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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.
00:04
The is so low to John, I don't even know where to start with that question. listen. guess the problem is, and by the way, I love that question. Interesting. This is an interesting topic. What's the solution here? Show up, understand your part, and just crush it. Pay per click, social media, we can talk about all this stuff. But what really matters is patient experience, that wow factor.
00:34
Please are you listening to yourself? Come on! What are you talking about? Yeah exactly, so sit back, take notes and listen. Oh, oh, I love this. This is gonna be fun.
00:49
Startup Unscripted. The questions you have with the truth you need to hear. And now your hosts, Michael Dinsio and John Bertagni.
01:11
Censored episode, what is this? Episode five, I believe, with Dr. Michael Unthink and Jon Bertagni. I'm super excited about today. We get to talk about hard bids and the architecture challenges through a project. And we've got a really special guest today. Jon, I know he's a personal friend of yours. You want to introduce our guest today?
01:34
I consider him a friend, but I'm not sure if it's reciprocal. We'll find out, but no, we're excited. This is an iconic show from my perspective and he's been doing right by the industry. And that's what we've been trying to bring to our listeners and viewers are people that have been doing it the right way. And Mike, thanks for being on the show, Graham, as I call it. Well, thanks. I appreciate being here.
02:02
I just give you a little background on me. I'm a friend of John's. You guys are both admitting friendship. It's nice. Yeah, no, no, John, a long time, actually. Good guy. My background basically is I was an architect first. I had my father and uncle were architects and so I knew from the beginning I was going to be an architect. And so I pursued that, had some talent that direction, a lot of interest.
02:26
and realized rather quickly that I didn't like being a jack of all trades in architecture. In other words, not really understanding each client's needs and never having a repeat client of the same need. In other words, no second police station, no second savings alone home office. And the analogy I use is like the very first crown prep you cut compared to what you cut today, totally different. And I was lacking that in architecture. So I decided leasing space from an orthodontist and office next to a pediatric dentist and
02:55
having nothing but good experiences in dentistry my whole life. I'd go to dental school after I practiced architecture for six years. And I would probably design a few offices on the side as a hobby. Well, that kind of turned around because Pride Institute hired me to become director of architecture for them out in San Francisco the day after I graduated from dental school. And it became after 11 and a half years of practicing dentistry and architecture, essentially burning it at both ends and I had to make a choice. And so these days I say,
03:23
I see patients infrequently. saw my last one in 96. Yeah. That's fairly infrequent. Fairly infrequent. designing offices is my life. was my next question is how's your re-care? How's your reactivation? Well, know, actually we've done several offices more than once for a client. People that have lived long enough or have siblings or they have
03:50
kids that a legacy that joins them and they need something else beyond what they had originally. So yeah, there's a little bit of re care there, I guess. There go. Well, I want to get right into it. I would love to know this. What are some of the craziest things that some of your clients have asked for in their offices?
04:16
Well, had a fellow out in Vegas who put in an aquarium that was four feet wide by 15 feet long and 11 feet high that had an actual live reef in it that he had imported. And that was one of the crazier things, but that was Vegas. So, you know, it's to be expected. But a lot of water features over the years that thank God that's kind of been gone now for a while because nothing better than
04:44
more humidity than you need in a dental office. so really not too much in the way of crazy. Yeah. Okay. The infamous fish bowl, the infamous fish bowl or a Petri dish, you know, and I know you hate water features. Yes. Well, I'm not, I'm not a fan. Let's say I don't hate them. just, right. That's judicial. I like that. Okay. That's, that's perfect. Like what
05:12
This segment in my mind is really like, I would just really love to understand exactly how to define the value for an actual architect. Because there's kind of like this movement of design build that's coming out of nowhere. Maybe it's not coming out of nowhere, but it's kind of catching fire in certain areas of the country. I do startups all over. Some areas are really,
05:40
are like all in like Texas types. And then there's, you know, places like Seattle where architect is still alive and well and really driving. So, doctor, give us like your perspective on this whole thing. Like what's the benefits of hiring an architect and going through the hard bid process and the I get you, moments of that process.
