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This Dental Specific Podcast is dedicated to the Dental "Entrepreneur" Michael Dinsio, Founder of Next Level Consultants, delivers #TRUTH when starting up a dental practice. From the very first step to getting the keys of a dental practice, Michael shares his raw & unscripted playbook with you. Not only does this podcast provide you with "What To Do" but more importantly "What Not To Do". With over over 15 years of experience & over 150 past clients, Michael delivers an educational and informative program in a real and genuine way. Start w/ Episode 01 - as we go through a STEP by STEP process.
Startup Unscripted.
The questions you have with
the truths you need to hear.
Help doctors get into
practice the way they want
to get into practice.
Hashtag truth.
That's why we put it out there.
What we want to do is we
want to bring truth to the startup game.
And now your host, Michael D'Anzio.
What up, what up, guys?
Welcome back to another
episode of Startup Unscripted.
You guys know me.
I'm Mike D'Incio, founder and owner,
one of the owners of Next
Level Consultants.
Super excited to continue
this week of Kids Teeth Week.
As you all know,
it's sponsored by Supermouth,
wearing the shirt today.
Supermouth is a great program.
I've been talking about it,
listened to all the episodes.
We even had the opportunity to...
interview Dr. Haas,
who's one of the founders of Super Mouth.
Again,
I'm just going to say it one more time.
If you've missed any of the other episodes,
my kids love this stuff.
It's a fact.
It's the one thing that got them,
one of the things that got
them really excited about
brushing their teeth and
really appreciating the
value of their oral health.
makes them excited, superhero theme.
They have non-fluoride and
fluoride options.
They've got programs from
infants all the way up to our age.
I think SuperMouth is a
really cool system that you
guys can leverage.
And the most favorite thing
about it is it creates a
residual income in your business.
And a lot of you guys, you know,
selling toothpaste and stuff is is,
you know, a business.
But this is kind of like an
intentional program that
sends the kits out to my house.
So that's why we get it.
And then you're creating a
revenue program within the office.
I just think it's so smart.
And it's fun.
They've got a movie.
My kids watch the movie.
They still watch it.
It's fun.
So anyway, Supermouth,
we'll throw a commercial on
the back end of this program.
All of the Supermouth
information is going to be below.
A little bit more housekeeping,
and I'm sorry, but we just got to do it.
I've mentioned it in some
episodes in the past.
In about a month or two, give or take,
we are condensing both the
Startup Unscripted program,
which is what you're listening to now,
and the Dental Acquisition
Unscripted brand and program into one big,
I don't know,
overarching program called
Dental Unscripted.
So I want you guys to go
over and subscribe right
now to Dental Unscripted
because all of our episodes,
startup specific, acquisition specific,
will be on that new program
called Dental Unscripted.
But
with a flavor of practice ownership tips,
because now I've helped so
many of you guys get into ownership.
Now you're wondering about
how to run your business a
little bit better.
And that will be all under
one house called Dental Unscripted.
So, all right,
sorry for all the
commercials and all the things.
Let's get into the meat and
potatoes of this episode.
And I'm lucky to have a
fellow podcaster and a
dentist in your guys' community,
specifically in pediatric dentistry.
Dr. Casey is on the other side of this.
He is the owner of Quiver
Creek Pediatric Dentistry
in Northeast Texas.
Missouri.
He did a startup four years
ago and he's absolutely
crushing and dominating.
His podcast is called bruise
and tiny teeth.
So get over there and
subscribe to that one.
He, he said earlier before we even started,
he's not super active on it,
but there's some great
episodes that you can check up on that.
But Dr. Casey,
thanks so much for being on the program.
Yeah, Michael, appreciate you having me.
The kicker is I do the podcast still,
but I created the podcast
because there's no other
pediatric dentist in Northeast Missouri.
Once you get into the
startup life and you get busy,
eventually it becomes
feeling more like work and
that initial adrenaline
rush of opening the practice fades,
and then it becomes kind of isolating.
It was more so my way of
networking and meeting up
with other dentists.
So
I think I've talked to
pediatric dentists from
like almost forty states
and done a couple hundred episodes.
And I still do an episode.
I do one every two weeks.
But it was more into drinking beer.
Like I would have like beer and whiskey.
More about beer.
Yeah, right.
So we'd have a drink, talk shop.
But I would do them at night.
And now that I'm a dad,
my nights are more tied up.
So I still do the podcast.
I just have to like squeeze
them in over lunches and
mornings over coffee more
than over like a stiff
bourbon or something.
Love it.
Love it.
Well –
There's nothing illegal
about drinking and podcasting.
Now, it could be dangerous,
but it sounds like you
figured out how to do it the right way.
Right.
That's awesome, dude.
I love it.
So bruise and tiny teeth.
Let's get into your story, man,
because I just found that
most people trail off after
a few minutes and I burned
through all of that with my
housekeeping stuff.
So let's get into the meat.
So, Dr. Casey,
you started a practice about
four years ago.
