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Optimizing Cash Flow and Revenue Cycles in Dentistry

Summary:

Centralizing and scaling operations is crucial for the success of multi-practice dental groups.

In this episode, Adin Bradley, an Executive Consultant and Fractional COO at Polaris Healthcare Partners, discusses challenges and solutions for doctor-owned, debt-funded dental practices. Adin shares insights on reducing turnover and optimizing revenue cycles and highlights the importance of aligning owners’ goals, investing in management and team members. He addresses the significance of establishing stringent processes for cash flow. Adin also discusses the associate equity model, emphasizing its benefits for doctors with high student debt and the need for a fixed cost structure and good marketing plan for practice growth. Adin further explores the concept of duct tape integration for larger group practices, the significance of cloud-based systems, and the importance of vertical growth and team commitment. He stresses the need for a clear vision, strategic planning, and continuous assessment of team growth. Finally, Adin provides practical tips for practice owners to ensure alignment with goals and overall success.

Tune in and learn how to navigate the complexities of dental practice management and growth!

Secure Dental_Adin Bradley.mp3: Audio automatically transcribed by Sonix

Secure Dental_Adin Bradley.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Dr. Noel Liu:
Welcome to the Secure Dental Podcast. Through conversations with the brightest minds in the dental and business communities, we'll share practical tips you can use to scale your practice and create financial freedom for yourself and your family. My name is Dr. Noel Liu, CEO and Dentist at Secure Dental, and also co-founder of DentVia. I'm your host for the Secure Dental Podcast, and I'm so glad you're joining in.

Dr. Noel Liu:
Hello and welcome to another episode of our Secure Dental podcast, where we bring in many different talents from and outside our dental industry. Today we have a very special guest, Adin Bradley from Polaris. But before we dive in, just want to give a shoutout to my sponsor, which I'm also a co-founder of, which is DentVia. It's a virtual dental administration company that helps with back-office tasks and also helps supercharge your managers as well as the front desk. They do a call confirmation, lead generation calls, and all the insurance eligibilities, plus any other back-end tasks that you have. So definitely visit them at www.DentVia.com. Again, it's www.DentVia.com. Now to the main show. Adin. So Adin is a consultant with Polaris. Polaris does group practices. We've been a client with them for a year and a half and he's been amazing. So I want to pass the mic off to you, Adin, and I want you to introduce and tell us exactly what your role is and what Polaris does.

Adin Bradley:
Yeah. Great intro, Noel, and as always, great to see you and hear about your success over at Secure Dental and the team. As you mentioned, I work with Polaris Healthcare Partners. We are a niche consulting group that works solely in the doctor-owned, debt-funded dental space. I work specifically, I work as a strategic consultant and also a fractional chief operating officer. And just to draw a line between the two of them, consulting is more of advisory to the ownership group and their vision, and fractional COO is a little more in-depth work where doctor's still in the chair, still producing, doesn't really have the time to commit. They're generally larger practices that need a lot more hands-on. I work with them and their team to lead operations. And some of the other main areas that we work with, which are really popular programs, are associate equity programs that we'll talk about in a little bit. We have two new verticals that one of our co-founders, Perrin DesPortes runs, called the Catalyst Project and Ascendant Executive. These are more geared for those looking to determine if they want to grow a group practice or build one. It's an interactive Zoom group that Perrin runs with specific subject matter each week with one-on-ones, and that sort of gives them a consulting light type of engagement. And then finally, we do growth capital solutions, which is a nice word for we help recap debt. We do a lot of sell-side advisory and M&A. So we run a full gamut of whatever services are needed in that group dental space.

Dr. Noel Liu:
That's awesome. That's a lot of stuff to absorb there Adin. That's great. What do you guys do? A whole bunch of services. So tell us a little bit about yourself. How did you get started?

