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The conversations dentists never get to have.
Between Patients is a professionally produced interview series for dentists and dental practice owners. Practice owners, associates, specialists, researchers and the people who keep practices running, talking honestly about the profession: the business, the pressure, the growth, and the parts nobody says out loud.
Hosted by Moiz Khurram, from a family four generations and seven decades deep in dentistry. His grandfather ran his clinic in Lahore for close to 25 years. This show asks the questions that world taught him to ask.
Most practice owners spend their whole career trying to build one successful practice. Just one. Today's guest built six. Rio De Janeiro, Lisbon, London, Liverpool, Birmingham, Cheshire. Three countries, two continents, and one brand.
Speaker 1:Doctor. Marques is an oral and maxillofacial surgeon, trained in Brazil, PhD here in The UK, and founder of the RIT Premium Dental Care. In the next thirty minutes, we're going to be covering how exactly he did it, what it costed him, and what exactly he's going to tell anyone trying to scale. Doctor. Alex, welcome to Between Patients.
Speaker 2:Thank you very much, Mohamed. It's a pleasure and an honor to talk to you and try to share a few chapters of this exciting journey.
Speaker 1:Absolutely. A player is all mine, Doctor. Alex. So Alex, take me back to Brazil. When you qualified, what did you think your career was going to look like?
Speaker 2:I qualified in 2001, getting my dental certificate in 2002, being entitled to practice dentistry. I fell in love with surgery at that time and right in the beginning of my career, I had the pleasure and the privilege of joining the military forces as a firefighter. So Rio de Janeiro military fire corps are part of the army. It's an accessory branch of the army in Brazil. And that allowed me to work part time in a renowned institution, reputable one with amazing clinicians that helped me to grow and to learn and to be exposed to several clinical scenarios that allowed me to grow.
Speaker 2:I did my max facts training, my maxillofacial surgery training in Sao Paulo University. It took me three years to get that accreditation, that certification. And after that I went, I spent one more year training in orthognatic surgery. So four years on max fax. Also did a PG dip in implants.
Speaker 2:And during that time I was working part time in the military and part time in the private sector. And that's when I, together with an orthodontist, a good friend of mine, we started our clinic. It was the first one that's our baby, our first clinic and we went from there. Fast forward ten years later, I came to The UK for a PhD in biomaterials and bone tissue engineering. And the reason why I ended up doing the PhD degree, Mohamed, is because Brazilian dentistry is not only very developed, high end, but extremely competitive.
Speaker 2:So having all those papers on the wall is something common in Brazil in every corner. People qualify big time. So I had my masters, I had my PG dips, my residency training and all that, but the PhD was lacking. So I had the honor of being accepted at King's College London for a PhD in biomaterials. That was a question mark that I had in surgery.
Speaker 2:I wanted to learn more about bone reconstruction, how I could use bone substitutes, understanding their properties, developing that critical thinking on research and at the same time understanding more about bone reconstruction. It was an outstanding experience.
Speaker 1:Absolutely. I do understand the first clinic is always like a baby and, you know, when you came to The UK, so was one of the main reasons just specifically so that you can further pursue the PhD degree or was that something else or was there any sort of other reason behind moving to UK?
Speaker 2:So I am a husband and a father of two. And of course, also like, I went to several conferences worldwide for so many years and I always traveling abroad and visiting different countries. My wife has European citizenship way before Brexit. So we had the possibility of living in The UK straightforward, just moving to the country. So the combination of a safer country, reputable, knowledgeable education, training that we could offer not only for me, but for my children.
Speaker 2:And of course, the possibility of exploring Europe and being immersed in so much culture. So it was a joint effort. It was a big combination of factors that allowed us to come and made us come. It was never business, to be honest. It was more like academic and lifestyle.
Speaker 2:And the business came as a consequence, of course, with the opportunity of expanding the operation to Europe. Yes.
Speaker 1:Absolutely. Yes. Previously you did mention regarding the Brazilian dentistry that it's really competitive. So when you moved to The UK, was there anything that really shocked you about The UK dentistry when you arrived?
Speaker 2:So when I came to The UK, the the biggest impact I had were, of course the difference in regulations and cultural aspects and type of public. Brazilian patients are extremely cosmetically driven and we don't have a strong public health care system. We have in Brazil a public health care system which was inspired by the NHS. We are also very proud of our medical health care system in Brazil, which gives access to unprivileged population to general health and why not oral health. But public healthcare system, especially in Brazil, it doesn't offer sufficient dentistry to keep the population healthy.