Um,
about the time I started this podcast
actually.
So back in, in two,
we were all going crazy and that's,
that's when you decided to, uh,
go ahead and set up shop.
Is that about right?
Yeah, that's right.
Yep.
And so backing up just a little bit, um,
I don't come from a dental family,
but I knew I wanted to do
pediatric dentistry.
Um, I worked at an engine shop in, um,
in college over the summers,
like fixing engines and
small parts and stuff like that.
And a pediatric dentist came
in and we hit it off and he
invited me to come shadow his practice.
So I went and shadowed the
practice and within like,
thirty seconds knew this is
what I wanted to do.
And so I was able to come up with a plan,
you know, a plan, a ten year plan to get,
you know, be like this guy.
And
overarching theme here is like,
find good mentors,
surround yourself with good
people as well.
Kind of agree.
But he was, uh, really instrumental in,
in getting me down the path,
pediatric dentistry.
But, um, so yeah,
working at an engine shop
is what kind of led me into, uh,
to become a pediatric dentist.
But I wanted a practice that
was like his small practice, small town,
super busy.
Um,
and he really knew his numbers and knew
the business side of things.
I love that.
So a really good mentor to you.
Really good mentor to you.
A good friend of mine to this day.
And we do dentistry.
He's very old school and I'm
kind of new school.
But, you know,
I was able to kind of use
him as a springboard.
And, you know,
it's just a you're gonna
hear me say it a few times,
but like doing a good,
successful startup is just
following a recipe of other
very smart people that have
done the same thing before
and just emulating what they do.
And he was that guy for me.
So you got to find your person.
And he was a good,
good mentor to kind of get
me kicked off and started.
Well,
that's a selfish plug for next level.
I mean, to be honest with you,
I'm not the smartest guy in the world,
but when you do something
over and over and over,
we do twenty five to thirty
startups a year and have for many years.
We've ran into all the problems.
Right.
And so it really is about.
following a recipe and you can't,
you can't bake good
cupcakes without following the recipe to,
to, to the perfection.
Right.
And so it's all it is.
I will say though,
podcasts like this and books and,
whatever else you're
watching or reading and listening to,
I will say there is a caveat to that.
And that is what we
discussed today may not fit
you in your situation,
in your demographic,
in your geographical location.
So I find that really honing in on
what you're trying to do and
finding your team, like Dr. Casey said,
is, is the key.
So, all right.
So for four years ago,
you got into pediatric dentistry and, uh,
own your own practice.
It's a rural area, rural community.
Correct.
Yeah.
Yeah.
So like we were saying, you know, I,
I did residency.
I did all my training in,
at the university of Iowa
dental school knew I want to do peds.
So I matched there, um,
did my two year residency.
Um,
Um, the entire time I was in dental school,
knowing that I wanted to be
a practice owner and do a
startup or own my practice right away,
I kept a big binder with all of, um,
you know, a bunch of startup materials.
Uh, you know,
you do lunch and learns in dental school,
the, uh,
finance guy would come or a
practice lender or, uh,
somebody who does dental
construction would come and
I'd keep all that paperwork
and all that information
would keep it in a binder
was very organized,
started working on a
business plan very early in residency.
So I really feel like if you
know that wanting to do a
startup and being a
practice owner is for you,
what's nice is you can
start that practice really early,
start gathering your team.
So I worked on all that during residency.
I needed to do a little bit
of associating because my
wife had some school to finish up.
She had one more year of training.
She's a pharmacist.
So we did that up in Minneapolis.
I worked up there for eight
months and COVID hit shut
the whole place down.
I love my associate shit, but I'm like,
man, this is,
it's an hour and everything like this,
the time to pull the trigger.
I've saved up some cash.
I got my speed up.
I've got a game plan.
Um, and so the,
the pandemic ended up being
a blessing in disguise where.
I had hours every day to, you know, to,
I learned how to do some web design.
I designed my own logo.
I built my own website.
I got lending secured.
I started shopping for, you know,
did doing the demographic analysis,
found my lease space, negotiated that,
did the build out process.
I learned how to do basic bookkeeping.
I just had, you know,
kind of turn lemonades,
lemons into lemonade, if you will.
And so it ended up working out great.
You know,
the pandemic was a blessing in
disguise for myself.
It really was for a lot of people.
It gave you a lot of time,
but also kind of kind of
scary to not know where we
were all going to land.
I want to back up.
So before we kind of get
into the mechanics,
this whole program kind of
goes through that lending and vision and.
you know, demographics.
I want to pause right there.
You chose to go in a rural area.
Did you do demographics?
Did you know that area
needed another dentist,
a pediatric dentist?
Yeah, I knew it did.
So I wanted to be moderately
close to family,
which we have family in Iowa, Missouri.
My wife's from Illinois.
I like Midwest.
I'm a Midwest guy.
Yeah, let's go.
Where are you from, Michael?
Ohio.
Oh, okay.
Let's go.