06:10
Break it down. Well, one of the most significant roles of the architect is they act as the representative for the owner in dealing with the contractor. So they are looking out for the best interests of the client, of the doctor who's building an office in relation to the contractor. When you now have the architect and the contractor under the same roof, which is design build, you lose that representation on the part of the architect.
06:38
You know, it's certainly easy for a contractor to bring an architect in with them, but that removes an awful lot of control and gives it over to the contractor for things like, well, is that really what was supposed to be there? Has that been changed? Change orders or things that aren't even change orders, they just get changed without anybody knowing. So that's one of the major roles of the architect is to represent the owner in dealing with the contractor. you saying, are you suggesting
07:08
that we need to hold these contractors accountable. I guess what an architect here locally says that a design build situation is kind of like having a fox in the hen house is what she always used to say. So I'll just repeat it. I mean, is that a good analogy? mean, having it all under one house, do you have the fox running around enjoying those chickens?
07:36
That Fox and the Hinn House thing, that's good. Could I use that? Yeah, use it. Thank you. Yeah. That's exactly what I'm saying is you commingle the person who's designing with the person who's building. And honestly, the incentives are not in your favor. They are now in the favor of the contractor. That's what I've always found to be a problem. I've never lived through a good design build contract in 40 years of designing. Never had a good experience with design build.
08:06
something always is not to the benefit of the client. Give some examples, give some examples of that. Well, there was that one over there and that one down the street. More specific, you suppose. Yeah. have, it's the whole gamut of, no, that wasn't included, you those kinds of things. Right. We, changed that to this because it's better. And, know, without any idea,
08:35
on the part of the client, because they can't read architectural drawings and they really have no sense of materials and use in construction. And so they're kind of at the mercy of people, one of which can certainly be the contractor. Yeah, and I mean, you see that not only from things that you physically can see within the space, you know, the actual environment, but it can be HVAC, it can be many other things where
09:05
that can affect your actual work environment more so, know, heating and cooling, which I know is something that you're adamant about in your design that can just go by the wayside. Yeah, exactly. We've done projects where the contractor will put in one zone for the entire office under design build because it's cheaper to do it that way. Whereas we're just doing an office right now, a 19 chair office out in the middle of a prairie in Nebraska.
09:35
with six zones because I want to make sure that we have control throughout the entire office, whether we have North exposure, West, South, East, and also separating off the receptionist space because they're always frozen. And the doctor's dying of heat prostration at the same time in the treatment room. So, you know, we need control and that gets many times cut out of the project when you really have no control over design build.
10:05
And the owner doesn't know Jack about that. mean, honestly, they don't have any clue about that. No, I've, and you know what, I've utilized that in, you know, in my lifetime talking about that, that, you know, if you have an oral surgeon, they want it even colder than the, GP because they're just, you know, high intensity, whatever it might be. I mean, gowns and it's, like an OR in a hospital. They're ice cold. And that's the way the surgeons want them. Yeah.
10:34
So I mean, that's a great point. mean, Mike, is, Dinsio, this is why we have someone with this mindset. Six zones, I don't know if you've come across that before in your tenure, but I mean, that's the attention to detail and that's also the attention to detail to hold that contractor accountable. Mike, you brought up a quote here that
11:06
Your experience indicates that hiring the unthink design group in general or an architect will eliminate significant change orders by not constructed wasted space and not verifying. And by verifying you receive competitive pricing for your project. Like that, think sums up everything on what you do, correct? Yes, yes.
11:36
You know, probably the best analogy is the prescription you write to the lab in dentistry. This is a prescription to the power of 10. It's really your shopping list of everything that you wish to buy that's appropriate to how you intend to practice so that you have everything nailed down. I mean, right down to the strainers in the sink and the hinges on the door so that whomever you have priced that project will price it apples to apples with anybody else that's pricing it. You don't have to take the low bid. You're not a governmental agency, but you do then have a choice.
