Host Track: : Welcome to Shared Practices 2.0 with another Update Ask George episode.
Host Track: : The collision of frameworks that we talked about last week, the mess,
Host Track: : the goodness, the learning, the joy.
Host Track: : We're going to talk about that a little bit more today. So, George, welcome back.
Guest Track:: Thanks, Richard, for having me back. And, you know, this will be a shorter episode
Guest Track:: because a lot of people who have kind of heard our, you know,
Guest Track:: original framework, this will sound more or less familiar.
Guest Track:: And I think that on the last episode, we talked about Scott coming on to the
Guest Track:: Shared Practices podcast.
Guest Track:: And we talked about shared practices, sharing best practices.
Guest Track:: And we talked about where Scott changed our framework.
Guest Track:: And he changed our framework in the minds of income, right?
Guest Track:: Like we've always proposed dentists take a fast path to growth that has a period
Guest Track:: of income turbulence that we just
Guest Track:: call something that they need to set expectations for and move through.
Guest Track:: And Scott suggests taking a slower, more patient path that doesn't necessarily
Guest Track:: have that drop in income.
Guest Track:: And that was a lot of what we talked about on the last episode of Ask George.
Guest Track:: And this episode, we're going to talk about the y-axis of that chart,
Guest Track:: which is just the movement through avatars of our philosophy through a patient
Guest Track:: flow hygiene-led growth.
Guest Track:: Because when we were in the process of recruiting Scott to join Shared Practices,
Guest Track:: that was one thing that we kind of said, no, this is our flag in the ground
Guest Track:: where we're different and we're unique.
Guest Track:: And it's what makes us, in our minds, so good at what we do is that we have
Guest Track:: this totally different way of taking practice management and topping it upside down.
Guest Track:: And that's through our hygiene-led growth. And so I feel like this episode,
Guest Track:: it's just a really good place to kind of bring that back into the conversation.
Guest Track:: Because, you know, we've removed the whole, you know, 700 episodes of the podcast.
Guest Track:: And, you know, that was, you know, like early, we hadn't yet discovered that way.
Guest Track:: And then later, it kind of came to fruition.
Guest Track:: And then we did start discussing this new way of doing things,
Guest Track:: what we call hygiene-led growth.
Guest Track:: And so I think that that, for me, is really where I would like to go in today's episode.
Host Track: : This was an instant light bulb, even as we hit record, because we just talked
Host Track: : about this in our previous episode a little bit in terms of there are two different
Host Track: : tracks or what are we maximizing for?
Host Track: : Are we maximizing for income all along the way or are we maximizing for growth speed?
Host Track: : And I think as you have been talking, the light bulb turned on for me of the
Host Track: : hygiene department is really where the rubber meets the road here.
Host Track: : We are either maximizing the hygiene
Host Track: : schedule for the most productive hygiene schedule and therefore a ton amount
Host Track: : of profitability in a dental office comes from that hygiene schedule or we're
Host Track: : maximizing it for openings and new patient growth and expanding of hygiene days
Host Track: : as a constant in our practice,
Host Track: : which is a little inefficient in terms of cost and in terms of maximizing profit.
Host Track: : You are sacrificing a jam-packed schedule for a schedule that can grow faster.
Host Track: : And you still can be profitable all along the way with a hygiene schedule like this.
Host Track: : But I love this episode because it is a major difference in these two frameworks
Host Track: : or these two paths is the ability to make a decision with what you're going
Host Track: : to do in your hygiene department.
Guest Track:: Yeah. And I'm going to kind of bring back Dental Money Ball,
Guest Track:: right? Dental Money Ball is the book that we wrote.
Guest Track:: And the purpose of that book is saying, I've never heard of shared practices.
Guest Track:: I have no idea what, you know, hygiene-led growth is.
Guest Track:: And, you know, we essentially kind of explain it all in 180 pages.
Guest Track:: And in that book, we talk about the dental two-point shot versus the dental three-point shot.
Guest Track:: And so I want to kind of talk through, you know, these two different hygiene
Guest Track:: gene approaches and what they each optimize for.
Guest Track:: And so let's start with the dental two-point shot because that's what...
Guest Track:: So the dental two-point shot, and a two-point shot is a known,
Guest Track:: predictable, responsible outcome. Robert Leonard.