Yeah, yeah, yeah.
I'm a big hunter outdoorsman.
So I just, I like the farm scene.
Um, so I took a big map of, of Iowa,
Missouri,
and was putting pins in where
all the pediatric dentists were.
So you're looking for, you know,
my idea was I want to find
a town that's growing.
That's a bedroom community
has a lot of people, a lot of kids.
You don't want something stagnant.
That's four hours from the
nearest kindergarten.
you know, a grocery store, but, uh,
something that's got some growth, but no,
no competition, no pediatric dentist.
And I found a few pockets,
but the one that worked
best was Northeast Missouri.
So I'm the only pediatric
dentist or the last
pediatric dentist between
the Northern suburbs of St.
Louis, all the way up to the Iowa border.
And there was a huge need.
And I mean, how many,
can you quantify that?
How many people are
families that feed into your kind of zone,
your area?
Yeah.
Yeah.
So the county that I'm in,
so the town is only fifteen
thousand people,
but it's kind of a bedroom
community for St.
Louis.
So there's about sixty
thousand people in the county.
But I also funnel down all
the kids throughout northeast Missouri.
And so I couldn't tell you how many.
But, you know,
so the drive time you're people driving,
how far to get to you?
Hours, hours.
Yeah.
I have a map in my office
where people can put pins
where they're from.
And it's like a big, like, um,
funnel from all of
Northeast Missouri up to the Iowa border.
People drive hours.
I do a lot of sedation work, you know,
referrals,
very referral heavy sedate them,
fix the kid's teeth, send them back.
But, um, you know, the,
we'll talk about it a few times,
but picking your demographics, right.
If you had to pick it down
or narrow it down to one key thing,
that's going to determine
how successful you are,
how quick are you to break even, um,
you know,
what your whole financial
perspective and the,
and just the health of the
business is going to be
demographics or everything
when it comes to doing a startup.
And, uh, I'm very much a fan of,
of a semi-rural type
environment where you don't
have a lot of competition.
I can't get a Starbucks every morning,
but I,
there's a local coffee joint down
the road that the lady
brings her kids to me still
makes good coffee.
So there's give and takes to it.
But, um, when you run the numbers,
it just makes so much more sense.
If you can find that, um,
sweet spot where there's
not a pediatric dentist,
you don't have the competition.
I couldn't agree more.
I would say that the
majority of my clients, pedo, GP alike,
are chasing areas that have
some competition.
And it's not that I'm against competition,
quite frankly.
Um,
you guys can differentiate yourself in
so many different ways that
super mouth is one of them, for example,
but the,
the point that I'm making is your
customer experience and all the,
all the things can,
can differentiate yourself.
But when it comes to
startups and picking location,
everybody calls me, he's like,
what's the best location?
Where, where do I go?
Well, it's what Dr. Casey did.
It's finding an area that
isn't overly saturated and
competition is fine.
You know,
Dr. Casey's like in a situation
where there's nobody.
It sounds like you don't
have to find that.
That's hard to find.
But like maybe just like
going on the outskirts,
the emerging markets,
places that are up and
coming in the next five
years or on the foothills
like here in Washington, you name it.
It's yeah, you got to like Dr. Casey said,
you might have to drive
thirty minutes to get a Starbucks,
but that's OK because
things are building out and
and and and development will come.
But when it comes to new patient flow,
the easiest marking is just
going in an area that
doesn't have the work.
So so let's actually talk
about that real quick.
Day one.
And folks, again,
this is that disclaimer that I said, like,
this is not going to be you.
Wow.
So don't think that this is
going to be you day one, doc.
Did you have patients showing up, uh, uh,
on your front door?
Yeah.
Yeah.
I had, uh, so the way that I did that,
and I think worked out
really well in retrospect
was about a month and a half,
two months prior to opening.
I started marketing,
networking myself again.
I had all this free time
practice being built.
So I went to all the pediatricians,
all the local referring, um,
general dentist went to schools.
I started passing out referral pads,
business cards.
I had my VoIP phone set up.
So the office was all
established and parents
would start calling in and
I have a voicemail set up, you know,
Quiver Creek can be opening
fall of twenty twenty.
If you're interested in appointment,
leave a
Voicemail, I would call parents back,
get the name, get the info,
chief complaint.
So I had a list of like a
hundred some kids ready for
appointments the first day I opened.
So I started by seeing eight
kids a day for comp exams,
started adding ops shortly thereafter.
So by the end of the first month,
we were already running
like two pretty solid columns,
probably like anywhere from
twelve to fifteen to twenty
kids a day just in the
first couple of months.
Um, but a lot of that goes in.
I just had a good buddy that
did a peed startup.
He had so many other things going on.
He didn't prioritize that.
And that seems to be a
common mistake is like,
you got to start this,
getting that stone rolling early.
Um, cause once it gets going, you know,
in peds, that's the benefit,
a lot of word of mouth marketing,
but you got to get it going
early and you can't wait
till like three days before
you're going to be sitting
around with no patients.
