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Align, Retain, Succeed: Equity Models for Dental Practices

Summary:

Are you struggling to attract, retain, and align top-performing associates in your group practice?

In this episode of the Secure Dental Podcast, Perrin DesPortes, founder of The Next Level Executive, and Adin Bradley, Executive Consultant & Fractional COO at Polaris Healthcare Partners, discuss strategies for structuring associate equity models and profit-sharing arrangements in group dental practices to attract, retain, and align top-performing doctors with organizational goals. In group dental practices, associate equity models and profit-sharing units are pivotal in attracting, retaining, and aligning top-performing associate doctors with organizational goals. Traditional 50/50 partnerships, where associates buy half of a practice, are often unfeasible in modern group practices due to high valuations and financing limitations. Instead, partial buy-ins, earned equity and profit-sharing provide ownership opportunities while balancing associate expectations and founder interests. Throughout this conversation, Perrin and Adin explain how thoughtful structuring of these models is essential to mitigate risks, maintain operational control, and create a mutually beneficial partnership for associates and practice owners.

Tune in and dive deep into the nuances of associate equity models and profit-sharing strategies to create a thriving, stable dental business! 

 

Secure Dental_Perrin DesPortes and Adin Bradley Part 2: Audio automatically transcribed by Sonix

Secure Dental_Perrin DesPortes and Adin Bradley Part 2: 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, everyone! Welcome to another episode of our Secure Dental podcast, where we bring in many different talents from both inside and outside our dental industry. And like always today we have Perrin and Adin again on part two of our podcast. And this is more exciting because we had a first part where we spoke about operations, and this time, we want to dive a little bit deeper into associate equity model as well as profit-sharing units. So, without further ado, we already know who these guys are from Polaris. I'm going to pass the mic off to Perrin and then Adin, and let's get the intro done, and let's get this rolling.

Perrin DesPortes:
Yeah, sure. Thanks for having us back on again, Noel. This is always such a treat for us, especially around the holidays. But hanging out with people like you on a podcast never feels like work. So, thanks for a little bit of a diversion. Yeah. So, my name is Perrin DesPortes. I'm one of the co-founders of Polaris Healthcare Partners, and previous to that, Tusk Partners. I've been in the dental space for almost well over three decades now. I have to think twice before I actually utter those words. But I spent 15 years with Patterson Dental, running three different businesses for them. Obviously two successful startups in Tusk and Polaris, both of which were consulting associate partnerships, equity partnerships for group practices, and then transaction advisory, which could either be sell side for equity or debt recapitalization offering. So all of our work, all of my work over the last better part of a decade or so, has been around the entrepreneurial group practice space. For me, moving forward into 2025, I'll actually be exiting Polaris as an owner, but will be staying in the space and launching a business that'll be an executive coaching business called The Next Level Executive. And that is the URL, actually TheNextLevelExecutive.com, and it's a one-to-many group coaching model for dentists and other healthcare professionals who have achieved practice mastery, they've achieved clinical mastery, if you will, and are looking to answer the question, what's next in their entrepreneurial journey? And that is really more about an executive skill set. It's professional development over clinical skill development. So it's a lot of leadership. It's a lot of structural alignment about how these businesses fit together. And if you decide to take it the full distance and actually build a group practice. Obviously you pick up and probably become a Polaris client at that point moving forward. So, I think the new business that I'll be focusing on in the market for it will be a little bit upstream from traditional dental practice management consultants and a little bit downstream from the Polarises of the world. So looking forward to it very much.

Dr. Noel Liu:
It seems like it sounds like it's a continuation of the journey, right?

Perrin DesPortes:
Yeah, I think so. I mean, I think for a client, right? Yeah. There are a lot of people, and Adin can attest to this as well, that there are a lot of people who would come to us at Polaris, and they might have 1 to 2 to 3 locations and would follow our podcast, would follow some of our content, our presentations, and things, and want to work with us. But their business wasn't, for lack of a better term, mature enough or developed enough to really warrant a full-scale commitment. And while we love talking with people like that, it's a heavy lift to to work with guys like me and Adin and Mark and Walker and everybody else at Polaris. And if you don't have enough meat on the bone yet, or you don't have a big enough business to apply all of that guidance to, it can become a little bit of a drag on it. So, for me, Next Level Executive will address a segment of the market that'll be pre-Polaris, and for those who aren't sure if they want to build a group, I'm not there to talk them into it, but at least I'm going to give them some better guidance around becoming a more effective executive for the business that they're building. And if they do decide to really go and commit to the journey of building a group practice, then that's a nice segue into everything that Adin and Polaris does. So I think it'll be a nice complement between the two businesses for sure.

Dr. Noel Liu:
Love it. Love the synergistic effect. And Adin, let's go, man.

Adin Bradley:
Yeah, thanks for having us on. And happy holidays to both of you and everyone out there. Yeah, just to piggyback, before I introduce myself again on what Perrin is talking about is personally, I'm really excited for Perrin. I think this is a great lifestyle change, and I genuinely believe it's a symbiotic relationship with us and what Perrin is doing because we've already proved that concept with a few clients that have gone through with Perrin with sent an executive and another vertical that we had where we have begun working with them on a fractional COO basis, they've decided to go to the next level. So, with Perrin incubating a lot of clients, determining what their journey looks like, you have an opportunity to work with them. And the inverse is true. Sometimes, a client will come to us, and they're just not quite big enough to yield the end results that they want to achieve. And I think they'd be better served, you know, working with Perrin for a time. So, while I'm going to miss Perrin greatly on our weekly calls and being a sounding board, I think that relationship is going to continue. So best to Perrin for sure. So, for the listeners that haven't heard us or just need a quick reminder. My name is Adin Bradley. I bring about 20 years of corporate experience, starting in HR and, ultimately, executive-level operations in multi-site healthcare. I'm employee number two, officially at Polaris. Been here almost since the beginning, and it's been a great journey. I bring about 15 years of C-level experience to the table, and while we continue to learn every day, our business, market, and segment is really starting to heat up. I think a lot of group practice owners out there are starting to understand that do it yourself model is not quite working, and our fractional COO vertical has been a really hot topic lately, where we do a little bit deeper dive into the management team and the processes of each group. So, I see things starting to pick up, and I'm excited and bullish about 2025 for sure.

Dr. Noel Liu:
That's great, Adin, thanks a lot. Appreciate you I appreciate, Perrin. This recording is taking place just exactly two days after Christmas. So Perrin is going to be transitioning to his new role, and I'm really looking forward to hear more about it afterwards. Today is something really important for a lot of group practices because it's something which is near and dear to their hearts: associate doctors. There's one aspect where we actually go ahead and attract them. Then, there is one aspect where we train them, and that's where leadership comes in. And then there's one aspect where we retain them. So those two first aspect is a totally different topic, right? What we are going to be diving into today is associate equity. How does it work? What are some of the models out there and what is it that actually works? So, without further ado, I'm going to be passing to Perrin. I wanted to take the first jab at this. The different kinds of models out there. What do you guys do at Polaris, and what is it that somebody will want to stick with a group, and why?

Perrin DesPortes:
Yeah. So this Noel, this is probably the biggest challenge, arguably, of any group practice. And if you can solve it and create stability, you stand a chance of creating a pretty decent business for yourself. If you can't solve it, you're going to create what amounts to a revolving door, and it's going to create chaos in the organization. It's going to create a lot of stress for the founder. It's bad for continuity of patient care, and it's really bad for cash flow. So if you get if you want to build a group practice and you get nothing else right, this is the one piece you got to solve. And even before maybe we touch on models, I would just back up maybe one step. And I think there are a handful of questions we want to think through from both an owner or a founder perspective as well as from an associate perspective. Associates come out of dental school and residency being taught by educators from what I would call a traditional perspective. And in the world of dentistry, partnerships were a 50/50 partner. Noel, you're the senior founder, you have a practice. I'm the young associate. I come in, I want to be a partner. I take on a bank loan, I buy 50% of your business, and we're 50/50 partners. And in ten years, when you retire, I buy out the other 50%, and that's partnerships, right? And dentistry has been unbelievably stable and I think successful off of that model. That being said, group practices are a completely different animal. And the young dentist entering the workforce, I think most of them are going to be employed by a group practice, whether it's private equity backed or otherwise. That's a different conversation. But I think the safe bet is that many of them are going into some semblance of a group practice. So when they come into our working world with that mindset around, let me buy 50% of the business and become a partner, that may not be realistic for quite a number of reasons. The most foremost, the group may be, it may value high enough that for somebody to become an immediate 50/50 partner would be an insurmountable hurdle. From a banking standpoint, they don't qualify for enough of a loan to buy into the business at that level. And for those of us as founders, we might not want to sell them 50%. So whenever an associate comes into a group practice and we, Adin and I get the question of, hey, can we hop on a call real quick? I got to talk with you about a conversation I had with an associate. I don't even need to hear anymore. I know what the conversation is, what the call is all about, and what we're going to be discussing, and it is the following. I was talking to my associate in between patients, and he or she mentioned the fact that they want to become a partner in the business. What do I do? And I think that's a good thing, because the associate is operating from a, or starting to operate from a commitment and an owner mindset with some degree of longevity, and that is a healthy thing, but we want to slow down, and we want to have a substantive conversation not in between patients, but as an owner and a prospective owner. And here are a couple of things that you want to ask your associate: one, okay, assuming that you want to entertain partnership, obviously, okay, doctor associate, when you talk about partnership, what does that mean to you in terms of dollar amount and percentage? What does that mean to you in terms of dollar amount and percentage? You want to understand their frame of reference and how they're coming into this conversation. Do they think partnership is equal 50/50? And a lot of them don't know any differently. So, we need to educate them about what partnership means. It can mean something completely different than 50/50. And then what's beyond the percentage piece? The dollar amount is indirectly. How big of a loan are you comfortable guaranteeing? Because if my business value's at $5 million and you want to take on a $2.5 million loan, I don't think the bank's going to loan it to you. But I also don't think you can make it cash flow positively over a ten-year term. So, a 50/50 partnership might not be in your best interest right now. We want to give them a yes. We're interested in continuing the conversation with you, but we want to back them down. If they have irrational expectations that may not be achievable by them or by us, okay? And there may be a heck of a lot of merits in somebody buying into the business at a seemingly inconsequential 5% or 10% today, that could still be $1 million, right? So they don't understand what valuation is. They only think about partnership as it means equal partnership, and that's 50/50, which might not be achievable. The second question you want to ask them is, okay, I'm interested in bringing in additional partners or having you possibly become a partner in the business. What does partnership and business ownership mean to you? What does it look like for you? That's a very open-ended question. And what you the reason you want to ask a question like this is because you want to get inside their head and see why do they want to become a partner. Nine times out of ten, all employees think that those of us who own businesses have an unlimited ATM machine, right? And we just pull cash out of the business anytime we want to. And we can buy anything we want to at any point in time, and we don't even have to work that hard to do it. If the business generated $10 million in revenue, 10 million bucks was in profit to us. Now, you and I both know that's not the case. Adin knows that's not the case. But for a young associate, they have no idea what business ownership really entails. And they think incorrectly, usually, that there's a lot more cash coming out of these businesses than there actually is. The other thing about it is those of us who built businesses, operated businesses, and seen the good, the bad, and the ugly know that business ownership comes with a heck of a lot of additional responsibility that is below the iceberg, below the waterline that nobody ever sees. The things that keep you up at night, that we all sweat the answers about that nobody else has the responsibility for. So if this person buys in or earns into the business, how do they think their role is going to change? What? How do they want their role to change? Do they want to take on a greater role in the business, or do they want to take more time off? And these are sort of some of the qualifying questions you need, a founder needs to ask of their associate prospective partner. Because Adin and I will tell you that philosophical misalignment around partners, the way we own the business, operate the business, grow the business, take risks within the business, and what our day-to-day responsibilities are that are beyond clinical chairside responsibilities. The misalignment of that creates insurmountable hurdles and will bring a business to its knees. And if you put partnership and somebody's buying in ahead of those questions, and you bring in a partner who's bought into the business, and they become a partner and sign the operating agreement, and then you figure out that our ideas about the way we run the business are different. Let me tell you what the legal process looks like to that. So, let's not answer yes to the associate equity question prematurely. Let's make sure we have rational expectations on associate and founder side, and also, to a degree, alignment or at least the opportunity to educate the young associate on what partnership looks like from our founding eyes. Follow me there, Adin, I don't know how much you want to chime in on some of that.

Dr. Noel Liu:
That, that is amazing.

Adin Bradley:
Yeah, I think you you hit on all the high points. I think the alignment and the expectations from the associate when they approach and know you may have experienced this yourself with someone approaching you. I just began reading a little bit about what's called open-book management, a philosophy of sharing enough information with everyone on the team to give them that ownership Mindset. I'm a fan of indexing that a little bit instead of being overly transparent, but the point is that educating them of some of the things that Perrin spoke about is that the business may not be as cashflow heavy as they think, there could be debt, there's obviously large overhead expenses, wages continue to outpace the cost of PPO reimbursements. So, I think there's a heavy emphasis on setting expectations and what I would call level-setting reality. Once you're there, the concept of associate equity is extremely powerful, whether you're looking to grow or scale, because we have seen instances in both, one, ... share with your group as everybody trains clinically with you and Dr. Jafri in one site, and then they go to another one. You've got a very consistent way of doing things. That's the way it should be. Other times, groups that have looked to partner strategically with a group. They add value to the business when they have associate equity partners locked up. Because it brings predictability to the purchase, they are, there, they have an equity role as well. And the private equity group that is partnering with you feels much more confident, if you will, ensuring that your lead docs are there. And one thing I'd be remiss about saying, because this has happened with a couple clients recently, we've seen, traditionally, group practices increasing year over year steadily, right? We have rate increases. We have like a 3% lift. And lately, we've seen some very strong practices starting to level out, and everyone's racking their brain about it. And I'm a big fan of the theory of Occam's razor. If you've never heard it, which generally is the easiest answer, is the right answer the most logical. And what we found is the exit of some real strong associates that had a very wide scope of clinical expertise that has not been replicated by the remaining docs or an associate that they've hired since then. So if you have a super GP or a specialist or somebody that really contributes beyond the norm, those are somebody you may want to lock up because they bring a considerable amount of value as it relates to their clinical expertise as well. So sometimes this is this has to be mutually beneficial, I think is the point I'm really trying to make, and it can be. So for those owners out there that think I don't want to dilute, I don't want to give up anything of what I've, you know, created. It is a, it's definitely an emotional and mental hurdle to jump over. However, if you look down the horizon, locking up some of these associates will generate far greater value on paper than it will in the little amount that you are potentially diluting.

Perrin DesPortes:
Yeah. And we can dive into some of the mechanics and the models like you were mentioning. I don't want to dodge the initial question, but I want to make sure we.

Dr. Noel Liu:
Sorry for interruption. I don't want to ask you, like when you say valuation, right, are you talking about valuation or just that one practice or like the enterprise value or is it like that one practice? And if it's like part of the enterprise now the multiples go up. So is that how the associate is going to be looking at things, or is it just individual like if it was a solo practice?

Perrin DesPortes:
So Adin loves to hear me answer every question with the phrase, it depends, but.

Adin Bradley:
I'm just thinking.

Perrin DesPortes:
Yeah, it actually does. So let's dive into some of the different aspects of models and solutions and things because I think you bring up a good point, and it's a nice stepping-off point from the traditional model that I referenced earlier. When a group practice, you've got a couple of different opportunities; I would say both for models and mechanics. So, when a group practice, you have a management company that sits above all the group practices. From a legal structure standpoint, the management company can play any number of different roles, depending on how big the business is and how developed the management company is. And so you can have ownership and equity at either a practice level or at a management company level. There's pluses and minuses to both, for sure, from the associate standpoint. Associates tend to think about ownership more from a standpoint of what they can influence and control and can control, which is usually things that a practice level; they're in a clinical role, after all, and they think they understand practice ownership. When it comes to management companies, that's a little bit more of a nebulous concept and one that's not very familiar to them. So, if you have an ownership opportunity at a practice level, it could be a buy-in, meaning I borrow money from a bank and buy into the valuation of the practice. It could be an earning model like either profits units or restricted stock units, which is based on either the practice's growth and development or my individual collection levels achieving some level of goal attainment beyond a threshold. I can actually earn ownership in the business without having to actually pay for it. There's a lot of intricacies to that, obviously, and practice ownership can be a great thing. If you're the founder and you're looking to have an anchor dentist in a location that's always going to be there and is really committed to that practice, achieving its full capacity. I would say if you intend to migrate dentists between locations, it may be that you want them to have ownership at a management company level. They would own a smaller piece of the entire pie, not just the practice level. Now, if we do that, this gets into your question around valuation. Practices have finite valuations, at least theoretically, because there's only so many walls, so many chairs, so many hours in the day. You can run a practice 24/7, but you're going to reach a threshold of you're going to reach terminal velocity as it relates to maximum revenue and profitability at some point. Ownership in a management company and thereby owning a smaller piece of the entire pie; well, the theory behind a management company is it provides administrative services that creates greater profitability and efficiency across the entire organization, and in theory, you could add as many practices as you wanted. So, the upside potential as it relates to valuation at a management company is far greater than what the valuation potential of a practice is. So now, from an ownership standpoint, I think we want to come back to the first point that I led off with, which is the stability aspect of associate owners in the business that owners don't tend to leave, right? So, as long as they're good clinicians, they're hopefully going to stay for the long haul. We're not going to turn them over as often. So from a founder standpoint, if we want to have more associates, be owners in the business, even if they only own 1%, 2%, 0.5%, or whatever, if we own 1% of Google, you and I are doing pretty good right now. So it's really not about the percentage. It's the dollar value. The management company values higher, it's more, you can continue to add additional practices underneath it. So, the opportunity for somebody ownership stake at a management company, even if it's seemingly inconsequential like 1%, the upside potential of valuation is much greater at a management company. And for those of us as founders, we can bring more people in because our diluted dollar goes further. So it still allows us to maintain control, even though we're adding more partners and number, but more partners with a smaller percentage in terms of voting power. So, I know I wandered around a little bit on that answer, but let me know if I left anything gray or untied.

Dr. Noel Liu:
Yeah, I just have a follow-up with that. So you are not recommending like on an office level, right? You are recommending like on a management level. So the money is so the percentage is diluted.

Perrin DesPortes:
So again, it depends. I would tell you that I tend to, I like ownership at a management company level more, more or more often because I think it aligns everybody's interests. Now, Noel, you may own 90% of the business, and Adin, I may only each own 5% of the business, but if we're all at the same level of the business, then all of the strategic direction and growth and everything impacts all of us positively and negatively. You own more than we do, but we're in this. We're rowing in the same boat with you, hopefully to the same end game. Now, if I'm an owner at a practice level, I'm only interested in maximizing the valuation, profitability, and cash flows out of that practice. If you go fire Adin in location number two, that's a you problem, not a me problem. My practice is going just fine. So I don't care what happens in location two, three, four, and on down the road if I'm ownership at a practice level, if I'm ownership at a company level, a management company level, I may only work in location number one. But now when you fire Adin in location number two, that impacts my ownership because it depletes the cash flow. So I might be willing to pick up a day shift or something like that in location do, until you can get it back filled, right? So, I think the thing about ownership at a management company is it tends to make governance and alignment of interests a little bit more congruent. Whereas if I'm ownership at a practice level, I'm interested in profit distributions out of this location only. And I don't really care what happens in other locations. There's good and bad to both. There's this is not a one size fits all and we spend a lot of time. Mark Flock at Polaris does a great job working with the clients that want to build equity solutions, and he spends an exhaustive amount of time asking questions like this that are current based, future based. He wants to know all about the associates, the founder's philosophy, about what they're trying to build, and why do you want to sell the business as a cash flow business. How much risk? What do you want the role like all this kind of stuff. And then it's usually the best solution of many that could be applicable.

Dr. Noel Liu:
And with these options, both these options, they can either buy in or they can earn it, correct?

Perrin DesPortes:
That's right, yeah.

Dr. Noel Liu:
And if it's at a management level, then they are basically buying. Let's say, if it's a buying, they'll be buying it at the enterprise level, the valuation level.

Perrin DesPortes:
That's right. The company-wide valuation level. That's right. So, the practice may value at $1 million. The company may value at $20 million. If I take on a $500,000 loan, I'm a 50% owner and a practice, and I'm, what, 2.5% owner of the business overall. If I buy in at a management company level, the dollar value is the same. The percentages are dramatically different.

Dr. Noel Liu:
Gotcha. And which is why you just mentioned, like it's so important to ask them exactly if it's what's a dollar value they're looking for, because sometimes it's 2% and 5% may not even make sense for them.

Perrin DesPortes:
Right. It's people in, maybe this is me coming from a world of a publicly traded company in my previous life, but I understood. You know, the equity that I earned at Patterson, I was a manager there, and we had these types of earned equity opportunities, stock option, and restricted stock. So, I was the beneficiary of that, but I also had some stock purchase options that I could exercise as an employee. And so whether it was an earning or a buy-in, my ownership in Patterson was never going to amount to a hill of beans. But if the stock appreciated, I could do pretty well for me and my family. So I think we want to understand the dollar impact of that. If we're going to borrow money and we want to understand the dollar impact of ownership, if the value of the business is going to increase.

Dr. Noel Liu:
Right, right. No, that was great, Perrin, because this is one of those things where a lot of people get like convoluted. They're not really sure exactly which route to go. And as a matter of fact, because they're not really informed on how this whole thing operates. So I remember you touching base when in the past about profit sharing. How is that different from the equity model, and why would somebody go with this route versus that route?