Adin Bradley:
Coincidentally, I have an undergrad in HR, but I didn't care as much for the day-to-day minutia as I did the analytical part; staffing, retention, the cost of labor. And later got into labor negotiations. So that morphed into operations. I was a regional president for a national EMS Corp and a senior VP for a national urgent care group, and then was with American Dental Partners for a while, oversaw 30 clinics there. I stayed in dentistry, I loved it. I loved the fixed costs, provider-driven model. Very exciting to work with. About three years ago when Polaris was born, if you will, with Perrin and Diwakar, I joined them and just celebrated my three years and I got to tell you, it's gone by super, super quick and I enjoy working with groups like yourself and Dr. Jafri helping group practice owners realize their vision. So that's, I've come out of operations into more of an advisory role now.

Dr. Noel Liu:
So you have like extensive experience in group practices, right? And what is some of the trends that you've been seeing before and where is, where are the group practices are, where they're going now?

Adin Bradley:
It's a great question. While there are so many different group practices that have issues, there's a lot of common themes. Generally, they've been unable to centralize and scale operations while they own multiple practices. They really are siloed. A lot of times, the management team has grown with the group practice since they were incepted. Getting the right people into the right seats and assessing talent is very important. Not having a clear strategy, a vision. What do I want to do when I grow up? We just come to work every day and plug away and hope things get better. So we try to align what the owners really want to do. Do you want to build the scale? Do you want to build the exit? Do you just want to build a grow and see where that goes? And then from there, we start looking at every single department along the way and what can be optimized. So that's where we find a lot of leakage. I would say turnover and revenue cycle are the two biggest issues that, once corrected, have a considerable impact.

Dr. Noel Liu:
Got it, got it. So revenue cycle: how does that impact any organization? As we all cash is king.

Adin Bradley:
Cash is king. So we normally find the same types of issues where there's not a really stringent process from both at inception, from having all the right information, documentation, submitting claims, focusing on your days of sales outstanding, which is the time of service to the time the money hits the bank. And then how do we deal with insurance companies that say we didn't have enough information or denials in ensuring that all patient payments are paid up front? We look at the AR buckets quite a bit in the aging. What I have begun to see is that when you have a dedicated revenue cycle department with subject matter experts doing centralized services, that process runs much more smoothly. We found that collections of percentages have increased dramatically.

Dr. Noel Liu:
So if I were to ask you, like from team inception to revenue to patients to doctors, to everybody, right, the whole thing, what's the top of your list? Is it the management team or is it the doctors, or is it the actual, the front desk and the DA staff? Like who controls and where do you see group practices to become profitable? Would you say, let's invest in the management or the team members?

Adin Bradley:
I'm smiling because no one's ever asked me that question before. And it is an awesome question, Noel. And I will tell you that the answer is all of the above. And the reason is, if one single part of the groups that you mentioned, whether it be the front desk, the admin side, or clinical side, if anyone misses their cue, the whole process falls apart. So just real quick; if front desk does not get the appropriate information, the wrong insurance, the wrong treatment plan entered the codes, the bill, the submission can have a problem. If the Doc or the DA or whoever enters treatment knows does not have a robust summation, and have all the scans and everything that's required, that can cause a hiccup. And then finally, the claim submission part in the posting part; if someone forgets to submit a claim or a denial comes back for more information, how are we jumping on that? And sadly, we see a lot of groups that will have buckets and buckets of AR, and we find that a lot of the claims have either not been submitted or worse, they were submitted, denied, and just nobody captured them. They just, it's plug and play, right? I sent it out into the ethos. It never came back. It's not my problem anymore. Meanwhile, the owners like, why are we collecting 88, 89, 90%? And those dollars fall directly to the bottom line because as an owner, you've already paid all the expenses on it. That's really the difference, the key to groups like yourself that become profitable from both a cash and margin standpoint and those that are just barely treading water.

Dr. Noel Liu:
We've been there, and we know exactly what it feels like. There's no question there. Let's move on to Polaris's role. Like when you guys take on a client, what are some of those challenges that you guys see in terms from a strategic point as well as like an overall operation point?