Speaker 2:And the NHS in The UK, on the other hand, they provide the basics, right? Amalgam fillings, cleaning, scale and polish extractions, they keep the patient somehow stable, but of course with no functional or aesthetic approach. That's not the role of the public healthcare system, but that does impact directly in the private sector and in my opinion, in the quality of the private sector too.
Speaker 1:Absolutely. Yeah. I mean, when I used to live in UK, I used to live in Deersburg, West Yorkshire, and I can absolutely relate that NHS, providing the basics of the dentistry, but this is where the key, this is where private dental practices, they would just play such an important role in the cosmetics and the advance for the modern dentistry where exactly it's heading. Yeah. It does actually bring me to my next question.
Speaker 1:You know, previously talked about the first clinic is always like a baby, the practice. So walk me through the first RIT dental practice. How did it start? You know, what was that that, you know, you founded it from scratch and wasn't anything specific that, you know, you went into such sort of a hurdle?
Speaker 2:So the story is I come from a restorative and surgical background. My business partner at that time was solely an orthodontist, fully focused on ortho. And we worked in collaboration in our office. So in our dental office, we started referring and counter referring patients between us. We soon noticed that we needed an endodontist.
Speaker 2:And then we noticed we needed a periodontist and we also needed a cosmetic dentist. And so we started inviting those outsiders to join the team. So we needed a bigger space. So we went to a larger venue and we built a practice. So that was our first RIT or RIT nineteen years ago.
Speaker 2:RIT is the abbreviation of Rehabilitation Innovation and Technology. And that's what we believed. So that was our first clinic. It was three surgery practice, ended up growing, four surgeries, five surgeries. Now we are in six surgeries practice.
Speaker 2:And those first associates, they ended up becoming valuable business partners and directors too. So the culture of our company is to share, to grow together and to know how to have business partners. I don't know if I am an easy business partner, but I have many business partners and I get along really well with them. Work is not easy. We have our obstacles, our challenges.
Speaker 2:Sometimes we don't agree, but it's not my opinion that has to prevail or someone else's opinion. It's the best opinion, The best opinion has to be taken into consideration. So our first clinic was built based on the interconnection between the specialties, the interdisciplinary approach, patient centered approach, respecting the field. There was no conflict of interest because I don't do root canals, I don't do braces, I don't do aligners, whitening, I just do surgery. So by having those other specialists with me, that helped us a lot.
Speaker 2:That's not my clinic, it's our clinic. That's not my patient, it's our patient. So nowadays the biggest challenge is trying to find people who are not that selfish because dentistry somehow you are trained to be the only hero, right? The only person that will be looking after the patient majority of the time. Whilst doctors, they are not trained like that.
Speaker 2:They are trained to be part of an ecosystem, right? Where they play their role, they have their nurses, other specialists, physiotherapists, nutritionists, and so many other professionals around them to achieve the best outcome. Whilst us dentists, we think that we are the superstars and we are the only ones who are right and we don't need anyone else's opinion or we don't need anyone's help. And when I came to The UK, Mohammad, I found that same mindset of clinicians who do everything. They do root canals, do fillings, they do wisdom teeth, they put aligners, they do everything.
Speaker 2:And to be honest with you, I'm not sure if that's the way to go.
Speaker 1:All right. So, you know, you mentioned about the associate dentists and the doctors getting into the practice once the practice is in the initial stages. What do you think is one of the most important key quality that you typically look at in any associate dentist before you get them onboarded with the practice? Is there anything specific that you want to highlight?
Speaker 2:First is understanding their roles in the team, understanding the importance of multi disciplinarity, understanding that they will not sort the patient out. Interestingly, all my orthodontists, they tend to diagnose orthodontic problems. All the cosmetic dentists, they tend to identify the importance of veneers and all the implantologists look for failing teeth. But is that the way to go? Ideally, you should assess the situation, plan the case, understand what the patient needs, and then involve the right professionals.
Speaker 2:So that's our motto here. That's what we want all the time. Sometimes when I assess a patient that needs implants, I am the last one in line because the patient needs perio first, then clinical care, restorative, then the proso team comes and then ortho team comes and then the implants are placed in the very end, like two, three years later sometimes. And this is the right way to be done. That's the way it should be.
Speaker 2:That's what's written in the books.