Guest Track:: So if you kind of look at like our, you know, high income earning,
Guest Track:: slower growth path, that's where this slides in, you know, very effectively.
Guest Track:: And the question that you asked between the two point shot and the three point
Guest Track:: shot is what are we optimizing for?
Guest Track:: What is our strategic approach aimed at accomplishing?
Guest Track:: And in the case of the two point shot, the strategic approach is aimed at optimizing
Guest Track:: for hygiene department profitability, right?
Guest Track:: So if you're taking that slower path and you are interested in income being
Guest Track:: something that is highly prioritized, then your hygiene department needs to
Guest Track:: be an income-generating engine for you and the practice.
Guest Track:: And so when you're making decisions around hygiene, you need to be thinking
Guest Track:: about it with income in mind.
Guest Track:: And so that's really the perspective that Scott is bringing into our podcast
Guest Track:: is the, Scott is a proponent of the assisted hygiene schedule,
Guest Track:: and he's a proponent of the profitability being like a staple of a well-run hygiene department.
Guest Track:: And that is optimizing for that hygiene department contributions to the practice level profits.
Guest Track:: And that ultimately means that you have a tight schedule, you focus on adjunctive
Guest Track:: services, You focus on kind of pulling value out of the hygiene department,
Guest Track:: but you're not laser focused on growing the hygiene department.
Guest Track:: And that is kind of the key difference. So, Richard, like,
Guest Track:: what do we need to say about kind of the responsible profit-focused philosophy
Guest Track:: on hygiene that, you know, has really been a staple in our industry for a long time?
Host Track: : I mean, this is where you can just build that stable profitability of,
Host Track: : you know, the beauty of a GP practice is your recurrent hygiene base.
Host Track: : And if you can really push towards maximizing, okay, we've got the assisted hygiene.
Host Track: : Here are the patients that maybe have less dental needs.
Host Track: : They're less likely to need SRP. They're less likely to need ongoing restorative care.
Host Track: : And so they're the straightforward patients. We kind of move those onto these
Host Track: : schedules and we've got the patients with higher needs.
Host Track: : But I also think there's the ability to evaluate all these parts and pieces,
Host Track: : and we're providing some paths, but there is the ability to take the best of
Host Track: : these and your unique situation.
Host Track: : So it's like maybe you really just can't find another frigging hygienist.
Host Track: : And so you're trying to grow, you're trying to accelerate your hygiene schedule,
Host Track: : and you need to do assisted hygiene to have more hygiene openings.
Host Track: : So while we're describing these as kind of dogmatic paths of here's one way
Host Track: : to go, here's another way to go, as an entrepreneur and as,
Host Track: : you know, this is why we provide coaching, this is why we help people on an
Host Track: : individual level, there might be times where your path is a blend of these or
Host Track: : you have to use one tool for a little while before you can use the other tool.
Host Track: : But the profitable hygiene department and a periodiagnosing fluoride using case
Host Track: : acceptance driving hygiene department is the pinnacle of a systems-based practice.
Host Track: : We love all of this stuff.
Host Track: : But what are you doing with all of that?
Host Track: : Are you really doubling down on profitability and controlling the costs?
Host Track: : Or are you doubling down on growth? And so it's the same tools just applied
Host Track: : in different directions.
Guest Track:: And I think, you know, one thing that was really interesting in our process
Guest Track:: of bringing Scott on board is...
Guest Track:: We both agreed that assisted or unassisted hygiene is not a one-size-fits-all
Guest Track:: answer to all situations, right?
Guest Track:: And so I think that we've always approached it from an unassisted hygiene perspective.
Guest Track:: But I say that saying that we have a client who I personally worked with very, very long ago,
Guest Track:: who started with five operatories, is now in 11 operatories,
Guest Track:: and grew using the the dental three-pointer in assisted hygiene the whole time.
Guest Track:: And so I think that whether you do assisted hygiene or unassisted hygiene is
Guest Track:: more a function of your local environment, the wage of a hygienist,
Guest Track:: the ability to attract new hygienists.
Guest Track:: I think that's where you make the decision if you're assisted or unassisted.
Guest Track:: I think that is almost independent of optimizing optimizing for profitability
Guest Track:: versus optimizing for growth. Those are two separate things.