Perrin DesPortes:
So, we do a few incentive comp models. I would, you know, profit sharing is an incentive compensation model. It's either based on the leftover profit or some type of an achievable hurdle. But profit sharing is pretty straightforward in terms of what it is. It's leftover profit that's income and cash to the recipient, whereas equity is an ownership stake in the company that hopefully appreciates over time, it may or may not have voting rights, it may or may not have distribution rights. But being an owner in a company equity is substantially different than simply some amount of leftover distributable cash at the end of a period. So I think they can be, either, can be good if used in the appropriate way and with the appropriate candidate. To me, profit sharing is good at a, to a degree, a practice level for line employees, sometimes with associates if there is no equity opportunity. But if you're talking about C-suite or leadership in the business, anchor doctors and things like that, you want people that are aligned with the business we're trying to build and committed to improving the company beyond just what their individual role is. And nine times out of ten, Adin can tell you, I'm sure that if you're recruiting a COO or a CEO or CFO or something like that, or even some of your VP levels, these are going to be people that you are entrusting to improve the performance of the company overall. And if they do that, sure they want to be compensated for it, but they want a stake in the game too. They're going to want some aspect of equity that will improve with their commitment and their performance to the company. So I don't know if you want to dive in on taking apart profit sharing versus equity, but you've done a number of these two.

Adin Bradley:
Yeah, I think either model, again, it depends on what, on both what the owners or owners trying to solve for and also what the associate, or even at a management level, some of the executive team deems to be valuable. We see so many scenarios, and I think this is why Polaris is a pioneer in this is because we may also, as we look at the valuation of the organization, not only do we help try to educate and calibrate the expectations of the associate and show them more in dollars than percentages, what downstream looks like. But also, if we feel like the doc or the ownership group is still has some meat on the bone, we may recommend optimizing a few things before. Because if you allocate shares vis a vis this earned equity model prior to being fully optimized, you will give an imbalanced lift to an associate. So there are times where we have said or advised to clean up a few things first and then allocate equity based on that. So, the owner always needs to be protected, or the ownership group needs to be protected with their capital investment. First and foremost, they should never go backwards. And really, it's to reward associates that take the group or their particular practice to that proverbial next level, meaning they have increased production. They've helped increase margin through expansive dentistry, have added services that were not there that hit top line. But there's a second part that we didn't really talk about yet, which I think is critically important is, what does your target associate profile look like? Someone can be a great performer. They can knock it out of the park as a super GP, earning one and a half to $2 million a year, but you find that they're just not a good culture fit. While they're great in helping the business from a purely financial standpoint, they may not be the right person that you want to hitch your wagon to. And lastly, I'd be remiss to say that we have seen situations where groups did not get in front of this before an exit, and the associates, for lack of a better word, have held them hostage at the table and wanted equity for the deal to go through. So there's a lot of legal agreements that come in here. There's drag-along tag-along clauses. There's voting rights, there's moral clauses. There's a lot to protect the associate, and there's a lot to protect the owner. So there's a lot of alignment in there. So, for any of our listeners that think that a potential strategic partnership, exit growth strategy, merge joint venture, you name it is on the horizon in 3 to 5 years or sooner, I would begin thinking about what associates you think could hurt the entity if they were to fly the coop. And where I see a real danger are higher end fee for service offices, where the docs are generating far greater W-2 income. They're generating $400,000 or $500,000, $600,000 a year. And as Perrin alluded to earlier, their ability to balance a mortgage, a family, and then a loan is far easier at that income level, and those are the groups, it's sort of a double whammy because, number one, you lose a very high-performing associate in a niche market, and they've become a competitor. So we've got to ensure that those that are really integral, particularly specialists that have you've built a business around a referral base, marketing all of those things to brand somebody. You may want to think about locking them up and making it attractive to stay on the team than saying, I've been making so much money, and I've got this pot. You've made it look so easy, Noel. I'm just going to go do it myself, right? And it's happened. So again, it depends, but it's much easier to try to lock up those associates that really the key question is, number one, I think is before production, dentistry, anything clinical. Is this the type of person I want with me on my journey? That's number one. And if that answer is yes, do they bring value and would they be motivated and committed to staying with us on our journey if we were to share in the upside with them? And if the answer to both of those are yes, and then the third question is if they leave, will my business suffer? I think that it would be time to consider some sort of earned equity program. Or if they want to buy in, you can do a hybrid of both, which we've done where they've bought in a certain amount, and they've also had the ability to earn additional sweat equity.

Dr. Noel Liu:
Love it. Those are great nuggets because this is something where everybody has this problem, but nobody ever actually tries to tackle it. And I think what you guys just shared was I think it's going to help a lot of people. One of those questions that approached a few of my colleagues, it's, now these guys coming in. And when I say guys associates coming in, they're not really interested in buying in or being part of the existing group they are looking to expand. What's your take on that? So, let's say I have a Tennessee location in my area. Brand new office, brand new location, no patients. Somebody approaches me and go like, hey doc, you know what? I'll go down there. I'll sweat it out. But I want a piece of the pie. Your thoughts, and how would you manage something like that?

Adin Bradley:
It depends.

Dr. Noel Liu:
Yeah, no.

Perrin DesPortes:
Yeah, right? I think this is a tough one, honestly, because I think that.

Dr. Noel Liu:
But he still wants to get paid as an associate also while down there.

Adin Bradley:
Sure, right.

Perrin DesPortes:
So do I, right? Hey, Noel. I got a great idea. I'm going to go open up a business. Why don't you put all the capital in to start it and make sure I get paid? But I'll be there, right? So I think we got to be careful in these situations from a couple of fronts here. I believe in the merit of competent, qualified associates and their ownership potential and to be an anchor doctor for us. I believe in all that. I also believe in those of us who own or who have developed a management company that is efficient and really effective at the services it provides, and creates a financial impact in the practices that it manages. There, these businesses, in order for all of this to work, we have to be profitable, efficient, effective at a clinic operational level. And without that, we're on, we're not on firm ground. So when you start talking about going across state lines or going out of your geography or over the horizon or something like that, it's my opinion that we lose. We, as founders, start to lose operational control of the businesses that we're responsible for managing. And if we are taking on more of the risk from an initial investment standpoint, then if it goes bad, well, the associate didn't have to put in as much or didn't have to put in any, and whatever went bad, not through their fault. They were there to cut crown preps and greet patients and everything else, but we're left holding the bag here. So, this is an element of cash flow and risk. In my mind, I'm much more I'm a bigger advocate for tighter geographies with more operational control. And I certainly agree in the merits, again, of, you know, minority partnerships and things for the right people. But when we start getting like way from a geographic standpoint, we get way over the horizon. I get a little bit squeamish about that. I mean, Adin, you're more of an operator than I am. And you work with Noel, obviously, in his model, but that, I'll let you chime in on some of that.

Adin Bradley:
Yeah, it depends. I was just reflecting back. I'm not sure if this perfectly segues, but I was the chief operating officer for a multi-site veterinary group years ago, and the gentleman that owned it, the founder, who was a, he still is, a wonderful man. When I first saw the model of what he was doing, I thought, gosh, you're overly generous. But what I found was the genius of what was, in fact, a profits interest model. The associates worked at the flagship office. He would then want to build a new location. So he owned the real estate 100%. They would open a new practice under the same brand. The associate would go there. Once all of the debt was paid, the capital costs were paid. They split everything 50/50, and there were distribution schedules. There were legal documents. They were changing control all of the things that you need to protect yourself. And I thought, gosh, what a generous man. And he was. I think it was born out of generosity. But what it turned into was like seven offices that he did this with. And he thought, and you'll know this, know with you and Dr. Jafri. And I say this to high producing owner docs. You can't clone yourself. So the best thing you can do is, and I'm going to inject your 70% rule, is get your associates to 70% of what you can do clinically the Secure Dental way, if you will, and then put them in offices that you have strategically decided is a good geographic location, which is a totally different conversation here, and what I found was this is brilliant, and it was something going back more than ten years now, and that model worked because the real estate became more valuable. The business continued to pay the real estate company rent, so that investment was secure. Once the debt for the capital costs and the running of the actual practice was paid, then he said, listen, everything that you do above this, we're going to split half. You'll get a salary and then we'll split half after all expenses. And when coming to Polaris and I saw that model, I thought it's ingenious for those that really embrace the concept. And I will say this again: for all the group practice owners and those that would say that have had practices for probably 20-plus years, there is probably a very tightly knit set of values. Or like, I don't want to give up what I've built. Don't look at it as not giving it up. Look at it as how can I expand further if I reward those that help me grow a little bit. And you will find at the end of that rainbow, your net worth has grown substantially because of that. So, I'm not sure if that answered the question directly. But, you know, I've seen this model work in different industries, even though it wasn't as formal, if you will, as Polaris would do. It was just back of the envelope. Hey, I'm $2 million into it. Once I get my two-mill back, you get half of it, and it worked. But again, what I will say is that a couple of the owners were not aligned, and there was not a real formal, tight-knit set of expectations at the top level to make sure that everybody was rowing in the same direction as Perrin said, because everyone's worried about their own office. So it works. It's proven to work, it's proven to bring value. It's proven to increase value because of the predictability. Anytime a private equity group comes in as a partner, and there's any flight risk of a top performer leaving, that's a problem. And one last thing I just want to share. I've got a couple of clients where I don't think I mentioned this earlier, where things have gone awry a little bit because that very predictable trend upward, and we try to look at what the inflection point is, and we often overlook the obvious. Both group practices lost 1 or 2 of their highest-producing docs that had an expansive clinical skill set that they did not replace. End of story. So they're focused on marketing and branding and patient flow. What's going on? And I'm like, guys, you lost your top quarterback, and you didn't replace them. So, to avoid that hiccup, I bet you if they had known then what they're experiencing now, they would have tried to lock them up, so don't do it after the horse has left the barn. Try to be very proactive because it also builds goodwill. You don't want to go into this type of relationship feeling like you are doing it under duress or for selfish reasons. It just creates a bad energy between the two. You want the associate to feel really good that the ownership group selected them and wanted them, and you want the owner to feel really good that, hey, this is a person I want with me throughout my journey before some sort of external force thrust the need upon you.

Dr. Noel Liu:
Epic, epic. Love it when you were speaking it in the whole time. I just a light bulb went off in my head to.

Adin Bradley:
What was that? Share with us.

Dr. Noel Liu:
No, you just laid it all out at like how it is. Like you go to a new location, you get it done, you get the associate down there? They're still getting paid. You're still getting all the marketing done. You're still putting in all the capital costs to get it up and running. Hey, let's get that paid off first. Love the idea. And this way, everybody wins. And then now they have some sort of an equity in there. They have this whole thing that they are the owners as well. And I feel like this is something which you just took it out of my head because this is something which I was thinking for the whole time because we have so many doctors who are like entrepreneurs, but they want to collaborate, they want to stay with the group, they want to grow with a group, but they want to be the part of the driving force. And remember, you and I, we spoke about this like wherever the Secure Dental stands right now, we lock in the valuation at this time, anything these guys are going to help us expand and scale. That is just an addition to the to the pie. And if they're getting 50%, who cares, right? That was never there, to begin with. Yeah, and that's one of those things where I like to tell a lot of my colleagues was actually running group practices that we got to share the pie. You cannot just be like, hey, I'm all in, and it is all mine. It doesn't work like that, and, which is why I wanted to bring this equity thing up.

Adin Bradley:
I say this, and you and Dr. Jafri have continued to prove what discipline foresight vision brings. No, I hope you don't mind me sharing, but we've touched on this in other podcasts. Back in the beginning of 2024, actually the end of '23, we created a very, I wouldn't call it aggressive, a very doable forecast for the business by month. We forecasted every single month we laid out the percentage of revenue for every expense line. And we said, if we achieve these goals in your managers and your director, David, sticks to this recipe right here. We're going to increase margin of profitability substantially. And every month, we would lay the actuals over the forecasted amount. And it would tell you how close you were to go above, at, or below. And I got an awesome text by Noel the other day, if you don't mind sharing, and just say how we did in '24 without giving a number, without giving numbers out. But as far as the plan is concerned, how do we do?

Dr. Noel Liu:
So here's the deal. We started off 2024 Q1 really slow. It was below 2023. Q2 was right there, but it wasn't so much happening. And that's where David was getting worried. He was like, man; I don't think we're making it. But I was like, hey, you know what? The game's not over yet. We still got two more quarters to go. And it was just half-time, right? And then Q3 and Q4, we crushed it. So Q3 and Q4, we doubled up what we did in Q3 and Q4 of last year. So there are more than just caught up what we did Q2, Q3, and Q4 in 2023 and Q1 and Q2 in 2024. So can't be happier.

Perrin DesPortes:
... the football going into the end of the calendar year, man. That's awesome.

Dr. Noel Liu:
Right? That's like one of those games where you see like a long pass at the end and just winning the Super Bowl kind of deal, right?

Adin Bradley:
I think the reason I mentioned it is, and it brings such a smile to my face, is that we knew the business; we made a plan. And even though we had a little bit of adversity, you said, no, we're going to stick to it. Just trust the process. Just keep trusting the process. And therefore, at the end, when you got your report card, if you will, all A's, no matter what happened earlier in the year. And it really heartened me to know and just watch this journey with all of you and your team. So congrats to all of you on an amazing 2020, continued success into '25. I have no doubt it's going to be even better. I'm looking forward to your Tennessee practice and seeing how that turns out.

Dr. Noel Liu:
That's still in the works. Still in the works. I was really shocked when the CPA called in and was like, all right, we got good news and bad news. And we all know what that means, right?

Perrin DesPortes:
Yeah. Give me the bad news first.

Dr. Noel Liu:
Well, guys, thank you so much for coming in and chiming in your knowledge and your expertise, because this is one aspect everyone suffers from, regardless of how small or how big the group is. And I know that the fact that we are going to have these kind of challenges as well as we grow and as we go along year after year. So with that being said, I'm going to land the plane here. Any last comments, Perrin?

Perrin DesPortes:
Well, Noel, thanks for having us back on. This is such a treat for me and Adin. And like I say, it doesn't feel like work, but really excited about sharing some knowledge with your audience today. And hopefully, they found it beneficial and thought-provoking. And obviously, if you want to get in touch with me or Adin, Adin is A D I N @ Polaris Healthcare, Partners.com Adin@PolarisHealthcarePartners.com, and I'm Perrin, Perrin@TheNextLevelExecutive.com. Look forward to being back on with you again in 2025. Going to be a great year for all of us, I know.

Dr. Noel Liu:
100%. I would love for you guys to come back. Next-level practice, that's what we're going to talk about next year.

Adin Bradley:
Amen to that.

Dr. Noel Liu:
All righty. Make sure you guys like and subscribe. We were going to land the plane here. Thanks for watching and thanks for hearing us, and we will come back 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 Perrin DesPortes

Perrin DesPortes was one of the Co-Founders of Polaris Healthcare Partners and (before that) Co-Founder of Tusk Partners. He is a Washington & Lee University graduate and earned his MBA from the Darla Moore School of Business at the University of South Carolina. Perrin has over 30 years of experience in dentistry, having run three different business units for Patterson Dental Supply over a 15-year career. Perrin is happily married with an 11-year-old daughter and two dogs at home. He is an avid cyclist in his spare time, enjoys cooking and reading, and loves good red wine and strong coffee.

About Adin Bradley:

Adin Bradley is an Executive Consultant & Fractional COO at Polaris Healthcare Partners. He is responsible for leading clients through the creation and execution of robust, multi-year strategic plans. Adin also supports clients through associate equity, health practice marketing counsel, buy and sell side advisory, clinician development, growth strategies, including location growth and vertical expansion, and business and legal structure development. He takes pride in seeing clients succeed and developing other Polaris team members. He brings extensive operational experience from positions held at Fastmed Urgent Care, American Dental Partners, and Rural/Metro Corporation. He has a bachelor’s from Niagara College in Ontario and an MBA from the State University of New York at Buffalo. He is a rabid Bills fan, sports fanatic and golfer. He enjoys spending time with his wife and two kids and hosting family and friends.

Things You’ll Learn:

  •  
  • Associate equity models attract and retain top talent while fostering long-term commitment and alignment within group practices.
  • Profit-sharing programs are powerful incentives that boost associate morale and enhance practice performance.
  • Compensation structures tailored to balance fairness, motivation, and profitability, benefit associates and practice owners.
  • Aligning associate goals with the larger vision of the practice creates a cohesive and thriving team dynamic.
  • Practical strategies and tips can help navigate challenges and successfully implement these models in group dental practices.

Resources:

Categories
Podcast

Avoiding Pitfalls in Dental Practice Growth and Acquisition

Summary:

As the dental industry evolves, entrepreneurial dentists face growing challenges in scaling and optimizing their group practices, making expert guidance more crucial than ever.

In this episode of the Secure Dental Podcast, Perrin DesPortes, co-founder, and Adin Bradley, Executive Consultant & Fractional COO, from Polaris Healthcare Partners, discuss how they seek to equip entrepreneurial dentists with strategic insights and practical guidance to successfully scale, optimize, and sustain group practices in a dynamic healthcare landscape. Perrin explains how Polaris’s tailored solutions address client goals such as scaling, lifestyle optimization, or exit preparation, and their expertise extends beyond dentistry to similar healthcare sectors. Adin highlights key strategies for success, including improving acquired practices’ profitability, centralizing operations, aligning culture, and recruiting top talent to support sustainable growth. Polaris emphasizes building practices with strong cash flow and efficient operations to ensure long-term value, especially as post-pandemic market conditions favor well-run businesses over inflated EBITDA multiples. Within this conversation, they talk about how, with a focus on deliberate planning, leadership development, and a people-first approach, Polaris helps clients navigate the challenges of scaling and achieving their goals in an evolving healthcare landscape. 

Want to scale your dental practice, boost profitability, and secure your future? Tune in to learn the right strategies and avoid costly mistakes.

Secure Dental-Perrin DesPortes and Adin Bradley: Audio automatically transcribed by Sonix

Secure Dental-Perrin DesPortes and Adin Bradley: 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:
Hey, everyone! Welcome to our other episode of Secure Dental Podcast, where we bring in many different talents from both inside and outside the dental industry. Today, I'm so excited because we have special guests today from Polaris and before we jump into it, just a big shout out to my sponsor, who I'm also co-founder. It's DenvtVia. DentVia is a virtual dental administration company that assists our front desk and our back-end staff with virtual lead generation calls, management, insurance eligibility, and all that good stuff. The stuff that our team hates to do. So, with that being said, make sure you guys visit them at www.DentVia.com. That's, again, www. D E N T V I A.com. Now, without further ado, I have Perrin DesPortes, and I have Adin Bradley, so both of them are here from Polaris. And I'm so glad and honored for them to join us here today and share some knowledge and some wisdom what it takes to grow and scale your dental practices. Perrin and Adin, I'll pass the mic off to you. So Perrin, let's get started. I'll start with you first.

Perrin DesPortes:
Yeah, thanks for having us on today, Noel. I've been looking forward to this for a little while, and obviously Adin and I know you very, very well. And we're big fans of the business that you've built. I'm one of the co-founders of Polaris Healthcare Partners. And for those who haven't heard of us or seen us speak or worked with us before. We're part consulting company, part transaction company, and we focus all of our work exclusively in the group dental practice space. We help entrepreneurial dentists build and execute on their growth strategy. So that's consulting services. It's associate equity models. When you want to bring associates and executives into the ownership ranks of the business and fractional COO services, which I know that Adin will dive deeply into, and then the transactional side of our business, we can do either debt placement or equity placement, debt placement, all of our clients, all of our core clients are what we call doctor founded and debt funded. So they're the entrepreneurial dentists who are using bank funds to grow. Bank funds are usually one of the Achilles' heels of every group practice. I think we'll probably talk a little bit about that, too. So, if they want to continue to grow through the use of debt funds, we can usually source lower middle market or middle market capital for them to do so. And at some point, maybe they want to take some chips off the table and find a private equity-backed, enterprise-level DSO or a straight private equity company to make an investment in their business, minority or majority. We can help anywhere along the way. So, think of Polaris as a general dentistry group. We've got the hygiene department, which is our associate equity and consulting services, and then we've got the transaction department, which is a lot like restorative and operative and a general dentistry practice.

Dr. Noel Liu:
I love the analogy. Yeah. All right, Adin. We had you last time in our show. You dropped so much nuggets, man. So today, tell us a little bit about yourself for some of our audience who've not heard the last episode with you.

Adin Bradley:
Yeah, firstly, thanks, Dr. Noel, for having Perrin and I back on individually and collectively. Yeah, it's been a great ride. I've been with Polaris nearly since its inception in 2021. So as we're heading into year four, you know, we continue to grow, not only, you know, as an organization, a boutique consulting and sell-side advisory firm, but also we have introduced new verticals as we've worked with a lot of clients like yourself that we have found that there's needs even beyond when we originally started. So I've been with Perrin, one of the co-founders, as well as Diwakar Sinha, our other co-founder, since the beginning, and been a great ride. You know, as anyone who knows that has seen or heard you and Dr. Jafri and Secure Dental on our podcast and on our website, one of the case studies. It was great working with you and your team, and always enjoy coming on to chat a little bit about what we do, not necessarily always what we did with secure, but how secure has grown your business, how we were along for part of that ride and hopefully share some of those challenges and solutions that you did in your group with our listeners.

Dr. Noel Liu:
100%. I remember when I was on your show there, Perrin, we spoke about in-depth about how we got started and how we got funded and all the problems and challenges, right? and I can still recall that time when I came to see you on that workshop where we were like, on our feet. So now the tables turned around a little bit. I would like to hear a little bit about your story, and how you founded Polaris, and what was like some of those challenges, and some of the work and successes behind it.