I'm going to add that as a
banner today because I
couldn't I couldn't agree more.
Start marketing early.
I couldn't I couldn't I
couldn't say that more.
We we we had a doctor,
a client in in the Bay Area.
I won't give his location up, but.
Um,
we had a delay in construction that was
like four or five months
because of permits or whatever.
It was awful.
It was absolutely awful.
But what it did is it forced
him to do what you did, which I,
which I try to get all of
our clients to do.
And that is to hit, hit marketing early.
He had two hundred patients
waiting for him to open.
because of that delay.
So any of you that are
dealing with construction issues,
it's a blessing in disguise.
I know that you're probably
going to start paying that
rent sooner and you're
burning up the free rent
and all that good stuff.
However,
just think of that as an
opportunity to really hit
the ground running.
So let's touch on that because doc,
what you just said is,
once we get kind of through
the hiring the team and
getting all the timelines in place,
you know, there's usually a four to five,
even six month kind of
build out timeline.
And to me, like your team set, of course,
you got to make a lot of decisions.
You got to keep your construction,
construction team on par and on, on task.
But during that four or five
months before you open, you,
I find that a lot of doctors
are thinking and they're
nervous about their systems.
They're thinking about their software.
They're thinking about who
they're going to hire and
all that when they should
be thinking about marketing.
Because all the systems in
the world could be in place.
And if you don't have any patients,
who cares about the system?
Any light into that?
You guys are high drivers.
There's got to be a balance there.
What do you think is more important,
systems or marketing?
Uh, that's a great question.
And I don't know if I'm
actually going to be in the
best position to answer
that with any credibility, just because
all of that comes with the asterisk.
If you're in a rural area
with no competition,
it really actually doesn't
matter that much, to be honest.
Like if you ask me what I
spend on marketing every month,
even in the beginning,
it's always been like less
than a half a percent.
Like even now it's probably dollars,
dollars wise.
Yeah.
Yeah.
Dollars.
I mean, as, as a percentage of my overhead,
it's like, I think so far this year,
like my marketing is consisted of,
I donated a Yeti cooler to like a
a school fundraiser.
It's just like giveaway fun stuff.
Like I, you don't have to,
to market in the rural area.
So super big perk,
if you're going to go rural or semi-rural,
like it, you know,
you go to a couple of local
meetings and get some word
out and the patients are
going to start flowing in.
But if I was practicing, let me get,
let me set the stage since
you have experience.
So, um,
my average client has maybe two to
three patients,
kiddos per day in their first month.
And that probably continues
on for a month and a half, two months.
It's not busy at all.
So does that add any, uh, to me that it,
I don't know if,
I guess if I woke up and
did another startup and
there was only two or three
kids on my schedule, I'd be,
I'd be concerned and
probably not sleeping great.
Um, but my thought is.
If I were to wake up and
that were to happen,
I always tell other podcast
listeners and stuff that
want to do startups, you're not above.
If you're sitting around,
if you only have two or
three patients scheduled in your day,
that means you only have
two or three hours of your day filled up.
That means you've got
another ten hours in the
day that you could be doing
other things with.
So if I'm you,
you're literally not above
pretending like you're
running for mayor and
go walk over to the grocery
store next door and meet the pharmacist,
go have, um, I mean,
you can literally go door to door,
look up current events,
what's going on now.
Like there's always
something you could be
doing and not just sitting
back and waiting for the, for the,
for the phone to ring.
So if you make the mistake
of not getting going right off the bat,
then like you got to make
up for it by being very aggressive, um,
on the backend,
as far as just getting your
name out there to,
to the community and
whatever aspect that might be your Avenue,
that might be.
Thank you, Doc,
because because the average
startup sets up in Bellevue, Washington,
Kirkland, Washington, Denver, Colorado.
And it's a maybe a two to
three thousand patients per
pediatric dentist.
You just said you had fifteen thousand.
So it's a total night and day.
And I and I find that.
you,
you can work on your systems and you
should, I'm not saying you shouldn't.
I mean, our whole program,
the last two months is all about systems,
but, but leading up to that opening day,
four months before you open,
doctor hit it right on the head.
And that is just get out, be, be the mayor,
talk, talk to people.
We're coming up on Halloween.
Think about how many trick
or treat or Halloween
things are going on kid.
I mean, they're the, the,
The world is your oyster.
Doc,
what are some of those partnerships
that you have today or even
when you first started that
you approached people like
the Y or the library?
I mean, can you do you have a good one?
Yeah, I got a good one.
So very first day we we
moved to this area again.
This is an area that.
I'm not from, we didn't,
didn't really know pretty
much anybody when we moved here.
Um, the, we went to go buy.
So instead of buying stuff, this is a here,
let's, let's summarize it here.
Instead of buying stuff from Amazon,
turn Amazon off for,
for a month and force
yourself to go buy those
items from someplace in person.