Guest Track:: You can optimize for profitability, assisted or unassisted.
Guest Track:: You can optimize for growth, assisted or unassisted.
Guest Track:: I actually don't think assisted or unassisted hygiene is really a differentiator
Guest Track:: between the two schools of thought. I think they're just tools in the toolbox.
Guest Track:: And I really think it's like, if you're paying $60 an hour for a hygienist,
Guest Track:: like you're probably going to want to get an
Guest Track:: assisted hygienist like right and if you're paying 35 40
Guest Track:: an hour for a hygienist you may want to
Guest Track:: skew towards the unassisted hygienist and so i think that you know it really
Guest Track:: depends on the makeup of your local market and the economies that are around
Guest Track:: your local area with insurance reimbursements and that type of thing to really
Guest Track:: dictate and also practice footprint right like you know assisted hygiene is
Guest Track:: more financially efficient,
Guest Track:: but it's like a little less space efficient.
Guest Track:: And so I think that you also kind of have to consider your practice as well
Guest Track:: in making that decision.
Guest Track:: And I actually don't think assisted
Guest Track:: or unassisted, it's something that somebody could easily focus on.
Guest Track:: And I would almost rather say that Scott and I kind of, I was the unassisted
Guest Track:: camp, he was the assisted camp, we kind of both agree that it's not a one size fits all.
Guest Track:: And it really has nothing to do with your hygiene department strategy,
Guest Track:: like in terms of the bigger picture of what you're optimizing for.
Host Track: : I think this all does come to a head when you are at the moment of having the
Host Track: : right number of hygienists or hygiene columns for the number of doctors.
Host Track: : In that moment, what are you doing next? So you've got a full hygiene schedule.
Host Track: : This is the fork in the road. Do I take that excess pressure of new patients,
Host Track: : of trying to fit people into the practice, and renegotiate insurances,
Host Track: : drop insurances, try and increase the profitability per patient right now?
Host Track: : Or do I want to grow into my footprint?
Host Track: : Because I think there's more opportunity in quickly growing into my footprint
Host Track: : and what's possible in this location and getting to another doctor.
Host Track: : And so do I take that excess demand and add more hygiene days?
Host Track: : And I think that's the crux of which path are you going to.
Host Track: : And until you reach that moment, this problem doesn't exist yet.
Host Track: : It's like you keep adding hygienists and assisted or unassisted until you have
Host Track: : maximized the amount of hygiene patients that one provider can see.
Host Track: : And as you're approaching that limit, now the fork exists in the road.
Guest Track:: And to Richard's point, there's kind of a fundamental truth where a dentist,
Guest Track:: if they're checking for too few exams, then they're not as productive as they could be.
Guest Track:: Then there's an optimal amount, and we kind of believe that to be two columns
Guest Track:: of hygiene per dentist, right?
Guest Track:: That's kind of what we've always said, is like two hygienists is sort of that amount.
Guest Track:: But there's that amount where I'm seeing, and that's maybe a little different
Guest Track:: for every dentist, but this is the amount where I'm peak productivity per patient.
Guest Track:: I'm seeing a healthy volume.
Guest Track:: But also, I have enough time with each one to focus on good case acceptance
Guest Track:: and comprehensive treatment planning and diagnosis.
Guest Track:: And so there's this optimal spot where you are in that good 55-mile-an-hour
Guest Track:: pace that Scott was talking about.
Guest Track:: And Richard's kind of fork in the road is, if you're in that place and you have
Guest Track:: more demand, and both philosophies generate more demand, it's just, what do you do with it?
Guest Track:: The kind of the Scott's approach is to increase the fees and value of each of
Guest Track:: those patient interactions to further push profitability.
Guest Track:: And our approach is to open the schedule ad providers and grow towards,
Guest Track:: you know, more hygienists, more patients, more providers, and that may mean more dentists.
Guest Track:: And that's kind of where, you know, Richard's saying the rubber meets the road.
Guest Track:: And so I want to kind of talk about our dental three-pointer,
Guest Track:: which we call retain, open, fill, or like those three things in that order.
Guest Track:: And where this originated was me.
Guest Track:: I bought a solo practice thinking it was a group practice.
Guest Track:: And so I elevated my costs all the way up to my revenue, and I was making no money.