Adin Bradley:
Again, while each one is a little bit different, there's a lot of core similarities. First, is the owner really committed to the process? It is the process can be arduous because it can get in the way of your clinical work. It can get in the way of your CE work. But normally what we do is we set the table for how the process is going to run, and we sit with the owners or owner and ask what their, how they define success, both personally and professionally, because they do intermingle. And from there we set forth to put what their vision is in about 3 to 5-year window and simultaneously are building out a financial model to see where they sit today. And then we'll meet for an initial strategic planning session put forth in the first quarter, about four initiatives that we think can gain immediate impact and results. We look at outcomes best and worst, what could happen, who's going to be responsible for them, and track them along the way. And then after the second quarterly meeting, we'll redo a financial model to see if we've moved the needle both in increasing revenue or decrease in expenses. We also look at other areas of care utilization. We look at your debt. Do you have the ability to fund growth if that's what your plan is? We look at turnover. So our model shows a lot of different areas within the business: doctor productivity, your payer mix. So once we get a good look at the baseline financial information in the health of the practice, it makes it much easier to devise a specific tailor-made strategy for your practice.

Dr. Noel Liu:
So it's not like one-size-fits-all, pretty much. The challenge is you guys, it's all over the place, right? Based on, and you just tailor it according to that practice or organization.

Adin Bradley:
Yeah, exactly. Like a three-group practice with a goal to just run a legacy business is much different than, say, Secure Dental, which is going on nearly a dozen, you continue to grow, and centralize. You're working with you, which was amazing, is that, and I continued to say this to other clients is I rarely see a team of two owners, especially two physicians that are married, you and Dr. Jafri that know their lane and have put together a really good team that has been deputized to manage the process. And you both know the numbers inside and out, what moves the needle. But most importantly, you've invested in your people and doctor education, clinical excellence. I think, like you said, we've all been there. When I look when we first met, where you were to now, it's been an incredible journey for you both. And it's not gone without a lot of hard work, but it just shows you when you stick to the plan, good things will happen.

Dr. Noel Liu:
And it's not been that long ago. It was just like what?

Adin Bradley:
I was going to say two and a half, three years.

Dr. Noel Liu:
Yeah, exactly. Adin, man, let's talk about some systems here. Some key takeaways, right? What are some of the metrics that you really would like to hone on for someone who wants to grow from, let's say, two locations to, they're like, Hey, I want to grow two, three, or 4, or 5. What would be some of the key metrics that you were really hone on to and they need to watch like a hawk?

Adin Bradley:
I'm going to throw a few out, but these are not in any order of importance because they're all equally important. First and foremost is profitability and cash flow. The only way to grow and scale is to be able to have enough capacity, leverage, if you will, to borrow money for growth. In order to do that operationally, we need to be producing more. And how we produce more is how much revenue, how much collections can we generate from every hour that we're opening the chair? One of the things that you've done, which I profess to a lot of partners of ours, is more expansive dentistry, especially in the GP world. We talk about doing more endo, full-arch cases, molar extractions, things that GP and the GP world, I don't know, maybe a dozen years ago would have ought have been, automatically been a referral out. So to generate that much more revenue helps in a fixed cost structure. Recruitment and retention of top talent is also very important; it creates stickiness with your, with the patients, which are number one referral source. A good marketing plan to continue to cycle through new patients. And then the rest is really locking up your associates under possibly either earned equity plan or some bonus-driven plan that makes them want to stay. One of the challenges, one of the biggest challenges that we see that probably has the most impact financially is if an associate leaves and there's not one there to replace kind of dead time, right? And as an owner, you don't want, you or Dr. Jafri does not want to have to keep jumping back into the chair. So an owner does not want to have to keep being relied upon once they've stepped out of the chair. So all equally important, but definitely to grow, is the ability to borrow dollars for future investment and then keeping the process going. Now within that, I would also say you would have had to scale and centralize services too to make sure that you are running truly as a group practice and not as individual sites, just doing their own thing with common ownership.