So like when we moved to Troy, Missouri,
this area, we needed a new washer dryer.
Instead of going to the big box store,
we went to the local mom and pop shop and
Started talking to the salesperson,
explained who I was,
bought a washer from her
and gave her a business card.
And she wound up scheduling her three kids,
you know, the next day.
So just always have your
business cards on.
You always have a collar
shirt on and just like go
interacting with local
business owners and being a
people person was huge.
So yeah, furniture company was big.
I got,
I got involved in some local
daycares pretty quickly.
I,
I bought another thing I did was the
referral sources was key.
I bought like eight hundred
bucks worth of black rifle
coffee and stuck my face
and business card on the
front of each one with a
handwritten letter.
Went around to all the
referring dentists with referral pads,
like physically shook their
hand in person during COVID
when nobody was doing that.
I love that.
Gave out my personal cell phone number.
People are probably thinking
you were a weirdo.
Kind of.
Yeah.
It felt, it felt strange, but the referral,
getting the referrals
coming in boosted my, uh,
my in-office GA really quickly.
And that's what really drove
us getting super profitable
early on was like doing those big cases.
And so a lot of people now
like to hate on having good
referral sources, but why is that?
I think it's because the kids come with,
you know,
issues and they tend to have
gotten messed with and had
bad dentistry done and
they're not cooperative.
But, um, for me, like I'd, I'd,
I don't want to work in a
profi palace where I'm
doing thirty checks all day.
Like I want hard cases.
I want heavy hitter
dentistry and the trenches
getting it fixed.
So I tend to argue that with
other providers like you want referrals,
especially early on,
because that's what's going
to put butts in seats.
Money in the bank is going
to get you busy right away
as good referrals.
A thousand percent.
That's interesting that I'm
hearing that from you.
Obviously, I talked to a lot of providers.
The downside of that is it
comes with a lot of baggage.
Is that what you're saying?
Yeah, essentially.
Yep.
Yep.
Yep.
Sometimes difficult parents,
they tend to kick you the
ones that are hard.
The kid's not cooperative.
Mom's difficult.
Oh,
that makes sense because they don't
want to treat them.
So they're like, oh, well,
you went to school for dealing with this.
So you deal with it.
But if you've got good
systems and that goes back to, you know,
with your systems in place,
if you need to have the
capacity to handle,
if you get a lot of kids early on.
And so having your, um,
anesthesia in place early
is really important.
So don't wait until you have
enough kids on your GA list
to start the process,
get a good relationship
with your anesthesia provider.
Or if you're doing hospital privileges,
jump on that early because
credentialing takes forever.
And that way you have your capacity,
like ready to go.
So you can do a lot of
anesthesia cases right off the bat.
Cause when you go from, um,
Say you have two or three or
four or five comp exams in a day.
Maybe you can produce like a
grand in that first day.
But if you can do three or
four in office GA cases,
that's probably going to be six, eight,
nine, ten grand a day.
So you need to get those
days like up and going
early and not wait on them ASAP.
So so so I love that because
what you're doing is you're
reverse engineering
how to drive more GA days by
the marketing that you're doing.
So you're networking,
you're going to the
hospitals and you're
talking about those big
things so that you can fill that in.
And then slowly you're
building that hygiene base.
I love that, Doc.
Really some solid points
here and some solid insight.
You mentioned that one of
the things that you love
and that you kind of really
honed in on was your efficiency.
And it's something that I
really try to hold my
clients back on when it
comes to hiring people too
quick and not expanding too
many days open.
So it's all about driving
production per day and efficiency.
This is a thing that you
were attracted to.
Obviously, the more efficient you are,
the more profit it drives.
What are some things that
you want to chat about or
you think really changed
the game for you as far as
efficiency goes?
I think it's maybe worth
touching on that I decided
to go five days a week
right from the start.
Wow.
Again.
Yeah.
Let's go.
Right.
So my motto was- Not
everybody could do that.
Not everybody could do that.
This is like very rural.
I can give my rural answer
and then what I would do if
I was in like a suburban America.
Fifteen thousand people per doc.
But look,
the five days probably made sense
for the amount of patient flow.
And that's the answer, right?
It did.
So right out of gate, you went five?
Right out the – yeah,
it actually was an issue
with the lending because Wells Fargo,
who did my loan,
didn't want to lend to me
without a guaranteed associate chip.
And I'm like, I've got some cash handy.
I've got a solid business plan.
I know I'm going to crush it.
There's no – I'm going to
work every hour if I have to.
And so I don't want to limit
what I can do because I can
only give this practice two
or three days a week.
And so they let me do it,
but I had to- Burn the boats, baby.
Burn the boats.
That's Cortez.
Burn the ships.
Let's do it.
So five days a week.
And in retrospect,
it was the best thing that
I did because I filled up
the five days right away.
You get profitability.
You reach that sooner.
And then I was able to
reinvest the first profit
off the first six months to
adding more chairs, more staff.
And so we just kept able to-
reinvest those funds.