12:05
as to who you want to hire. And they have given you essentially a number that says, if you hire us, we're going to install, build, provide everything is shown and specified in these drawings and specifications for this amount of money. And that's what I want you to get to. And then because it's all spelled out, there shouldn't be change orders. We don't want change orders on a project, but best little internet cartoon or actually photograph I've seen is where there's a very huge boat towing a little dinghy.
12:35
And the dinghy says, proposal. And the big boat says, change order. Those are the names of the boats. I've seen that. Yeah, that's a classic. And it's so true. It's just so fricking true. mean, really, that's. Well, and Mike, I've seen your drawings, right? I've been a part of some of your projects. And I mean, they're this thick. And I've seen other projects and the architectural drawings are this thick.
13:05
So, D'Inzio, what's encapsulated in that? And I had my fingers up. It's more like that, isn't it? It's more like that. But, you know, the bottom line is, the drawings themselves and the specifications literally spell out everything. Everything. You know, a page full of polls, a page full of, you know,
13:34
everything. So that way you cannot have a change order, correct? I mean, that's the bottom line. Yeah. The downside is, as everyone who's ever built anything understands, change orders can end up costing far more than what you pay your architect. It's that simple. Right. So what I tell our potential clients is, you we're going to save you more in our fee than what you would spend if you don't have us involved. And that has to do with change orders predominant.
14:04
Well, let me ask this question. me tap into that brain and experience of yours, Doc. So we're talking a lot about change orders, right? Like the things that contractors are bidding on the front end so that there's no surprises. And that obviously is going to save you lots of money, no question about it. My concern sometimes with architects and
14:31
And I want you to speak to this directly because I see it too much through the country where they're almost given a license to kill the architect. So as we talk about the fox and the hen house, where there's definitely some issues there, right? The flip side to that is the architect just gets to design the Picasso of the year. They want their picture and some
15:00
trade magazine for the most beautiful space in the 50 foot fish tank. And when I was a banker, my concern was always that the architects never called me and said, Mike, are we even in the realm of budget right now? Like, didn't I get that call? I should have gotten that call weekly on all the projects that were happening. And so,
15:26
So do you know what I mean? So is there over design? What are the expectations for an architect when you hiring a decent firm like your guys's firm? Well, generally speaking, architects tend to price their fee based on a percentage of the cost of construction. And we don't do that. We quote a flat fee based on the number of treatment rooms. And I never want the perception that we're causing the project to cost more so that we make more.
15:56
that should be removed from the equation. So we quote a flat fee. We'll do everything you need for this amount of money based on the number of treatment chairs. And it's just a, you know, it's a scale I have in my office and I say, okay, you want eight chairs? This is how much it is. You got 11 chairs, this is how much it is. And it doesn't vary from that. But architects, generally speaking, could get carried away with over design. Our website carries a ton of photographs of offices we've designed.
16:26
And so I say to them, if you like this level of finish, this is about how much you're going to spend per square foot to build this office. So that they have a very good idea of what they need to budget ahead of time. We can certainly do it for less. It's just a matter of leaving out some of the finishes and changing maybe some of the light fixtures, but that's not a huge expense anyway. So it's really level of finish and also being absolutely as efficient as possible with the amount of square footage that you're using.
16:55
For instance, we designed an office that won the Dental Economics Office of the Year a few years ago, that also won the most efficiently planned office. And that's really what I'm most proud about is let's plan this as efficiently as possible because every square foot is gonna cost you money. Whether it's construction or lease, both ways. That's that trade magazine I was just talking about you guys. Dr. Anteng got the award of the country.