Dr. Noel Liu:
And that's really important because we see that all the time. And that's what they call the duct tape. That's how I think the term came about when a group of friends, they just collaborate and just go, Hey, we're all going to partner up together. Let's talk a little bit about PMS, right, practice management systems. When you see these practices and you're trying to scale these guys, and I know a lot of them, they do acquisitions and they all have different systems, what are your thoughts on different systems or running like a something centralized which has everything enclosed or would you like just prefer one system for every location?

Adin Bradley:
Man, I got to tell you, you know, you got some great questions this early in the morning. It's a little bit of art and a little bit of science. I think the larger the group practice and I would say getting above 10 to 12 practices within the group. I would highly recommend being on the same platform. If you are doing acquisitions and someone is on one practice management system and you're buying one on another, set aside with your implementation team enough time to both integrate the culture, the standards, the benefits, the pay scales, and then move to get all of their data extracted onto your platform that's cloud-based. It makes for extracting patient data much easier. Everybody's doing the same thing, your reports are pulling. So if you're using Jarvis or a practice-by-numbers dental Intel care stack, the dashboards will collate from being on one system. It may not be possible right away because there's a lot of work, a lot of things to be done. But I would say any practice over 10 to 12 within six months of an acquisition merge joint venture should all be on the same web, certainly, cloud-based system.

Dr. Noel Liu:
And I think that also drives up the valuation of the organization. They're all on one.

Adin Bradley:
Absolutely. And what is even better is that if the group that's looking to partner with you as a strategic partner is on the same platform, that makes it even easier, not only from a technical part, but also from an expertise part, and then integrating the data into that system. A lot of times when I see these one-off custom-built systems, I always think down the road you're going to end up, you're going to end up proverbially paying for that. I don't want to give plugs to certain ones, but most of our listeners know what the 3 or 4 main practice management systems that are cloud-based out there, and I would play in that sandbox.

Dr. Noel Liu:
That's an excellent advice, by the way, because that's one of those things which we see all the time. And a lot of people have questions like if we run different systems. So that answers that. So now let's dive into your field. We were talking a little bit about associate equity model. And we were talking a little bit about how expansive or how small do you want to keep that role within the organization, or you want to put it at a practice level? Let's dive a little bit into that. Let's talk about it.

Adin Bradley:
Yeah. So this has been one of our more popular services that we offer. And you and I were were talking just before the call. The FTC came out a couple of months ago with the ruling that Non-competes might be not recognized under certain situations. Obviously, we got a flood of calls like, how does this impact us? I wouldn't let the FTC ruling really be the driver of that. I would let the strategy and the value, the intrinsic value of the product really sell it. So with associate equity, what that allows you to do is a couple of things. One is to grow and scale where you can't be the primary associate. So you can continue to build, whether through acquisition or de novo practices, that you have associates that you place in there that you build the practice around, and they earn a portion of the value of that particular office or of the group above your capital interest. So without digging too deep into the weeds, ownership never loses their capital investment in an associate equity. We always think, I'm going to dilute. I'm going to dilute. They only earn equity on productivity and EBITDA or profitability above a certain threshold that we set, and they have to keep growing year over year. What this does is it keeps it an associate engaged, they become a true owner. And more importantly, when you mentioned earlier about selling, we have found that groups that have associates locked up under associate equity plans with real vested ownership becomes more highly predictable to a buyer so there can be a premium on the price because the fear of losing an associate is gone. So for those docs that want to buy, but they're coming out of school with hundreds of thousands of dollars in debt, the cost of capital, as we all know right now, we feel it at the kitchen table every day is very high. This gives them an opportunity to have real ownership in a big group at really no risk or cost to themselves. They just have to perform. And for you, entrepreneurial docs that continue to grow, that system just continues to work as you build more practices outwardly and just say, I'm going, I've got a great recruitment stream through a school that I've got a great relationship with, I meet with their associates in one of the things that I sell them on, not only is our culture, our clinical direction, our doctor development, but hey, you're going to run an office on your own and you're going to earn equity in that. How does that sound? That sounds like a pretty good competitive advantage to me.