And then all of a sudden
we've got this big giant
organization with a lot of
chairs running in a very
short amount of time.
So five days a week, um, is,
is kind of key there.
Um,
I guess that's probably the answer I
would get,
but that's definitely a rural
based answer.
Like not everybody can go
five days a week.
It speaks to the rural,
to the rural pros that
started this whole conversation again,
um,
in kirkland uh someone I
just set up could never do
that kirkland washington
for example but but it
speaks to why you might
look at some of these
emerging mark markets but
big picture doc when you
when you did start getting
the flow how fast did you
hire you had to hire
probably pretty quick
because you were getting
flow so folks for the
average startup this might
be you in like month
nine to twelve when we start
talking about some of the
things Dr. Casey had to do.
But him,
he was right out of the gate busy.
But what were some of the
mechanics of the things
that come to mind when you were thinking,
OK,
is it time to hire someone or should
we wait a month?
OK,
let me break it down as miles like
timeline chronologically.
Yeah, perfect.
Right.
So started
Start at three thousand square feet.
I've plumbed for seven chairs,
but I started with two open
bay and one op.
And that's enough to get going.
Right.
So I have three three employees.
I started with one up front,
one in back and one hybrid
on month three.
We picked up another gal.
And what's nice, too, this goes back.
I hire all employees.
really awesome local employees.
Most of them are still with me,
very little turnover.
Um, but no dentistry.
Um, no, actually I did, I did, uh,
pick some that had some
experience in pediatric dentistry,
but what's nice about, again, being rural,
there's a lot of assistants that live or
employees that live in this
bedroom community that were commuting.
And once you open up, they're like,
I want to work.
I don't want to drive every day.
So another perk, like it's really,
I've never had a problem
finding employees, you know,
another huge perk.
It's awesome.
So the, um, so the, the,
and then the local girls, they've all,
a lot of them have grown up here.
They know everybody,
they know members community.
That was, uh, uh, uh,
generated growth in an
organically in and of itself.
So a lot of benefits there,
but I hired a fourth.
Um, we, we were in the black,
like profitability wise on month two,
which was good,
but then just kept reinvesting in.
So I added some more chairs
at month six to start
keeping up with the six
month recalls that were coming in.
And so we got it to five fully plumbed
opera.
Like I still have two chairs
I don't really use on a daily basis,
but got to five chairs.
So I think by the end of the first year,
I ended up adding two
additional employees.
So what were your,
what were your collections
in the first year?
Can I ask?
Yeah.
Yeah.
I'd like to be pretty open.
Cause, and again,
like you've been caveating it, this is,
this was like lower interest rates,
you know,
is a little bit easier to start up.
Like it wasn't quite so
expensive four years ago.
Um, but, uh,
just because I think it's also
nice to know sort of what's possible,
but our first year we
collected nine eighty five
to the first twelve months.
Yeah.
Um, and then, uh, and then year two,
we were at about one point six and, uh,
we kept on jumping up from there.
But yeah, by the end of year two,
we were up to like my cruising.
level of staff that we've
had since then as we keep
adding and growing like I
try to run a really lean
practice we don't have a
lot of extra bodies sitting
around um I like to pay and
like take really good care
of my team when I find them
but we run a we have seven
employees myself and then
seven others three up front
four and back one of which
is a hygienist um all right so
So the big question I have
now that you're talking
about these numbers, a million bucks,
one point six,
the next just just the Bank of America,
Wells Fargo came from the
same school of banking.
We these banks ask you guys
for your numbers regularly.
uh throughout the year just
to make sure you're on par
and they actually harvest
those numbers and and and
use those numbers to
underwrite right and so um
the average pedo startup
their first year is four
hundred the next year is
like four fifty can you
believe that so you're
you're double what the
average startup was which
is fantastic um but here's
here's the question once
you once you started
hitting some of these
numbers and a lot of my
startups are now and they're like
third, fourth year.
Are you talking about
keeping all the insurance?
As you mentioned credentialing,
you went all credentialing.
Did you go Medicaid?
No Medicaid.
Medicaid.
Yep.
Yeah.
I'm a,
the way I had a few ups and downs
with that, but in general,
I kind of focused in on
what were the big employers
in our area and what plans,
what carriers did they have?
And the answer to that question was Delta.
So.
We tried dabbling out of the
network Delta game, but I actually,
honestly,
I have a pretty good
relationship with Delta.
If you're rural,
you can actually kind of
somewhat negotiate to get
some decent reimbursement.
It's not like it's a hard pass.
They need you.
They actually need you.
I'm the only one.
So Delta,
I actually have a good
relationship with because I
know exactly what they're going to pay.
It's just like Medicaid.
I'm in network with Delta
and the Medicaid plans.
It works for me.
I love it.
Everything else is out of network and
It's it's so I never took
any of the other insurances.
We just use the Medicaid as
kind of a faucet.
When I had openings or gaps,
we turn the Medicaid valve,
get more patients coming in.