Perrin DesPortes:
Yeah, happy to give some background to it. It's a little bit of a circuitous route, if you will. I've known my partner, Diwakar Sinha, for probably over 15 years or so. He comes from the world of healthcare banking, predominantly dental, but had done a lot of other lending and other healthcare verticals, and he was in greater New Jersey, New York market for a while, where he worked with a couple of different lending institutions. And I actually ran one of the operating businesses for Patterson Dental Supply. That was, they called it Metro New York, New Jersey. So Staten Island, Manhattan and Westchester, and then central and northern New Jersey. And Diwakar was one of the finance reps who called on our branch. He thought about that finance relationship completely differently than anybody I'd ever worked with before, and that is Diwakar in a nutshell. He sees things differently. He has insights that are multiple levels deep and tends to be very solution-oriented, not just for the end user being the dentist, but also who is an equal core client. And that situation would be the distribution company. So our relationship goes way, way back to different lives that we both led at that point in time. You kind of fast-forward the tape. For a couple of years, I had moved out of the New York market to Charlotte, North Carolina, which is where home is right now for me. It was still working with Patterson. He also got married and moved out of the New Jersey market to Charlotte, North Carolina. So we actually found ourselves in the same city, and we're also having some of the same, maybe career challenges about the same time and contemplating leaving our cushy corporate America jobs, as I like to call it. And we decided to launch a venture called Tusk Partners with some other co-founding partners. And that was a business that I guess really came to the fore in January of 2017. And if you think about January of '17, the movement to consolidation was happening in dentistry across the board, and all of us had a little bit of a different insight into what consolidation was, Diwakar from the lending institution piece me from the distribution side of the world. And then our third operating partner from the aspect of valuation of these growing group practices. And, you know, there were a lot of people, there were a lot of individual dentists who were interested in building group practices, but I would say incorrectly, they assume that just because they had built a successful practice in and of itself, that it was easy to replicate times two, times three, times four. And on down the line, as you well know, it's not just twice as complicated to have two locations versus one. It's geometrically more complicated. And we were seeing those entrepreneurial dentists all making the same mistakes, you know, and along the growth path. I mean, and, you know, you sit there and kind of say to yourself, wow, somebody ought to provide business-level resources, because the challenges that they were encountering in building a group practice were far beyond what a traditional dental practice management consultant would offer in terms of solutions. Most of them hadn't worked in a multi-site environment anyway. None of us were clinical dentists, but we all came from big business corporate America backgrounds. And then if the target audience, the target dentist ever did reach some level of success in a multi-location group, and they wanted to sell it. There was nobody really there to help them transact the business because, once again, a traditional dental practice broker wasn't equipped to handle a transaction of that complexity to a financial type of a buyer. So you put the growth need on one side of it, and you put the exit need on the other, and you keep repeating that same message to yourself long enough. And then finally, kind of like Beavis and Butthead, you know, the light bulb finally goes off above you, and you're like, well, if nobody else is going to do it, why don't we do that? And so we built a business that helped entrepreneurial dentists start, grow, and sell their group practice. Diwakar and I left Tusk Partners in March of 2021 to launch Polaris. We had a different vision for what we wanted the business to become, and I mean, things end up the way they do. Launching Polaris four years ago gave us a lot more freedoms to create the business that we wanted to bring more people into the business, to look at subsequent healthcare verticals that weren't dentistry, but they basically operated the same way and had the same challenges, after all. And Polaris, we decided to call Polaris Healthcare Partners and not Polaris Dental Partners because we believe the application has an equal merit in a lot of different verticals, and that's what we're focused on pursuing right now. And I think the business finds itself at a wonderful point in time in terms of opportunity and certainly in terms of need. And we can talk a little bit more concretely about those services as this conversation unfolds.

Dr. Noel Liu:
Oh, absolutely. You know, like you guys with any kind of business, any entrepreneurial spirit or business, I mean, there are challenges, there are victories. Something along those lines. When you were expanding, would you say it would be the same kind of growth pattern like you would expect when a dental practice is growing with your Polaris?

Perrin DesPortes:
It's similar, and the reason I kind of hedge on that is because we can probably dig into this at a deeper level, too. But I think when you look at a group dental practice or a group healthcare practice, it's a wonderful blend of fixed costs and variable costs. And then most healthcare practices, certainly general dentistry, you don't suffer from what's known as concentration risk from either a variety of services standpoint, you don't provide one widget to one consumer. In other words, you do. Dentists do a lot of different procedures on a lot of different patients. And all of those patients most of the time, at least come from different payer structures, be they fee-for-service or cash pay or different insurance plans and employers. So, when you look at a group healthcare practice, and certainly, this is indicative of the world of dentistry. You have a nice blend of the cost structure that allows you to get some advantages around growth and scale, certainly, but you also don't suffer from being a one-trick pony from either a service delivery or a consumer standpoint. And I think that's highly advantageous of the model itself. A consulting company like what we have scales a little bit differently. The cost structure can be a lot less because we don't have as many fixed costs aside from wages and payroll, which doesn't come cheap. Adin's a lot smarter than he looks, I'll tell you that. And the price point for a guy like that is usually pretty high. So.

Dr. Noel Liu:
Steep. It's steep.

Perrin DesPortes:
Yeah, so, you know, while our payroll is our biggest expense like it is in a dental practice, we can flex that a little bit. And then the way we choose to scale can be a little bit more akin to like what a tech company would be beyond a flaw of initial investment. The more revenue we can pile on without adding on additional costs makes it a little bit different. Although our consumer is dramatically different, price point of services is different, so some similar, but some different based on the model, I would say.

Dr. Noel Liu:
Thanks for sharing that because, you know, a lot of times we always have this notion that, okay, consulting companies, how are they operating, what is going on, what are their fixed costs, right? So that kind of gives a little bit of insight. So we're going to switch gears a little bit. I wanted to kind of dive in a little bit into what you guys actually do. You help scaling grow practices and grow practices and doctor-backed offices, right? What are some of those biggest mistakes that you are seeing when you are actually consulting with a company when they want to grow from 2 to 3 to 4 to 5? I mean, we see this all the time. Everyone wants to grow, grow, grow, grow, grow. But what are some of those mistakes you're seeing, and how do we avoid them?

Perrin DesPortes:
Adin, do you want to take the first crack at this? And I'll add some to it as well.

Adin Bradley:
Yeah, I'd love to, and it's a great question. And because we are, you know, what we would consider a white glove consulting group, we generally, not generally, we always tailor our output to what the owner wants or what we think the owner thinks they want. And to answer that question specifically, no, I think a lot of times what we try to do is get them to really identify what type of group practice they're looking to build. Is it a lifestyle business? Is it building to grow just to scale, potentially exit, maybe just optimize it as much as they can, and then make a decision? And the reason why I say that is what I've seen out in the field. And then I'll touch on a couple new verticals that we have started, basically out of necessity, with some of the groups that we worked with that needed a little higher touch. Is it really is going to have a commitment to how dollars are allocated and in dollars are spent, so those that are looking to scale and grow are going to have to be disciplined and reinvesting back in the business? If you're trying to scale and grow while paying for, you know, the new Mercedes and the country club membership at the same time, it's going to make those a little bit more difficult to do. And, you know, I say that, and maybe we get a chuckle out there, but that is the reality with some, so really defining who you want to be when you grow up is going to really determine the path on how you're going to operate the business from the time of our engagement and post engagement because what we're our goal is to leave you with the tools to be able to eventually have us leave and have, as you and Dr. Jafri have done, continue on that journey with precision based on the things that we all worked on together. And all we really did was kind of ride side saddle with you to just open up some opportunities and looking at things through a different lens with full confidence that you'll know how to execute on that. So once we've been able to define from the owner or owners purview what they want to do, you know, we set out to really focus on the levers that are going to make change in their organization. The type of dentistry that we do is absolutely paramount. The type of payer mix, you know, are we a fee for service office? Are we a PPO office? And then recruiting and retaining top talent that can ultimately push you out of the chair so we can replicate your skill set? I think in the past, no, you've used the 70% rule, or at least 70% as good as you. So you've learned a little from me, and I've certainly learned a lot from you along the way. So, I try to implement the 70% rule with clients and talk about that. And then, you know, down the road, once they start to really see that this is attainable, you know, we'll down the road talk about setting up legal structures, accounting structures, how they want their books to be, whether it's a cash basis or accrual basis. But really, it's getting a good foundation of my target acquisition profile, my access to capital, the human capital, our team that we have, and really skilled docs that, along the way, I'm going to want them to be part of my journey and potentially offer them a piece of the organization that rewards them for the incremental growth or additional growth that we've experienced prior to them coming on. And then from there, you ask the question to Perrin about the similarities between consulting and owning a group practice. We have also changed a little bit over the three years and brought in different verticals, because what we found was the needs of clients went beyond what we traditionally offered in consulting. So, you know, fractional SEO, for example, is a new vertical. And anyone that's heard our podcast on Group Practice Accelerator, Perrin summed it up perfectly. Consulting is done with you like we did, Noel, right? You and your team, we advise, you execute. Some, I would say most group practices, the owners are still in the chair that don't have the time to devote to the execution part. They want to do it. All their intentions are great, but time is finite and the team may lack the ability to execute. So you're going down levels, right? You're going from Adin, Perrin, or whoever, down to the owner, down to the team, a lot of information is distilled through there. So, what we introduce in our fractional COO vertical is a done-for-you model. It's far more integrated. The team I've been deputized to be the conduit from the team to the ownership, and we are really deep into the operations, revenue cycle, retention, turnover, doctor production, ADA codes, payer mix, AR; we run the whole gamut, and what we look for are areas to optimize the practice or the group, but also, at the same time, we're assessing the leadership team and the management team and developing them to a level that they can continue to scale and grow. And either they accept the challenge and can do that so they can continue to integrate new offices, whether it be de novo or acquisition, or unfortunately, if they've kind of hit the limit of their capabilities, then how do we identify the type of leadership team members that you might need to bring in from the outside to help you grow? So, you know, obviously kind of painting with a really broad brush there. But what we've tried to do is be able to offer our services for every, kind of, every step along the journey that a group practice has. We want to be part of that solution and not turf it to somebody else. So, we have a complete data and analytics team. We have transaction executives, growth capital solution team members, myself that does consulting and fractional COO, as well as associate equity ownership, whether buy-in or earn. So, there's not really anything that Polaris cannot help or guide throughout the life cycle of that relationship.

Dr. Noel Liu:
Absolutely. I can attest to that, Adin. No doubt.

Adin Bradley:
That's awesome. And I'll tell you, you know, from a couple of things that I said, you and you shared your journey about the tough times. And I was fortunate enough to see you when you had kind of come through most of that, right? You were sort of on kind of the execution part. And what I was really, you know, enamored by was the emphasis that you put on the team, the human capital, the branding, and the autonomy given to your team with a clear vision and set of core values like this is who Secure Dental is and this is who Secure Dental is not. And you guys have continued to grow and capitalize on that. And I'm a big follower of Secure Dental, as you can tell, and also the things that you have done to give back to the community. You know, we just experienced a Veterans Day about a week ago, and I saw that Secure had done a lot of work in providing implants and dental work for, you know, our bravest men and women out there. And I think it's wonderful to see that you've gotten to a place that the business is strong and healthy, and now your purpose is become more noble and giving back while still growing the business and having your team involved in that. So you are my poster child, if you will, for groups that really have embraced the process, executed on it, and then, on their own, continue to take it to a next level.

Dr. Noel Liu:
Oh, thank you very much, Adin. You know, I feel like it's a blessing. It's a blessing because when, once, when we can provide this opportunity to our veterans, it just comes back like tenfold for us. It's always been like planting the seed and not worrying about the cost at that time, because most of these procedures that we are doing, I mean, it's just me and Dr. Jafri, we initiated this ourselves, and then all our associates, they followed and everybody worked without pay that day except for our team members, of course, except for our like DAs and front desk, we made sure they were compensated, but all our doctors work without production, so that saves a lot. So, we are really grateful and very glad to have this opportunity with NYU. So, back to you, Perrin. You wanted to add something along those lines about mistakes and pitfalls, right? And what are some of those things that one should look out for or do right away if they want to expand from 1 to 2 locations?

Perrin DesPortes:
Yeah, I think, obviously, when you're building a growing business, you can make 101 different mistakes, and they all kind of vary according to size and magnitude or jeopardy. Maybe not all those mistakes are going to sink the boat, but there are a couple of things that we have seen through the last decade of working with so many emerging group practices that get people into trouble all but immediately, and it's tough to dig your way out of. So one of the first things I would say is most people who take on the risk to build a group practice are acquiring practices. Occasionally we work with clients that are a de novo model. But I don't know, Adin, probably like 95% of them are acquiring practices as their primary growth strategy, right? And so the first things first, they look at buying a practice. They feel some pressure from it because they feel like if they don't buy this practice, I'll never find another one to buy, right? Which we all know. It's like buying a home. You just need to be patient. But there's not just one home for everybody. There are plenty of practices out there, and there will be plenty to acquire. So when they look at buying a practice, they tend to focus on the top line sale price, the valuation number, it's too high. I can't pay that much for it, or this is a screaming deal, or whatever it is. In a solo practice acquisition, it's really less about what you pay for the practice versus what you intend to do with it. And I'm always alarmed that, you know, when people buy a practice, and I say, okay, you bought it for $1 million, you bought it for $500,000. Whatever it is. What did you expect the revenue line to be a year down the road? What did you expect the revenue line to be a year down the road? Meaning, did you investigate how many new patients they're getting each month? Did you investigate how much they're spending in terms of marketing and advertising? Did you intend to drop another associate in there and expand days, hours, or even the clinical procedures? They're sending out all of the implants to the local periodontist, and you have the ability to recapture that, but you never buy a business to maintain it. You always buy a business to improve it. So the first thing we think is, okay, you're going to buy it today. The revenue is whatever the revenue is; what are you going to do to it to increase the revenue by whatever percent 12 months from now? What is it, quantifiably? And along the same lines, you had a good look at the expense structure of the business during due diligence. What are 2 or 3 areas of the expense structure that you think you can take a point or two out of the expense structure along the way? Is it lab and supplies? Is it professional services? Do they have too many people on the payroll? God forbid. But like they're bound to be ways to improve the cost structure of a business. There should be a lot of ways to improve the revenue trajectory of the business, but that has to happen based on your insistence. And you have to have insight into it and you have to hold yourself accountable. 12 months down the road to say we either did it or we didn't. And if we didn't, what did we get wrong? So the first thing is, how are we going to improve the business? Quantifiably the second thing is when we buy the business and we are going to pay whatever it is, is the selling price. Again, all of our clients are using bank funds to grow. So you look at the revenue line of the business we're buying, you look at the marginal profitability and we think that's it. Well, that's never it because now we got to pay the bank back some amount of money every year. And after we create operational cash flow and then we pay the bank what it costs us to finance the acquisition, what's left for us? Is it free cash flow positive? If it's an owner-driven business that you're buying and the owner's exiting, and you're not going to work in it for free, you're going to pay an associate to work in it for free. Did you even normalize the clinical compensation at the point of acquisition? And if the answer to that is no, I can all but guarantee you this thing's going to be in the red. So now, our great practice that we started with, that we built from the ground up, is now funding directly the underperforming practice that we just bought because we didn't accurately assess free cash flow and debt service, and we've gotten no improvement in the business whatsoever. The third thing that gets everybody into trouble, that makes all of this so much worse, is that most of the people who buy practices are working basically full time in their core business, their first practice full time, usually being four days a week clinically, right?

Dr. Noel Liu:
Well.

Adin Bradley:
Right.

Perrin DesPortes:
One of the things they want to do is start dropping clinical days of responsibility in their core business so that they can focus on finding other practices to buy. We call this business development. Well, when you do that, the clinical needs don't go away from the patient base. You have to pay an associate to do the work that you're no longer doing. Well, where does that come from? It comes out of the owner's back pocket, right? So now we're making less income out of our core practice while we have a nice lifestyle on the home front. And when we have less income, we all of a sudden find ourselves in conflict with our family. And we have an underperforming practice that we just bought this sucking the cash flow out of our core business. How does this all sound to you, Noel? You know, I mean, it sounds like a great project, right? I mean, everybody would want to do that. Well, of course, nobody would want to do that, but everybody does because they don't quantify how any of these changes are going to impact them from a cash flow standpoint. We probably do this example that I just kind of walked and talked through. We probably do this with more than 80% of our consulting clients. Through some of the financial modeling that Adin referenced, for the very reason that I alluded to, when somebody comes to us and says, I think I need to work with you guys because somebody's got to tell me how it is that I'm making less money today when I own four practices versus what I made when I only owned one. How is that possible? And I can do it on a whiteboard in about 30 seconds, but it looks a lot better if we use Excel and do all the modeling and make it look like it was really hard to come to the conclusion, but it's not. It's really straightforward, and it's usually exactly what I just said.

Dr. Noel Liu:
You know, and that's spot on, man. I mean, that is one of those reasons how we got in trouble in the first place. It's like we are always trying to grow and thinking the cash flow is going to increase, the valuation is going to increase. But little do we understand, like how the whole business would work as a whole versus 1 or 2 locations. And I feel like, you know, we are probably hitting another breakpoint in our own businesses. It's like, where are we comfortable with our ten locations? Now, if you go to the next level, which is 15 to 20, that's a different animal altogether again, right? It's like the same cycle would repeat again and again. So I'm seeing two folds here, right? So, if owner is going to acquire a practice, there are two things that I'm seeing here, from what I heard from you and Adin. The selling doctor needs to understand that there is some meat left in the bone. They're leaving some meat left on the bone before they sell. And the buying doctor needs to realize that potential that there is still meat left on the bone. So what I'm thinking is the first selling doctor is a super GP doing everything and firing on all cylinders and making $2.5, $3 million a year, and they sell it at a valuation of two and a half, or maybe $2.1 million or whatever, right? The selling doctor, if they are not as good as a super GP, you know, it's like two opposite ends of the spectrum. Now, they're just going to buy their practice, and they're not going to be making it. So I can see like what you're seeing is like, it's got to have the balance and almost to a point where the selling doctor needs to be underperforming, that the guy overtaking the practice, right?

Perrin DesPortes:
In an ideal world, sure. Yeah, I completely agree with that.

Dr. Noel Liu:
And that's a great, great point right there, Perrin.

Adin Bradley:
Yeah, I was going to say that's sort of the secret sauce there. And what we talk about is being really disciplined with what we call a target acquisition profile, which really it really keeps you disciplined in exactly what you're looking for. And from a high level, the geographic location, so you're close enough to your practices without cannibalizing them. You know, is there quote unquote meat on the bone Perrin mentioned about, you know, your new patient flow, is there enough patients? What you don't want to do is buy a practice from a doctor that may be ready to sunset it, and the patients are actually aging out with them, right? So, at some point now, you're without patients. You know, a minimum of, you know, what we would like to think is a minimum of six operators because, you know, your fixed cost expense is so high, your overhead just to turn the lights on it. The only way to kind of build some profitability in there is to have the ability for more production. And then, you know, lastly, one of the things that I find often is owners think that more practices equal more money just because we're generating a lot of dollars. And Perrin was referencing this. And what I find is we can tell right away. And here's an easy whiteboard litmus test, if you will, like if you've bought more practice practices and you're either less or just the same profit-wise and dollars, you have not scaled, you're not a group practice. You are a common owned five-practice outfit. Every practice is running differently from each other. They're not scaled. You don't have any centralized services. Your processes are probably all over the place, meaning, you know, in particular a call center, revenue cycle, areas of efficiency that you would get as you scale any kind of practice. And if you're buying that practice too, is in the beginning, is our associates going to stay with you through the transaction? Do you have a team that is, you know, sort of a fast team? It was an acronym where they can integrate that practice into your group immediately, meaning, you know, setting the stage for what the culture is like, the benefits, the payer mix, getting on your reimbursement fee schedule. How does this look? Like Perrin said, 12 months out, it is more predictable than one might imagine when you stay committed to looking at the levers that you have to look at. And, you know, we said, you may look at 30 or 40 practices and whittle it down to just 2 or 3 and really be disciplined to just walk away from those that don't check all or nearly all of the checkboxes that you are going into. And at what point does it make sense to start centralizing services, not just to reduce overhead, but really to have continuity of care and continuity of operational expertise as it comes to marketing revenue cycle, risk, and compliance, HR? Where, when they're handled from one particular department, you, not only do you have redundancy there, but you have subject matter expertise that is being spread around the entire operation instead of 1 or 2 really good practices dragging along three underperforming practices, and we see that a lot. So, you know, in our modeling, we look at a consolidated basis. We take all the practices together. And we we have an adjusted EBITDA number. But where the real dissection comes from is looking at each individual practice. And, you know, just for kind of a layman's example, you might say, well, I'm doing a million and a half worth of EBITDA. I'm growing. You have a 1.25 of that comes from one practice. You know, 250 comes from another, and the others are kind of at equal or best. And it's almost at the point you'd be more profitable if you literally just cut off three practices from your group. You'd be further ahead in a far less stressed. We're not advocating that for those types of groups. That's where we come in and help and say, let's get those profitable. Let's find out why those are dragging the group down and why they're not as optimized. What are you doing so well in practice, one that you're not doing in three, four, and five? Once you learn to master that and really understand all the levers that need to be pulled. Now, as you talk being ten practices, I am fully confident that you could buy a practice equally as big as Secure. Envelop them into your own, and I don't think you'd miss a beat. I think your team internally; I've got some tribal knowledge of your team and how you and Dr. Jafri work. I have no doubt that you would be able to do that, I think. And Perrin maybe can attest, I would say, probably less than 5% or 10% of owners in that number might even be generous. Could literally take on a group the size that they are now and actually scale them to be even better. I think most would crumble under the pressure of all of those.

Dr. Noel Liu:
It all comes down to people and culture. That's where it lies with acquisitions. So yeah, I mean, it's a challenge, and it's always going to be a challenge regardless of what we do or how we do it. So that was one of my biggest challenges when we were growing to it's like we wanted to acquire more practices, but not knowing the after effect what it would do to us. So the big question then becomes is, with you guys dealing with so many different providers, the question is why? Why would you want to scale and grow? Why would you want to take all that headache and take that risk?