Dr. Noel Liu:
That's so true because nowadays a lot of these students coming out, their biggest thing is student debt, because as time is going by with inflation, everything is going up pretty significantly. So they don't want to practice; too much headache. They don't want to take the risk; there's way too much involved. What is the best route? And I think what you just laid out, that's like a win. 100%.

Adin Bradley:
Yeah. And it gives the owner some time too, because when they, when you enter, if I can back up for a second, once you have the actual associate equity program developed, it doesn't mean that every associate gets it. You should have a criteria about who you want to be a partner. And it's not just about production, it's about culture. It's about ethics. It's about their vision. Does it align with yours? And then once they enter into the program, there is still some time for you to assess their fit within the organization. Are they everything as described? And they generally, we have what we call an effective year; one year when they're in the program. And then it's at the end of the second year with their first allocations of shares would be given to them. So it's a five-year vesting schedule and it is based really like the market share. There's a total number of shares generally into what your market cap is. I'm using that in air quotes and each share has a dollar value, and they're allocated a fifth of the total amount over a five-year period that vest. And there's operating agreements. You're going to have clauses on clawbacks, buyouts. You're going to protect yourself 100% in the operating agreements with them. So they'll have to continue to perform. And you can also have accelerated vesting if you were to decide to sell. And they need to be part of that exit where they might vest a little sooner if they have not hit their five-year mark. So the worst that really can happen with them is that if they don't produce, they just don't earn a lot of equity. So the analogy I read one time, and I can't even give credit to you because I don't know who it was is, for those that are fearful of giving away a little bit of the company that they built, I always say, Do you want to own 100% of a grape or 10% of an apple? And it just allows you to continue to scale and grow. And while the percentage might go down a little bit of ownership, the actual value is going up exponentially.

Dr. Noel Liu:
Exactly. That's such a great nugget that you just dropped, because that is something where a lot of people, they are like, so caught up in their own little world that they want to own and control 100%. And what you just said, that makes perfect sense.

Adin Bradley:
So we've had some clients like that, unfortunately, and they are just very steadfast in their core beliefs, and there's not a lot of wiggle room to look at other solutions. And to me, no matter what industry it is, this expands way beyond dentistry, that is a recipe for failure. The inability to pivot. I think, I don't think, I watched it in real time with Secure the ability to pivot, make changes, implement new processes, invest in technology, invest in people, invest in your docs has shown marked improvement over the years on the success of the practice, the profitability of the practice, and now your new growth plan. And I can't wait to see, I have no doubt that in another couple of years, I'm going to see what you're doing and how it's worked, because you have perfected the model on how to scale and integrate every single practice into the secure model.

Dr. Noel Liu:
One thing we've done is now as we are growing, we have changed that instead of just opening up locations like crazy, like how we were before, it's more about how do you grow vertically and how do you invest in your people. And this is one of those things. So this, tomorrow we are going heading down to Brazil. And one of the reasons we're heading down there is so I'm taking a group, my doctor, and it's been part of the whole strongman group learning nothing but full arches. So when they come back, they are all prepared and they're ready to rock and roll and we practice the same system. So we are, so I'm heavily involved and integrated with my team, and I think that really helps and change what you just said: If you're not investing in your people, you're not investing in the company, and it's the people that makes the company, not the other way around. So I feel like any future expansion has to be dictated by two factors: by patients and by our team. Not, hey, you know what? I found this location, I love it. I want to open up another Secure. No, I think it's got to be dictated by where the demand goes. And I think that's how a lot of the big successful corporations have done it. So I'm just following that path, studying those guys and just doing it one at a time.

