesia. What are we looking at a timeframe before we get baby out before we're really concerned?Dr. Nicole Rankins: Yeah. I mean so if it's true, like an emergency, because a lot of people say they had an emergency C-section. It's actually not emergency. Meagan: Right. Baby was born two hours later. D; Yeah, or even 30 minutes later. So emergency is going to be like we're ripping the cords out of the wall. We're running down the hall to the operating room. When we get in the operating room, the heart rate is still in the 60s. So we want baby out in five minutes.Meagan: Okay.Dr. Nicole Rankins: We want baby out as quickly as possible, and the quickest way to get a baby out is general anesthesia and then go, if you don't already have a spinal.Meagan: Right. Perfect. That's also another common question of like, well, how long do I have if I don't have that? Because that's a big deciding factor for people with not wanting to go unmedicated or wanting to go to medicated but not wanting to be in an emergent situation. Those emergent situations, they happen. We can't sugarcoat it. They happen, but they are more rare. I love that you pointed that out. A lot of people say this was an emergent situation and we hear, well, then they went out and they came back, and 25-30+ minutes later, they had a baby.Dr. Nicole Rankins: That's not an emergency. As a matter of fact, emergency C-sections are fairly rare. Knock on wood, I can't remember the last time I've had to run somebody down the hall for a C-section.Meagan: And I call those crash like crash sections. Everybody crashes and goes. Yeah.Dr. Nicole Rankins: Mhmm. Mhmm. Things are moving so quickly.Meagan: Okay. So someone says, do I need an OB for a VBAC? I have lost all trusts in nurses and doctors after being forced into a C-section which breaks my heart that this question is a thing. I see it all the time. People have been "wronged" or bullied, and it shouldn't be that way. Dr. Nicole Rankins: It should not.Meagan: Sometimes it happens for whatever reason. But yeah, like do you have to have an OB? Obviously, we know the answer is no.Dr. Nicole Rankins: No, you can have a midwife. For sure.Meagan: But maybe I want to spin it to more of a positive. If we have an OB, how can we better establish a relationship with them so we're not in a situation in the end feeling pressured or bullied?Dr. Nicole Rankins: Yeah. And actually I want you to even back it up even further, and this is for anybody having a baby. What you want, you don't specifically want a midwife. You don't specifically want an OB. What you want is someone who's going to listen to you, respect your wishes and really center you in your birth experience. So yes, midwives are great at that, but sometimes midwives can be tricky too. The way that the reason I said that is because I know people who were like, "I had a midwife and I thought it was going to be great," and it wasn't. And they were hanging too much weight on that midwife hat.Meagan: The midwife word, yeah.Dr. Nicole Rankins: Yes, yes. So you really need to start with is this person listening to me and respecting me? So whether that's midwife or OB, okay?Meagan: Yeah.Dr. Nicole Rankins: So take that away first. And then if you have an OB, again because the midwife is also going to work with an OB, I'm assuming you're doing in the hospital, you want someone who is not just like, "Oh, if you go into labor, you can have a VBAC. I mean, I guess that's okay." Or you want somebody who's really actually supportive of it. I think you've used this language before, not just tolerant of VBAC that they actually you and don't just tolerate the possibility.Meagan: Yeah, I have kind of been thinking about that. Like we as doulas. It's like, oh, I want someone to advocate for me. That big word "advocate", and what does that look like? But in a lot of ways, I think that's what I want a supportive provider to do is advocate for me. Like I understand, validate me. I understand this is what you want, and we're going to do everything we can in our power to do this. If there's something along the way that is saying maybe we shouldn't, I will have that discussion with you. I will not just tell you what you have to do. Dr. Nicole Rankins: Exactly. Meagan: Again, it goes back to that conversation we were having in the beginning of that collaborative relationship. If that is there, I think you set yourself up for better expectations no matter who it is with an OB or a midwife.Dr. Nicole Rankins: Definitely. Definitely. Yeah.Meagan: Nurses can be tricky. We love our nurses. They're incredible, but sometimes they have opinions, and sometimes they