Lots of same day dentistry
because it was profitable.
Have you considered now
dropping some now that you're so busy?
Um, to be honest, I don't know.
Cause I've tried,
I tried right when I first
opened staying out with
Delta and our patient population,
it just didn't work with
like mailing the checks.
And we had a lot of AR stuff
that was hard to follow up on.
And then, um, the kids with Medicaid,
I just am, I, I like seeing those kids.
They're good kids.
They have, they need a lot done.
I like, again, you kind of have to,
you kind of have to your rural doc.
Like, you know, it's,
it'll break your heart with
your rural and you show up to the, the,
um,
furniture company in town
and the lady who's selling you furniture,
like she very well may have
Medicaid and then you can't see,
see her kid.
Like, I don't know.
It just seems like the right thing to do.
And those kids are always
the ones that need a lot of help.
And, um,
I just have never wanted to be the
pediatric dentist that
doesn't get his hands dirty
and just does checks and exams all day.
Like I like heavy GA, heavy sedation,
lots of crowns,
lots of like big hitter dentistry.
It just,
I feel better like when I work a full day,
when I'm doing a lot of
heavy hitter dentistry
versus checks all day.
So I will probably never drop Medicaid.
I like
Well, the only reason I ask,
and you're a hundred percent right.
And as a consultant, I have to say this,
but with the proper verbal skills,
you can still accept that.
Not Medicaid,
but let's just talk about all
the other insurance companies,
but you can still accept their benefits.
Just be out of network and
charge what you want.
So,
but Medicaid is a different conversation.
I get that.
I think a lot of my clients.
that have had that big success,
the question becomes,
do I add those other
operators or do I add these
other days or do I drop a
couple of insurances?
And you just start you start
looking at your business's
scale versus efficiency and
profitability.
Not that you're not,
but I it's kind of a fun game to play.
And and depending on your number,
I would say you shouldn't
even consider that unless
you've hit a million bucks.
Can I interject something here, Michael,
on the Medicaid topic?
Of course.
I've kind of become
convinced that seeing
Medicaid was one of the
better decisions I did
right off the bat for a couple reasons.
You're basically getting
paid to do marketing
because there's so many.
Sure, you've got to weed out.
There's going to be families
that don't value your time
and break appointments,
and you can develop systems
to weed those out.
But there's a lot of really
awesome families.
Families that are dual insured,
like dad works at the
factory and mom stays at home.
They qualify for Medicaid.
They have a private XYZ insurance.
But like Medicaid,
if you see those families
and you provide them a
really good experience,
you're going to get a ton
of Google reviews.
They're going to tell
everybody how awesome you are.
It's just going to be the best free.
word of mouth type marketing,
you're going to get paid to
market because you're going
to be able to help these kids out,
fix cavities,
provide a great dental home
and experience for these kids.
The moms are going to love you.
They're going to shout your
name for the rooftop.
And ultimately,
like you do have to make
sure that it makes sense to
break even in your state.
Like when I opened,
luckily Missouri increased
their Medicaid fee reimbursement.
But I would argue that if
you're doing a startup and
you're not – if you've got
gaps in your schedule,
I think it's easy to add
Medicaid from the get-go
because the administrative
side is so easy.
You know what you're getting paid.
I would say if you can maybe break above –
Like ad do a hundred bucks is pretty good.
If you're getting above that through,
through Medicaid for like a
recall appointment,
probably worth seeing
stainless steel crown a
hundred bucks is like the cutoff.
If you can make above a
hundred bucks on a stainless steel crown,
it's probably worth seeing,
but some States like Illinois.
are well under those measures,
it doesn't really make sense.
You don't want to lose money on it,
but there's other hidden
monetary benefits besides
what's your profit margin per procedure.
You're going to have a lot
of advertising and marketing,
way less administration costs,
tracking down accounts
receivables on that MetLife
claim that didn't pay what you thought.
Medicaid is very cut and dry.
You can do same day.
If you've got time in your schedule,
you can start working same
day without having to bring
the parent back for a second appointment.
And so just Medicaid,
the profit per procedure is
far higher than you think
because you save costs in other areas.
So definitely really
strongly consider looking
at it if you're doing a
startup in a state that has
halfway decent Medicaid.
Yeah, I can totally relate to that.
I think some of those
numbers obviously are gonna
vary on like wages and
rental rates and all the
different math that you figure out.
But I think the core,
exactly what Dr. Casey said there,
is it's free marketing.
And that's every insurance, by the way.
You're getting patients.
Guys, don't forget,
when you do a direct mail
or a pay-per-click campaign,
you're throwing money out
there and you're hoping
that the ROI comes back.
With insurance and Medicaid,
you're taking a lower rate,
but they're also sending
you patients in that.
And that's that's the
benefit of of of of jumping
in that into network.
So think about all the Google reviews,
too.
When you're startup practice,
you have no Google reviews.
That might be a reason in
itself to just take
Medicaid your first year,
because if you can get two
hundred fifty Google
reviews your first year
just from Medicaid, that
That's a winner for sure.
So I I love that tip and I'm
glad that you said that.
I think when you're in a rural area,
you almost have to is kind of my feeling.
When you start going into
some of those more populated areas,
I think it's where it gets dicey.
Well,
Dude,
we powered through so many topics today.
I know you got to go get lunch.
I don't want to keep you from lunch.
I do want to do a plug for a doc here.
He's starting up or maybe
has already started up.
Give us some more information.
But it's an online course.
I haven't even seen it.
I just found out about it.
I can't endorse it,
but I'm excited about
seeing it and hearing it.
Tell me about this online
course that you've got going on.
Yeah, real quick.
It's a, it's actually kind of a new thing,
but basically from,
from being a little bit
more active in social media
and online and our community and,
and the podcast that I do,
I constantly have like
young docs reaching out,
asking questions like,
how'd you put your business
plan together?
And not really like,
tell me how to do the whole thing,
but like specific kind of questions.
And somewhat selfishly,
I just kind of got tired of, you know,
answering the same
questions over and over.
And so me and another doc who, um,
Uh,
Dr. Corey Hastings has done a ton of
really good startups.
He's done like six Pete startups.
He's a great pediatric dentist.
You know,
I put our heads together and we're like,
let's just like put all of
our knowledge and thought on like,
on like film at all,
put it all in a course and
that way it's there.
So like,
it's not anything we're going to
retire off of,
but if people are reaching out,
wanting these questions
instead of like our time is
more valuable now, I don't have to
I don't do half hour phone
calls for free with a bunch
of other docs like I used
to when I first started up.
So I say, Hey,
we put everything down on this course.
It's a couple hundred bucks a month.
You can binge it all.
And then we just had some
professional videos filmed
where we just talk about all the major,
like basic terminology, you know,
kind of our story,
how we did the startup and tips,
a lot of marketing tips, um,
It just, if you follow it,
are you drinking beer?
Are you drinking beer?
I wish I was.
I wish I was.
Cause it was a lot of,
it was actually a lot of
work to put it all together, but, uh,
I want to check this out.
Yeah.
Yeah.
It's great.
It's just,
it's not going to help you
through the entire process,
but I would say it would be
good for if you're it's peed specific.
So it's called, um, little smiles,
practice mastery.
is the name of the course.
It's easy to Google,
but it's just an online
like monthly subscription course.
It's really cheap,
but basically it'd be great
if you're just interested in,
in knowing is a startup right for me.
And like,
what are some basic business
acumen terminology?
Just get your foot in the door,
get comfortable with the lingo.
You can power binge the
whole thing in just a few
days if you want to.
And you still like,
you have good resources for, for,
you know,
you may need a consultant after
that to help you get started,
but I feel like it might
just give you the
confidence that you need.
Like, okay, I've seen this recipe laid out
It's not as hard as I think
it makes it less intimidating.
And I think it can give
listeners that whole like I
can do this and then get
you started and get you
fired up to be an owner.
I think I think any
consulting in general is is
right for some people wrong for others.
Some people want just to dabble,
some people, whatever.
I think things like this are great.
We just put the link down below.
Um,
we'll put it in the description as well.
Dr. Casey, thanks so much for your time,
man.
I,
I really appreciate you just being open
and sharing your,
your knowledge and your experience.
Congratulations, dude.
You got a freaking awesome business.
And I, I want to know one last thing.
Do you regret going into business?
And if not, I assume it's no.
Should you have done it
sooner if you could have?
No, I don't regret it at all.
I love entrepreneurship,
love business ownership.
There's, you know, I would honestly,
there's not really anything
I would do over again.
I think it's a little bit
harder to start a practice
now than when I did a few years ago.
Um,
but it's just such a changing dynamic
and I'll leave it on this.
You know, when we,
we first started the conversation,
we were talking about my
mentor being more old school, you know,
times of starting a
pediatric office have changed where it's,
we're maybe not in that
golden age of doing
startups where patients come flooding in.
There's much less competition,
but on the flip side,
we have access to so much
more information.
Like you're putting out the, you, Michael,
putting out podcasts.
There's a lot of online resources.
There's great podcasts.
There's so many other people
that have done it.
Social media.
Um,
There's,
there's never been more
information in the history of humanity.
So, um, I think, you know,
the best time to start a
practice was yesterday and, uh,
the second best time is today.
So hopefully our little
conversation could inspire
somebody to get going and
get after it and burn the
ships and start a practice.
I love that, dude.
Well said.
Guys, again, thank you, Dr. Casey.
Go get some lunch.
I'm going to segue right
into Supermouth Commercial.
Guys, I'm dead serious.
You got to check it out.
It's a great program.
Without further ado,
thanks again for the time.
And again, guys,
be looking for the conversion,
the switch over from
Startup Unscripted to
Dental Unscripted.
Thanks again, guys, for tuning in.
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