Perrin DesPortes:
Yeah. I mean, I'll take the first stab at that. And I think it's a good question, and it's one that the answers changed as we head into 2025 versus what it was, you know, pre-pandemic. And I feel like, historically, if we go back pre-pandemic, the people building group practices were innovators and early adopters and marketing parlance, right? They were the tip of the bell curve. And they they had a vision, they saw something and were aggressive in pursuing it. Most of them had an exit strategy. They were building a business to sell. And then, we started transitioning into the early mainstream of the bell curve. Pandemic hits, you know, and there was an acceleration of global M&A coming out of the pandemic like the world's never seen before. And there were a lot of enterprise level groups that bought practices or small groups for a heightened valuation because the cost of funds to borrow was negligible at best. And then, all of a sudden, we had this run-up in lending rates. That created a problem at the top end of the market as it relates to M&A, created cash flow problems, and a lot of those businesses and a lot of them were not able to recap. So, they were not able to fulfill the promise that they put forth to their practices, the practice owners that they had acquired. And now you have this segment of the marketplace that is seeing that from afar. And they're saying, wow, you know, I had a bunch of friends that transacted their businesses, and maybe it didn't work out that well. You know, maybe it was unfulfilled promises and a lot of frustrations. This wasn't the road to easy money the way we were all guaranteed that it would be. And so I think the why question for many people who are building businesses is much more front and center around what somebody's motivations are. And I'm not going to get on a soapbox here, but I actually think this is the best thing for the profession that it has been in the better part of the decade that I've been working in it. And I think there are a lot of people that are maybe in the first half of their career that are simply building a small, manageable, methodical group practice because they see the profession of dentistry as being very physically demanding. You know, from a musculoskeletal standpoint, from a vision standpoint, I mean, dentistry is a very physical healthcare profession, and I don't think people really give it its due unless you are a clinical dentist and you've walked that path or you've seen it kind of like Adin and I have. But now there are people that are saying, hey, I don't know if I'm going to be able to physically last 40 years of doing this, and if I have a really good practice, that cash flows wonderfully. What if something happens to me? You know what happens to my family at that point? So maybe I'm going to add another location every couple of years. I'm going to bring a few of the associates into the ownership ranks at a minority partner level. I'm going to grow methodically. I'm going to pay down debt service along the way. So I'm not, like, hitched to the bank forever. And you know what? Maybe I don't want to sell it. So maybe my why is now more of a cash flow-driven business than it is a wealth-driven equation around a transaction. If I decide to sell it way down the road, maybe it's an internal sale to my associates who are minority partners, or maybe it's an enterprise buyer. I'll figure that out in 20 years, but in the short run, next decade or so, maybe I just want to build a multi-location group whose success is not dependent upon my clinical skills. And I think that kind of a why is really, really great because it's an independent ownership, it's a doctor-driven mindset, and you can make a really healthy case that it's also with the best interest of the patients as it relates to clinical care, too. So I think that the why question I've seen from my vantage point, if you will shift. I don't want to say 180 degrees, but there's been a lot of changes in it over the last handful of years coming out of the pandemic.

Dr. Noel Liu:
Oh, excellent. Excellent answer. So, for people like with this kind of why would you argue that they should still have an exit in mind in order to be successful?

Perrin DesPortes:
Yes, but I don't think you should have any urgency in mind. So Adin and I talk with people all the time and say, hey, look, if you build a successful group practice, whether it's for locations or 14 or 40, whatever the number is, and it is, to use Adin's term, optimized, it's operating efficiently. It yields tremendous cash flows. Systems and processes are dialed in. You've arguably got a handful of minority partners in the ownership structure. So everybody has a little bit of a leadership hat on. You know we're all rowing in the same direction if that business is truly optimized. I got news for you. It's going to value really, really highly. And there's always going to be a buyer for it. But I think the difference is that maybe pre-pandemic or coming right out of the pandemic, people just felt like, hey, I got ten locations. It's going to value at ten times EBITDA. No problem, man. Well, that's not the world we live in anymore. If you build a ten-location group, that's a mess. There's not going to be a buyer for that. So whatever it is you want to build and however fast, just optimize it, yeah.

Dr. Noel Liu:
Optimize, yeah.

Adin Bradley:
But buyers, what we have found are becoming a lot more savvy in their own due diligence. They're looking for groups with continued same-store growth sales. They're looking deeper under the hood of all the practices within that group. And at Polaris, because we're advisors, we know what those groups are looking for, and we work towards that goal. The days of just aggregating EBITDA and buying all these practices and sweeping them up and selling, they're no longer there. I mean, the cost of capital is higher. The supply and demand has shifted a little bit more to a buyer's market. So if you have created a really good group practice, and I don't want to overuse the word, completely optimized it where, you know, a middle market or any other kind of private equity strategic partner can envelop them into their group. They're going to pay for your group at a square price, because you're bringing to them a level of predictability that they're willing to pay for. But if you're just buying up practices to say, I got more production, and I have a little bit more EBITDA, these groups are looking really deep under the hood. And what's going to happen is not only are you not going to get the multiple you thought you were, they know how to pull the levers to buy that practice and optimize it post-sale. So basically, they're going to take all the value that you left on the table, and they're going to achieve it themselves. So you know, we have done a couple consulting to sell-side engagements where we find those holes and fix them prior to sale so that the exiting owner or the owner that's going to partner with a strategic group is getting full value for their work, instead of leaving some on the table and then letting them add their secret sauce to it. So you're 100% right. I mean, those days are, if you're building a group right now to exit, that's your plan. You need to be extremely disciplined and ensure that your way of doing dentistry and operations is scalable across the entire platform. And you don't have many weak spots because they'll be found, and they're going to devalue a portion of your business.

Dr. Noel Liu:
And that's why they need guys like you.

Perrin DesPortes:
Thank you.

Dr. Noel Liu:
Right. Chicken or the egg question, people or processes?

Perrin DesPortes:
They're equally important.

Dr. Noel Liu:
If you were to pick one, Adin, which one would it come first?

Adin Bradley:
I'm going to say the people because you can teach them the process part, and they'll already have the cultural and empathetic standpoint that we need. We can teach them the systems. You can have the greatest systems in the world, but if you don't have the right complement of team members and the human capital that come with that, those processes are, they're never going to be achieved optimally. And you may be second-guessing whether or not the process works because of those trying to execute on it. So you weren't supposed to ask me that question, though, because I need a little time to think about it, but my gut reaction is I always go with people first. I think when you build an organization with your people at the forefront, it transcends into the work, the processes, the clinical care, into your patients. And I call it the, you know, really the concept of making money in spite of yourself. You've created something special with the right people, and your patients will feel and know that and come back.

Dr. Noel Liu:
You nailed it. And, you know, you just said that, I think. Yeah. We're done.

Adin Bradley:
All right.

Dr. Noel Liu:
No, I'm just kidding. One other question I get asked. A lot of times, it's people asking me, acquisition or de novo?

Perrin DesPortes:
I'll take a cut at that one really quick. So, as I've prefaced. What's that?

Dr. Noel Liu:
And why.

Perrin DesPortes:
Yeah. So I think everybody, most everybody, wants to acquire practices because they feel like there's an abundance of them. And they also feel like, well, what's the downside risk? It's an existing business. It has existing patients. It's got existing cash flows. Like how much can I really screw this thing up before it goes belly up, right? And I get the mindset. That being said, the margins are a lot thinner in dental practices after you normalize clinical compensation and after you start factoring in debt service, like we mentioned before. So we typically advocate that if somebody is going to buy a business, they do something called pressure testing it and pressure testing. It simply means how much of a revenue downturn would this practice have to have before it went cash flow negative. And what you'll find if you run that exercise is you've got a less a lot less margin for error than you think you do. So the other thing that people don't think about in an acquisition is that, Dr. Liu, we understand that you're the new owner of the business, but that's not the way he or she did it for the 40 years that I've worked in the business. People don't like change, long-tenured employees especially. And nothing erodes value faster than a culture mishmash born out of change management. When you really learn that lesson the hard way, a couple of times, you'll understand why we love the de novo model so much. Yeah, de novos are harder, they cost some amount of investment up front. It's scary to have to attract patient number one. But it's your systems, your processes, and if you understand the variables that you're solving for a revenue number at the end of the year, an EBITDA or a net income, or a free cash flow number at the end of the year, the average value of a first-year patient in your practice in the first year, your conversion rate and your cost to acquire a patient. If you can connect all five of those dots, a de novo becomes very formulaic, and a lot of it is driven by the marketing campaign to solve for the net result at the end of 12 months. We love de novos because it's your systems, your processes, usually, your people that are driving that business. It is altogether, for the most part, at least very formulaic, and you don't have any of the culture change management problems that you inherit with other businesses. My partner, Diwakar Sinha, I said was a PE of sales for East West Bank. Their largest client at the time was Pacific Dental Services. A pretty good business, I think we'll all agree. Historically they had been, up to that point a de novo type of a model, and he got to see this thing work out at scale. And how the people at Pacific built that from a de novo perspective and used bank funds to do it. So once you see something like that, it's a complete game changer, and we really love the de novo model for all of the right reasons, I'll say.

Dr. Noel Liu:
Love it, and that's my model, the way to go. And we've seen successes, so I completely concur with you. Well, with that being said, I mean, any last minute thoughts you would like to add before we land the plane?

Perrin DesPortes:
I'll take one last pass at it. And, you know, we're recording this a little bit before Thanksgiving. And, you know, as we look into 2025. I think we have some great years ahead of us in the world of healthcare services and dentistry specifically. I think that we're starting to enter reenter a new normalcy phase that looks a lot like pre-pandemic levels as it relates to lending rates, inflation rates, employment rates, you know, heck, you can even make a case that the guy in the White House is the same. But, you know, like there's a lot of things that look really similar. And political perspectives notwithstanding, I think that the coming years are going to be really, really good and really healthy for the profession. I think we'll be back to a normal level of M&A activity and valuations. I think that more things being kind of back to normal levels means we all know how the game's played, and when there's predictability, it's usually very good for business, 100%.

Dr. Noel Liu:
I mean, I think you're spot on. It's going to happen. I have a good feeling about it as well. Well, with that being said, thank you very, very much, gentlemen. It was a pleasure of, way too much. I think we need to have another episode. What do you guys think?

Perrin DesPortes:
Let's do it. You put out the call, Noel. We'll be on with you anytime you want. We've enjoyed it very much. Thank you.

Dr. Noel Liu:
Because I really want to touch a little bit based on a little bit about associate equity model and kind of like, how do you guys get that arranged. So I'm definitely going to keep an eye out for some dates, and we'll try to shoot this again.

Perrin DesPortes:
Looking forward to it. Thanks for having us.

Adin Bradley:
Thanks for having us.

Perrin DesPortes:
Happy Thanksgiving to you and your team.

Adin Bradley:
Happy Thanksgiving.

Dr. Noel Liu:
Take care. Thank you very much.

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 Perrin DesPortes:

Perrin DesPortes is one of the Co-Founders of Polaris Healthcare Partners. He is a Washington & Lee University graduate and earned his MBA from the Darla Moore School of Business at the University of South Carolina. Perrin has over 25 years of experience in the business side of dentistry, having run three different business units for Patterson Dental Supply over a 15-year career. Perrin is happily married with a 10-year-old daughter at home. In his spare time, he is an avid cyclist; enjoys cooking and reading; and loves good red wine and strong coffee.

About Adin Bradley:

Adin Bradley is an Executive Consultant & Fractional COO at Polaris Healthcare Partners. He is responsible for leading clients through creation and execution of robust, multi-year strategic plans. Adin also supports clients through associate equity, health practice marketing counsel, buy and sell side advisory, clinician development, growth strategies, including location growth and vertical expansion, business and legal structure development. He takes pride in seeing clients succeed as well as developing other Polaris team members and brings to the role extensive operational experience from positions held at Fastmed Urgent Care, American Dental Partners, and Rural/Metro Corporation. He has a bachelor’s from Niagara College in Ontario and an MBA from State University of New York at Buffalo. He is a rabid Bills fan, sports fanatic and golfer. He enjoys spending time with his wife and two kids and hosting family and friends.

Things You’ll Learn:

  • Dentists should define whether their focus is on scaling, lifestyle optimization, or exit planning and allocate resources accordingly.
  • Post-acquisition, it’s essential to improve profitability, integrate operations, and align culture to ensure sustained success.
  • Recruiting and developing culturally aligned, skilled teams is critical for driving operational efficiency and patient loyalty.
  • Centralized operations, standardized processes, and financial “pressure testing” are vital to navigating thinner margins and ensuring resilience.
  • Optimizing cash flow and efficiency maintains long-term value, as buyers now prioritize well-run, growth-ready practices over-inflated valuations.
  • A strong, adaptable team is the foundation for clinical excellence, operational success, and long-term scalability.
  • The dental industry is poised for stable growth and opportunities in M&A, with a shift toward predictable, sustainable business models post-pandemic.

Resources:

Categories
Podcast

The Crew Behind The Screw

Summary:

Embracing setbacks can lead to unexpected opportunities, as demonstrated by Patrick Dewey’s career journey in the dental implant industry.

In this episode, Patrick Dewey, President & General Manager of S.I.N. Dental USA, discusses his entry into the dental field and his experiences with Nobel Biocare, Neodent, and Straumann. Patrick details the importance of customer service and support, especially in the context of full-mouth rehabilitation, and explains the advantages of photogrammetry and CT alignment in digital dentistry workflows. He also highlights the company’s focus on innovation and collaboration with clinicians, emphasizing the development of new products. Finally, Patrick shares his insights into market trends, the importance of reinvesting cost savings into growth strategies, and the future of digital dentistry. 

Tune in and learn how adapting to change, listening to customers, and focusing on innovation can drive success in the dental industry!

 

Secure Dental-Patrick Dewey: Audio automatically transcribed by Sonix

Secure Dental-Patrick Dewey: 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, everybody. Welcome to another episode of our Secure Dental podcast, where we bring in many different talents from both inside and outside our industry, which is our dental industry. Today we have a very special guest, Patrick Dewey, the CEO and co-founder of SIN 360. Patrick has been in the dental field for the longest time, as far as I can remember. He has helped launch multiple dental companies as well as dental-related dental implants. So without taking away the thunder from Patrick, I'm going to let him explain what he has been involved in the past with Nobel Biocare, with Neodent, and with Straumann. So without further ado, I'm going to start right off and dive right into and pass the mic off to Patrick. Hey Patrick, thanks for being here, and appreciate you coming along this part of mine. And let's kick it off, man.

Patrick Dewey:
Yeah. Thank you for having me. Where do you want me to begin?

Dr. Noel Liu:
Let's start with your intro. How did you start into dentistry?

Patrick Dewey:
Okay. 2005, one of my close friends actually was chasing a girl out to Northern California. We were both living in Arizona. And he kind of baited me out for, like, a guy's weekend. He's like, Hey, let's spend the weekend in San Francisco. We'll do a bunch of fun stuff. And he's a really good salesman still in the industry today. He kind of bait and switch me. I flew out there and he picked me up from the hotel. I'm ready to kind of go explore, have fun. And he's like, We got to make one stop. So we kind of hit an exit off, go to a hotel, and he's actually has a surgical training course the entire day at a hotel. So I sat in the back of the room. This was at Nobel Biocare. I sat in the back of the room with his manager and kind of hit it off with him. I was a little upset for having to work that day, but I hit it off with a guy named Mark Larimore, and from then I got in the industry. I was 22 years old. Northern California. Started off as a sales rep, kind of slinging titanium and sitting in on surgeries, primarily with oral surgeons, some general dentists. But how long have you been in the industry as far as dentistry goes?

Dr. Noel Liu:
Man, since '98.

Patrick Dewey:
Okay. If you could rewind back to say, 2004, 2005, 2006 up to say 2009, there was a big tug of war between specialty and general dentists on who should be placing implants. And that was a big contention back then. So I kind of got pushed into the oral surgery side. That's the side that I kind of chose just because I didn't know anything about implants. I didn't know anything about full-mouth rehabilitation. And these are the guys who win the big cases, in my neck of the woods, which is the Bay area. So that's kind of how I got into the industry. If you fast forward, I was with the Nobel Biocare until 2015, but I moved my way up into management, relocated to Arizona, built a team, one of the more successful teams in Nobel Biocare within full arch. I don't know if you remember this, but there is a branding of teeth in a day treatment concept or all-on-four concept. Yeah, so I remember talking with the executive management team thinking that they need to go direct to consumer with that back in 2012, 2013, just to keep up the growth. They didn't like it. They wanted to, actually, that was right when they were doing their sell to Danaher. So I came back, thought about it, put my two weeks in, in 2015, and started Neodent with Petra, David Tony, Chris Luder, and Chris Testa was there as well. So at that time, it's 2015. It's a lot of ex-Nobel Biocare employees. Here Straumman just acquired Neodent in Brazil primarily to, yeah, it's primarily to gain access to Brazil. It's such a unique market in Brazil.

Dr. Noel Liu:
You were right at the pinnacle at that time when Neodent was kind of like established in Brazil. But Straumann was starting to get in, right?

Patrick Dewey:
Yeah, I think it was 2011 when they acquired the first 51%, and then around 2014 when they bought 100%. It was basically, to be honest, they had launched it in the US under different management, but it wasn't launched properly in my opinion, and they didn't really have, there's pretty much no sales from an annual perspective. So we basically came in. Petra Rump, who's one of the best leaders in the industry, she just said, Here's a white canvas. You guys build it as you see fit. And we all agreed we would go to people like yourself and many other clinicians in the industry and kind of say, What do you want from an implant company? What do you need from an implant company? And take that feedback and bake it into the portfolio. So we know we're bringing something to the market. That was the concept and the theory at that time. That was around 2015.

Dr. Noel Liu:
How well did that work out with Straumann and Neodent?

Patrick Dewey:
It actually worked out really well in the beginning, in the beginning. And I'll say this because we were very much independent. We were under Petra Rump, who is again one of the best leaders. I don't think you'll find anybody who say anything bad about her, but she's on the board of Straumann group still to this day, very respected from clinicians all the way up to executives. But she's very much a non-micromanager. She's very much, you know, Make decisions. And if you make risk, make sure they're measured risk, and learn from them. That was her mentality. And from there, we basically tried to really build a brand around full-mouth rehabilitation, which we did. I also launched the, in 2017, we rolled out the in-office milling with Zircon Zan, partnered Straumann Group with Zircon Zan, but then things kind of changed. 2017, at the end, in 2018, that's when Straumann kind of put their hands on the business, so to speak, you know. Not to say anything wrong about Straumann. Straumann's a great company. So is Neodent. But they definitely made their mark. For sure.

Dr. Noel Liu:
So this was until 2021. Then you came up with your own brand.

Patrick Dewey:
Well, there's a little more context and I'm very transparent about it. But 2020, I was a vice president at the time of Neodent and Straumann Group. May 29th peak of Covid, they basically laid me off and fired me, so to speak. And I basically just really thought through things with my wife, like, what are we going to do? What should I do? And it was the first time in my whole career that I kind of had no obligation, which was kind of nice. And I just thought about what's the best thing to do. And it didn't last over, say, three days before I started getting emails, contacts from people. And I've known about SIN, but not very much. But they actually reached out to me and said, We know you brought another Brazilian implant company to the US very successfully, and we would like to see if you're interested in doing the same. So it took me about a year to really vet that to see if that's a good portfolio. What are the people like, you know? What's the culture like? And not only that, but an implant system is only an implant these days. It's not about the titanium. It's not about just the screw. Yes, you have to have a certain product just to be at the table. But you also have to have amazing service, amazing support. You have to have other products that like for yourself, right? You own multiple practices, you're proficient in full arch and you want your team to be educated further, as much as they can be on, say, remote Anchorage or new techniques to help treat your patients better. So we have to have a path to take practices through that journey. And it's not just about a piece of titanium. The screw, there's a doctor in California that says, he's coined this phrase, Dr. Ebrahimian. He says, It's not the screw, it's the crew behind the screw. And that's the important piece because as long as the company is there to help you through that journey, the money's going to come, the products they're going to buy from you. What matters is we can get you over those humps and hurdles, and we know what those latent needs are before you even know what those problems are going to be. And that's something where I look back when we started this June 1st, 2021. Almost, we're three years. Yeah, we're going on four here. I'm really grateful and thankful where we are today. But here we are. We have the number one photogrammetry system in the world, the only FDA-approved photogrammetry system in the world. We've got an amazing product portfolio from solutions that Gonzalez would say, One solution to rule them all. Because we can address pterygoid sites, we can address transnasal, palatal approach, zygomatic. We can approach every indication needed for full-mouth rehabilitation, but with a very deep knowledge on every aspect, from photogrammetry to CAM strategies to CAD strategies to education and so on and so forth. So you name it, anything that touches full-mouth rehabilitation, we train, sell, support, and we innovate, and we check those off and we take those four pillars very seriously at SIN 360.

Dr. Noel Liu:
I've kind of gotten a little bit gist of that, let's put it that way, when I was down in Texas.

Patrick Dewey:
Yeah. I'm curious. Give me your side. What have you seen?

Dr. Noel Liu:
You know, I was blown away because of the level of implant support that you guys had and the level of, like, let's say, the influence that you had, like with a number of clinicians nationwide and the support and the system. And I know, Juan, he loves your system for the zygotes and the terrorists. Right? So I'm like, okay, fine. I had Juan like back in my podcast. And he was like, really, really like on all the zygotes and everything. But at that time, I never dove into SIN 360. And when he actually started explaining all the pros and the cons and how you guys take like the inputs from him from Simon and go back to manufacturing and go like, Hey, this is what we want to incorporate, that just blew my mind away. Because honestly man, I have not seen this with any other implant system that would actually take the clinicians' input and go in and incorporate inside, you know, with the manufacturer. Is that something where you kind of got into it after, or was this always a culture with SIN?