come in and they put it on us.Dr. Nicole Rankins: Here's the thing that people don't realize. You can ask for a new nurse.Meagan: You can.Dr. Nicole Rankins: Yes you can. You can absolutely. There's always a charge nurse who's in charge of making patient assignments. You can ask to speak to the charge nurse, and you can get a new nurse. Don't feel bad or guilty or like you're hurting anybody's feelings. People will be fine. I promise you. They'll go home, and they'll keep going on about their lives if you ask for a new nurse. So I know it can be challenging, especially sometimes for women to speak up about things, and you're worried about hurting people's feelings and things like that, but you can always ask for a new nurse.Meagan: Absolutely. This is not related to birth, but I signed up with a personal trainer at my gym, and I was assigned to this amazing person, and she was great, but I realized a couple weeks into it that maybe we weren't the best fit for one another. I hesitated for two more weeks to say, "Hey, can I switch?" And now that I've switched, oh my gosh, it's the best decision I made, and I get to see her at the gym all the time. I went up to her and was like, "I love you. Thank you so much. This has been great, but this is what I'm doing." It was a wonderful breakup. You don't even have to break up with someone like that, though. You really don't. It doesn't have to be. I was so nervous, but this is your space. This is your birth. This is your experience. You have to protect it and keep it what you need. If someone's not jiving that or that nurse specifically, you can say, "Hey, thank you so much for your services, but I would like to switch." It's okay.Dr. Nicole Rankins: Definitely, Absolutely.Meagan: And you don't want to go back at the end of the day and be like, oh, I had this nurse, and it was the worst seven hours. That's not positive. We want to look at our birth with a positive view, not a negative view.Dr. Nicole Rankins: Yeah. And your nurse is going to be there way more than your doctor. Way more. You definitely want to be in sync with your nurse.Meagan: Yeah. And something else, too. I tell our clients all the time, our doula clients, like, "Hey, upon arrival, if we're not there, say, 'Hey, I would really love a nurse that fits in line with blah, blah, blah.'"Dr. Nicole Rankins: Exactly.Meagan: And a lot of times, they assign it right then, and you're like, "Oh my gosh, you guys are amazing. Thank you."Dr. Nicole Rankins: Yeah, exactly.Meagan: Okay, so next question. What should I consider if my goal would be to have a home birth? So from a hospital OB/GYN, where do you fit in that? What would you suggest? I know a lot of JOBs are like, "Don't go to home."D So yeah, so I personally I would TOLAC at home makes me nervous, but that's because I've seen uterine ruptures before and how quickly things can change. So but however, like in Canada, I think their specialty society guidelines support doing a TOLAC at home after one C-section. So it's not that it's unheard of, but I will say it makes me nervous. Now, if you do want to do it at home, then absolutely have someone who is experienced. This is not the time to have like a brand new midwife. I think you want to have somebody who has some experience in particular with looking for any signs and symptoms of when to go to the hospital. We also need a clear plan for hospital transfer and ideally, that midwife should have a relationship with the hospital so that she feels comfortable going to the hospital in a timely fashion. One of the things that I've seen unfortunately happened during my career with home births that have not turned out optimally is that people are afraid to go to the hospital, so they stay at home too often, and then by the time they get to the hospital it's a train wreck. That's not good for anybody involved. So you want it to be a situation where the midwife feels comfortable going to the hospital in a timely fashion. For example, I work with home birth me bias in my community. I have gone out to the birth centers and things and say, "Hey, if you want to transfer somebody, just let us know. Call."Meagan: I love that you've done that.Dr. Nicole Rankins: Yeah, it's, it's important. So call. Send the records. We have a really smooth process. Nobody bats an eye now when there's a transfer from home birth. Meagan: Oh good.D; So you really want to have those two things in place. A skilled midwife and a good backup plan, preferably with the relationship to the hospital.Meagan: I love that. Such great advice. That's awesome that you're doing that for your community. I just had an interview