Adin Bradley:
Yeah. They say imitation is the greatest form of flattery. And when we do another one of these in chat, I'd love to to flip the script and interview you a little bit and talk about the pain points that you had along the way, because we see the successful part of it, how we centralized, how we've optimized, how we're building. But I'm sure you could spend a lot of time on the first number of years that you and Dr. Jafri had, where things were not so rosy, and whether being the chair all the time and doctor development came second. And staff, you might have not have had everybody that you wanted on the team just plugging holes here or there. And then when do you hit that precipice where you say, Okay, hold on, I'm going to stop and pump the brakes here. I'm going to start doing, every decision is going to be the right one. You mentioned just, I love this location; let me buy it. Do you have a real target acquisition profile? Demographics, geography. There's a cannibalize a current office. Is it in your footprint? What's the competition look like? Does it have the residential base, the density to support all the things that you talked about? And I think it's great going down to Brazil because you being knee to knee with your associates is no greater testament to the commitment to what you're doing than the owners there with you and highly skilled at doing it. If that doesn't jazz them up, I don't know what does.

Dr. Noel Liu:
And I think that's one of the reasons why we're so attractive, because I really like to be in the trenches with them. And one thing, Adιn, we grew this way before horizontal, and that caused us to go far and thin and we were stretched out. Now we are planning to go vertical and just maximizing every single opportunity we have within our practices rather than going out. And we did a lot of stuff that you told us, hey, how about addition with subtraction? But it never crossed my mind before. And when we started doing that, all of a sudden, the bottom line, the EBITDA just went up.

Adin Bradley:
Yeah, sometimes out-of-the-box thinking works. And for me, I'm humbled by the trust that you put in us to help along the way and in a myriad of issues, not just in running the business, but in the people part and certain day-to-day employee relations issues and marketing and growth. And it's amazing to see how in just a couple of years from when you came to visit us in that masterclass in Charlotte, to us engaging and all that you guys are doing right now. I think it's proof that if you have a vision, you are committed to it and you have the right people, it is achievable. But you have to do all those things every day. Φor the listeners out there that anyone who doesn't know Dr. Noel here, this is a man who's up at 3:00 every day taking an ice cold bath, working out, very disciplined. And you just do the same things every single day, not looking for a magic bullet.

Dr. Noel Liu:
Well, thank you very much.

Adin Bradley:
Hell, you've even inspired me.

Dr. Noel Liu:
It's been inspirational, because this is what exactly the grind that we go through every single day. And then you don't get scared to tackle problems. Now, let's pivot a little bit here. Now, for the people who does not want to grow, they are like 1 or 2 practice and they're like, how do I optimize and become really profitable? And I just want to stay in those 1 or 2 locations. How is that different from somebody who wants to grow?

Adin Bradley:
It's tough because I, it would depend on if they're doing it because they generally like their work-life balance. Right? There are some groups out there, they've got young families or hobbies that they like to do. In the business side of things, detracts from that. So the business is really just a driver of cash flow to fund their activities. And I'm making an assumption in an example of only one core group. The other one could be really just a fear of the unknown, so it's just easier to stay in your safe place. So for those one and two off practices or I'm sorry, one or 1 or 2 office practices owned by a single doc is ensure you've got a really good leadership team, particularly if you are still the driver of the practice, it's highly dependent on you to be in the chair. The problem with that is that when you do want to take a vacation or you get sick, not only are you out, but when you talked about growing vertically, the practice takes a significant hit financially because you have to pay the staff to be there and the biggest economic driver of cash is gone. My biggest recommendation would be is if you do really want to say stay smaller because it fits your lifestyle, at a minimum, I would try to work yourself out of the chair a couple, 2 to 3 days a week, not only to work on the admin side, but to make the business less dependent on you so when you want to engage in those activities outside of the office, that you've got a team in place that can continue to keep the trains running on time. The team around you has to be really good at what they do, because differences and inefficiencies don't show as much in one and two practices. In 12 practices, 10 practices, being 10% off in collections is much, much bigger than 1 or 2 practices. But I would still say to keep a heavy eye on the key metrics, which obviously is collections, your collections percentage. I would be looking at all of your expenses to make sure that as a percentage of revenue, they're within those guardrails. And what I mean by that is, outside of your fixed costs, labor and supplies should be moving with the amount of production that you're doing. If production tends to come down and your expenses continue to go up, someone's not managing the store. If you're collecting 85 or 90% of your adjusted production, we've got a hole in the bucket there. I mentioned earlier all the expenses have been paid. This is where the technical expertise makes the difference between being almost profitable, or just making it to having a little bit of buffer there. And when you do that, you might think, Oh my gosh, this is doable. I can scale this. Maybe I want to be three practices, maybe I want to be four. But it will open a doctor up to at least the opportunities to pivot if they want. Just running two offices, letting associates do what they want, not investing in that staff turnover all the time. Collections not being done is a recipe for a doc that's going to end up working merely for free, because you can't afford to pay himself salaries, going to pay for overhead and bills.