Patrick Dewey:
Well, SIN 360 is different than just SIN Global. SIN is a, SIN implant system is a global brand. SIN 360 is paving the way for the global brand. They've been around for a while, 20-plus years, similar to Neodent, and quite frankly, I'll say this here. There's two implant systems that are both Brazilian, and they've been stealing each other's proprietary knowledge for the past 20 years. It's very evident. So the 16-degree Morris taper that you see on the GM helix, SIN had that in 2011, a 16-degree connection. That's a Morris taper as well. So but then if you look at SIN, there's things they've taken from Neodent that, I mean it's not verbalized, but if I look back at the history and you see when one company releases it, oh, and then they release it as well. So and that's gone back and forth pretty often. But back to your point about taking clinicians' input or industry feedback and bringing that back to R&D and executing that in our product portfolio, that is not an easy task. It is absolutely brutal, I would say, because, yeah, I mean, in 2014, I flew to Israel to try to launch my own implant brand. And Israel, I would say Korea, I would say Germany and Brazil are some of the dominant implant kind of innovators, not just in dental but in medical device and technology, but very much so in some sort of implantable device. And it's very difficult. I would say some of the easiest to work with is probably the Koreans, but the Brazilians are great to work with. They're just a different school of thought, a different philosophy. So we have to go back bringing the feedback to them, and we have to reiterate what that feedback is. And we're at a point now where the team in Brazil, you know, they understand. They understand what the shortfalls are, what it is, where the market is going. But if you look at the US things that you are training on, things that you and your team are training on and the direction that a lot of the full-arch customers in the US are going, it's not very common around the world. It really isn't. So the US is kind of kicking things off, and our goal is to dominate that top 1% of the US, which is the tip of the market. So that's where innovation's rapidly changing. And I'll go over some things that aren't even on the market yet that I can kind of showcase here.

Dr. Noel Liu:
I'd love to. We'd love to.

Patrick Dewey:
Yeah. So I'll go into that here.

Dr. Noel Liu:
But before you do that, I just wanted to point one thing out. You know, like how you said 2020 when you were laid off from Straumann. I just want to be like, you know, like, I just appreciate the fact that you were so candid about it because a lot of people, you know, like when they go through hard times, they never try to see for the other the opportunity that's going to open up for them, and you actually embraced it what it was. So I just wanted to like say, hey man, hats off down to you.

Patrick Dewey:
Thank you. Thanks for bringing that up because it's, like I was at the progressive Full Arch course, the big one with Mark Wahlberg over there. What is that? Last week. And I had a conversation with the doc at Affordable Care, Dr. Hasan. She came in from Sudan as an immigrant. Had to go through so many different trials and tribulations. But it's not about what happens to you or what setbacks you're faced with; it's what you do with that. And that's such a cliche saying, but if you actually take it as such, it does, everybody's going to deal with setbacks. But if you find that pearl and work through the hard times and stick to what you're going after, it becomes so valuable and so rewarding during the process. And to be frank, I mean, me being laid off by Neodent was the best thing that's ever happened. That is the.

Dr. Noel Liu:
At the time, it felt like crap, right? Like, .., what happening. Right? Yeah. No. I love it.

Patrick Dewey:
No no. I just, yeah, we just found out my wife was pregnant. We had so many plans on doing things, and then the future just kind of erases in front of you. And it's like, okay, I got to rebuild this, so.

Dr. Noel Liu:
I love it. Yeah. No, thanks for sharing that. That was really, really powerful, Patrick. I mean, like, this is something I truly believe in. All right.

Patrick Dewey:
That's cool. It's the truth. So. Yeah. All right. Onward. So SIN 360, we're focused on that top 1%. Right? And that 1%, it's not like we can peek around the corner or look at consensuses or see where the market's trending. We have to be in surgeries down on the ground level, have an R&D team like throwing things against the wall, trying to figure out what's going to stick next. So it's a constant kind of self-discovery, if you will. If you rewind back around 2021, that's when like photogrammetry just bulldozed the entire market wide open. Photogrammetry changed the game, changed the landscape, and it's still changing today. Although a lot of these systems out there, it's, how do I say this, the processes and workflows, there's a lot of like one-offs or there's offshoots of, Oh, you can approach it this way or you can approach it that way. I don't believe that. But I would say this. If you have a photogrammetry device such as like an eye cam 4D, a micron mapper, tuple is a photogrammetry device, but a lot of indications you have to take multiple scans and stitch them together. So personally, I don't think that's a fully-vetted solution. So I do like pick eye-cam, micro mapper; those are photogrammetry devices. I'm biased with micro mapper. I think there's you know, that's the only one we sell. But at the end of the day, I'm honest that they're all photogrammetry devices. So let's say, let's just stick in that category. If somebody's using a photogrammetry device opposed to like Nexus, OPTISPLINT, Shining Elite, these are not photogrammetry devices. These are scan bodies, and giving you a path to take an intraoral scan via an intraoral jig and transferring that information to a software. But it's not photogrammetry. So for the sake of photogrammetry, if you're on that path, the problems, challenges, and issues that you're dealing with are totally different than those dealing with, say, OPTISPLINT, Nexus, Shining Elite, or even analog workflows. So, and I say that because if you pair that photogrammetry path with remote anchorage products and solutions, quad zygo cases, very extreme remote anchorage stuff, and then you take on on top of that, you deal with milling, printing, hypodense, CAM strategies, changing geos and softwares; this is a lot to understand and deal with and this is the area we live. So we're trying to own that top 1%. We have to master this top 1% workflow with remote anchorage, photogrammetry, CAM strategies, and why the photogrammetry data is important to bring into the construction info when you go to mill out a zirconia framework. They're all interconnected. So I'm giving you this backstory and a little bit of color on this because this is who our target audience is, is that top 1%. If you look at who our customers are not, it's like the general dentist coming out of school looking to get into do their first implant, it's not like we're trying to boycott them. Our solutions just don't even apply to them yet. They don't understand some of the solutions we have and why they're so valuable. So that's why we try to stay hyper-focused on that top 1%. So hopefully that gives you some context. But that's kind of who SIN 360 is at the moment.

Dr. Noel Liu:
In all transparency, Patrick, you know, I'm one of those guys with the clients that I have been staying away from photogrammetry.

Patrick Dewey:
Okay. Yeah. I appreciate the open and honesty.

Dr. Noel Liu:
And for me, it's never, it was never about the accurate records. I mean, photogrammetry, hands down I would say, yes, it's the greatest to get that microns dialed in. But for me about multiple locations, multiple doctors, right, trying to carry that machine over. What would you say for a guy like me or for many others like out there, right, just a short sentence that, Hey, listen, everybody's like, Hey, photogrammetry's future is not looking too great. What about somebody like me? Like, I mean, I'm kind of on the fence, right? Like, I know photogrammetry works, but again, because of the cost factor, and, you know, the ROI wasn't adding up for me. What do you suggest for somebody like me?

Patrick Dewey:
No, no, no, this is great. And the number one thing, it's not just with me. But you'll find this with my team as well. At the end of the day, we're all in this together. We understand what those challenges are. One of those is cost. This is not a cheap machine. We've tried to do things like, for example, we've got a if you buy a micro mapper through SIN 360, it's 6.99 a month for 39 months. We pay all the interest. So we've tried to remove as much margin as we can for the company just so we can get more in the hands of our customers, but at the end of the day, it's still 25-27 grand, depending on how you go about it. So it's expensive, right? A guy like you that's got multiple practices, you've got nine practices. You know, you go do the numbers. He gets 25 grand per office. So I can see how that's a big investment. So what I would do is this. At the end of the day, if your nine practices are going to be focused on full-mouth rehabilitation, you're going to have some inefficiencies by doing analog anyway. So first it's key to understand what those inefficiencies are. For example, if you say you do one arch a month at an office, it's not worth, you're better off doing like an OPTISPLINT or some other option, because the investment and the workflow and all the things that are needed because it's not just a photogrammetry device, you also need a printer, you need to partner up with a digital designer, you need to have the right internal scan to do the pre-op scan, and then adapt that to the post-op vertical scan in Exocad. So there's a lot of steps to it. So it's one of those things you either dive in digital, go all in, or not. So I would say this. If somebody is doing three arches to five arches, that's when it starts to make sense per month for sure financially because you can eliminate titanium cylinders, you eliminate having to get a pre-made denture, you eliminate doing impressions, you eliminate any remakes. Plus, when you're in the digital world, you can carry that all the way through. If somebody's doing ten plus, you're absolutely leaving resources on the table from a cost standpoint, from your monthly expenses and the accuracy remakes, changes that need to be made, having to do that in the physical world, and then bring it to the digital world to mill it out. So I would say we can go into those details if you want, I can, I spell it out for you. But the easy math, if somebody is doing, say, 1 to 3, three, it starts to get interesting, but lower than three financially it doesn't make sense. And it's not the photogrammetry because you can get that for 6.99 a month, so if you look at your monthly expenses. But what it is, is just everything on top of it: the printer, the workflow, the acumen, training of the staff; those are the key things to this.

Dr. Noel Liu:
Cool. So, Patrick, what's your role right now? We met before like three years back. You were, like, hustling, like, you know, down to the ground.

Patrick Dewey:
Oh, yeah.

Dr. Noel Liu:
Now what's your role?

Patrick Dewey:
Yeah. So now president and founder of SIN 360. It's a mix. So the one thing that I definitely do is I want to stay close to the market because I'm definitely heavily involved on the R&D side. I'm close with Blake Roney who runs our digital team. Gus Khalil, I'm very close with. So myself, Gus Blake, Brian Geist, they're the head of our sales; those are like my core people that I rub shoulders with every day. And these individuals, we are just basically tackling problems. What's our next obstacle? What's our next goal? Where are we trying to develop the new product or workflow? So what I do every day is a lot of R&D. There's a lot of, you know, dealing with financials, reporting back to Brazil. We also were acquired by Henry Schein. So we're a Henry Schein company.

Dr. Noel Liu:
Oh, when did that happen?

Patrick Dewey:
June of last year.

Dr. Noel Liu:
Congrats. Wow. That's awesome.

Patrick Dewey:
June of last year, we were acquired the global brand. SIN was acquired by Henry Schein. So there's a lot of strategizing, planning. Not just in the US, in other countries, but I would just say for the sake of understanding the day-to-day, it's a lot of putting out problems, a lot of hiring, a lot of vetting of new strategies, new talents, a lot of management meetings. But it's not uncommon to find me in the warehouse helping the team, you know, just making sure everybody top to bottom in the organization has what they need, they're enjoying what they're doing, or at least having my ear if there's an issue going on. So I do attend a lot of events, but I'll kind of zoom in if that's cool with you on some of the most exciting things. So the R&D stuff is definitely something you'll find me kind of going into surgeries with, say, a new product in my hand or with a team of people with the new product. So for example, like today, the team just landed in Austin, Texas. There's a doctor, Dr. Adam Carter. They're testing out three new solutions tomorrow. So today they're prepping, but they're documenting it, they're testing it all at his office. So it's very common that.

Dr. Noel Liu:
You're heavily involved in this whole operation. Like day to day. Love it.

Patrick Dewey:
Yeah. It's not just, it's definitely not a money thing. This is something that I have a passion for.

Dr. Noel Liu:
It's a passion. Yeah.

Patrick Dewey:
Yeah. Our team loves what they do. There's nobody on the planet doing what we're doing that we know of. So we're the only company that's got this robust digital portfolio. And we have got the full implant side. So we got to stay ahead. So.

Dr. Noel Liu:
Where are based off right now?

Patrick Dewey:
Based in Scottsdale, Arizona.

Dr. Noel Liu:
Scottsdale, okay. And in Brazil, where are you guys?

Patrick Dewey:
Yeah. So in Brazil, we're headquartered out of Sao Paulo, Brazil. We just finished our new building in Brazil. So we've got, imagine three Costcos stacked on top of each other times three. There's three big Costco buildings. And then there's three of those. One of them has a bridge crossing a major street. That's all glass. So it just finished the renovation. So it's beautiful. We host a lot of courses there, a lot of events like this past weekend. We just had a suite at the F1 race in Sao Paulo, right at the edge of the Senna's trip, I guess they call it. Our CFO went. I didn't go this time, but I will be in the Vegas one. So we'll be there as well.

Dr. Noel Liu:
Nice. I love F1. Who's your favorite team?

Patrick Dewey:
You know, I'm not that into it. So I just love watching Max because that guy seems to wait for the finish no matter what.

Dr. Noel Liu:
You know, it's funny because you know, we as entrepreneurs and as hustlers, we love to see like sports where it's challenging, where these guys are going for it, you know, and it's just an internal spirit. Let me ask you about your Brazil. So you said courses. What kind of courses and who is it open for?

Patrick Dewey:
Yeah. So there's a couple different options. We have a very robust site on on the education front, but when it comes to Brazil specifically, there's two courses primarily that were part of right now. One is Dr. Vanderlin, professor Vanderlin. Okay, so how do I say this? Professor Vanderlin is a very unique individual. He's one of those guys where he does something by the book every single time. And he gets very frustrated if you force him to skip a step. He wants things done perfectly. Now it can be maybe uncommon, but it's the best quality you would want in a lecture and a professor. And he's got some amazing cases. So his claim to fame is the Vanderlin technique. You'll see him do the V. He's huge. He's one of the best, in my opinion, for the transnasal technique. So for very remote anchorage atrophic maxillary arches, he has the best technique when it comes to transnasal. He does do zygoma training and in pterygoid training, but that's what he's known for, is his transnasal course. Every year we put around, I would say 30 to 35 doctors through those courses. We run two a year with him, but those are very much open to the public. They're on our website, so those are totally open. We also have a lot of stuff going on with ORCAA in Guatemala. That's quite interesting as well. I think you were with some of that group and at that last course in Austin. And then we also have a hospital not too far from our headquarters in Sao Paulo, where they do full sedation. They have oral maxillofacial surgeons on staff. They've got dentists on staff and prosthodontists. So a lot of times we can create custom courses if we need to. Maybe we have a small DSO or a certain group that wants to learn a certain specific technique or strategy. We can customize those as well.

Dr. Noel Liu:
Oh, I love it. Okay.

Patrick Dewey:
Yeah. What are you seeing as more of the, let's say, interesting CE out there from a clinician's perspective?

Dr. Noel Liu:
Let's put it this way. You know, with our associate doctors, we host our Tijuana trip that we do internally, and we do that twice a year. For our docs, right? And basically, all my single implants and overdentures. Guys who are a little bit more advanced than that, we introduce a sinus lifts and we do full arches. So that is something we do internally. And that is something which Liz and I, we were speaking about last week.

Patrick Dewey:
I like it. Yeah.

Dr. Noel Liu:
So that is one thing. But you know, when it comes to, let's say remote anchorage or it comes to like transnasal, that is something I would love for, you know, some of our more, you know, proficient docs to be down there to attend. And maybe someday we can even plan something for our little group there, like a group of 9 or 10 doctors.

Patrick Dewey:
Yeah, we are open to it. We've done it in the past a few different times. We've got a whole team internally at SIN 360 that will handle all the logistics, because the logistics, when we do those customized courses, get very robust from private transportation to making sure everybody has their meals accommodated for, there's dietary restrictions. But we've done it before. We'll do it again. So it's just a matter of putting some legwork in. But we just finished actually a customized cadaver course with the AOCs Academy in Scottsdale over the weekend. We had 16 participants, and then we had a number of faculty that came in. Dr. Seth Gonzalez, Dr. Saeed at Ace Dental in Chicago. There's a number, of Dr. Drew Phillips came. It was a really good event.

Dr. Noel Liu:
I love it. So lastly, what's the future for SIN 360 and you?

Patrick Dewey:
So I'll kind of put some feelers out there. Those that are in the know on the full-arch digital side. There's a lot of talk on say, CT alignment, which is, so those that are doing digital will know about this. But the, when you do a case 100% modeless meaning in the digital workflow with photogrammetry, historically you'd have to put fiducial markers in the retromolar pads. You have to put some fiducial markers in the palate, which are bone fixation screws. Sometimes you'll have a little sleeve on them, or you'll just manufacture them in titanium. But you put some sort of a marker that stays in place throughout the entire surgery. So by the end, you can relate the post-op situation to the pre-op vertical. That way you've got the proper vertical throughout the whole process. So the key is to eliminate that on the maxillary arch is very simple. Put two in the midline of the palate, take a pre-op scan, stitch it to the pre-op or the post-op to the pre-op. Very easy. On the lower, it gets a challenging in those retromolar pad areas. Sometimes you'll have eggshell bone, sometimes they get you bump them and they move, and if they're bumped, then your bite's off, your midline's off. You got a big can't. So they can be a pain in the butt. So when you look at what's called CT alignment, you're basically doing the same thing with fiducial markers, but you're actually using a CT scan and natural anatomy. So you can use like the nasal spine, you can use the condyles, you can use any sort of natural anatomy in the CT scans. But you have to make sure the patient's in the proper pre-op vertical. And then post-op, if they're fully sedated, you generally need to have either an Xcat from, like, Jeffrey Toobin, or you need to have something like an Icat where you have a Velcro strap because the patients aren't fully awake. But then you'll just take the post-op scan, you'll segment it into two pieces. You'll stitch the maxillary arch to the pre-op and the mandible to the pre-op. And then from there, you'll edit and adapt your wax up and Exocad and then create your design, print it, place it in the patient's mouth and you go. So again everything would be digital. But that's kind of where, I look at 2025, I'm going to see a lot more of that happening. In addition to that, we're building a lot of products and solutions around the CT alignment workflow, because if it was a family member of mine, I would want them to have a CT alignment or some sort of modeless workflow without the fiducial markers because it's more predictable, it's easier, quicker, less traumatic, and you can get the bite every single time with no issues.

Dr. Noel Liu:
I think the downside would probably just be the CT, right? Like trying to get that.

Patrick Dewey:
Yeah, yeah, you're right. Yeah. You got to get the CT right. Yeah. A lot of times that's why you see those doing CT alignment that do not have the mobile CT scan.

Dr. Noel Liu:
Oh, yeah.

Patrick Dewey:
Yeah. Which are expensive, right? That's the drawback. Yeah, a quarter million bucks to get one of those. I know Jeff Toobin's working on getting one for around 120K or somewhere around there. So hopefully that happens. Makes it a little easier. But if you think about that, the only drawback, the weakest point in the workflow would be capturing a post-op intraoral scan. And after that, everything else is cookie-cutter. I mean, very predictable, no issues. But even with the trios five, which is arguably the best intraoral scanner out there for large spans of soft tissue, now we're releasing a tissue mapping function for the post-op scan, where you can use the micromapper to actually probe the tissue, and within seconds the AI will fill in the tissue. I can send you some video if you want to attach that to your show notes, just to show everybody. It's super exciting. So you still need the trios for the pre-op, capture the bite, but postoperatively you would do a photogrammetry, leave the scan bodies on, and just take this probe probe in approximately between each scan body and it'll prefill the gingiva. Yeah, and then you export a file directly into Exocad, adapt it to the wax up, and you're done. And you just 3D print it.

Dr. Noel Liu:
I am digital, Patrick. It's just that, you know, I was never sold on photogrammetry, man, you know. Yeah. I got the printers, I got the IOS, I got everything, I'm doing all the stuff. You know, I use scan bodies, you know, Jonathan's. people love him. People hate him. You know, so.

Patrick Dewey:
You know what? I think a while back, I listened to him. I think you did a podcast with him, right?

Dr. Noel Liu:
Yeah.

Patrick Dewey:
Jonathan is like, he's one of those personalities, that, right, yeah, people either love him or they hate him. But I think he loses a lot of viewers because maybe some people say they hate him and they're everybody else should hate him or whatever, but he actually brings up some good points. He's got some real big pearls that a lot of people, though, because of whatever the stigma is about his name, they automatically like write it off. And I say this because Dr. Abenaim, he's not a huge proponent of photogrammetry. He's not. But he still has some really good points. It's funny. Now, I remember because I actually listened to your podcast. I listened to that one. And Jonathan, I forget what it was, but he brought up some really good points. I think it was about soft tissue. I think that's what it was. He brought up some really good points about everybody's looking at surgeries and doing the remote anchorage or stuff along that nature, but the one thing that his myopic focus is, is that how much importance and stress he puts on closure, proper closure, making sure that tissue doesn't run away.

Dr. Noel Liu:
The basics. Yeah.

Patrick Dewey:
The basics. Yeah. And doing it extremely well. And how valuable that is for the life of the implant. So anyway, I respect everybody. Jonathan, I know he's a contentious figure out there, but I think he's got a lot of value to add as well. And hey, it's okay not to see. Like I don't see eye-to-eye with him on photogrammetry. I believe in photogrammetry. I've seen it. I mean, we have an office that does almost 200 arches a month, one single office. They've got eight micro mappers. So I mean, it's.

Dr. Noel Liu:
Something that, you know what, Patrick? I'm going to take you up on photogrammetry. I'll give it a shot.

Patrick Dewey:
Yeah, yeah.

Dr. Noel Liu:
I'll give it a shot, man. I'll give it a shot.

Patrick Dewey:
I'll make it easy for you just so you can see the light. But my point is, Dr. Abenaim's got some really good pearls. And I hope, I would challenge your listeners to. If they do think one way or the other, just to hear him out and listen to those things. Because there are some good pearls there.

Dr. Noel Liu:
100%. Hey, Patrick. Thanks so much, man.

Patrick Dewey:
It's been a pleasure. Thank you for having me on. I appreciate the time. Yeah, hopefully we can do this soon after you implement photogrammetry.

Dr. Noel Liu:
We will get back again, for sure.

Patrick Dewey:
Okay. Perfect.

Dr. Noel Liu:
I'm definitely going to take you up on that one. Awesome try. All right, Patrick. So yeah. Hey, we're going to land this plane now. Ladies and gentlemen, thanks for watching and hearing and listening. Patrick was a great, great resource and lots of nuggets today. So just make sure to like and subscribe, and we will see you on the 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 Patrick Dewey:

Patrick Dewey leads S.I.N. Dental USA, a full-service provider specializing in solutions and support for Full-Arch Digital Workflows across the United States. With 16 years of experience in implant dentistry, Patrick has held pivotal management and executive roles at industry leaders such as Nobel Biocare, Neodent, and Straumann Group.

A recognized expert in marketing and selling cutting-edge medical products, Patrick has consistently driven innovation in the dental implant sector. At Straumann Group, he disrupted the North American market with a groundbreaking product venture and partnership, setting new standards in the industry. His career is distinguished by successful large-scale product launches, the development of high-performing sales teams, and the implementation of transformative sales strategies tailored to dynamic markets.

His areas of expertise involve sales leadership, new product launches, strategic selling partnerships, salesforce strategy & development, team management, and market growth.

Patrick’s visionary leadership and deep industry expertise position him as a catalyst for growth and a trusted partner in advancing dental healthcare solutions.