the other day with a VBAC mom who's toying with the idea, not sure where to go. She asked me and I was like, "Well, you could do dual care. You could establish a relationship with a provider. You can ask your provider out-of-hospital of choice if they do have that relationship," because I do think it is important because sometimes even the midwife is like, "I don't know where to go," so I love that you've done that and gone into the birth centers there. Okay. So we just talked about fetal monitoring, but one of the question was, is intermittent monitoring safe with VBAC just in general?Dr. Nicole Rankins: Yeah. It hasn't really been studied very much, and it's not going to be. That's the thing. It's just not something that anybody's going to sign up for and say, "Hey, you get monitoring. You don't get monitoring," and see what happens in assess that situation for VBAC. So I can't answer that question based on data. I will just say that in general, we want to do continuous monitoring.Meagan: Right. That makes sense. Okay, so small lumps under my C-section scar. What could that be? Would/could it impact the outcome of my VBAC?Dr. Nicole Rankins: It's probably scar tissue.Meagan: That's what I thought when I saw that question come in. I think that dials into like going and chatting with someone like askjanette or a pelvic floor PT or someone who can help massage that scar tissue because anytime we have a cut whether it be from a C-section or you fell and scraped your knee and cut your knee open on a rock or a twig, our body will develop scar tissue, and sometimes it clumps. Sometimes it gets that.Dr. Nicole Rankins: It's probably just scar tissue. And no, it should not impact your ability to have a VBAC.Meagan: Have you ever seen this within your TOLAC world, your VBAC world where sometimes we've got thicker scar tissue and sometimes there's separation within the scar tissue internally as babies coming down and making their way through or uterus is contracting? And so sometimes it can be like, oh my gosh, I've got this burning sensation in my scar which we hear, and it's like, that's concerning because we know that sometimes uterine rupture can be that feeling of burning sensation or pain, and usually that pain doesn't go away and just keeps improving. But have you ever seen that with someone and where they're like, "Oh, I've got this burning sensation," and could it be scar tissue stretching maybe?Dr. Nicole Rankins: Not that I can think of off the top of my head. Definitely, sometimes you have to be careful when you hear people say they're Having pain in their abdomen. Could it be scar tissue stretching? Possibly. That's definitely a possibility.Meagan: It's something that's crossed my mind, over all the years, especially as baby's coming down and putting that extra pressure there.Dr. Nicole Rankins: Right.Meagan: Okay. So again, yeah, this is something that we asked talked about earlier. So to what extent are decels considered normal in early and late labor? Dr. Nicole Rankins: We don't categorize decels based on the stage of labor necessarily. It's based on how they look, and again, over the course of how the tracing looks. Now sometimes right at the end, we're going to tolerate during pushing some decels, because you're pushing and squeezing, so there's going to be decels. So we may tolerate them more towards the end, but other than that, it really just depends.Meagan: Okay, that makes sense. I feel like sometimes as a doula, we're getting into that transition, almost pushing stage and they come in and they're like, "Hey, so we're wondering if maybe you're ready to push here soon or something's going on based off of some decels." Not that they were concerning, but they're seeing them. But really decels in general, overall, you're going to look at a whole versus one contraction or two contractions.Dr. Nicole Rankins: Yep.Meagan: Okay. PROM. So premature rupture of membranes and pre-e with VBAC it says is it still safe? I will answer from my own experience.Dr. Nicole Rankins: Yes, absolutely.Meagan: Yeah, but yeah, time too, with PROM So if we're not having labor begin or we're maybe contracting, like what's handled in that situation, especially knowing that in some hospitals around the world and in the US don't allow Pitocin?Dr. Nicole Rankins: Right, yeah.Meagan: Even though that's also not necessarily a contraindication.Dr. Nicole Rankins: Correct. So with PROM, so water breaking before labor starts, it's not as common, but it does happen. You can do expectant management and roughly within 24 hours, most people will start to go into labor on their own. So you can do