17:22
15 of them actually, Oh, wow. Mic drop. That's impressive. So sorry, John, I know you're probably dying to ask a question. I'm gonna go keep going because I love this. I'm gonna keep rolling because if we're talking about startups, right, Doc, you know, startups should have a different mentality about that first office you you know, they don't have a business yet. They're
17:48
They're building this business plan. They're putting it all together. They're stacking all the pieces and making sure that they're gonna be feasible. And John and I talk about that all the time that cashflow is king and who cares if you have a fish tank the size of the Empire State Building, if you don't have any patients, you're toast. so, to that point, over designing is absolutely a thing, right?
18:14
What are some things that startups can ask other architects just to keep them dialed into the big picture of the budget and the overall vision and maybe even give us some tips or tricks about like how to save costs. mean, cause startups, you know, they just don't have as much money as maybe the doctor looking to. Yeah, absolutely. They may still have considerable student debt as well.
18:41
One of the first things that they should ask their architect is, you have a number for Unthank Design Group? That would be a good first question. That's below in the description, by the way. That'll be added. Don't worry, Doc. We got you. We've actually done a number of startups. We did one for a periodontic grad student. graduated in periodontics. And he took a previous small three-chair general dental office, and we remodeled the front desk slightly so that there was
19:10
good separation from public to private at the front desk. And then three years later, he contacts us to do his 10 chair new building. So, you you don't necessarily start off with a 10 chair new building. But we also did a new startup down in Kansas City for Sarah Brent and her seven chair startup, which is pretty ambitious. Not all of them were equipped to start with. They equipped them as she needed them. Yeah. But that one, the dental economics office of the year award too for best new practice. So.
19:40
The people and budgets come in all shapes and sizes. Some folks roll out of dental school with a head start with some funding from a family member. We actually had done her father's general practice down in Joplin, Missouri after the tornado destroyed it. So, know, it's variable, but you do not need to have the Taj Mahal as your first office.
20:06
And many times these students, as you know, come out and they practice for corporate dentistry for a while until they get their proficiency up and they get some student loans paid off and then they're ready to do something on their own many times. Well, you brought up, you brought up a point there about remodel, right? Because some people will be, you know, their startup might be, they're going into a space, right? That's existing, you know, talk to us about that a little bit. that, sounds,
20:36
that sounds like, you know, because that's not always as budget conscious as it might seem, correct? Well, the finish out for space, whether it's a condo, leaseholder, whatever it may be, a fresh empty space, let's say, a strip center, perhaps. The finish out per square foot is going to be every bit as much as you would pay to finish out a new building as far as the interior finish out. The only difference is you also have to buy the building shell that wraps around your practice.
21:03
Yeah. Well, building shells, not as much as the finish out is the building shell, maybe $120 a foot where the finish out is 180. Yeah. And these figures are construction costs, not including equipment or technology or furnishings or art and accessories, those kinds of things. Um, but yeah, going into a space, uh, can be wise to start with, but you're going to spend a lot of money to do that. And in, let's say in five years, you need more space than that. And it's not available next to you.
21:32
So what are you going to do? You put all this money into that space and now you're kind of stuck. It's a tough nut to crack. Yeah. People call it buying other people's problems. Right? Yeah. They're really funding somebody else's retirement program. For instance, the periodontic practice I mentioned, that was for the most part laid out where he could go in and make use of the three chairs that were there with just minor remodeling and a little bit of freshening from a decor standpoint. That's not bad.
22:02
but that means you got to find a dental office that you can go in and spiff up, so to speak. Yeah. Let me ask you a question on just overall design. Open Bay with the center councils and all of that versus closed operatories. And you're laughing almost hysterically, but talk to me about that because I think it's important, especially in timestamp today, COVID. you talk a little bit about that?
22:31
Yes, as you know, I've never been a fan of the cabinets that separate chairs because there is no privacy acoustically chair to chair. They, you know, they'll stick a sink at the treatment corridor end of that cabinet. Well, that opens up head to head from one room to the next, to the next, to the next. You go down to the Scottsdale center for dentistry and they're four in a row like that. You can hear what's going on in the fourth room because there is no separation chair to chair and it's all hard surface. You got to have soft stuff to soak up sound.