Things You’ll Learn:

  •  
  • Cost savings from switching implant systems should be strategically reinvested for growth.
  • Photogrammetry, while initially expensive, offers significant long-term cost benefits and improved accuracy in full-arch cases. Clinicians performing three or more arches per month should consider adopting this technology. 
  • A successful implant company focuses on more than just the product; comprehensive service, support, and education are essential for long-term partnerships with clinicians. 
  • The future of implant dentistry is digital. Embracing technologies like CT alignment and tissue mapping can significantly improve predictability and efficiency in complex cases.
  • Don’t dismiss differing opinions; even controversial figures can offer valuable insights. Be open to learning from various perspectives, even if they challenge your current beliefs.

Resources:

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Podcast

A Blueprint for Patient-Centered Growth

Summary:

Patient-centered care, strategic growth, and community impact are redefining success in dental practice. 

In this episode of the Secure Dental Podcast, Dr. Jonathan Theis, the Full Arch Coach and President and Co-Founder of Smile Score Solutions, shares how he built and expanded successful, patient-centered Full Arch dental practices by using strategic business models, innovative patient financing solutions, and collaborative buying power for private practitioners. He developed the Full Arch Buying Group (FABG) to empower private practice dentists by giving them the purchasing power of larger corporations while preserving a patient-centered approach. Dr. Theis talked about his humanitarian initiative, Orcaa, and how it addresses severe dental care shortages in Guatemala by training local surgeons in advanced implant techniques, and improving access for underserved populations. Within the conversation, he also discusses upcoming projects, such as Smile Score Solutions, a credit-improvement platform for patients denied financing, and software solutions to streamline operations and enhance data retention in implant-focused practices.

Tune in to uncover the strategies driving modern dental practice success, from patient-focused care to innovative growth and community transformation! 

 

Secure Dental - Jonathan Theis: Audio automatically transcribed by Sonix

Secure Dental - Jonathan Theis: 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. Jonathan Theis:
All right. Hey, everybody, welcome.

Dr. Noel Liu:
To another episode of our Secure Dental podcast, where we bring in many different talents from inside and outside our industry. Today, I have a very special guest, Dr. Jonathan Theis. Now, before we dive into it, I just want to give a shout out to my sponsor, which is DentVia. It's a virtual dental administration assistant company that does all the back end office tasks to supercharge our front desk, So definitely visit them at DentVia.com. That's for DentVia.com. Now, without further ado, the introduction to this man. One thing that really caught my eye with this bio was he's an entrepreneur, a true dental entrepreneur. He has multiple expertise and experience in private practice as well as DSO space, and now he runs a group called Full Arch Buying Group. Dr. Jonathan, man, there's not enough things to say about you. Why don't you give your intro? Because you are probably the perfect person to tell us exactly what you're doing and how we got started here.

Dr. Jonathan Theis:
Sure, man, I was in, I graduated from Temple 2009, came out, I did private practice for about nine years, actually practicing clinically. Started my own practice in 2014. It was a, it was your startup. Like I bought a dump, it was cheap, and I turned it around. I worked really hard. I learned a ton about the business side of owning a practice, and I was able to turn that thing around in a couple of years and make it profitable and successful. And then, from there, I partnered with a lot of my best friends who were also dentists, and we created a group. And in 2018, I took over that group. I had the opportunity to take the reins and run it, and it was something I was always interested in. I've always had that entrepreneurial spirit from the business side of things, and I was able to take that group over, and we had on the back of the discovery of the Full Arch model and just learning a ton and putting into play stuff that successful groups that I learned about were doing. I didn't reinvent the wheel in any way. I basically looked at what are other successful groups doing, and I put those things into play in ours, but where it made sense and we turned that thing into being very successful. And from there we ended up getting purchased by private equity. And that was in 2020. And so then we were part of a large group, 85 offices. I was the VP of operations overseeing Pennsylvania as well as the regional clinical director over at Pennsylvania. So I had a couple hats on while I was there. And after about a year of integration where whenever they join all these offices together, they've got to get everybody using the same suppliers, using the same management systems. Everything has to be integrated. And so that took about a year to get the PMS, everyone on the same PMS, everyone doing the same thing. And then, from there, they turn their focus to our Full Arch business that we created a subdivision called Smart Arches Dental Implants with my business partner, Dr. Simon Oh. And so we co-founded this what we intended to be a national brand for Full Arch, and implant-focused offices, and I believe they're now at about nine offices. And so I had lots of experience from my the first one we did, we, it was like a failing office. And that was Dr. Oh's office, and we took it and turned it into an implant and Full Arch focused office. And within about two years, it went from about half a million to 5 million. And so it was just explosive growth. And we were like, wow, this is amazing. And so we started doing that at another office that was a de novo of ours that was like on the other side of Philadelphia. And that that was already doing about 800, some thousand. It was pretty successful de novo. We started adding in Full Arch, and that went to 3 million. So, pretty quickly. And so that was very successful. So from there, we started to, we added it to another office, and then we started to do De Novos where we were taking offices that either building up brand new offices or taking closed offices and just redoing them and opening them up, rebranding them and opening them as smart arches. And so I was involved in all of that. So I got to see it from every level and be involved in creating all that I created all the operations. I created the sales department and helped guide them. And then, as time went on, my vision for things didn't really align with where they were going. And I'm not a big fan when it comes down to it of DSOs. I believe they're a little bit more profit-driven and not as patient care-focused. And as a doctor, I was looking at a vision that was more patient care-focused, and I sold my shares. I separated from them, and I rekindled my entrepreneurial spirit, and that's when I decided to create the Full Arch Buying group to put the power back into the hands of the private practice doctors and help them get the same type of negotiating power that these large groups have. That's where all this idea born from.

Dr. Noel Liu:
No, I love it. I want to dive into a little bit about like, how you took that $500,000 office turning into a $5 million office. What were some of the challenges or some of the wins if somebody were to take, let's say, a private practice, and we have a lot of doctors looking into making Full Arch centers, including myself? So what would you give as an advice, like some of the pitfalls to watch for and some of the wins that you really need to go and hunt down?

Dr. Jonathan Theis:
Sure. So the way that it all started was this office was, I think, doing about, oh, I think it was like 430,000 or 450,000. We were losing a lot of money. I think it was 80,000 a quarter we were losing. And so at the time, what we were doing was we had 11 offices and we were looking at we only had we didn't have a lot of capital to invest. And because we were our company at the time, we were struggling and when I took it over and so we didn't have good credit to borrow, we didn't have a lot of free capital. I was, what I was doing was we were shrinking to grow. So I was looking to cut the loser offices so that we could take our profits and reinvest them in the offices that were doing well so that we could maximize what we had without overextending ourselves and having to pay for some of the offices that were losing money. So I and we had turned our attention to doctor office in Langhorne. At the time, he was a part-time doctor there, and it was losing a lot of money. And he was like, we were at a partners meeting and he had said, hey, before we close this down, I think that there's potential here. But if we turn our focus to Full Arch, I think that's where I see the potential in this. And he was a partner, and I respected his opinion, and we together decided, okay, let's give that a shot. And so we started to just do some light marketing and kind of we did some mailers and we started doing some Facebook marketing. And when you're a $450,000 office, and that means you're doing like 40, 50, 30, 40,000 a month in production, it's pretty low. And so you start, you get a couple cases a month, a couple arches at $20,000, $30,000, and all of a sudden, like, you've tripled your revenue. We're like, Holy cow. So within the first couple of months, we were like, this is amazing. We've tripled our revenue and some of the things we went through, all the difficulties figuring this out. We had to retrain the staff on the workflow. He was it was a tiny little office. So we had to really focus on our systems and where the patients were going to be at the office when and like we were bringing in third-party anesthesia. So figuring out like when we could schedule them. And one of the other difficulties that can happen at the time that we were lucky enough to have a connection to, was we had a really great lab tech who would come to our office and he would convert all the cases. Okay. And so that because we were analog.

Dr. Noel Liu:
The digital age, right?

Dr. Jonathan Theis:
Oh, yeah. This was, yeah. So we were, we first start off, you don't even know if it's going to work. You don't even know if it's going to be viable. So you're not going to invest in a full digital workflow on something you're not sure if you're even going to do. So we started off doing analog figuring out that way, which actually I think is, I think it's always good to know where you came from first, like the basics and how to do all that gives you a great understanding when you do go to digital of exactly where that technology comes from. It's like learning how to do a full hand map and then understanding, yeah, understanding why the calculator is so nice. But as we grew. So one of the things that I did that I think was unique was when we did our Facebook marketing, I actually did all of the messaging myself. Okay. And so we would have ads, and I would be I'm working, and I'm all over the place, but I always have my phone with me. And every time a message would come in on Facebook Messenger from one of our ads, I would answer it. And an advantage because you've got a doctor answering all the messages. And I was Johnny on the spot, which I think gave us an advantage to anyone out there that was in the area because these patients were clicking on the ad, and they were immediately getting responses, and they were getting responses from a doctor. And so because of that, I was able to drive these patients into the office. And then we started using, yeah, and then we started to use a marketing agency as well. And so as we started to grow, one of the big bottlenecks that we found was anesthesia. Dr. Oh, is actually a general practitioner, and but he's trained in oral surgery, and his belief was the best thing for the patient is to have proper airway during these procedures. And the only way to really do that is with general anesthesia. So we used a third party, and we would bring in anesthesiologists into the office, and they would bring, and the company that we used was actually really nice. They would bring everything. And the only thing we needed to supply was the oxygen. So that was really nice. And what we would do is we would charge the patient for the anesthesia. And because we were trying to be very competitive, we would just charge it as a break-even for us, we just because we wanted to keep the price down as low as possible. And I think one of the other things that we did, in the beginning, was just to get reps for Dr. Oh to get his name out there. I think we were probably not, we were probably not super profitable with the procedure in the beginning. We kept it very low. I think when we were doing it back in 2018, we were charging like 14,000 to 15,000 an arch. And with analog, what's even more expensive, yes, than it is with digital. And so the profits probably weren't great, but because we were so well priced, we were getting flooded with patients. And what we did was we started to utilize that through social media with testimonials, started building authority, and pretty soon patients were coming in not because of our ads, but because they just had heard about us. They started to see us organically through social media or word of mouth. And so as we started to get demand, then we could raise our price a little bit and we would slowly raise our price over time as we became the place to go in the area. Then, we could get ourselves aligned with a proper business model that was actually profitable. But we used that, that drawer in the beginning to really bring those patients in. And that really helped Dr. Oh get a ton of reps so that he was very proficient. You know what I mean? And then one of the other things that we noticed is in the beginning, we had to turn some patients away. They had severely atrophied backs. And we, Dr. Oh didn't have to do those cases yet. So he went down to Brazil. He was trained on zygotes. And then when he came back, and we started to do those, and then as he took more education and really started to become proficient with Zygomas. Now, every case was coming to, we could do, and not only that, but he was starting to get known as the zygote doc. And actually oral surgeons were sending their cases to Dr. Oh, but they didn't want to do that. Yeah, some of the most complicated cases. And so now we're not only getting word of mouth and getting from our marketing, but also getting referrals. And so, these are the things I talk about to docs that are Full Arch. Like it's very competitive, and so you need multiple ways, supplementary ways of getting your patients besides just your marketing. You can't expect to just dump market money in the marketing and and be able to reach your goals. So you want to look to have set up referral networks, right? So what we used to do was we would send our GP patients to doctors. When they would come in, they didn't need that much and say, hey, we're an implant-focused office. We're not looking to do like ... filling that is in a cleaning. So, those doctors in our network around the area, they would get new patients from us. And then, in exchange, when they saw a patient with dentures that was struggling or anything like that, they would send them to us. And so now we've created a referral network as well as a marketing network. And then you eventually, as you build your authority, you're getting that word of mouth more satisfied patients. And that's what really built us up over time from doing starting out at 2 or 3 arches, building up to ten to eventually get into 30, 40 arches above.

Dr. Noel Liu:
So tell me something. I know Dr. Oh is pretty quiet. How important is it when you guys are closing sales or closing patients? Like, is he the one who's, like, actually interacting with patients, or were you the one or did you have somebody else, like a treatment coordinator? Because I feel like the doctor really needs to have very well-oiled communication with their patients. What, do you have any insights on that part?

Dr. Jonathan Theis:
Sure. It's, it all matters, right? It's all about the process and how that patient feels from the moment they're contacted all the way through. But for instance, on the doctor's side, it's very, what we did was we built a lot of authority and familiarity. The patients would see them over and over again, whether it's providing education to them. Teaching them about implants. Teaching them about Full Arch via these videos that we would make and put out on social media and we would use as ads as well, just free education, but then also the patient testimonials and things like this. And so when the patients would come into the office, it was so funny. They would, you, it would be like, oh my God, it's you. Like I've seen your like it was like a celebrity type of thing. So we're already winning by the time the patient even sees the doc. And so now all he needs to do is go in. And one of the things that we did was we would take an extremely thorough medical history. And the reason we did that was one, because that's the best thing to do for a patient that's going to be going under major surgery, right? You have to have that. But two, when a patient goes to a normal dentist, it's pretty hard to fill out this form. There's not a lot of questions asked. And so that really they knew when they were being asked that all those questions by the doctors, oh man, this is different. This is something else here. And that really makes an impression on them. And then, of course, the doctor's ability to connect with the patient. And so not every doctor is the same in their charisma and their ability to connect, but that you can make up for that by your preparation of the doctor. We didn't let the doctor in there 20, 30 minutes talking to the patient. That's not productive. But at the same time, we've got to create that emotional connection to that patient so that they want to move forward. And so the best way to do that is to make sure that doctor is well prepared beforehand. What we would do is our sales consultant would do a discovery portion of the sales process ahead of time, collecting all that data. And then when about the patient, the personal things and especially like things like why they're in there in the first place as far as do they have a special event coming up, a wedding? Things like that that they're really like that's pushing them to this goal. And so then when you review the CBCT with the doc, and you go over everything about the patient that we've learned, he goes in there fully armed and able to shorten that time span. Now he's not asking all of these questions and doing discovery himself. He's going in and immediately knows the points of emotion to hit on, to really get that patient to connect to him. And so that's where he can be efficient with his time, but really still get that connection to that patient so that when they get done, they feel very good about the office that they've chosen and they're, and as long as finances are in line, they're able they want to move forward.

Dr. Noel Liu:
Man, you just dropped like several bombs over here. That's awesome. These are some golden nuggets which, I think, like anybody and everybody, should listen to and get a takeaway from this. So that's great, man. I love it, I love it. So, let's switch gears a little bit. Let's go to ... What's Orcaa and.

Dr. Jonathan Theis:
Yeah, man. So Orcaa was, we had an opportunity and I was I got in after it was discovered. So, the founders are Dr. Eldad Drori and Dr. Simon. They're the first ones that had connections down in Guatemala. People that he knew down there. And he brought Simon in because there was this huge humanitarian need down there. One of the crazy and surprising things is there's such a lack of access to care down in Guatemala, in the remote villages, that it's actually common practice for families to bring their 15-year-old daughters and sons into the city and as a gift, have their teeth removed and fitted for dentures at 15, if you can believe that. And that's considered a gift, because if they get infections and anything like that as they age. There's so little access to care. It could be life-threatening, and it just causes misery for them. And so that's their solution, and it's looked at as a gift. And so there were so many people down in Guatemala that had done this. And there was decades of maxillary resorption and just the inability to chew their indentures. The dentures don't fit them. They're suffering. And that's just the way of life for them. And it's horrible. And so we really saw an opportunity down there because they had not been trained on these remote anchorage techniques like your pterygoids and your zygomatic. So the first thing that Dr. Oh did was he went down there, and he trained all their top surgeons at the University of Guatemala on how to do zygomatic. That was the first step. And then also on how to take care of and handle complications post-surgery for these patients, Setting them up to be able to take care of their own people. Okay. But because there's such a huge volume, could, you know, he also wanted to help these people. And so we, and we also saw an opportunity to help spread knowledge, and across the globe really of this of these techniques to help people all around the world. And so we said it was, Orcaa was created, and we partnered with University of Guatemala so that we can bring doctors from all over the globe to train and learn these remote anchorage techniques so they can go back to their country, their office, and help their patients, but then also at the same time to be to help a ton of people in desperate need down in Guatemala. So it's really just like this perfect storm that created this really wonderful event. And it's extremely fulfilling. It's all about the very top people in the industry all meeting down at the University of Guatemala, which is actually an, it's actually a really nice facility, top of the line. I went in there; I was like, this is nicer than my dental school. I was blown away. We do the, we, these and these patients are all level three ones for zygotes are done under general anesthesia in the OR, so it's in the very best setting possible, and we've got very best faculty. And it's really it's like 2 to 1 ratio. So you've got two trainees and one surgeon, one faculty member overseeing them the whole time, and one is doing the surgery and one is assisting. And then they switch out on the second case and it's just huge volume. So we're doing 50 plus cases in that one week that we're there, or 50 plus arches about usually about between 30 and 40 patients we see in that one week. And we are changing so many lives down there, and it's just tremendous.

Dr. Noel Liu:
So each participant is probably getting, what, about 5, 4 to 5 arches?

Dr. Jonathan Theis:
Yes, exactly. So it depends on their experience. So we've got a level two and a level three. The level three is your remote anchorage. That's going to be your advanced surgical techniques. And then level two is your conventional Full Arch training. And within each of those, there's different levels too. So like, for instance, the conventional Full Arch, you could be a newbie who's placed maybe 300 or 400 implants, and maybe you're just getting into it, and you've tried a few cases, and you've done a few cases under your belt, but you want to get proficient and they come into the course. And with those, we pair them up with someone of similar experience, and then they're given particular cases that are like home run cases, right? So that they can just practice on getting proficient and learning from the very best on how to approach those cases. And then within level two, there's also docs that have maybe done 30, 40, 50 arches, right? But they want to get better. And also, anytime we're doing a maxilla in level two, we always do what's best for the patients and play centers, and creating that AP spread is always ideal unless it's contraindicated. We're placing pterygoids on any maxilla that we're doing in level two, and if the participants are ready for that, if the faculty deems them ready for that, then they'll be trained on pterygoids in level two. So, the level of advancement depends on your experience in level two. And then, of course, in level three, we're seeing we're doing a lot of maxilla, mostly maxilla, because we're training them on zygotes and ... and trans nasals. And you're seeing and that even within that, you've got your standard place of two zygotes to the most advanced cases where you've got quad zygotes and severely atrophic maxilla, and patients with complicated health histories and other issues going on. And this really gets you ready to be able to treat any patient that walks in the door at your private practice.

Dr. Noel Liu:
I don't think I've heard of any other course that offers this kind of like comprehensive training.

Dr. Jonathan Theis:
Yeah, I think it's unique in that way. The volume, the quality of the faculty. But I, and I think the big factor there is that in Guatemala there's such a need for it. And because of that situation that I told you about, with so many people not having to teach for so many years, we end up getting so many cases that this is like the best place where you could find the most difficult cases to train doctors along with people that really need it. There's no overdiagnosing here. It's so many people need this that they're there, and they need their help.

Dr. Noel Liu:
And is that still the case right now, currently as we speak with 15 year olds?

Dr. Jonathan Theis:
Oh, yeah. Absolutely. And we're even doing other cases, too. We do charity cases there as well where people come in with huge, mild blastoma, and we bring in microvascular surgeons and fly a man down there. And we're resectioning jaws and using the tibia and reforming the entire jaw. And those aren't ones that we're training on. Those are just. We're just, we're trying to help as many people down there as we can. Yeah, and we've recently added an advanced prosthetic digital workflow training course to this that runs coinciding. So you've got the surgeries going on, and alongside that, you've got an advanced prosthetic course that's training doctors on how to plan these cases, what proper records need to be taken, how to troubleshoot occlusion, everything that you need from the restorative side so that it's one thing to be able to do the surgery, but you also want a good outcome you want. You don't want all those problems of not understanding how to properly restore the case. And so now we've got this comprehensive course where doctors can learn the restorative side of things and also learn all the surgery that you're needed for this.

Dr. Noel Liu:
So go from level 1 to 3 and then restore, love it. Absolutely. So talking about helping you help a lot of people down there. So now with your Full Arch Buying Group, you are also helping dentists and doctors like solo practitioners to get that volume discount and get that group buying power. Tell us a little bit about this FABG. Is that what is that how we say it?

Dr. Jonathan Theis:
Yeah, FABG. Absolutely. Yeah, FABG.

Dr. Noel Liu:
Right, FABG. So what is this group? How does somebody get involved with this and what is the significance? What is it that you're trying to do with this group?

Dr. Jonathan Theis:
Sure. So I'm noticing that there's a lot of large groups and dentistry in general, right? Being taken over by ... we've been seeing it over the last 10, 20 years being taken over by corporate dentistry. These groups are coming in, and they're purchasing private practices, grouping them together, and creating these large corporations. And although that's good for business, from a business standpoint, it's not good, in my opinion, for patients necessarily, and I believe that the private practice for my time in the DSO space, what I noticed is that private practice doctors are more focused on the best patient care and not as much just strictly myopic when it comes and focused on profits, right? And so I want to keep corporate dentistry at bay as much as I can. And the way to do that is to organize private practice doctors together, much in the same way a DSO, but allowing them to keep their anonymity and their business ownership to themselves. And the buying group takes Full Arch doctors. And what I've done is I've, I went to all the top people in the industry, and I said, hey, who are you using? What vendors do you use? What brands do you use when it comes to everything that you're using in the office? Who do you use? What do you like? And so then that's how I created my target list of who I wanted in this buying group. So any company that I use in the buying group that's in there, it's because they've been recommended by the top people in the industry that want to. I wanted to make sure that every vendor in there was if I'm telling a doctor about this group, it's, listen, this is what the top people, the most successful people in the industry use. And so, wouldn't you want to emulate that? And then you also want to get a great deal. And so I did that across every category: implants, biologics, Full Arch focused labs, surgical instruments, anesthesia equipment, surgical supplies, operative supplies all the way down, you name it. Even down to like, surgical chairs and headlights. Everything that a doctor needs and spends on whether digital technology, everything so that cumulative savings across all of those categories is going to help bring their overhead costs down so that they can compete better in this. In what's becoming a very competitive environment now, I believe Full Arch is probably the fastest-growing sector of dentistry in the past ten years. And so it becomes more and more competitive. Costs of marketing are going up, and it's becoming more expensive for patients with interest rates going up. And with inflation and people have less money, it's more expensive to borrow. Costs of everything are going up, and the landscape is becoming more competitive. It's becoming more expensive to market. So what is a doctor to do if the large corporation down the street is offering a very low price and patients are hurting for money, and he is forced to to have to charge much higher, that becomes a big disadvantage. And us organizing together as a buying group enables us to get that power back and negotiate prices, much like a DSO would, and able to help us lower that overhead and be more competitive in the space.

Dr. Noel Liu:
So does a dentist have to be placing implants to join the group, or is it something which anybody can join? What is the barrier of entry? Let's put it that way.

Dr. Jonathan Theis:
Yeah, I would say this. This is tailored to Full Arch doctors and implant-focused offices. If you're not placing a lot of implants, there's plenty of other buying groups out there that would probably that have a larger that have been around longer, and are probably going to be more beneficial in comparison, right? But if you are placing a lot of implants, doing a lot of bone grafting, surgery, stuff like that, then this certainly could be something that could save you a lot of money. And then, of course, if you're into Full Arch, that's where it's going to really start to save you a ton of money, because we're looking at specific pricing for Full Arch doctors, whereas the digital workflow technology, the Full Arch Labs, or if you've got your own in-house lab, zirconia pucks, lab equipment, mills, furnaces, everything that you need for your in-house lab and for your Full Arch workflow.

Dr. Noel Liu:
Oh, that's awesome. That's awesome. That's great info. What are some of the other requirements? Let's say I'm a Full Arch doc. I just got started maybe a year ago and I want to be part of the group. How does it work? So it's very a long time.

Dr. Jonathan Theis:
Yeah, it's very easy. All they need to do is they go to the website FullArchBuyingGroup.com. And that is the, that's the portal. And they can create an account right there. They log in, I get a notification of every member. It's got to be a doctor, join the group. So, I vet everyone that comes in. But beyond that anybody can. Any doctor can join. And it's as easy as going to the website, FullArchBuyingGroup.com and creating an account. And what we do is generally, we'll be running different promotions and stuff that kind of give you a trial. You try it out for a couple months. That way you can see what the value is before you're ever charged. I want to make sure for me, this is about being a win for your business. And if it's not a win for your business, I don't want you to be a part of it. I want this to be something that helps you be more successful. And also, some of the stuff that we do is beyond just saving you money. So I've created a litany of different vendors that help provide support and resources, and that could be from staffing to social media management to marketing to sales training to business consulting software. There's just a bunch of different resources on there, and they're all been ones that I've either used myself successfully or have been recommended by the top people in the industry. So the idea is you don't need to look anywhere else or wonder you go there and you just you can see what you need, pick it out and what's going to work.

Dr. Noel Liu:
Like a full-service center, I love it.

Dr. Jonathan Theis:
That's absolutely, we're creating a Full Arch ecosystem to breed success, yeah.

Dr. Noel Liu:
One question for you. What's your future and where is this this Full Arch Buying Group going to go? And what are you going to do as an individual? What are your plans and goals?

Dr. Jonathan Theis:
Sure, I've got a brand new family. I've got a new boy. Yes, I've got a newborn, thank you. Three months, and I've got a toddler of 20 months, so I've got two under two. So I've been I on top of trying to start all this business. It's been very busy, and/but the plan with all of this is also we're going to take this to the next level. Okay. So, the foolish buying group is just the beginning. We're creating something that eventually will become what's called Full Arch 360. Okay. So Full Arch 360 will be everything besides the buying group. It'll be a ton of other businesses and services that you could get involved in to help you be more successful. For instance, there's another business that I'm now that I'm about to launch right now as well, called Smile Score Solutions. And what Smile Score Solutions does, it is a platform that a doctor can subscribe to. And it is a full library, video library of educational videos, and a step-by-step process that your patients can go through that educates them on their on how to improve their credit and gives them a step-by-step process on how to quickly improve their score and also remove negative items that helps them junk their score up. And so what we do is the doctor pays a subscription to be a part of it, and then they will get a link to their own customized portal with the full library of educational videos and pre-made letters and templates that go along with the step-by-step system that the patient just fills out and sends in to help them remove negative items, and so the doctor can hand this link out to every patient that comes in. 50% of patients that come in are declined for financing, and 60% to 70% of your leads are not qualified. And what do you do with those patients usually after they're declined? Or what if they're not even qualified? Usually you don't even bring them in for a. You just put them on a drip campaign to keep them, keep your office in there in the forefront of their brain. Or if they're been if they came to your office for a consult, they've been declined. Usually, you put them on a drip campaign. There's really not much you do for that patient. They feel hopeless. And so this is something where the doctor can say, hey, you're not a lost cause. Here's a free course from us to you. Normally, it would be like a $600 value, and you're able to give this away to all of your patients and give them the ability to take this course and over the next few months, improve their credit. And because they're on your portal, because it's branded for your office, it keeps them in your ecosphere. And so when they improve their credit score, they are ready to come back to your office to change their life and get that procedure that they've been, that they were declined for in the past. And so that's called Smile Score Solutions. So that's another business that we're about to launch. And then we've got a bunch of other ideas lined up, whether it's software that's going to help track all in one, your operations, your clinical, your marketing, and your sales for Full Arch. And it's going to be focused towards like implant focused office. But to bring all of the, all that data under one dashboard, it doesn't really exist. A lot of times right now, you're probably not like some marketing agencies will give you data on your sales, but it's only related to their leads, right? It's not right. What about all your other leads that are coming into your office? How are you tracking your sales performance? Really. And so we want to capture sales as a whole. We want to capture your marketing. We want to provide a CRM for you so that when you if you decide to switch marketing companies, you're not losing all of that data because the marketing company owns it. You have your own that they just plug into, right? So we're trying to create this so that doctors have this. They have they're self-sustaining. And then they can just hire who they want and try out different companies because everything they need is right there. It's right there.

Dr. Noel Liu:
No, I love it. I love this idea because right now, currently, we are using our own CRM, like with Go High Level. And the problem is it's all these guys coming in. They all have their own data, but they do not want to sync with ours. And that's we understand everybody has their own business. And what I think what you're explaining here is it's going to make perfect sense, because that's really going to keep a good track of everybody, because all us sudden we get taken advantage of every single day by these marketing agencies.

Dr. Jonathan Theis:
100%. I see it all the time, and the key there is to get them to be more honest. The ones that are out to take advantage need to drop away, right? They need to be exposed and drop away and fail. And the ones that are actually there to really help you succeed and are honest in what they're offering and do what they say. They're the ones that need to rise to the top, that we need to use their expertise to help us be more successful. And that's hard to find in this industry, sometimes.

Dr. Noel Liu:
Very hard. Jonathan, man, thanks for your time. This was great. Is there anything you would like to add last minute?

Dr. Jonathan Theis:
I mean, I think we covered a lot today, man. I'm really excited about the future and what we can do to help docs. And if anybody wants to reach out to me, I do consulting too. So, like on the when you're when you're a Full Arch buying group member, you can book time with me, and I do one-on-one coaching some of the stuff that we talked about today. I've got tons of advice to give. I've got all the blueprints, all the everything that I did. I can share that knowledge, and I want to share it. And I want to help everyone be successful. When everyone else wins, I win, too. We all win. And that's the idea behind all of this. Anyone that wants to join the group, there's one-on-one coaching. And so that's why my email is Jonathan@TheFullArchCoach.com. And so that's how anyone can reach out to me with questions. And of course, you can go to FullArchBuyingGroup.com and sign up for your membership. Anybody that uses the actually, I've got a two-month trial code going right now. It's GROWTH24, so anyone that uses that code will get two months free.

Dr. Noel Liu:
GROWTH24. I'll make sure I put all that information on the link. Awesome, man, I appreciate it.

Dr. Jonathan Theis:
Yeah, very excited about the future of this. And I just want to help as many docs out as possible. We've been on the side of training docs. Running offices and seeing patients. And now I just want to help. I want to help. I want to have as big of an impact on this sector of dentistry as I can. Love it, love it.

Dr. Noel Liu:
Hey, thanks so much, everyone. We're going to land the plane here. Thanks for watching, and make sure to like and subscribe. We'll come back with another episode and in the meantime, reach out to Jonathan. He's on his site, and hit him up. Thanks a lot. Thanks, John.

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 Dr. Jonathan Theis:

Dr. Jonathan Theis is a general practitioner with over a decade of clinical experience, specializing in cosmetics, implants, and aligner orthodontics. He graduated from the Maurice H. Kornberg School of Dentistry at Temple University in 2009 and began ownership of his first private practice office, Legendary Smiles, in 2014. Over the past six years, he has focused on the business side of dentistry, building private practices, multi-practice groups, and corporate expansions.

He is the co-founder of Smart Arches Dental Implants with Dr. Simon Oh and serves as the Director of Sales and Finance for Orcaa, GP. A dentist and entrepreneur, Dr. Theis recently launched his own full arch consulting firm, The Full Arch Coach, and is developing a full arch-specific buying group and a company called Smile Score Solutions, which helps patients improve their credit scores for dental financing. Dr. Theis is committed to making any business he is involved in successful, and he has the experience and expertise to help doctors achieve success in their own practices.

In his leisure time, Dr. Theis enjoys writing, playing, and recording music. He is skilled in multiple instruments, including guitar, bass, and drums, as well as singing and songwriting. Additionally, he is passionate about health and fitness, is an avid weightlifter, and considers himself a nutritional enthusiast. Dr. Theis has a loving wife, a one-year-old daughter, an infant daughter, and a toy-sized Goldendoodle. On most Sundays, he can be found cheering on his favorite NFL team and checking his fantasy football stats.

 

Things You’ll Learn:

  •  
  • Establishing authority and trust through social media, patient testimonials, and educational content can significantly increase patient engagement and reduce the need for aggressive sales tactics.
  • Utilizing third-party resources, like anesthesiologists and specialized lab techs, can optimize operations and improve patient care while keeping costs manageable. 
  • Forming a buying group allows private practitioners to leverage collective purchasing power, which helps them compete with larger corporate entities while maintaining independent ownership and patient-focused care.
  • Building referral networks with local general practitioners can increase patient flow and create mutually beneficial relationships that support specialized practices. 
  • Innovative financing solutions, like Smile Score Solutions, help patients improve their credit, allowing practices to retain potential patients who would otherwise be declined for financing.

Resources:

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Podcast

Ensuring Long-Term Savings in Healthcare Real Estate

Summary:

Landlords, motivated by profit, often have the upper hand in negotiations, especially with inexperienced tenants. 

In this episode of the Secure Dental Podcast, Colin Carr, founder and CEO of CARR, emphasizes the importance of healthcare providers having expert representation in lease negotiations and property purchases. CARR specializes in tenant and buyer representation, helping healthcare providers secure fair lease terms, concessions, and overall profitability. Throughout this conversation, Colin highlights the risks of predetermined lease renewals and the benefits of having an independent advisor review leases and negotiate on behalf of the tenant. By hiring experts like his firm, healthcare providers can save significant amounts of money over their careers and ensure they get the best possible deals. 

Tune in for insider tips on how healthcare providers can save hundreds of thousands of dollars on their leases and property purchases! 

 

Secure Dental-Colin Carr: Audio automatically transcribed by Sonix

Secure Dental-Colin Carr: 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:
Hey, hey, welcome again to our Secure Dental podcast. This is another episode where we bring in many great talents from both inside and outside our dental profession. And today, we have a really, really great treat here. So before we get started, big shout out to my sponsor, DentVia. DentVia is a virtual dental administration company that assists our front desk and our office managers with back-end tasks such as calling leads, insurance verification, and all the back-end stuff, which we all hate. Definitely visit them at DentVia.com. That's www. D E N T Via.com. Now, without further ado, I'm going to jump right in. I got Colin Carr. He's the founder and CEO of Carr, a nationwide leader in healthcare real estate. Colin knows doctors inside out. He knows healthcare, and he helps us get the real estate as well as lease spaces to better serve our needs. Now, without giving out any further information, I'm going to pass the mic off to you, Colin, and I want you to do the intro and take it from there, man. All yours.

Colin Carr:
Thanks for having me. I really appreciate it. So, I've been doing commercial real estate for over two decades now. I started in real estate when I was 19. I got out of high school and was not sure what I wanted to do, but I knew I was fascinated with real estate and a few other things, so I jumped right in.

Dr. Noel Liu:
Did you say 19?

Colin Carr:
Yep, yep. So, I started managing apartment complexes and doing a lot of property management. And then, I got into brokerage, like helping people lease and purchase when I was 22. And the first company I worked for was basically a tenant-buyer firm, mostly for like large retailers. So we did Walmart, Wendy's, fast food like Wells Fargo, Blockbuster. We had a coffee franchise that competed with Starbucks, so it was stuff like that. I did that for a couple of years, enjoyed it, but I started just by default. I started working with a lot more business owners. I started doing office and industrial tenants, and then I found myself involved in a handful of medical and healthcare deals, and I had a couple clients that I'd worked for that owned industrial buildings, that purchased some medical buildings, and so I got thrust into the medical space just by default. And I realized that I really liked working with healthcare providers. And so I started doing more and more healthcare, more and more medical, and I got to eventually to the place where I was doing almost exclusively healthcare. And I had a series of deals that happened sequentially where, I knew this is how the game was played. I had lived it, I had done it. But just for me, I had this epiphany like, hey, we need to adjust the business model and shift how we're doing things differently. And so I'll give the quick little story about, you know, I had a couple of medical buildings that I was listing. I actually had quite a few, but I had these specific ones that I was listing for this landlord, and we had a couple doctors who had leases coming up for renewal. So they'd been in the property for a long time. They had thriving practices, and I was talking to the landlord, who was a large publicly traded REIT that owned the real estate, and the asset manager called me one day, and he said, hey, let's talk about Doctor So-and-so's lease. It's coming up for renewal. And he said, have you met with the doctor? And I said, yeah, I met with them last week. And he said, does he have a broker? And I said, no, he's doing it by himself. Then he asked me, does he know the market? And I said, you know, he thinks he does, but he doesn't know the market even close to what he should. And then he asked me, do you think he's willing to move? And I said, I know he's not willing to move because he told me that he shouldn't have told me that, but he told me that. He told me he didn't want to move and he couldn't move. And so he was already paying like $4 or $5 a square foot above what we were asking for new tenants at the property. Like, if this guy would have just gone on our website and looked at the marketing materials, he would have seen we're marketing spaces that are vacant in the building, like $4 or $5 a foot below what he was paying. And the landlord says to me, go back to him at a lease rate. That was another like $4 or $5 above what he was currently paying. And so I'm like, well, that's going to put him like literally $11 a square foot above market, like $400,000 or $500,000 in excess rent from what he's going to pay over the next 7 to 10 years than if he was at a competitive lease rate if he knew what he was doing. And the landlord just said to me, he goes, get it done, or I'll find someone who will. And I got it done, got the lease done. And the interesting thing is the doctor didn't even know he was overpaying. Like it wasn't like he was kicking and screaming and yelling and sending, you know, bad emails that people and he didn't even know, he literally just signed off on the lease and went back to his business. And so I had a couple of those scenarios where I just watched landlords just completely manhandle these doctors. And the landlords were professional negotiators, professional investors, and then they were hiring me as a professional negotiator. And then the group of us is going up against these doctors that are incredibly intelligent. Like, you can't become a dentist or a physician if you're not intelligent. But they had no idea how to play the commercial real estate game, and it is truly a game. So, after a number of those deals, I just realized it is a fair fight. Both sides are ready, willing and able. No one forced the doctors to lease a space or to sign a lease. But I just realized that these guys need our help. So 2009, I launched our company, which is called CARR, and the idea was we would do only healthcare, and we would do only tenant and buyer rep. So we'd always be advocating on behalf of the doctor that the practice and we would eliminate conflicts of interest. We wouldn't have one person pretending like they're working for one party, but they actually have a fiduciary with the other. We just draw a clean line of separation where only on the doctor's side. We're going to protect their interests, level the playing field, help save them a couple hundred thousand dollars per deal, if not more, save a ton of time, and we launched it in '09. And today, we're now licensed in all 50 states. We have over 5000 clients that we're doing. I think actually we have over 5500 clients that we're actively doing work for right now where we're helping them renegotiate a lease, buy a property, start a practice, what have you. And our whole focus is just protecting the doctor's interests and helping them to maximize their practices' profitability by getting the best possible terms.

Dr. Noel Liu:
So you've seen both sides. I mean, you know, that's a big, big, huge plus because you were working for the other side before. So you know exactly how these guys are going to be treating, you know, us professionals. And then now you're working on this side. So, what do you think has changed? Like, you know, from the time when you were working for them in this time. Is it like pretty much the same deal if it's a, you know, owned, like, let's say, real estate or if it's like a mom and pop owned real estate, or do you see like a difference in like how they handle their leases?

Colin Carr:
Yeah, you know, I mean, there's definitely different types of owners. You get somebody that maybe inherited a building, it's their only property, or, you know, maybe their parents own the property, and then they inherited something like that. Then you get these guys that are, you know, maybe they own a building or two, or maybe somebody bought a property for their own business, and they're leasing it out to a few other tenants. So they kind of know what's going on. And then you get into this realm of like just truly professional landlords, like institutional landlords, whether it's a REIT or it's an insurance company or just a very well capitalized investment group. And so you deal with different tendencies as far as how they operate. But the one thing that's the same, no matter who you're working with, is everyone wants to make the most amount of money they can. And this is not like limited to landlords. Like no dentist wants an insurance company to reduce their reimbursements. No dentist is going to tell an insurance. No dentist is going to tell Delta Dental. Hey, listen, if you guys want to pay me 20% less next year than you pay me this year, it's not a problem. Like everyone wants the most they can get. You want to do it with integrity. You want to do it fairly, but nobody wants to have their money. Give them an average yield, you want the highest return from the stock market. You want your 401K to push out the biggest returns. And so it's a really obvious game when you think about it. But a lot of doctors approach landlords as if the landlord actually thinks that they care about them. Like, landlords will say stuff like, you've been a great tenant, we want to keep you, we'll treat you fairly. And they're saying that so the doctor puts their guard down and then signs off on a lease where they overpay by a quarter million dollars in a 5, 7, or 10-year period. So, the tactics haven't changed a whole lot. You get savvy landlords that want to make as much as they possibly can. They might even be a patient of the doctor. They might send them a Christmas basket. They might take him golfing every couple of years to try to keep that relational equity there, so to speak. But at the end of the day, these landlords, they want the highest return. They want to make their properties worth as much as they can. And that only comes through increasing lease rates, reducing how much you give in concessions. And so landlords are savvy, and they play the game well, and they are in it to make as much as they possibly can.

Dr. Noel Liu:
Great. Let's talk about this here, like renewals, lease renewals, like a lot of the misconception, is like, hey, you got this two five-year options or, you know, coming up, is that somewhere whereas a tenant we can still negotiate, or is that set in stone?

Colin Carr:
Yeah, that's a great question, truthfully, because a lot of people will get a lease renewal option, and there's two main types of options on a lease renewal. There's one option where you have predetermined lease rates for a predetermined amount of time. So you might do a ten-year lease and then have two five-year options to renew. And then, in the lease, it will say that the first five-year options would be maybe year 11 through 15. It'll start where your ten left off with a 3% increase or a 4% increase. And so year ten ends, and then it just ratchets up for the next five years and keeps going up. So a predetermined lease rate over a predetermined amount of time. The other type of lease renewal option is what we call just an option, where the landlord has to negotiate with you in good faith. So typically, I'll say things like then market rents or to be negotiated terms, that's typically a much more favorable renewal option because when you just sign off on that predetermined numbers, like on a five-year option with set lease rates, number one, you're probably above market. I mean, most leases have an annual increase, and that annual increase outpaces inflation. Now, we've had record inflation the last couple of years. But even so, typically, those leases increase at a rate each year. That outpaces where the lease rates would be if you vacated that space, what would the landlord go to market and try to release that? Typically, you're paying more than they would charge a new tenant. So we've got to get that lease rate back down to a competitive lease rate. And then, on top of that, savvy tenants don't sign off on lease renewals without getting concessions, free rent, renovation allowances. And so if you just exercise a renewal option and you're an above market lease rate and you get no free rent, no build out or renovation or tea allowance, you probably just lost $100 or $200 or $300 grand like that. Starbucks is not going to sign another 5 or 10 years and give a landlord another 5 or 10 years of guaranteed cash flow and make their life super easy. They don't even have to release the space. They just sign a document without capturing concessions. So savvy tenants need to realize every economic concession that's on the table, for a new tenant, doing a new lease is on the table for renewal. Why wouldn't it be? It's the cheapest, easiest, fastest with the least amount of risk deal a landlord could do. Why would a landlord not give you some level of concessions? Yet landlords tell tenants all the time, oh, we don't do that on renewals or.

Dr. Noel Liu:
Right, right.

Colin Carr:
Stuff like that.

Dr. Noel Liu:
But you've seen it happen, right?

Colin Carr:
... everything.

Dr. Noel Liu:
Right.

Colin Carr:
And that's the thing. When you deal with institutional landlords like the REIT that we were dealing with on that one specific renewal that I mentioned earlier, they had budgeted like they had literally several months of free rent budgeted. They had commissions for the tenant to have a broker even though they didn't. So, I got a double commission on that one as the landlord agent. They had free rent; they had a lower lease rate scheduled. And then when the tenant didn't have a broker, didn't know what he was doing, and wasn't going to move, the landlord was like, I'm not going to give this guy anything. In fact, I'm going to charge him a premium. So that deal, literally, if that doctor would have had an expert advisor helping him, he literally could have cut his rent down to $10, $11 a foot lower. He could have gotten 4 or 5 months of free rent. He could have gotten enough money to fully renovate, like flooring, paints, you know, upgrade some millwork, you know, window treatments, lights, etc., and instead, he just signed off on it.

Dr. Noel Liu:
So in a case like that, is a doctor paying you guys a commission there or is it the landlord still?

Colin Carr:
That's the beautiful part of it is commissions and commercial real estate are paid just like residential real estate typically is paid. They're paid by the landlord. And so, like in residential, anyone who's ever bought a house that's hired an agent or broker to help them, they know that the seller has a commission set aside for the deal, and they offer half to their agent, the listing agent, and then they offer half to the buyer's agent because they're trying to attract agents to bring them, buyers. Commercial real estate is the same thing. Landlords want tenants, they want to lease spaces, they want to sell spaces. So they hire brokers typically, or they do it internally. And there's almost always a commission set aside for the buyer or the tenant, in this case, the healthcare provider, to have representation. And if the healthcare provider doesn't, the landlord's agent just gets a double commission. So it's not hard to figure out why a listing agent would want to make you think they're helping you, but they're actually not. Or why the landlords would say things like, hey, if you don't use an agent, we'll give you a better deal. I mean, it's complete nonsense. Like literally what they're saying is if you don't use an agent, I'm going to save myself the money, put it in my pocket, and then I'm going to overcharge you by $200,000 but make you think you got a deal.

Dr. Noel Liu:
So and so. Let's say, if the doctor wants to renew now, right? And they want to look for some sort of representation now. So that would be the doctor's responsibility then, correct?

Colin Carr:
Correct, yeah. Because the landlord's not going to say, hey, call Colin or one of his guys because the landlord knows that we're going to hold them accountable. We're not going to disrespect them. We're not going to take advantage of them. But the landlord knows I can't pull the wool over this guy's eyes. I'm going to have to treat him fairly because Colin knows the market. He knows what other landlords and sellers are willing to do, and he's not going to allow the doctor to take a bad deal.

Dr. Noel Liu:
Love it, love it. And what happens, like, in a predetermined renewal when you're doing, like, let's say everything is figured out, is there a room for some sort of negotiation there, or is it like?

Colin Carr:
Yeah. So the best way to handle that, that's a good question to kind of bring this all together for this topic. The best way to look at it is contact an expert real estate advisor that specializes in healthcare tenant-buyer rep. Let them look at your current lease and the renewal option, and then let them do a market evaluation for you. If, for some reason, that option to renew actually is competitive for some reason, let's just say that your original lease was so competitive, and the renewal option terms are so far below market. Just because the market's gone up so much, there's a possibility of just signing that renewal option could make the most sense for you and waiving any options for free rent or TI, because the lease rates are so much lower, and the landlord would not give you that lease rate if you negotiated. But typically, you're better off to waive that option and just have your agent rep negotiate a brand-new deal. Because here's the reality. The tenant might say, well, yeah, well, I don't want to move. Here's the reality. The landlord doesn't want you to move worse than you don't want to move, like the landlord doesn't want a vacant space. If the space goes vacant, they're going to spend 9 to 18 months waiting to release the space. Then they're going to have a new tenant come in. That's not going to sign off on a bogus lease rate and pay above market like you are. They're going to be more competitive, and they're going to negotiate harder. And so the landlord's going to have to bring that lease rate down to get that space leased. Then that new tenant is going to want to renovate the space anytime. I don't care how nice the space is when someone moves out of it. You see every floor. You see, the flooring needs to be replaced. You see, all the walls need to be touched up and repainted. You see chips and cabinetry. And so that landlord is going to sit vacant for 9 to 18 months. They're going to end up with a lower lease rate, typically, for a new tenant, they're going to have to give free rent and other concessions. The landlord would rather just have you stay in that space, sign a renewal. And so, the game plan is to educate the landlord on we know how the game is played. You're going to lose $100, $200 grand if our client moves out. We're not trying to take advantage of you, but you've got to give us a fair deal. It's got to be you winning and us Losing is not a fair deal. We've got to both win. You keep a tenant, you dramatically reduce your risk factor of having a space go vacant for a longer period of time that you want. You cut down your exposure on what the new deal will cost, but you've got to give us concessions. You got to give us a fair deal. And when savvy landlords know that you know how to play the game, they just cut to the quick. It's kind of like if an attorney is working with another savvy attorney, they talk to them totally different than if an attorney is talking to someone who's not represented, like they know that the other attorney is not going to play that game. If the IRS is doing an audit and they're talking to an individual, they're going to talk to them differently. If they're talking to a savvy tax advisor, it's just it's not hard to figure out. Judges talk to attorneys different than judges would talk to an unrepresented person. And so it's not to escalate it to a lawsuit or to a tax, a tax situation, or an audit. But it's just one of those things where the landlords are asking themselves, is the tenant in the know, or can I get whatever I want to accomplish here? When they know that the tenants are represented, they just handle the entire transaction a lot more intentionally with respect. And ultimately, you typically get better terms.

Dr. Noel Liu:
That's huge, man, what you just said. I mean, it just makes total sense what you just said because this is like kind of deal like where you're going to be saving them so much capital upfront and along the way that is automatically going to pay for your services.

Colin Carr:
Yeah, it does. I mean, people always say, well, they'll say, all right, well, if the commission is built into the deal, can I still save money if I'm not? And it's like, no, because you're not the one cutting the check as the commission payer. Like if you were the landlord or seller, sure, you could choose not to pay commission or only to pay one. In that case, you would save money. But if you're the tenant or the buyer and the landlord is paying the commissions, you're not saving money by going it alone. You're literally just patting the landlord's pockets, or the listing broker gets a double commission. So the best example I can give you is this: every single dentist who has patients that have dental insurance, they run a report like in the, towards the end of the third quarter of the fourth quarter. And they see which patients still have benefits they have not used yet. And then they contact those patients, and they say the patient will call them and say, hey, listen, you've got enough money to do this, or let's get that filling taken care of, or let's get this done. Because if you do not use it, the insurance company is not sending you that check if you don't use it. They're not going to pay me for the unused portion. They're not going to reimburse you for the unused to use it or lose it scenario, right? And so that's the best example I can give is if you don't use a broker, the landlord just keeps it or pays their broker a double commission. And so it's really when dentists would look at how many patients didn't come in and use the remaining benefits that year, they're like, man, you just lost it, and so there's really no reason not to.

Dr. Noel Liu:
Exactly, exactly. Well, that was such a great nugget that you dropped. I mean, I think this is something which we should highlight, definitely. So, let me ask you this here. Why healthcare? And how do you know so much about dentistry?

Colin Carr:
You know, I've done a pretty broad segment of real estate. I've done the large retailers like Walmart. Like we said before, I've done large international companies like Honeywell and, you know, large publicly traded companies. I just liked working with the doctors. We definitely do large groups of practices and people that have dozens or hundreds of locations, and those guys function on a more institutional level, but I just like to work with the doctors. I remember the first dentist that I helped save him like $350,000 on a leash. You know, he'd been trying to negotiate with his landlord, was getting just completely annihilated in the negotiation. And someone said, hey, bring Colin. He did. I saved him $350,000. Like, that was super meaningful for me. I got him a nicer space. A bigger space saved him a ton of money. And just from a relational position, it was more meaningful to me. And then Walmart saving a little bit of money. That's great. But they don't really care. Like, right? You are a number to them. Where for me, my very first dental deal. I wasn't a number. The guy really cared about me, and I was it was very intentional about how Pam and I knew that it would make a difference for him and his family, and so for me, it just felt more meaningful.

Dr. Noel Liu:
I love it, so I have an example for you. I'm looking at a practice right now, and the space is leased. The practice is for sale, right? And what would you recommend, you know, going over there, speaking with a landlord directly or somebody like your caliber, going in there and looking at the lease for us, what's in place, and what needs to be done?

Colin Carr:
Yeah, that's a great question. So you never want to talk to a landlord until you know what's going on. And people say, well, I'm just going to ask them to send me this or that. Don't do that. Let the current practice owner give you their lease, or the practice broker give you their lease. That's step number one. Step number two would be to have someone like me or someone else review the lease for you and then give you feedback on the quality of terms. It's again, it's not uncommon when a lease is getting ready to renew in a year or two for it to be above market, so we're not concerned if it's above market. That doesn't stop a transaction from happening. It just gives us insight into what's available as you move forward. Now, if that doctor just signed a new ten-year lease and there's nine and a half years left, really, the only reason you're evaluating is just so that you have information to realize if you have a good, bad, or average lease. But if that lease is coming up for renewal in the next year or two, or it's coming up for renewal in six months, and you're going to have to deal with it, then the person you're talking to can say, let's put together a strategy and figure out how to get you back to a competitive lease rate, or let's figure out how to get you money to renovate the space. It could be a fair lease rate, but the space could need some upgrades. And so that stuff's all on the table. Sometimes, people buy a practice. Ten years left, seven years left. You just inherited. And then you live to fight another day. You wait till you get inside 12 or 18 months in the future, whether that's 5 years away, 8 years away, and then you renegotiate it. But if there's a chance for you to renegotiate that lease in the next, you know, year or two, probably you're going to be doing that simultaneously to buy into practice. And then a couple other quick pointers. You don't want the current doctor renegotiating that lease for you. Okay. They're not going to be there. You want to keep them out of that process. You also do not want the practice broker renegotiating that lease for you because they do not work for you, right? They have a legal obligation to help the selling doctor make as much money as possible in the transaction, and they might make you think that they're helping you because they're giving you information, and you can call them and ask them questions, but that's not your advisor, right? This is a person who has a legal obligation to help the selling doctor maximize their profitability. So you want an independent, neutral person that's not tied to the landlord, that is then tied to you. And that person will help advise you. Talk about how to handle the process. And again, ultimately, it's the same scenario. This current landlord does not want to lose any tenant, whether it's the current tenant they've known for 5, 10, 20 years, or it's you coming and buying the practice. They don't want a vacant space. And so we just want to make sure it's a fair trade. Good terms. And if we need to renovate the space, if you're going to get that landlord another 5, 7, or 10 years, that landlord needs to contribute financially to the deal.

Dr. Noel Liu:
Awesome. I know you mentioned about like you're helping like big groups as well, right? It's DSO, one of your specialty as well.

Colin Carr:
We do a lot of DSOs. Yeah, we do a lot of DSOs, MSOs, VSOs on the veterinary side; we do a little bit of everything. Our bread and butter has always been the sole practitioner, individual doctor, whether they own a practice or 2 or 5. But we have so many clients that we've taken from 1 to 20 practices, or 1 to 10, that we've just entered that space kind of automatically by the nature of how we help them. But we also do a lot of DSOs as well.

Dr. Noel Liu:
Great. Well, Colin, I mean, this is huge, man. I mean, you've changed my mind about getting help.

Colin Carr:
Yeah. I mean, there's a lot of analogies I could give, and people don't usually think this way, but, I mean, it's not hard for a dentist to look into someone's mouth and to see if they have a receding gum line. It's maybe not as obvious for a patient to see their own receding gumline or understanding what's going on. Most patients aren't going to be able to tell you if the color of their gum is right or if it's incorrect. You X-ray their teeth, and you can tell if you need to put a filling in or not, or if the roots that I mean, you just know these things because you have the instruments and tools, and certainly there's a very specific skill set that you employ when you perform the work. But analyzing someone and saying, hey, listen, we have too much crowding here. This is not right. We need to remove a molar. Like that's what you do every day. A really good real estate agent that knows the market, that understands how healthcare, real estate deals work, that understands the landlord's motivations. They're going to be able to analyze your situation very quickly, and then they're going to give you information and give you options. So no one makes the decision for you. No one forces you to sign a deal or not sign a deal. They're just arm you with information saying, let's come up with a game plan. Like if you want to stay in the space, that's great. But we've got to have other options that we compare it to. We've got to know what it looks like if you wanted to own real estate and purchase. If you want to look at multiple locations to expand, like we can't just pick one property and negotiate with one landlord; we've got to go at the entire market, look at 4 or 5 options, eight options, and then negotiate with 3 or 4, because we don't have a basis to compare any deal unless we have multiple options. Like if you pick one landlord and you start negotiating either on a renewal or a new deal, the only basis you have for comparing the terms are where they started versus where they end. But that's a terrible way to measure the deal. If you look at eight properties and you can do that literally in an hour and a half, two hours, you don't have to spend half an hour on every property. You can do it very efficiently. And then if your agent negotiates with 3 or 4 landlords simultaneously on a non-binding basis, if one landlord is giving $50 a square foot and build an allowance, the next one's giving $45, the next one's giving $55, and then one tries to say, we'll give you $10 a foot. Well, ten is better than zero where they started. But that's a terrible deal. You're leaving literally $180,000 to $200,000 on the table. And so having that information just helps you realize this is what's possible. And you can get away from things like, well, we never do that, or we've never done that before. That's not how the game is played. I wish I could, but my bank won't let me. Like, landlords throw all these like completely arbitrary and unilateral statements that have no basis, and then they're waiting to see if the doctor honestly is ignorant enough to believe it. And typically, they are. And so when you have someone who's savvy, they're like, that's if that's your stance, you don't have a deal to make here. We're going to move on to the other three landlords that are competitive. When they hear that, they instantly change their tune. And here comes the revised proposal with what you asked for. And so it sounds, you know, pretty straightforward. But it takes a strategy and it takes a way of saying things. So again, it's always done with respect. It's done with dignity and integrity. But if you don't hold the landlords accountable, they will steamroll you, and they'll do it with a smile on their face. And they'll send you a Harry and David gift basket with some pears after you signed a lease. And I've never had a landlord send me a gift before, and it's like, yeah, you just overpaid by $300,000. Like they're $40. Harry and David basket saved them, you know, saved them $300 grand. Like, it's amazing the way that people don't see what's actually happening.

Dr. Noel Liu:
Now, one last question for you. So we spoke about leases. What about triple-net? Like a lot of times, I see like these leases, they have like humongous admin fee management fees. Like they just kill it. I mean, like, they're almost equal to the size of the rent on the lease itself. Is that negotiable or is that just set in stone?

Colin Carr:
It's very hard to negotiate triple-net leases. It's very hard to negotiate any of the operating expenses. But what you can do to make sure that you're not setting yourself up to get taken advantage of is start by just asking for a line item breakdown of the operating expenses. And that plays whether it's a full-service lease or a modified gross or a triple-net lease, because what you're going to get from most people that are running their properties properly is you're going to get a like an Excel spreadsheet or like a QuickBooks printout, but it's going to have everything, and you're going to see the property taxes, property insurance, property management, and then you're going to see like historicals on electrical, on water and sewer, on janitorial, on landscaping, on snow removal, and then you can start to get a feel for if these numbers make sense. If you see a management fee, and the management fee is, let's say, the equivalent of like $1, $1.50, a square foot on the property, that's a regular fee or a 3% fee. That's a fair fee. If they're charging, you know, a 20% management fee, that's probably going to be egregious, and it's probably going to be an unrealistic amount of money, and the landlord's just pocketing that as more profit. So you can determine if you want to do business with those people or not, or if you want to try to address that. A lot of things, though. A lot of times, the triple nets are made up of the three-nets are taxes, property insurance, and then operating expenses. And it's not uncommon to see property taxes account for even half of the operating costs. Like our office that we have is in South Denver. It's in a suburb called Lone Tree. The taxes alone in our office space are $10 per square foot per year. I mean, you look at just astronomical and it's a complete abuse of the tax system. I'm not here to get political. I'm just saying like $10 per square foot, just on property taxes. I mean, a 4000-foot space, and we're paying over $40,000 a year to the county in taxes. I mean, that's I feel like it's personally egregious, but that helps to make more sense when you see what the operating costs are $15 a foot. Well, 10 of the 15 are taxes, so it's a little bit more palatable from that standpoint because we can't do a whole lot with the county. Then we break down that $5 a square foot and figure out all right how much that's going to utilities. That's a direct pass-through. How much goes to snow removal direct pass through. And so then you get down to the areas of management fees and reserves. Those are the two areas that may have a little bit of play. So management fees and then how much you're putting into reserves for the property, those concepts are able to be addressed or discussed. And if you're going to have any success on capping something or negotiating, it would come there. But I will tell you this: most landlords won't touch those things even when they're charging excessive amounts. They'll just say, that's the way I run the property. If you don't like it, go somewhere else. So at that point you're looking at how does this property compare to other properties? And even if it's higher than you want to pay, if it's still the best property, the best terms, it just kind of comes with the territory.

Dr. Noel Liu:
And you always recommend doing it before signing the lease, right? Getting the itemized breakdown.

Colin Carr:
Absolutely, because there's zero you can do afterwards. I mean, you can audit the operating expenses for most leases. You can ask questions, you can get a CPA involved and make sure they're not, you know, violating accounting laws. I mean, they are under accounting principles and laws. I mean, they can be found to be fraudulent or to be, you know, stealing money and so forth from the association or from the tenants. But you're just better off to do it ahead of time. Like most things, you're better to measure twice, cut once, and this is one of those areas for sure.

Dr. Noel Liu:
Well, Colin, I think that's it from my side. What else you got to add, man? I mean, you gave like a ton and ton of info. This is something which I think a lot of our healthcare providers, as well as our dentist colleagues, they'll definitely find it helpful for sure.

Colin Carr:
Yeah. I mean, the final advice I would give is simply this. Just hire great people in every area that you're not an expert in. And there's a reason that people, you know, go to an oral surgeon to have a tooth removed or an orthodontist have braces put on or do Invisalign. You go to people that are trained in an area that have a history of better results. And in real estate, typically, you're not actually cutting a check for their services, which is fantastic. But even in other areas, like you hire a really good real estate attorney, you don't hire your brother-in-law who does family law in Iowa if you live in California, like you hire people that are qualified in your area. You hire a good architect, good contractors, good attorneys. You get good insurance, you hire good marketing companies, you hire good real estate brokers like the top practices in the country. This is how they operate. And it's the same thing for the top companies like go outside of healthcare. Like Chipotle is not going to get taken advantage of on a lease because they hire the best brokers. They have the best attorneys. You know, you're not going to see Starbucks sign a bad lease. They just don't do that. Like they hire really good brokers, they know what they're doing, and they have a strategy. So if Lockheed Martin, or Charles Schwab, or any office or retail user is going to handle real estate with a very specific focus and make sure they maximize the opportunity, just do the same thing. It's literally once every 5, 7 or 10 years, no one's asking you to dedicate your entire life to a new skill set or a new career. Just hire someone who's really good. They'll help protect you. And then if they save you $200,000, $300,000, you do that 4 or 5 times over your career, and you'll find out that you've got literally millions of dollars of savings cumulatively over a 20 or 30 or 40-year career. And that's meaningful for most people.

Dr. Noel Liu:
And a peace of mind.

Colin Carr:
Absolutely. I know we're ending it, but I would say this, that peace of mind is honestly worth almost more than the savings. Nobody wants to wonder if they got a good deal or a bad deal for the next 10 years. Like having information, having the ability to just say, hey, I know that I got the best terms at the best properties that fit my budget that I could afford. That made sense, like I did the best I could with what I had. And that's a great place to be in any position, but especially in real estate.

Dr. Noel Liu:
Well, Colin, you just changed my mind, honestly. Like, you know, thinking about, okay, I need to get professionals because the way I look at it is I like to delegate all my weaknesses. Honestly, if I have an HVAC problem, if I have an electrical problem, who am I going to call? I'm not going to tackle it myself. So, like you just put it, man. You put it. I mean, like, I don't think you can put it any nicely. Because we, as dentists, we're always trying to see like, hey, we delegate everything. But when it comes to lease negotiations, we want to do it ourselves.

Colin Carr:
Absolutely.

Dr. Noel Liu:
And that's crazy. I love it. Well, Colin, hey, thanks so much for coming in. We're going to land the plane here. We'll definitely have your info there. Just verbally. How would they reach you or your agents?

Colin Carr:
Yeah. Best way to get in touch with us is our website. It's CARR.us. So C A R R.us, upper right-hand corner or on the nav bar. If you're on mobile, click to find an agent, and then you can pick your state. Pick your market. You can start a conversation with anyone that you want to. You can see different bios. Some markets, we have a lot of agents, some markets, we have a few. But you can see the different agents, or if you want to keep it simple, just click the Contact Us button. Basically, like literally, like check 3 or 4 boxes, and we'll have someone get in touch with you within a matter of literally a couple hours, and they can start the conversation. And whether you have a need coming up in the next year or two, or even if you just signed a ten-year lease, but you're just curious how you did, we'll give you the time you deserve and set you on the right course. And even if you're ten years out, we'll still give you the time, the conversations and give you a few tips in the meantime.

Dr. Noel Liu:
Awesome. Thank you so much. Appreciate all your info. All right. Great. So ladies and gentlemen, make sure you like and subscribe. We know Colin was a great, great help. Make sure you look up for his agents. And if there's anything that's coming up related to leasehold improvements or lease in itself, definitely hook them up. All right, Colin, thanks so much.

Colin Carr:
Thank you.

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 Colin Carr:

Colin Carr is the founder and CEO of CARR, the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Every year, thousands of healthcare practices trust CARR to help them achieve the most favorable terms on their lease and purchase negotiations. Colin has been involved in commercial real estate for over two decades and has personally been involved in thousands of transactions.

Things You’ll Learn:

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  • Even with predetermined rates, lease renewals offer opportunities for negotiation, and tenants can benefit from expert representation to secure better terms and concessions. 
  • Having an independent real estate advisor specializing in healthcare is essential for reviewing leases, evaluating market conditions, and negotiating on behalf of the tenant. 
  • Hiring an expert healthcare real estate advisor can save healthcare providers significant amounts of money over their careers by ensuring they get the best possible terms on leases and purchases.
  • When considering purchasing a practice with an existing lease, it’s crucial to have the lease reviewed by an expert to understand the terms and potential for renegotiation.
  • Triple-net leases, where tenants pay a portion of operating expenses, can be challenging to negotiate, but an expert can help analyze the expenses and identify areas for potential savings.

Resources:

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  • Follow CARR on LinkedIn.
  • Explore the CARR website
  • Visit Secure Dental’s website and learn more about them!