Speaker 1:Alright. Absolutely. So the way you're currently running R and D dental practice and care is gonna be ensuring the patients are being most probably transferred or being referred to the right specific department. And there's a whole funnel that's been designed according to that. So if they need, let's say, for example, cosmetics in the very first get go, they're gonna be treated with cosmetic, and then later down the line, let's suppose, whenever the term for implant comes, then they're going be referred back to you so that you can treat them accordingly.
Speaker 1:Right?
Speaker 2:Yeah. But most importantly is, again, when you do the initial assessment and you collect the initial data and data collection is very important, like doing a proper analysis, x rays, images, pictures, if possible, When you collect all that data and when it comes to start planning the case, the more you involve other specialists, the more accurate you're going to be on your treatment planning. So sometimes patients come to see us because they want composite bonding from one premolar to the other, but then the bite is not great, then the gum health is not ideal. So it's our duty to inform those patients and act accordingly to prevent future problems. This is not a sales pitch.
Speaker 2:And that's something that is driving me crazy, not only in The UK, but in the entire world, part because of social media. People are somehow becoming blind. They are just prescribing what brings money to the clinic, and that's just wrong. We are oral doctors. We have to work for our patients for the best of their interests.
Speaker 1:All right. So quick one, before we carry on, if you are a dental practice owner or you are a dentist and you've got a story worth telling, go to betweenpatients.online and I would love to have you on the show. So go to betweenpatients.online, make sure to reply. And I'll personally get back to you with a date, time, and topic to discuss. Let's get back to the episode.
Speaker 1:Absolutely. From what I really see in the dentist and where the modern dentistry is really heading is there are two different types of clinics and practices. One is the practices like you who consider themselves as patients oriented practices, who think for the best case and cause of the patients. And the other one, which I typically see are the the business oriented practices who try their possibly, you know, the whatever they really can to make the most amount of money from the per patient. But on top of that, what you really mentioned is is something that really, caught my attention about the dentists who pretend and try to be jack of all trades.
Speaker 1:Why do you think it's something that typically halts their growth and it's really bad for their own practice as well?
Speaker 2:Well, I normally say that bad products cannot be sold for so long, right? You can make a huge effort, have an amazing sales team, a beautiful practice with an amazing perfume when you step in, light song, everyone dressed in the fanciest scrubs. But if you're not a good dentist, bad products will not be able to be sold for so long. So of course, we truly value the whole patient journey, the entire marketing scheme and generating leads and getting the qualified leads. We are working hard in each sector of the business development.
Speaker 2:But down the line, if you don't offer what the patient came looking for, you won't survive, man. The business won't prevail. That's it.
Speaker 1:Absolutely. There you go. So another thing I really want to cover is one of your practice. So your practice in Birmingham, it got registered with the CQC in June 2024. And I mean, honestly, your UK expansion has been really fast.
Speaker 2:Thank you.
Speaker 1:So what changed that made you push, you know, multiple UK sites in just such a short window?
Speaker 2:Well, we are a small group. There are groups that are growing crazily fast with foreign investors and outsiders investing money in the business. Whilst we are just a group of dentists that got together with the purpose of offering high quality stuff in a fair price. Birmingham was a key city for us because it's the second largest city in The UK, it's in the Midlands. So we are in between London and Liverpool, Manchester up north.
Speaker 2:So it was a key geographic position for us to get the traction of The Midlands. And yes, we've been lucky to have a group of enthusiastic business partners that devote time and resources to try to develop the business together. So we are keeping our heads above the water. We are growing consistently. Of course, challenges every month, but that's part of being an entrepreneur and I'm enjoying the journey.
Speaker 2:It's working.
Speaker 1:Absolutely. Absolutely. You know, as long as you're enjoying the journey and ensuring the patients are happy, that's all you need. True. Yeah.
Speaker 1:Another thing I was looking at is your whole brand sales principles implemented in Brazil. What exactly is it about Brazilian dentistry that you felt like, you know, The UK was missing?
Speaker 2:Basically, European dentistry is highly functionally driven and the American dentistry is extremely aesthetically driven. And in my beliefs, if you look at the Brazilian dentistry the way we are educated, we join both components in a very interesting blend where we can gather all the cosmetic, the smile design, the veneers and shade matching and details and everything that we should achieve from an aesthetic point of view where the Americans are very developed. But on the flip side, you can see Europeans way more driven to occlusion, function, guidance, establishing OVD, and then I think that when it comes to that sort of functional aspect, the Europeans are ahead with many companies, I can't even tell you how many companies we have here to measure pressure of the bite, jaw movement and so many functional aspects that again, the Brazilians also are very into it. So I think that this interesting blend makes Brazilian dentistry unique And I believe you are seeing more and more Brazilians standing out in several conferences worldwide and dentists coming from all over the world to be trained in our facilities in Brazil.