Dr. Noel Liu:
You know what I think, Adin, is? It's about efficiency and knowing the how and the what and the why. Once they understand that aspect, they can become better leaders. And once when they figure out how to run that 1 or 2 practice successfully, I think they usually start wanting to venture out a little bit. It's just because they are having to put out fires every single day in their own 1 or 2 locations, which is why they are like, you know what? I'm not even going to bother with anymore. I think that's probably the main driving factor that a lot of people, they don't want to expand. So what you just said, I think that hits it right nail right in the head. Because once you understand the process, you understand leadership, you understand the whole gamut of taking care of your people, I think that will really open up their opportunity door. So that's what's ...

Adin Bradley:
Listen, we're Gen Xers and Boomers, some of us. But for those Gen Y and Gen Z's out there that have not seen The Karate Kid, I highly recommend watching it because if you remember wax on, wax off. If we just learned those core movements and repeat them every single day, what you just said will ultimately happen. I call it being successful in spite of ourselves. Just do the right thing every day. But if you are managing chaos, who would want to grow? All you're going to do is extrapolate the chaos. I wouldn't want to grow. So yeah, great advice. And you've been there. So again, you can share nuggets of being one, two, three practices. And I can clearly state that your operation now in the double-digit practices runs way more smoothly than it did with 1 or 2 practices.

Dr. Noel Liu:
Oh, absolutely. Absolutely. I'm less on a journey also, and more on the business and in the business. Right? That makes a whole of a world of a difference. And here's another thing too I would like to share. A lot of people think, oh yeah, you're off the chair. You're not working. No, it's actually the other way around. When you're not on the chair, you're actually working harder because now when you're working on the business, you're actually creating opportunities for the team and the members, because if we are in the business constantly, what's happening is we are not able to grow ourselves and then we're not able to let anybody else grow underneath us. So I think that's a huge nugget that I would like to share as well, because once you ..., you can see so much better from like 30-40,000ft² up in the air than if you are ...

Adin Bradley:
I was just thinking the same. No, I was going to say the only way you can really have a high level look at the entire landscape is to get yourself out of the rabbit hole. Once you're entrenched in that chair, you're not seeing what's blazing around you. So that gives you a bird's eye view of getting in there and identifying an issue and correcting it immediately. And it may not even be an issue. It just may be an opportunity to enhance an associate's skill set that they want to do. You might see a lot of promise in someone they may not see in themselves. So you become a coach and a cheerleader, working with the team to have them understand why the numbers work they are. We hear this, They're just worried about money. And I'm like, Well, this is the driver of how we get paid and turn the lights on and growth. But it also gives people opportunities to go into different positions as you grow. If you're training and mentoring your folks properly and leading them, as you open up new practices and they know your processes and your culture and they share your vision, it's plug and play from there.

Dr. Noel Liu:
Plug and play. And that's what I always say. Like, you got to do what ticks for your team so that the team can do what ticks for you and the organization and everything works and in alignment. Not growing is really an injustice to your team. That's what I always say. Yeah. So Adin, before the end, man, I would like you to share two tips that anybody can take away and start using right away. What are some of the, it doesn't have to be two. It can be like any number.