23:00
So basically you gotta have walls between the chairs that's sealed to the foot of the chair, sealed to the ceiling and go past the head of the chair toward the treatment corridor, or you're going to have a loss of acoustic privacy, which is a HIPAA violation, quite frankly. And these days with COVID, absolutely you need separation chair to chair. we're, know, doctors are thinking about more closed rooms with doors and negative pressure, those kinds of things.
23:27
Yeah. And I know that's been a part of your design scape for, you know, since the beginning, which to me makes a lot of sense. It really does. So kudos. I know that means a lot to you coming, you know, that I'm giving you kudos. Oh, John, I love it. Thank you. Did you saw like just softball? Is that what that was? No, I mean, I thought it was a good time stamp for where we were. Come on. Yeah. In the era of COVID, absolutely. But thank God it sounds like we've got some
23:56
vaccines on the horizon. That's right. Hey, doc, final points like what what are some things just quickly like that that doctors can pay attention to in these startups like I, I find lighting being one of those things that it seems like I'm always looking at that budget. John and I talk about curved walls all the time. Like, what are some of those things that if you're looking to cut down on some budget things?
24:26
what to focus on? Well, you mentioned curved walls, know, construction materials generally don't like to curve. And so that can easily be a labor expense as well. But it's, really in an office, you need lighting of an adequate level, but it doesn't have to be overly costly lighting. And these days, I tell you what, we've got a lot of docs who go into treatment rooms using headlights. Their assistants are using headlights. The hygienists are using headlights. They don't want an oral cavity light.
24:56
And really what they want is a very little in the way of ambient light. So the contrast ratio is still okay between the arrow cavity and the surroundings, but finishes in an office or what can run up the cost. You do not need wall covering, vinyl wall covering on every wall throughout the office. You need it only where it makes sense to either be aesthetically pleasing or to prevent some damage bumping into that wall and flooring materials as well. And ceiling materials, know, many doctors will go,
25:26
I don't like that grocery store ceiling tile stuff. But in reality, it soaks up sound. It doesn't have to be ugly like the grocery store, but it soaks up sound and it allows access to all the utilities above the ceiling. So that's a relatively inexpensive ceiling solution long-term especially, because if you ever have a problem up there and it's a drywall hard ceiling, you got to knock holes in it and get to the systems and find out that you're not in the right place for that leak anyway.
25:54
You know, so I would say finishes as far as the interior design is one of the big contributors to over paying for an office.
26:05
That makes perfect sense. you know, Mike, this was this is exactly what we wanted for this session, you know, and, you know, I'm going to summarize something that you've stated in your career that it costs more money to build an office the wrong way than to build it the right way the first time. Am I saying that correctly? Absolutely. Yeah. And over the life of the practice. Right.
26:31
Right, I mean, there's so much more to it about ergonomics and flow and, you know, patient flow, but also, you know, to make the environment right for the patient, but also for the doctor and staff. So you've done that throughout your career and evidently you have 15 awards on your mantle behind you, which is amazing. Is that an Emmy behind you also? I'm not sure. Yeah, it is. But Mike, thanks so much for not only your friendship, but for.
27:00
helping our viewers and listeners. Obviously, this was a great session and you've represented the architectural world so well. So thank you. Thank you, John. Thank you, Michael. Yeah, it was a pleasure, Doc. Thanks so much for being on the show and viewers, listeners. If you're trying to get a hold of the Unthank Group, please check out our description. You'll have full access to his team and him and
27:28
Ask away, you've got a legend in the program and we're offering that up to you. So thanks again everyone for listening and stay tuned to the next episode. Thanks. Thank you.
27:46
Thanks for listening. Tune in next week for another truth-filled episode of Startup Unscritped.
27:55
Check out Startup Unscripted on Facebook and YouTube. Click like, subscribe, and interact with Michael and John.