Speaker 1:Absolutely. So Brazil is more like a balance and mix of both of these different, different continents, you know, the American side as well as the European side. So it's like a mix of both. Got it. Talking about, you know, the practices and is something a lot of practice owners are watching this this podcast.
Speaker 1:They they may have question regarding this is how do you keep six different practices on two continents at the same standard when you physically can't be in them?
Speaker 2:So first thing first, I am privileged of having amazing business partners in each one of them, who of course are compliant with our beliefs, with our principles, with our standards. But at the same time, Mohamed, we have to adapt ourselves to the local aspects. So our clinic in Portugal is different than the one in Brazil. It's of course, slightly different than the ones in The UK. When it comes to regulations, when it comes to one or two products that are approved in a country and are not approved on the other.
Speaker 2:But the way we ensure our standards, it's more related to the workflow, the lead generation, how we look after our patients since day one and how we follow them up and the treatments that we offer. So we have a very close, nowadays because of internet, it's so easy to be close to each other, isn't it? That we tried our best to keep in contact and keep everyone updated of what we're doing. And of course we have the local managers and the local business partners who make sure that the business are compliant to what we think is right.
Speaker 1:Got it. Got it. So it's the business partners that you've got that you can trust them by even closing your eyes. And, I believe from your perspective, you believe, ensuring and having right business partners is something that would help any of the dental practice to grow and reach its absolute maximum potential.
Speaker 2:Yes. I normally joke that choosing your business partners is like a wedding, isn't it?
Speaker 1:If you
Speaker 2:are with the right person, you're going to be happy for the rest of your life. If you are with the wrong one, you're in trouble.
Speaker 1:Absolutely. There's one Asian man. He spent about $4,500,000,000 with Warren Buffet, and he had a lunch with him. And what exactly is one of the things that Warren Buffet mentioned is ensure that the wedding partner that you're going to choose, choose that really meticulously. Right?
Speaker 1:So, I mean, you're almost making your entire life to seen as someone who you're going to live for the next five, seven decades. So it's the same case with a business partner. I believe it's, it's really important for us to choose the right business partner at the right time. Okay. But sweet, that was absolutely insightful.
Speaker 1:And I mean, some people would also say that you can't deliver premium care at six locations. You know, that, founder led practices that typically lose his soul the moment the founder isn't in the building. What do you say to that? What do you say to those specific people?
Speaker 2:I partially agree when it comes to if you want to deliver it yourself. But if you multiply your leadership and you find the right people who have the same beliefs, the same values, the same level of qualification, and the ones who want to multiply that, you can make the dream team, right? So of course we had several dentists and several potential business partners that we met along those twenty years that are not with us because it's a natural selection. On the other hand, we have those ones who came and started working with us and showed and demonstrated their values, not only technically, but as human beings, as potential entrepreneurs, and they joined the forces and here we are. And hopefully we're going to get more people joining and we want to make this be a community of dentists.
Speaker 2:But I agree with you that if you escalate that to 100, 200 practices, it loses its soul. It loses its soul because it's very hard for you to train them. I still believe that if we train them properly, we can escalate. But it has to have a proper pace. And that's why we are growing, we are going to open more, but it's not realistic to open dozens per year and keep the same standard.
Speaker 2:It took me twenty years to build a REIT in Brazil. Here in Liverpool it's been five years now. The other two are newer and next year we'll be launching a new project. I have also other projects in different countries coming up, but preparing the nest first, preparing the people who will be there leading and allowing you to multiply your values. That's the biggest challenge.
Speaker 2:I agree with you, Mohamed, that what people say like, Oh, it's hard to escalate too much and keep excellence. Somehow I agree, but we've been lucky because it's not an army with one soldier. We have more soldiers.
Speaker 1:Yeah, absolutely. Absolutely. It's a very interesting fact that you know, I've been researching the dentistry dentistry whole space for quite a time now, and it's something I've recently came across. I mean, I've spoken with a couple or more doctors and dentists as well. One of the problem they typically tend to mention is dental schools, they teach you how to be a great clinician, but they just never teach you how to run your own dental practice one day.
Speaker 1:I mean, think about it. Every other dentist, to some extent, they have got their own dream to set up their own practice one day. What's your take on that? Why exactly do you feel like dental schools are absolutely lacking this whole vital and really important gap that's missing in the market?
Speaker 2:Well, I can only explain that, Mohamed, considering that the dental schools are preparing students or the future generations to work to the public health care system. Because you don't have to have a business mindset to work for someone else. So if you want to know more about business, you have to search somewhere else. You have to go somewhere else. You have to seek for extension, postgraduations, PG dips, MBAs, immersion courses, podcasts, whatever.
Speaker 2:You have to educate yourself or surround yourself with people who have that knowledge.
Speaker 1:There you go. Yep. Absolutely. I believe it's something really important my father always tells me. If, for example, if you want to become a businessman, have at least five businessman friends.
Speaker 1:And the sixth one is going to be you. If you want to become a billionaire, have at least five billionaires around you. And the sixth one is going to be you. So I believe it's really important to all the dentists, associate dentists who are listening or watching this podcast. If you really want to open up your practice one day and become a great business owner and, and ensure the growth, like how RIT has really attained, and you can be one of amongst them and, you know, attain some sort of a growth at a really fast and steady pace.
Speaker 1:It's really important you surround yourself with other practice owners who are doing a great job. But that's absolutely important for any other dentists out there.
Speaker 2:Yes. I absolutely agree with you. And also the new generation is falling into an illusion of thinking that you're going to find a magical recipe and that they will magically find a weekend course and they will become the masters of something. Nothing is going to happen without time, without experience, without expertise. That takes ages.
Speaker 2:Be patient. That's the only way to go. But follow the steps, build a robust foundation. And that's the advice I give to my son who says he wants to follow my steps. So there's no other way apart from hard work, studying, investing, taking some risks, but surrounding yourself with the right people indeed.
Speaker 1:Absolutely. I absolutely do agree with you on that. Let's get into the most interesting part. I do have three questions on top of mind, and it's something that's really, really close to my heart. A practice owner listening right now has, let's say, one successful clinic and is just itching for a second one.
Speaker 1:What do you have to tell them?
Speaker 2:Well, first, in my respect to opinion, find a reliable business partner or time. Because if you want to run that alone on your own, you're going to have to surround yourself with an amazing management team, you're going to have to be very lucky and if you don't have good business partners and if you decide to be alone, best of luck, there will be no holidays, there will be no time off, your phone will never stop ringing and you don't have anyone to share. So my best advice is trying to find someone that is on the same symphony and good luck.
Speaker 1:Absolutely. Try to find someone who's on with you with the same bandwidth and get a great business partner. Sweet. That's amazing. So, and let's suppose the overseas dentist who just landed in The UK with a degree and has got nothing else.
Speaker 1:What do you tell them?
Speaker 2:Well, first they have to validate, right? They have to qualify. I had to go through all that through the overseas registration exam, the ORE. For the ones who are lucky to come and have their GDC numbers, then it's a different story. You can either have your performing number and do a part time job on
Speaker 1:the
Speaker 2:NHS. That's a good pension scheme for you and it gives you a lot of exposure. There are other ways for you to just go on the private sector and get a few part time jobs. There are many opportunities in The UK. So dental market was always competitive anywhere in the world.
Speaker 2:But in some countries there is still a bit of room to grow. And I believe The UK dentistry, there is a lot of room to grow yet. So if you come with good intentions and work hard to offer the best for your patient, there will always be room for you in the market.
Speaker 1:Absolutely. Sree, that was perfect. Again, it's not the horse, it's the horse rider. But Doctor. Alex, this has been a brilliant conversation with you, six clinics, three different countries, and more honestly about what it actually takes than most people share in a lifetime.
Speaker 1:I do appreciate you coming on. I've, and you know, it's, it's been a delightful conversation we had. So if you're a dentist or a practice owner and you want to be my guest on patients, then make sure you check out betweenpatients.online and apply there. It's only gonna take you thirty seconds, and I'll personally get back to you with a date, time, and really hard topic to discuss and your story as well. So make sure you check that out and make sure you apply.
Speaker 1:And if you want to go deeper on the business side of dentistry, make sure you check out my book, The $2 Dentist. It covers why exactly great dentists they build broke practices. It's got ninety days install, and it's got 18 working tools for your dental practice. Again, it's gonna be on between patients online. There's gonna be a top announcement bar that the book is officially live.
Speaker 1:Make sure you check that out as well. And I'll be uploading new episodes every single week. I'm Mohammed Moyeskrum, founder and CEO at Selenic AI, host at Between Patients and author of The 2 Dollar Dentists. See you on the next one.