Adin Bradley:
I would first look at the team that I have around me and ask myself, How long have they been here, and can they take me to the next level? That would be number one. And I think how you assess that is: Have you grown? And if you have not grown, ask yourself why. The second tip I think for any group-practice owner or single-practice owner or two-practice owner, really define what your real vision is. And what I call it is utopia. I don't want to grow because I'm scared is not a reason to grow. If you weren't scared and you were profitable, would you grow? So having a real clear vision of what 3 to 5 years looks like. What are you building for? What's that hit-by-the-bus solution that you have? What if something happened to the main driver of the organization? So is there a plan to grow and scale, a plan to optimize? If not, I would say get one in place right away. Last I checked, Father Time is undefeated and for any callers out there that would, their listeners out there that would even like just a cursory chat with us, Adin@PolarisHealthcarePartners.com. We are PolarisHealthcarePartners.com online. We have a whole list of services and we often set up Zooms for young emerging groups that just want to chat and say, I don't even know where to begin. So I would say one of the nuggets is to give one of us an email or a call. And you've always been excellent at talking to other groups too, and sharing your vision, your strategy, your pain points. And I hear it all the time, and I love connecting folks with clients that we've worked with, that have seen the struggle that can give you all of the good, bad, and the ugly that's not coming really from an advisory person, but someone who owns practices and has been there, done that. So the two things. Look at your team and ask yourself, can they bring me to the next level and have a clear vision for at least the next 3 to 5 years? And every decision that you make is got to be congruent with that vision.

Dr. Noel Liu:
And with that being said, I'm going to add one more thing to it. You got to have a growth mindset. You got to have a learning mindset. One of those challenges that I always felt initially when I was starting off was, I know it all, and that is like the worst position to be in, because even at this point, we are always learning, always networking, always collaborating and always knowing what I don't know. So it's like pretty much you don't know what you don't know. And I always feel like I always have opportunities to learn more and do more. Always keep learning, always keep pushing because there's never an end to it. So Adin my friend, thank you so much, man. Thanks for being here. It was a great pleasure. You dropped so much good information.

Adin Bradley:
Yeah. Thanks, Noel. It's always great to connect with you and hear how things are going. Give my best to the team and Dr. Jafri as well. And enjoy your time in Brazil. I'm sure the associates are going to have a great time and I can't wait to hear when you get back of putting their new skills to work.

Dr. Noel Liu:
Hey, thank you very much.

Adin Bradley:
Will talk to you soon.

Dr. Noel Liu:
Yeah, yeah, absolutely, man. We're going to land the plane now. Thanks, everyone for listening and tuning in. Make sure to like and subscribe. We will definitely see you on our next episode.

Dr. Noel Liu:
Thanks for tuning in to the Secure Dental Podcast. We hope you found today's podcast inspiring and useful to your practice and financial growth. For show notes, resources, and ways to stay engaged with us, visit us at NoelLiuDDS.com. That's N O E L L I U D D S.com.

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About Adin Bradley:

Adin Bradley serves as an Executive Consultant and Fractional COO at Polaris Healthcare Partners, guiding clients through the development and implementation of comprehensive, multi-year strategic plans. He assists clients with associate equity, healthcare marketing advice, buy and sell side advisory, clinician development, growth strategies, business and legal structure development, including location growth and vertical expansion. Adin finds fulfillment in his clients’ success and the development of his Polaris colleagues. His extensive operational background includes roles at Fastmed Urgent Care, American Dental Partners, and Rural/Metro Corporation. He holds a bachelor’s degree from Niagara College in Ontario and an MBA from the State University of New York at Buffalo. Adin is an avid Bills fan, sports enthusiast, and golfer, who enjoys quality time with his wife, two teenagers, and hosting family and friends.

Things You’ll Learn:

  • Centralizing and scaling operations is crucial for the success of multi-practice dental groups.
  • Aligning owners’ goals with every department’s optimization can help address common management issues.
  • Stringent processes for cash flow, from inception to money hitting the bank, are essential for practice growth.
  • Investing in management and team members ensures smooth patient payment processes and profitability.
  • The associate equity model allows doctors to build practices and earn equity without financial risk.

Resources: