Summary:
Understanding the rapid consolidation in dentistry is crucial for positioning your practice successfully amidst powerful entities.
In this episode, Charles Moser, a seasoned dentist and executive business coach, dives deep into the intricacies of dentistry’s consolidation wave, the rising influence of private equity in practice management, and the critical role of leadership and ethics in providing quality patient care. Charles brings his 16 years of hands-on dental practice and 15 years of DSO expertise to the table, discussing the challenges and opportunities that come with managing group practices and the delicate balance between patient care and profitability. He also tackles the perception of ethics in dentistry, the importance of personal accountability, and the impact of corporate influence on the day-to-day life of practitioners. Charles offers invaluable advice for dental practitioners at all stages, from solo practitioners to associate dentists, emphasizing the importance of maintaining a patient-centric approach and the benefits of mentorship and coaching. He explores how the culture within a dental practice can affect team retention and the success of the practice, along with insights into making practices attractive for acquisitions and investments.
Whether you’re a freshly minted dentist or a veteran in the field, this episode will provide you with the tools to navigate the changing tides of dental practice ownership and management. Stay tuned because you won’t want to miss the wisdom Charles Moser has to share.
Secure Dental-Charles Moser: Audio automatically transcribed by Sonix
Secure Dental-Charles Moser: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
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.
Noel Liu:
Welcome back to another episode of our Secure Dental podcast, where we bring in many bright individuals and talents from both inside and outside our dental profession. Today we have a very special guest, and this guy used to also be my mentor back in the day. Before we get started, this part is sponsored by DentVia, a dental virtual administration company that focuses on back-end dental office tasks like calls, claims, AR, etc., to assist our front desk and personnel with office tasks that we get done daily. Visit them at www.DentViacom. That's www. DentVia.com.
Noel Liu:
Now, let's dive right in. So today we have Doctor Charles Moser who is an Executive Business Coach for Dentists. His 16 years at the chair and over 15 years in the DSL space give him a perspective that has helped many dentists owners build and expand their businesses the right way. Whether you're looking to grow or maximize your current situation, Doctor Moser can help. He was a key member of the DEO team once upon a time. And is a certified speaker, trainer, and coach for the John Maxwell team. He always has an interesting perspective on the state of our dental industry, but we'll never waver in our belief that quality patient care and an excellent experience should be the primary focus of any practice, which is what I love about you. Without further adieu, I'm going to pass the mic on to you.
Charles Moser:
Oh man, no, great to be here. I couldn't have said that better myself. You know, that was really well done. I appreciate the kind words, and it's great to reconnect with you.
Noel Liu:
Absolutely. It's such an honor to have you here on my pod and share some insights for everyone listening.
Charles Moser:
What do you want to know about?
Noel Liu:
So, let's dive right in. Dentistry, in general, is solo practice versus group practice versus corporate. Give me a little bit about the insights and a little bit about the pros and cons of each.
Charles Moser:
Well, well.
Noel Liu:
It's a broad topic. Yeah, I was gonna say how.
Charles Moser:
Yeah, I was gonna say, how much time do you have? All I ever wanted to be was a chairside clinician ever since I was 13 years old. The reason I say that is because I'm not sure. I would love to think that. That's still why people are going into dentistry, and they still have that passion to go into dentistry at that type of young age. I mean, I knew exactly what I wanted to do. I wanted to hang out a shingle. I wanted to help people by fixing their teeth. I recognized that a healthy oral cavity was somewhat of a gateway to healthy systemic health, as well. So, it was all I ever wanted to do. When I ask people those questions and believe me, I understand that I have a bias because of the people that I talk to and the arena in which I play that maybe those people have a different opinion and a different reason for going into dentistry. But what I see right now is a bit of confusion out there as to what the mission is for people. Now, you said it perfectly when I said quality care is absolutely number one, no doubt about it. You've got to do as I used to tell my associates. You got to do the best quality that your hands can possibly do. That's all anybody can ask. And then second to that is making money. I'm a big believer in making money. I don't think there's a problem at all with making as much money as your two hands can possibly make, morally and ethically, are the two key words there. And again, that's kind of a broad topic, too. We all know that if you give one patient to ten dentists, you're going to get 11 treatment plans, right? You know, and I'm okay with that, really.
Charles Moser:
I have no problem with that. As long as you believe in your treatment planning and you can walk the walk, you can do the dentistry that will last the appropriate amount of time, bring the patient back to a state of health, and maintain it. If that's 28 crowns in your world, I guess, great. It might not be in somebody else's, but we know people who do that, and we know people who do it well, and we know that they believe in that. So whatever. But I just hope that people are going into dentistry with their eyes wide open, if you will, recognizing how hard it is. I've said this so many times on so many podcasts, and I'll say it again: there is nothing harder than dentistry. There's not a job out there that is as tedious, works on an awake patient, has the margins that we have, has to deal with external forces that we're not prepared for, and has to be an entrepreneur and a producer at the same time. There's nothing as hard as being a dentist. So, I just hope that people are going into it with the right frame of mind. And there's so much more dentistry to learn now than there was when I was a dentist, and yet we're still trying to do it in four years. I didn't have scanners, I didn't have milling machines, I didn't have CVTs, I didn't have any. I didn't have to learn any of that. And I don't think they've taken nearly as much out of the curriculum as they have put into the curriculum. So find yourself a good coach, find yourself a good mentor.
Noel Liu:
So basically, what you're saying is whether it's a solo practice, a group practice, or a DSO or corporate dentistry, I mean, the patient-centric, that is like the key focus, right? Because that's what I see. Many solo practitioners really hate the DSOS and they really hate the corporates because they feel like it's just a money-grabbing machine. But what you just said, I think it kind of nails it right in the head.
Charles Moser:
So look, I want to speak to people out there who are working as an associate anywhere right now. If you're an associate, right, and you're not on a pathway to partnership, I know that most of you out there are thinking, well, I'll do it right when I own my own practice. You know, when I own my own practice, I'll do it differently. I'll put the rubber dam on it when I own my own practice. I wouldn't seat that crown, but I'll seat it in somebody else's practice. Hey, man, I know it. You know what I mean? So, let's just be honest out there.
Noel Liu:
Let's just be honest.
Charles Moser:
Let's just be honest: if you're working, especially if you're working for a DSO, I know it, I just know it. And so I would say to you, I know it, I understand it. And stop it, okay. Just stop it. Just tell yourself right now, no, tomorrow I'm going to walk into the office and treat these patients as if they were patients in a practice that had my name on top of the building.
Noel Liu:
I love what you just said, you know. I just love what you just said.
Charles Moser:
Because you can't turn the switch, right Noel? You really can't. Once you learn those bad habits, baby, they're there, you know. They are there. So I understand that being an associate is viewed by many as quote-unquote practice, the warm-up or the B team, or whatever you want to call it. But let's use it as practice. But let's make practice our perfect practice.
Noel Liu:
Exactly. You know, like I always keep saying whether it's a solo practitioner, if it's a group practice, or if it's a corporate right, if we have the right habits, we have the right mission. Like you just said, you have the right vision, of what you want to do for your patients, it doesn't really matter whatever setting you're in. And I think people with the solo practice guys they need to start looking outside the box and having a little bit more wider mindset than to just have this narrow frame of mind that only these guys can do it better than anybody else.
Charles Moser:
Well, let me ask you a question. Where are we in the bell curve of consolidation right now? What do you think? Are we on the downside of it or where do you think this bubble is right now?
Noel Liu:
My thing from the last time I checked, we were still climbing up. I mean, last time we checked, it was around 20%. And I believe like today, somewhere around like 27 or 28, maybe even 30% at this point in time, maybe even more. We just need to understand it's coming.
Charles Moser:
Yeah, right. Well, it's here, it's here.
Noel Liu:
Right? Yeah. It's here. You're right, it's here. And whether we embrace it or we fight it, I mean, I would say we just go with the flow and just try to do the best that we can as dentists. And eventually these roll ups are not going to stop. It's just going to get even more and more.
Charles Moser:
I'll agree with a caveat to that. And by the way, I think that it does take us back right to our core values and our mission of I don't care where you're practicing, do great dentistry, and if you can't do great dentistry, find out how to do great dentistry, and don't settle for less than what you would settle for. As I said earlier, as if your name was on top of the building. Okay, so let's keep that in mind no matter where you're practicing. Having said that, I think the dumb money has left the building as far as private equity and venture capital and those types of things, I think we can still see big multiples, but we're not going to see big multiples for these duct tape type of roll-up DSOs. If you've got 15 practices with five different practice management systems, no real sense of training and onboarding, no roles and responsibilities in place, and the margins are all over the place at every different location, then I think you're going to have trouble getting rid of that. And in my opinion, what's going to happen to those DSOs or those group practices is they're going to get sold off into chunks to individual people like, you know, like I said, okay, well, I'll buy three of them type of thing. I'll buy the three that have open dental, and Noel will buy the three that have Dentrix and somebody else buy the three with Eagles often.
Noel Liu:
Let's talk a little bit about this.
Charles Moser:
Okay.
Noel Liu:
This is an interesting point that you just brought up duct tape DSO. Yeah. You know, number one, why would somebody do this. Number two is what are group practices or bigger DSOs or even private equity or venture capitalists. What are they looking for when they're looking into buying a dental deal. So you're the expert in this. I want to hear you.
Charles Moser:
Yeah, well, I'll put it into I always talk about hamburger places, you know, it's like if you're an investor and you want to buy some hamburger joints, you're not going to buy five McDonald's, five Burger Kings, five In-n-out's, and five Whataburger's to make 20 and then say, I've got 20 locations and then take that to your team and say, we've got 20 hamburger joints, right? He's like, no, you don't. You have four groups of five is what you have, and your COO is going to hate you, right? Because he's got five different operating systems to deal with and five different systems to train on. And so I think the venture capitalists and the private equity groups have figured that out. And they'll pass on those 20, but they'll look for a group that has five of the system that they're already running. I think that we're on the other side of people expanding just to expand their numbers because they're finding out that's just too hard to stabilize once they buy it. So I think we'll see those types of duct tape DSOs. And again, I'm just pontificating. But I think we're going to see those 15 to 20 locations that are somewhat duct taped together get split-off. And I still think we will see consolidation, but it'll be more like let's call it NCAA football, where we're going to have super powers, we're going to have the heartlands and the Pacifics and the out of California.
Charles Moser:
We're going to have groups of 3000 or 3500 offices, and we will have some superpowers in the consolidation. World of dentistry. And I think the good news with that is if they do it right, I think Heartland does a really good job of it, actually. Didn't you work for Heartland? Did you?
Noel Liu:
No. No,
Charles Moser:
No. Okay. They have a really robust training program. If you come into Heartland and you want to be a great dentist, Heartland creates that opportunity for you. My hat's off to them. So I think that's a really great avenue. And we can have that. Now how does Heartland get out? You know, once you've got 3500 locations, you know, that's another podcast. But yeah. So I think that's where we are. I think that private equity has gotten smarter. There will still be some really nice multiples if you have something of value for them to buy. There's still plenty of money on the sidelines out there, but they're not giving crazy multiples for bad deals anymore.
Noel Liu:
And how important is management in a group?
Charles Moser:
Well.
Noel Liu:
or it's not really important?
Charles Moser:
Give me more to that. So in other words, if I'm buying something how important is management.
Noel Liu:
Correct. So let's say if you are a private equity guy and you're looking into a deal, let's say eight locations, for example, how important is the management company like in terms of managing all the offices like oh, it's probably managers.
Charles Moser:
Well, as far as the org chart goes, I don't think that the management company is going to be that important because they're just going to dissolve your management company and put everything underneath theirs.
Noel Liu:
Okay.
Charles Moser:
You know, I mean, I think certainly. But would that.
Noel Liu:
But would that consider them like it's not a duct tape DSO and it's like a little bit more aligned with what they're looking for rather than just everything clumped up together.
Charles Moser:
I think the big things that they're looking for are what is your practice management software. That is first and foremost. So if you're listening to this and you've got multiple locations and you have multiple practice management software, you need to be looking by the end of 2024, or at least the end of 2025, if your goal is to sell it. And that's your exit strategy, which is fine. It is a business. That's the first thing you should be looking at is, how do I get all of my practices on the same software. That is first and foremost, from a private equity standpoint, what they're looking for. The next thing that I think they're looking for is what are your onboarding and training systems. Because I think that COVID is well behind us as far as from an employee standpoint. I love what I heard not too long ago at a seminar where they said, the labor war is over and labor won, okay? They did at $20 for minimum wage in California now. And we know what hygienists are making. And I don't know how you put that toothpaste back in the tube. So labor won. But having said that, we do have people now that are looking for jobs.
Charles Moser:
People are coming back into the workforce. We are paying a lot for it, but at least we have options. Now, having said that, I do think that we still see a certain amount of turnover. And again, if you're listening to this and you want to know how to win the game, you have to figure out how to train and onboard people to be productive fast. That's the key. When you lose an office manager, when you lose a regional manager, when you lose a dental assistant or hygienist, whatever it is, the faster you can bring in somebody new and train them and onboard them to be productive, the better off you are and you win. Because now you're not a slave, you're not held hostage or whatever. I don't know what I can say politically correct. You're not at the beck and call, right? Thank you. You're not at the mercy of the employee anymore. You could take somebody and you can onboard them, train them. And if you want to go just another layer deeper into that, I'll maybe give somebody a nugget here. Ask yourself the question, what position are you training and what are they going to be doing 75 to 80% of the week? What is their role look like that they do 75 to 85% of the week trained to those things?
Charles Moser:
Don't necessarily put somebody next to somebody and say, hey, sit next to Doctor Liu and watch what he does. That person may not be doing what Doctor Liu does, right? So why are we training them on something that they're not going to be doing every day, all day? The idea is to get them trained on the things that they're going to be doing every day, all day. You have to recognize when you turn people over to train people, what are they going to train them on? They're going to train them on the things that they do well, which, again, might not be the things that person is supposed to be doing. So again, big gold nugget for people out there right now. If you've got somebody that's new that just started or is starting tomorrow, ask yourself the question what is their main function? What are they going to be doing 75 to 85% of the week and train them on those things? Get them proficient as fast as possible.
Noel Liu:
Love it. So onboarding number one is practice management and onboarding. What else?
Charles Moser:
Yeah. So I think that, you know, a good healthy new patient flow.
Noel Liu:
Are they also looking to the retention of associate doctors or?
Charles Moser:
I mean I think they are. But again I think that is probably the biggest unknown out there. So look I think that you can't talk about that in a gross generality type of thing. So let's talk about the extremes. I was a dental director for a Medicaid, DSO. We do 12 things, we just don't do a lot of stuff. So our onboarding and training was what I just said. We trained, we took new grads, and we trained them to do sealants, trophies, composites, pulpotomy, and stainless steel crowns. And if we could get them proficient at that, they could be a great asset to a Medicaid DSO. Flip that around. And now you've got these super GP DSOs, and you've got people that are doing all on X, sedation, all these kind of really fancy things, the veneers, and just really complex dentistry. You better have a path to partnership in place for those people because it takes you way too long to get those people up and running to do ten, 15, $20,000 a day, right? But in our case, when the Medicaid DSO, nobody was a partner, we had 200 associates. None of them had partnerships because they were easy to replace. So we got bought three times. We went through three flips, and associate retention was not an issue at all, because we could take a new grad and get them up to speed in a matter of months.
Noel Liu:
Makes perfect sense. Yeah. So for someone to start with a group practice, I mean, somebody who has one practice and now they want to be like, hey, I want to open up a second or a third. What is one of those main things you see in the industry that's the why. Why do they want to do it?
Charles Moser:
Ego.
Noel Liu:
Love it.
Charles Moser:
I think come on now. Let's be fair, I'm not saying that as a negative either. I'm just saying that we all just again, let's be honest, okay? A lot of ego out there, which is fine. Again, I think it's my bias from the seat that I sit in is how many people call me during the week and say, how do I get out of the chair? And I've had dentists, three or four years out-of-school tell me, I don't like this. How do I get out of the chair? It breaks my heart, okay? Breaks my heart because I injured my hand and I had to quit at 16 years or I'd still be sitting there and I would have never met you, which would have been a terrible thing. But, you know, I'd still be cutting teeth and taking care of people, right? So when people call me and say, how do I get out of this? And there's a couple of Facebook groups out there that are posting things from dental students, right, that are already talking about, oh my God, I hate this. You know, what should I do? Like, man, I mean really, it just breaks my heart.
Noel Liu:
And then dental school, they can always just say, hey, I'm going to call it quits rather than going through the whole nine yard and then quitting afterwards. Right? I mean, the sooner they quit, the better, right? Because you and I, we both know dentistry is not for everybody.
Charles Moser:
So it is not.
Noel Liu:
It is not these guys they got in by mistake or they thought, you know, the money was good and now they're finding out that, okay, it's a lot of back-breaking kind of procedures.
Charles Moser:
It is hard. Yeah. So I mean I don't know I think that maybe there are more entrepreneurs in the dental space than there were 20 years ago. And so that's why they want to create a group practice.
Noel Liu:
So going back to your first statement that you said, do it for the love of patients and do it with the patient care and patient-centric, these guys who actually hold the dental degree. And now they want to open up a good practice because they just don't want to practice dentistry. Do you think they are contributing to the problem, the issue, or are they solving the issue? Not to name anyone specifically, but just kind of pointing it out.
Charles Moser:
Don't have anybody specific to name. I mean, look, there's good guys and bad guys in every industry.
Noel Liu:
Sure.
Charles Moser:
But I can tell you is that dentistry 30 years ago was, I believe, third in ethics perceived by the public.
Noel Liu:
Correct.
Charles Moser:
That's not the case anymore. So that says a lot. Yeah, it says a lot. And the problem is, is that low quality dentistry is so damaging to people. If you get a bad haircut, a bad manicure, you buy a bad suit, a bad car, or whatever, you know, I don't care if you buy a $75,000 Mercedes, right? And it's a bad car, you can still get out of that if you do bad dentistry. You cripple people for life. There's some serious consequences to it. One of my mentors used to say surgeons bury their mistakes. Dentists have to see them every six months, you know?
Noel Liu:
Right. Let's just stick on this for a little bit because, you know, you and I, we both know. Like even I had associates in the past where they burned those patients. And, you know, we get to deal with them still. And my new associates are getting to deal with them. What do you think is going on? Is it because of one of those scenarios where you felt like this guy went to dental school, and now he came out, now he doesn't want to do dentistry anymore? Or is he just like doing it for the money, or is he just doing it for. You know what, I don't care, it's not my mouth.
Charles Moser:
I think there's a lot to be said about what we were talking about earlier, about if I were you, I would take that expression back to your associates and say, I want you to pretend like your name is on the top of the building. Every time you see a patient, I want you to see your name at the top of the building. And it'd be interesting to, I don't know how you do this study, but my office, the name of my office was Charles S. Moser, DDS. It wasn't Apple dentistry, best case scenario dentistry, or amazing dentistry, right? I mean, it was personalized. My brand was my name, not some fancy elite dental partners type of thing right?
Noel Liu:
Right.
Charles Moser:
So there was an old commercial as a car commercial that said, would you do your job differently if you had to sign your name to everything that went out of your office? If you had to put your name on everything that you did, would you do it differently? And so I think that's what I'm saying to you, is that people should tell their associates, I want you to practice dentistry like your name was on the building, and as if you had to sign everything.
Noel Liu:
And that changes a perception.
Charles Moser:
I mean, yeah, yeah. You know, so that's number one. But we were talking about.
Noel Liu:
So we were talking about like these guys who are actually got into the dental field, let's say by mistake or they don't like it or they change their mind, they cannot do dentistry anymore or, you know, various reasons. And they want to go and start group practices. And now they are looking at the hard work in group practices where profit is all of a sudden is dipping because it can't be everywhere at all at the same time. And now they are like, all right, cool, I hate dentistry, I don't like to be in that dentist. And now I got to run this business and now I'm in a dark zone. So with this whole circle of cloud, how do you analyze situations like this? Because since you are coaching a lot of people, I'm sure you come across guys like this.
Charles Moser:
Oh yeah. Well, all you're doing is shifting your challenges. You're just shifting your problems. You know, if you want to create a group practice and build a network of offices with a bunch of associates and not be at the chair, if you think that's easy, then you need to think again. It's just a different hard, you know, it's just not practicing dentistry. Which by the way, at least practicing dentistry is within your control, right? Your associates practicing dentistry is not in your control.
Noel Liu:
That goes back to the core value that you just said. Right. Patient centric. But let's say these guys, you know, they don't care about their work. They don't care about their name. They're just like doing like crappy work, for example. And now they have a group practice. Now I can see what the culture is going to go and now when they get in trouble. So basically it's like, hey, what about patients, right? Patient first or is it the profit first?
Charles Moser:
If you do great dentistry and create great experiences for people, and you understand how to lead teams of people, inspire them and value them, and empower them to make decisions, you'll find that you'll make money. Just figuring out how to make money without those things means churning patients, right? Just a whole bunch of new patients, a whole bunch of same-day dentistry, and just churn, churn, and churn. By the way, when I was practicing dentistry and when my clients told me about the same-day dentistry that they did, I said, that's great, but I want you to know, my goal is that you don't do same-day dentistry. That's my goal because I'd like you to have a schedule of patients that come in to get their work done. And it's predictable. That's the work you're doing. You already know what your production is. All the insurance is taken care of. This whole idea of same-day dentistry is Russian roulette. You know, it's just mind-boggling to me. So the goal should be not to do any same-day dentistry. The goal should be to treat people well. Look, man, when was the last time you bought something for $5,000 that you took 45 minutes to think about? We don't. I mean, we research the shit out of things. We got to go talk to people. We're going to get on the internet. We're going to look it up. We're going to look at reviews, and we have patients that come in and we create five, ten, $15,000 treatment plans, and we put them in a room with a treatment coordinator and expect them to close that case. And we do it. I mean, it's done. I think that's pretty incredible, frankly.
Noel Liu:
But well, I guess it depends. What's the patient's goal and patient's outcome like, you know, what are they looking for? If they're looking for somebody who wants to get it done the same day, that's a different story, right?
Charles Moser:
Well, if you have an emergency or something like that or some small dentistry that you can fit in. Sure, absolutely. But when we talk about same-day dentistry being 50 to 60% of a person's production, everyday. That's a tall order. I think what I heard just the other day was that same-day dentistry should be about 15 to 20% of your day. And I was like, okay, I can handle that, right? That's the emergency that walks in or something like that, or something that comes out of hygiene, that you turn around and put them into a restorative chair. But they've already been a patient of yours. It's not that new patient that came in at 9:00, and at 3:00 they're still in the chair. You know, they've spent all day at the dental office. Correct, correct.
Noel Liu:
There are those days where these doctors will be, you know, seeing patients for at least like 4 to 5 hours. Yeah, that's a little bit excessive I agree, I agree 100%.
Charles Moser:
Yeah.
Noel Liu:
So switching gears a little bit now since we spoke about the group practices, what is a good part about a solo practitioner and they're partnering up with let's say a DSO or maybe like a group practice with multiple offers? And they want to grow still. Where do you see like the collaboration? What are some of the good and the bads that you're seeing?
Charles Moser:
Well, so there are a lot of good, frankly. I mean, dentistry for so long was a cottage industry, the whole shingle thing, right? And we were on our own island and we didn't talk to the dentist down the street. We really were very isolated, which meant that we didn't share ideas, we didn't share concepts, we didn't share out of the box thinking. And so I think it delayed the industry's growth medicine. You had these hospitals, right? So you had these just huge, abundant amounts of clinicians. If you've ever been in an operating room setting, you know that there's this room where all the surgeons sit, right? And they all eat their donuts and drink their coffee while their patients are being prepared for surgery. And they get to sit there and talk about things. And maybe not all of it's medicine but at least they have a way to share. And we didn't have that. So I think the group practice, the larger practice settings, create an environment where we're much more willing to share information and collaborate and ask people. And again, if you have the ability to be vulnerable and say, hey, this didn't come out so good, you know, how do you handle this situation? Right? So I think that's been a really good thing. Now, why hasn't that happened? Well, it hasn't happened for the most part, because people won't drive 50 miles to go to the dentist.
Charles Moser:
They will drive 50 miles to go to a hospital to have surgery. But we want our dentists to be close by. So we're having to move that patient mindset out of this dentist on every corner type of thing in this consolidation realm. And I think that probably in 30 to 50 years from now, you will see people driving further to go to the dentist, because we'll have more dentists in one location type of thing, and we'll be able to share expenses and share some costs and hopefully control the price of dentistry these days. So I think that's a really big plus about group practices, is being able to share ideas and learn and have a mentor, maybe even just somebody that's 2 or 3 years out of school ahead of you. Right? But just someone that you can I used to call it a hand that you can high five and a shoulder that you can cry on. You know, they filled the bill for both of those. So that's a really good thing. And I think that also look, dentistry is a business. And clinicians who go to dental school are not trained to run businesses. So I do think there is definitely a need for corporate dentistry. I think that absolutely, we should be letting business people run the business, and we should be letting clinical people run the clinics. And when you have that synergy, when it works well, which we did, we had a really great CEO.
Charles Moser:
It worked very, very well. We made money and we like to call it. We put enough pressure on each other to create a diamond, right? Because they would push us and we would push them. But neither one, the clinicians, had 51% of the decision-making power. That's the way it was set up. We told the business guys, you can decide what number two pencils we buy. You can decide what computers we use, but you do not walk into the laboratory. And so I do think there's a need. I mean, we do need to be teaching these clinicians business. They need to understand what the metrics are. They need to understand what the baselines are. How much of your PNL should be your staff, how much should you be spending on labs? Because, look, a percent is a big deal.
Noel Liu:
Of course.
Charles Moser:
A percentage is a big deal. People don't think it is until you say, okay, well, what'd you do? Like what was your production last year? We did $1 million. What's 1% of that? It's $10,000. It's like, okay, well, give that to me. Like you're crazy. So evidently 1% is a big deal. You know, if you don't want to just give me ten grand. If it's not that big of a deal, then I'll take ten grand.
Noel Liu:
That's a big deal, right? Exactly, exactly. So how much of it do you think it's supposed to be? Like a school's responsibility to teach those students? Or is it something that should be like part of the curriculum, or should it be like part of the CEE or something where these guys should just, like, collaborate and just let him do it? Or should a dentist even learn all these financials?
Charles Moser:
No, no, nobody should be teaching it. They should all go to www.bluehorsepersonal development.com and reach out to me and let me help them with that. So.
Noel Liu:
No definitely. Definitely. I don't think you've been coaching right. You've been coaching for a while. Yeah. And you know some of the drawbacks that, you know, we all go through.
Charles Moser:
Oh yeah. No, I so you asked a question earlier that I didn't answer properly. It was about some of these clinicians deciding to go into group practice and how to do it the right way.
Noel Liu:
The right way. Yeah. And avoid some of the pitfalls.
Charles Moser:
Yeah. So step number one is you need to evaluate what your risk tolerance is. Okay. And that's a question that a lot of people don't ask themselves. It's like so I used to ask my patients. Because selling dentistry and I don't mind the word sell, what I was selling was moral and ethical. Selling dentistry was a matter of creating a treatment plan that met the needs of the patient, such that they were able to do the things that they valued with their teeth. I would say to them, what's the most important thing to you about your teeth? And they'd say, well, I want to keep them. I like to eat, I like to smile. Everything that I've designed for you is designed to do just that, to keep you eating, to keep you smiling, and to keep you healthy. Would that be okay with you? And the patient would say, of course, it is. The next thing I needed to figure out was what is their risk tolerance. And so I would say to them, would you drive your car from Houston to Dallas, which is a 220-mile drive? Would you drive from Houston to Dallas on a bald tire? Now think about that. Would you drive yourself? Would you drive four hours on a bald tire on the highway?
Noel Liu:
Personally, I wouldn't, but okay, somebody would, right?
Charles Moser:
Somebody would. So the person that says no has a low-risk tolerance, right? The person that says yes has a high-risk tolerance. If I've got a patient that's got a three-surface restoration in their mouth, that's got a little bit of an open margin or whatever like that, and they have a high-risk tolerance. Do you think I have a real good chance of converting them to do a build up in a crown? No, because they're going to say to me, I'll come back when it breaks. I'll come back when it hurts. Right? It's like, okay. I mean, I'll explain to them the ramifications and the consequences, but I'm also going to just write in their chart that this person is willing to take the risk, and we will be here for them when they need us. But when Doctor Liu comes into my office and says, hey, man, if anything looks like it's going to blow up in 2 to 3 years, I want to fix it now. That is a low-risk tolerance. So I'm going to present the treatment plan to you. I'm going to quadrant it out to you. And I'm going to say we're going to do this. And each quadrant is going to be two appointments and an eight appointments. Three months. We're done. And you're on re-care.
Charles Moser:
Here's what it costs. Here's how you can finance it. When would you like to start? We have Thursday at 8 a.m. open-type of thing. So the clinicians who are going into business and who are going into group practice need to ask themselves the same question, what is your risk tolerance? When your banker calls you and says, hey, that balloon note that you took out 12 months ago is now due and your line of credit is maxed out. How does that make you feel? Because that happens. It's fixable. You can solve it, you can take care of it. But if that's going to cost you stomach lining and sleep, you need to think about slowing your pace down a little bit, right? Make sure you've got the cash in the bank to do these deals. Don't be taking loans from people named whatever. You don't want to end up in the bottom of Lake Michigan because you can't pay your loan.
Noel Liu:
Correct.
Charles Moser:
So what is your risk tolerance? And if you can take a lot of risk and you can get the money and dentists can, then go for it, man. Have a great time. Do quality dentistry. But you're taking a big risk. If you are not a risk taker, then you want to go slower.
Noel Liu:
And so with that being said, how important are mentors and coaches?
Charles Moser:
They're everything right now and I love what I do and I am one of so many great ones out there. There are a lot of, again, I don't care who your coach is, I don't care if it's me or not but you got to get one because you will have so, let's take it into the positive, things will be so much easier for you if you have an objective opinion that can push back on you and say, no, why are you buying this office? Your other three practices are not even close to maximized. Why are you looking at a fourth practice? It's kind of like what we were talking. When we were talking about how do people train people? They train people on what they do. Well, well, you're buying this practice because you get excited about buying practices, not because it's the right thing to do, because it excites you. And that null ego, right? It's like, oh, now I have four practices. Now I have five practices. Right? And that's a great thing to say at a dental convention. But it's a crummy way to be if you are taking money from practice one and two to pay the bills for practice three and four, that is not a good place to be.
Noel Liu:
So got it.
Charles Moser:
That's definitely a need to get a coach. You definitely need to get somebody who will push back on you. And if they're not creating pain for you, they're not a good coach. They need to be pushing back enough on you to where you're kind of pissed off at them every once in a while.
Noel Liu:
I love it.
Charles Moser:
No, no, seriously, because you don't want to hire just a yes man. I mean, this is not a job where you just, oh, you're amazing. Every once in a while, they're going to tell you something you don't want to hear, which is typically you're the problem, not your team. That's typically what they don't want to hear, so yeah.
Noel Liu:
It kind of reminds me of the analogy of when Jordan was playing and Grover was his coach or his mentor, right? I mean, he used to pick stuff out, which used to piss a crap out of Jordan. And I still remember this time where, you know, he's considered the greatest basketball player of all time, but yet his coach knows his weaknesses.
Charles Moser:
Yeah
Noel Liu:
I love it. And I love it. What you just said.
Charles Moser:
One of my favorite stories was Jack Nicholas in The Masters. He was on part three, and his son, Jack Jr, was his caddy. And Nicholas looked at him and said, you know, what's the yardage to the pen? And he said 182, or 183, something like that. And Jack Nicklaus looked at his son and said, which one is it? I mean, you know, right, if you're not going to give me a number, then I don't need a range. I can see, right? I need a number. So, wow, that's what your coach is for, is to tell you, hey, this is not about blind spots. Yeah, it's not about getting close. This is about getting it, you know?
Noel Liu:
Yeah, exactly. So it's either you win or you don't, right?
Charles Moser:
You know, that's a really great statement because I see a lot of people doing great things out there. And they're making money, and they're doing good dentistry, and they're living the life and they're having a good time. And then I see people that are just underwater, and there doesn't seem to be a lot of middle ground, you know. And here's another really interesting thing, Noel; this came to me the other day, too. It's like I have clients that have one practice. And when I ask them to do something, they'll say to me, I don't have the time. I have clients that have 20 practices, and when I ask them to do something, they say, oh, I don't have the time. And I'm like, wait a minute, what's going on here? That this guy's got 20 practices, and you've got one practice, but neither one of you has the time to do anything.
Noel Liu:
What did you make out of it?
Charles Moser:
I don't know what to make out of that. Well, Parkinson's law.
Noel Liu:
Yes.
Charles Moser:
Parkinson's law, right? Parkinson's law simply says that the time allotted that you give to the work will be filled by the work that you give the time allotted to.
Noel Liu:
And I'm a true believer in that.
Charles Moser:
Right?
Noel Liu:
Right. I procrastinate a lot of things.
Charles Moser:
Well, if I give you an hour and a half to do a crown prep, you'll take an hour and a half. If I give you 45 minutes to do it, you'll take 45 minutes. If I say to you, this patient is late, but they want to do two crowns, and you only have 35 minutes, you'll do it 35 minutes.
Noel Liu:
Precisely. It's all the goal and the target that you have set in place for us.
Charles Moser:
Let's get to work. Let's get to work.
Noel Liu:
So, last question for you.
Charles Moser:
Sure.
Noel Liu:
Let's talk about leadership. How important is leadership in practice, in group practice, and in any organization?
Charles Moser:
So, however important anybody thinks it is, quadruple it. And then double it again.
Noel Liu:
Quadruple it, and then double it again.
Charles Moser:
You have no clue how important it is unless, you know you know, you know, type of thing. Here's the proof. You can have great systems but lousy leadership.
Charles Moser:
Now, do you like that combination, or do you like average systems with great leadership? Which one of those scenarios would you prefer?
Noel Liu:
Second one.
Charles Moser:
Give me average systems with great leadership every day and twice on Sunday. Another way to put it is I would rather have everybody hitting on all cylinders, executing a mediocre plan than people not executing on a great plan. And the way that happens is through leadership. It doesn't happen through systems. It happens through leadership. Leaders do three things every day. They value the people they work with. They inspire people to do things that they never thought they could do on their own. And they empower people to make decisions, not tasks, but to make decisions that will retain your people. They will not leave you for $0.25 an hour if they get to come into a place and make decisions and know that their boss has their back. Look, man, none of these decisions that are being made are all that big of a deal. We're not asking them to make the decision. Should we buy this practice or not? But we might ask them to say, hey, I want you to evaluate the front desk of this practice.
Charles Moser:
I'm giving you the power to bring me the information on this. There's a really amazing statement that says the sophistication of an organization can be determined by the number of people who can say, yes, now think about that. If you're listening to this, I want you to ask yourself how many people in your organization can say yes to something, and if you're the only one that has the ability to say yes, guess who the problem is. You're the bottleneck, right? Every decision, if you're out there and you're like, oh my God, every day I have to make every decision. They come to me and ask me, can we buy more C-fold towels? Can I go get some more swifter mop things to clean the office? Can I order more copy paper? Can I call the IT service? If you're the only person that can answer those questions, that's ridiculous. That's why you hate dentistry, okay? That's why you hate coming to the office, is because you're overwhelmed with ridiculous decisions that you should not be making. All of that is leadership. It's all leadership.
Noel Liu:
And how does it affect the vision of that practice?
Charles Moser:
Well, you can't execute a vision because nobody has been buying your vision, right? Your team isn't bought into it
. First of all, they don't know it. I mean, if you're that person, your team doesn't know your vision. Okay? You probably haven't even established a vision yet, frankly. Dentistry is a very unique situation where we do need a vision and we do need core values because from the core values culture is created. It just doesn't happen any other way. If you want a culture of teamwork, then you have to embody teamwork every day. And I have to say to you, Doctor Liu, I would say, okay, well, how do you demonstrate teamwork every day? And if we have a team of people that embody and demonstrate teamwork every day, then our patients will walk in and say, y'all are a great team here. And guess what? That means we have a culture of teamwork. But if it's just words on a page and you're trying to build culture from words on a page, it doesn't happen that way.
Noel Liu:
It doesn't happen.
Charles Moser:
It doesn't happen that way.
Noel Liu:
No one feels it, right?
Charles Moser:
No one. Feels it. So you cannot execute your team if you don't have the buy-in from your teammates on your vision, and you will not get the buy-in from your teammates if you're just managing them every day. It's carrot and stick, carrot and stick, carrot and stick. If you do it right, you get the carrot. If you don't get it right, you get the stick, and you will not get people to buy into your vision, and they will leave you for $0.25 an hour to go work for the guy down the street. And you cannot. Look, you weren't taught this stuff in dental school, right? I mean, so this is why you need a coach. They're not expensive. It's the best investment you will make. Believe me. You spent more on your lab five times your lab bill. You know, whatever. I'm just telling you, you have to do it. It doesn't have to be me. I don't care, by the way, I only have room for, like, three more clients if anybody wants to call me, so you know.
Noel Liu:
Exactly; with that being said, how did it get a hold of you?
Charles Moser:
The name of the company is Blue Horse Personal Development, and the website is www.bluehorsepersonaldevelopment.com or bluehorsepd.com is all one word, of course. Now, my friend and partner, Doctor Tarek Aly, and I are about to launch a new program, and I really can't say much more other than the first 30 people who get in will get in at a 60% savings.
Noel Liu:
Wow.
Charles Moser:
So here's the deal. If you go to my website, www.bluehorsepd.com, and you just reach out to me, you just do that contact me page. I will put you on a list to reach out to you in May, and you will be first up to be one of the first 30 people. We will not sell your information. I am not fishing for emails. I just can't tell anybody really anymore about it. But it'll be some of the biggest powerhouses in dentistry. Might even be Doctor Liu involved in this. And it is going to really stand the dentistry world on its ear. In www.bluehorsepersonaldevelopment.com just send me your email. I'll put you on the list. We will not sell it. We will not solicit you. We will just offer you first into this new opportunity.
Noel Liu:
So we'll definitely have the link us as well and the URL as well on the pod. So,
Charles Moser:
Oh sure.
Noel Liu:
Awesome. Absolutely. So let's land the plane. Well, thanks again, Doctor Moser. I mean, it was a great honor to have you and share so much insights. Great, great nuggets that you dropped.
Charles Moser:
The pleasure was mine. No, it was great to see you again. And yeah, I hope your listeners got something out of it that they can use.
Noel Liu:
100% I think they did. So, with that being said, thanks again for joining us on our Secure Dental podcast. Make sure to like and subscribe, and we will be back next month with more episodes with great talents, just like Doctor Moser.
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. Charles Moser:
Dr. Charles Moser is an executive business coach for dentists. His 16 years at the chair and over 15 years in the DSO space give him a perspective that has helped many dentists/ owners build and expand their businesses the right way.
Whether you are looking to grow or maximize your current situation, Dr. Moser can help.
Dr. Moser was a key member of the DEO team. And is a Certified Speaker Trainer and Coach for the John Maxwell team.
He always has an interesting perspective on the state of our industry but will never waiver in his belief that quality patient care and an excellent experience should be the primary focus of any practice.
Things You’ll Learn:
- The dentistry field is rapidly consolidating and morphing into powerful entities. Understanding this trend is key to positioning your practice for success.
- The quality and vision of leadership are pivotal in driving any dental practice’s success, even more so than the systems in place.
- Balancing profitability with ethical patient care remains paramount. Dentists must commit to accountability and prioritize patient-centric decisions.
- Navigating the trends and understand the inevitable wave of consolidation in dentistry and what it means for your practice.
- Discover the pivotal role of effective management and why private equity may redefine your business model.