Guest Track:: And I kind of had two options.
Guest Track:: I had a group practice. I had multiple dentists. I had three hygienists. I had four assistants.
Guest Track:: I had this big team. And so it was like, if I wanted to go back to earning a
Guest Track:: sustainable income, my options were to remove a lot of people costs,
Guest Track:: maybe remove a dentist, remove a hygienist.
Guest Track:: Maybe get rid of a front desk and an assistant and really free up some overhead
Guest Track:: so that I can have profit.
Guest Track:: Or on the other side is grow my practice this to have four hygienists so that
Guest Track:: each dentist was seeing enough patients to produce.
Guest Track:: And then the revenue would grow to a point where I could be profitable as a group.
Guest Track:: And that was really kind of the genesis for our philosophy.
Guest Track:: And so I went to practice management courses that I'd been to.
Guest Track:: One of them was the Scott Lewin Education Course.
Guest Track:: And I saw Scott's philosophy about maximizing hygiene profitability.
Guest Track:: But in my unique situation, hygiene profitability is not solving my problem.
Guest Track:: My problem is that I had too many team members for the number of patients I had.
Guest Track:: And that was where I had this lightbulb moment, which we call kind of the epiphany
Guest Track:: behind our philosophy, which is there's a very linear correlation between...
Guest Track:: There's like a very like, you add more patients, there will be more exams,
Guest Track:: there will be more diagnosis, diagnosis there will be more doctor treatment and it's like.
Guest Track:: It's almost accidental practice growth. If you focus on adding more patients
Guest Track:: to your recurring subscription of hygiene, right, then there's more patients
Guest Track:: coming back every six months.
Guest Track:: You will just have more revenue each month because you have more people walking
Guest Track:: through the door that have potential solutions.
Guest Track:: And so our, you know, turning hygiene up on its head is essentially saying we're
Guest Track:: going to optimize for hygiene department growth.
Guest Track:: And that's really going to be where we sell out.
Guest Track:: And we're going to sell out so much so that maybe for a period,
Guest Track:: the hygiene department won't be as profitable because we're going to have openings in the schedule.
Guest Track:: And openings in the schedule are hygiene department profitability hindrances.
Guest Track:: They make it harder for the hygiene department to produce as much profit if
Guest Track:: you have periods of time where your most expensive hourly employee,
Guest Track:: the hygienist, is sitting there without seeing patients.
Guest Track:: And so this was a very innovative philosophy because what it allowed for us
Guest Track:: to do is to grow practices at a faster rate because we took this kind of risk.
Guest Track:: But the downside and the flip side of that is that for a period of time,
Guest Track:: a dentist has a reduced income because they have less profit contributing from hygiene.
Guest Track:: And so, you know, that's really the kind of the hour side of things is,
Guest Track:: you know, first we focus on retention
Guest Track:: because we're trying to grow that hygiene base as much as we can.
Guest Track:: Then we open up the schedule to allow for more people to come in.
Guest Track:: Then we fill that openings and we teach team members how to be really creative in filling openings.
Guest Track:: And then we retain all those people. And we just kind of do that in a cyclical fashion.
Guest Track:: And the number of patients who come into the hygiene department grows.
Guest Track:: And we can go from a solo to a group. And then we can go from a group to a mega
Guest Track:: group, because we're essentially methodically growing the practice by adding
Guest Track:: hygienists and adding a subsequent group of patients with each hygienist.
Guest Track:: And so really kind of the dental three-pointer and the hygiene-led growth kind of.
Guest Track:: Elements of our philosophy are around that predictable practice growth through
Guest Track:: increasing the number of patients who come to your practice every six months
Guest Track:: by aggressively opening and filling the hygiene schedule and optimizing for
Guest Track:: practice growth instead of hygiene department profitability.
Guest Track:: So you're running a hygiene department with growth as the key objective,
Guest Track:: and it does trade for income in the short term, but it does grow your practice faster.
Guest Track:: And so that was kind of where the shared practices hygiene-led growth philosophy
Guest Track:: takes some of the, you know, maybe more profit-focused,
Guest Track:: you know, traditional beliefs in the industry and kind of flips them upside
Guest Track:: down because we say, you know what, the hygiene department does contribute profit,
Guest Track:: but we actually want it to contribute practice growth instead.
Guest Track:: And so we need to operate it differently with that in mind. so that was a very
Guest Track:: long-winded but just kind of like the full very my most succinct way of describing
Guest Track:: kind of what we do that's different as it pertains to hygiene.
Host Track: : Well and and one of the key parts of
Host Track: : this too that redeems this you know ache in a dentist's stomach when they're
Host Track: : like oh hygiene openings and they push back one of the redeeming qualities of
Host Track: : a new patient is the higher production per new patient and i also think it it
Host Track: : leans back into this conversation we were having earlier that's not that important
Host Track: : around assisted hygiene versus a hygienist.
Host Track: : Hygienists are going to close better on needed treatment when well-trained than
Host Track: : in an assisted hygiene setting.
Host Track: : And if you've got more new patients, your ability to close on these higher potential
Host Track: : dental need patients because not been regularly in your care is going to be
Host Track: : better, which can redeem some of those openings.
Host Track: : And I also just had a light bulb moment. I'm sure we've addressed this before
Host Track: : and talked about it before, but I haven't fully grasped this.
Host Track: : By having openings in your schedule, your retention is better.
Host Track: : If your schedule is packed, not only do you decrease your number of new patients,
Host Track: : you also inherently decrease your retention numbers and percentages.
Host Track: : So we're accelerating the two halves of practice growth by paying for those
Host Track: : openings, both the retention and the new patient flow and the overall growth of the practice.
Host Track: : And the economics of it is helped by the additional revenue per new patient.
Guest Track:: And so, Scott, if he was listening to this, I think he would say that he also
Guest Track:: has sufficient openings in his philosophy for new patients and patients who want to come back in.
Guest Track:: And that's like Like if you're going at 55 miles an hour,
Guest Track:: There's going to be, you know, three openings in the next week or whatever it
Guest Track:: might be to offer a new patient.
Guest Track:: Like that's kind of something that's like kind of believed to be like best practices
Guest Track:: is to offer a set number of opportunities in the next week, but to not have
Guest Track:: like 13 chances for them to come in in the next week, maybe three or four.
Guest Track:: So it's like we're kind of riding that line between profitability with breathing room.
Guest Track:: And where we come in is we say, okay, let's have 13 openings in the next week
Guest Track:: to bring in a new patient. And, you know, to Richard's point,
Guest Track:: if you do that, there's going to be two consequences.
Guest Track:: One, the hygiene department will be less profitable. And two,
Guest Track:: more patients will book and more patients will be retained because there's more availability.
Guest Track:: And so, you know, we have always slanted towards that patient growth is the
Guest Track:: number one objective in operating a hygiene department because we've always
Guest Track:: had a very entrepreneurial dentist who wants to grow their practice aggressively, right?
Guest Track:: But we also have some dentists who have gone to two dentists,
Guest Track:: they've gone to a group practice, they've gone from a solo to a group,
Guest Track:: and they say, all right, I don't want the third dentist.
Guest Track:: I want to have myself, I want to have an associate.
Guest Track:: And then we're going to use that strong retention, but the openings are going to dwindle.
Guest Track:: And we're going to kind of evolve back into hygiene department being profitability driving.
Guest Track:: And so we view it as like a gas pedal, where it's like, yeah,
Guest Track:: I'm going 55 miles an hour. I can keep doing that forever.
Guest Track:: But I really want to get to this place. So I'm going to go 110 miles an hour
Guest Track:: for a short period of time.
Guest Track:: And it's going to hurt my income. I'm going to get there. And then I'm going
Guest Track:: to kind of turn the screws back to 55.
Guest Track:: And that's kind of where we really include that. It's like we want to have those
Guest Track:: intermediate periods be as fast as possible.
Guest Track:: And so we're going to use practice growth through hygiene opening as a way to
Guest Track:: get there maybe a little faster.
Guest Track:: But, you know, in the meantime, maybe hygiene won't be contributing as much
Guest Track:: profit to the overall picture, but we're going to be growing.
Guest Track:: And so that's sort of the trade-off that a dentist needs to make.
Guest Track:: And you can see how this kind of builds on the last episode,
Guest Track:: because we were talking about it from the perspective of choosing what you want and avatar selection.