expectant management, but Pitocin is actually quite safe in those circumstances. The risk of uterine rupture is low. So Pitocin can definitely be used. You just want to use it carefully.Meagan: Yeah. You mentioned that most people within 24 hours will start contracting and having labor, whether it be active at that point or not. But at what point could it be concerning? And maybe if we have GBS or something like that as a factor, would we be like, "Hey, we could keep waiting for the 24-hour mark," and that's not to go in and have a C-section, that's just maybe to augment. When would you encourage augmentation sooner?Dr. Nicole Rankins: So I'm a little bit of an outlier. I just offer the options, and we can talk about that it may take longer if you wait to augment and that's it. It may take longer, and that's it. That can potentially increase the risk of infection. But we don't really do time limits. I don't do 18 hours or 24 hours. I kind of pick. These are moments for us to have discussions about where things are. So definitely usually 6, 12, 18, 24 and just to touch base and see where things are and develop an ongoing plan. Not necessarily have a hard and fast rule that you have to be delivered or by a certain point makes sense.Meagan: And then preeclampsia. So we have seen this quite a bit in our community, on Facebook and on Instagram where they said, "Hey." There was a post just the other day that said, "Hey ladies, I just wanted to thank you so much for being here in this group. You guys have been amazing. Unfortunately, I have to sign off of this group because my provider said I have to have a C-section now because I've developed preeclampsia," so they didn't even offer the option to TOLAC or monitor. And everyone's like, "Wait, what?" This is a thing? So obviously, we know that we can, and everyone's numbers vary. If we've got severe preeclampsia and maybe that's not gonna be best for the stress of mom and baby and everybody, but do you have anything to say on that? I don't really know if I'm asking a question.Dr. Nicole Rankins: But yeah, no. You can definitely try for a TOLAC in the setting of preeclampsia. Now, if even in severe preeclampsia, it just may take longer. But if we're seeing that you're getting sicker and labor isn't progressing or the baby is under distress, then the safer thing may be a C-section. So if you have severe preeclampsia, for example, and it's affecting your liver and your levels of your liver enzymes are going up, up, up, up, up, and we're not close to delivery, then it's going to be safer for your health to expedite birth, and that's going to be a C-section. So it really depends.But the option of completely taking it off the table, that is not standard or that's not evidence-based.Meagan: Yeah, yeah. And for HELPP syndrome, where it's gone to that extreme. Now we've got platelet issues and things like that. Can someone with HELPP syndrome TOLAC or is that truly a better option to have a C-section?Dr. Nicole Rankins: I would actually prefer if someone ideally is in labor with HELPP syndrome. Actually, a vaginal birth is going to be safer because when your platelets are low and then we're adding surgery, the risk bleeding goes up.Meagan: That is what is so weird to me. My fifth birth was a HELPP syndrome. She was a VBAC, and they're like, "You have to have a scheduled C-section." But then we did all these transfusions and all these things and in my head, I was like, but isn't platelet meaning we have a higher risk of bleeding? But so yeah, that's another question.Okay, I think there's only one or two maybe. Oh, this is a really great question. Is it safe to TOLAC? So again, listeners, TOLAC, if that's new for you, is a trial of labor after Cesarean. I know I've thrown it out a couple times this podcast. After having a hemorrhage in a C-section. So had a C-section hemorrhaged. Now they're wanting to TOLAC. Is that considered safe?Dr. Nicole Rankins: Sure.Meagan: Okay.Dr. Nicole Rankins: Okay. I want to discourage people from using the word "safe" because I think what you really want to know is what are the risks of something happening again? So yeah, because what do you mean by safe?Meagan: Right.Dr. Nicole Rankins: What you really want to know is what are the risks of this thing happening again? So there are no identified increased risks in having a TOLAC after you had a postpartum hemorrhage during a previous C-section.Meagan: Okay, I love that. So that's good because I mean anytime anyone hemorrhages with birth, I feel like it's a little bit on everyone's radar.Dr. Nicole Rankins: Right. Okay, and then I have one more question for you before I let you go, and I don't know if it's Bandl's ring or Bandl's. How do you say that?Meagan: Yeah, Bandl's ring. What is a Bandl's ring for those who it's very new to, and then can you TOLAC or have a VBAC with Bandls ring?Dr. Nicole Rankins: It's a really tight ring of muscle in the uterus where it's just really tight, and it doesn't contract. I can only recall seeing it, like, once in 22 years, so it's not common.Meagan: It's more rare.Dr. Nicole Rankins: Yes, very rare. So it's just really hard to have a vaginal birth if there's a really tight ring of tissue that is preventing the uterus from opening. If the uterus can't open, then the baby can't come out. So that's the issue. It's not like we can release it or clear it up or anything. I don't know why. We don't know why it develops, but it's just, like anything, if it's tightly closed, it's really difficult to open.Meagan: Yeah. Okay. That makes so much sense. And is there a way to find out if we have that beforehand?Dr. Nicole Rankins: Not really.Meagan: Not really. Okay. And the signs of that Bandl's ring is just lack of progression it seems like.Dr. Nicole Rankins: Overall, it seems like lack of progression. And also, the baby usually doesn't come down in the pelvis.Meagan: Yes. Yeah. Okay. Thank you. That was a one-off random one that crossed my mind. I keep seeing that one too. Anything else that you'd like to touch on? I love all of your points of stop considering the word safe and talk about, what are the risks here? What do we need to know to make the best educated decision? Having a collaborative discussion and relationship with our provider. So many great points along the way. Anything else that you'd like to add or say to the community to someone who really is wanting to know all the information they can to VBAC and are unsure of which way to go?Dr. Nicole Rankins: I think that the best thing is just to really find a supportive provider, doctor, midwife, and do that in the prenatal appointments. Ask those questions early, and don't be afraid to change to someone else if you feel. And sometimes you may not have options, but if you have options, then find someone who is the most appropriate for you because that is going to be the thing that most sets you up for success. Oh, also, get a doula.Meagan: Hey. I love it. I will never not advocate for doula, but really, I mean, I love that you're pointing it out again. Before birth, early on, ask those questions. Always have a conversation with your provider. If something is switching, it's okay to switch. I know it's daunting. It is daunting. It really is. I didn't want to cheat. I felt I was cheating on this doctor. We had this relationship. I don't even know what I thought. I thought I was cheating on him by leaving him. And I didn't leave him, and I didn't find myself having the experience that I wanted or feel like I deserved. And, looking back, I probably should have switched. Well, I didn't. I have learned, but I don't want anyone else to be in that situation of, dang it, I saw all the red flags, and I didn't switch because I felt bad.Dr. Nicole Rankins: Yeah. Yeah. I don't mean to sound flippant, but I can guarantee you. Your doctor, if you leave, they're just gonna keep seeing patients. They're just going to go home and keep living their lives. It's going to be fine.Meagan: I know. I had a friend, and she was like, "Looking back, do you realize how it wouldn't have impacted his life at all?" And I was like, "Yes. But in my mind, I had a deeper connection."Dr. Nicole Rankins: I know. In the moment, you can't because you have that emotional connection, and you care about those things? So that's totally natural.Meagan: Yeah. And in a lot of ways, he was saying, "Yeah, sure. I'll support you." But then in a lot of other ways, he wasn't saying this with his words, but he was saying, "No, that's not my thing."Dr. Nicole Rankins: Right.Meagan: So, yeah, you deserve the best and keep doing your research. Find the provider. Get a doula, hands-down. Just a reminder, everybody, we have VBAC-certified doulas on our website all over the world. And yeah, thank you so much. You're the best. And everyone, go follow her podcast and wait it out for these new updates. Yes.Dr. Nicole Rankins: Yes, these new updates are so exciting. I'm so excited.Meagan: I'm so excited for you. That's so awesome. You are just incredible. We really enjoy you. So, thank you.Dr. Nicole Rankins: Thank you so much for having me. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan's bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands

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