Guest Track:: And now we're talking about it in the framework of how are we going to operate
Guest Track:: the hygiene department with different objectives for different people.
Guest Track:: And, you know, hopefully that kind of starts to come together for people,
Guest Track:: and I'm sure we're going to touch on it again in future episodes.
Guest Track:: But that's kind of more or less on a high level, how the differences in how
Guest Track:: we think impact how we operate, you know, the same thing, which is a hygiene department.
Guest Track:: One school of thought optimized for profitability, the other school of thought,
Guest Track:: optimize for practice growth.
Host Track: : The instant like place my brain goes here is I really want to have a conversation
Host Track: : next about the alternative of the dropping insurances because I think people talk about that as like,
Host Track: : you know, it's easier than it sounds or it sounds easier than I think it really
Host Track: : is either renegotiating insurances for higher rates, dropping insurances, raising your fees.
Host Track: : And that is a different version of painful. There is different things that will
Host Track: : occur in your practice. And so exploring that other fork in the road of,
Host Track: : do we optimize for hygiene growth and practice growth?
Host Track: : Do we optimize for revenue per new patient? What is the good,
Host Track: : bad, and ugly of that? What is painful about that? What's good? What's hard?
Host Track: : Where are the challenges? How long does this realistically take to go through this process?
Host Track: : And whether that's you, me, and Scott, or Suzanne and Scott and I,
Host Track: : I would love to have one of those conversations here in the next month or two,
Host Track: : because I think it's the natural place my brain goes when thinking about these options.
Guest Track:: Yeah. And I think that we've always taken the philosophy of saying,
Guest Track:: we want to get a client to their ideal patient flow before we start making it
Guest Track:: more difficult for patients to stay in the practice.
Guest Track:: And so, you know, like if we're going to start cutting insurances,
Guest Track:: we want to cut insurances when we've met the long-term configuration of the practice.
Guest Track:: So if a dentist comes to us as a solo, and they say, I want to have one associate
Guest Track:: in a group practice, we've got seven operatories, and so a two-dentist configuration
Guest Track:: is the long-term configuration I'd like for the practice.
Guest Track:: We're going to keep the insurances, grow to that size, then we're going to use
Guest Track:: all the growth that that our philosophy creates.
Guest Track:: To cut insurances, the same way Scott has been discussing, right?
Guest Track:: Scott's philosophy, retention-focused, also efficient systems,
Guest Track:: he's also going to generate in practices this excess demand.
Guest Track:: And so we're both using that tool, it's just we may be using it at different
Guest Track:: times, or we may be more strong in saying we're comfortable with the insurances
Guest Track:: to get us to our desired volume.
Guest Track:: And then once we're at our desired volume, then we will bring them back down,
Guest Track:: maintaining our long-term desired volume.
Guest Track:: And so, you know, I think we, it's so, you know, when you can hear these things,
Guest Track:: you could think that we're super different from one another,
Guest Track:: but it's like, we all have the same tools in the tool belt.
Guest Track:: There's only these set ways to kind of operate dental practices.
Guest Track:: And I think it's more of an order of operations differences than it is like
Guest Track:: we have different beliefs on what to do.
Guest Track:: It's just, we have different beliefs on when to do certain things.
Guest Track:: And I think, again, that goes back to personal preference for the client, right?
Guest Track:: We use these different tools to help our client know the best way for them using
Guest Track:: all the analytics and knowledge and everything that we bring to the table is like,
Guest Track:: we're going to help you based on your situation and using all these tools assess
Guest Track:: what's the best path for you and your practice.
Host Track: : Well, I couldn't summarize it better. George, this has been an awesome discussion
Host Track: : of, once again, kind of the merging
Host Track: : and the exploring of these similar but slightly different frameworks.
Host Track: : Works, but it's really just a set of tools to get the dentist to wherever they
Host Track: : want to go in whatever route they want to get there.
Host Track: : So thank you, George, for coming on. This has been awesome.
Host Track: : I love these conversations. And I'm looking forward to the next one.
Guest Track:: Absolutely. Thanks, Richard. And I look forward to coming back on to another episode of Ask George.
Guest Track:: And keep chugging along and creating great content for our audience on the Shared Practices podcast.
Host Track: : Love it. We'll talk to you next time on Shared Practices 2.0.