Dr. Dixson is a three time INC Magazine 500 out of 5000 awarded entrepreneur, and the Founder and CEO of The DSO Project, dentistry's first and only dental support organization, DSO accelerator. Formerly, he was the Founder and CEO of Smiles Services LLC and Founder and President of Smiles Dental Group PC. He is a visionary, inspirational, and transformational leader who builds unified individuals, teams, cultures, and world class organizations. Dr. Dixson became the managing partner of Smiles Dental in 2008. In 2010 he finalized a buyout of his former partners, assumed the role of President and immediately accomplished a successful relaunch of the organization, setting Smiles Dental on a path to explosive growth. The company proceeded to double its number of locations, triple revenue and quadruple its valuation in the ensuing three years. From 2013 to 2015, Smiles Dental roughly tripled the number of locations, revenue, EBITDA and organizational valuation again. He also concurrently codeveloped the dental analytics technology software platform that became Practice Analytics, one of the industry leaders in real time dental practice management analytics. Under Dr. Dixson's leadership, Smiles Dental was recognized three years in a row, 2013-2015 by INC Magazine as one of the fastest growing privately held companies in the United States, topping out at 550 in 2013. Additionally in 2013, he completed a successful private equity transaction. In addition to his MandA Advising and Consulting work at The DSO Project, Dr. Dixson provides Board Services to private equity firms. He also currently serves as a trusted DSO and dental industry advisor for private equity firms, dental technology companies and global dental brands in a variety of capacities. Dr. Dixson returned in mid 2017 from a one-year sabbatical where he and his family visited six continents and thirty-five countries while homeschooling, with only what they could carry on their backs. Visit dixsonsout.com to learn more.
Ian is a Partner at The DSO Project, a national consultancy advising dentists on how to start, grow and successfully exit a DSO. Ian is also a Co-Founder and Partner at WEO Media, a 3X award winning “Best of Class” dental marketing firm. Under his leadership WEO Media has grown quickly to become one of the most widely respected dental marketing firms in North America, and has garnered an impressive list of industry endorsements and awards.
Ian McNickle is a nationally recognized marketer, writer, and speaker. He has developed significant expertise in online marketing, website optimization and conversion, search engine optimization, SEO, pay per click marketing, PPC, social media, video marketing, online reputation management, marketing strategy, and related topics. In addition, he has developed a set of critical KPI’s, key performance indicators for measuring the effectiveness of any marketing program.
Ian lectures all over North America at dental conferences, study clubs, dental societies, and conducts numerous seminars and webinars. His teaching style breaks down the complexities of dental marketing in an easy to understand approach that the non marketer can comprehend and implement. Ian writes articles for Dental Economics, Dental Products Report, The Progressive Dentist, and other industry publications on various aspects of digital marketing.
Prior to his work with The DSO Project and WEO Media Ian worked in the high tech industry for 10 years in various engineering and management positions at Siltronic and Xerox. He left high tech in 2006, and founded a regional marketing consulting firm which he ran for several years before eventually cofounding WEO Media in 2009.
Ian has a BS in Mechanical Engineering from Washington State University where he was also a graduate of the University Honors Program. In addition, he graduated Cum Laude with an MBA from the University of Washington.
Ian is an avid endurance athlete having competed in numerous marathon, ultramarathon, Ironman triathlon events. His favorite activity is simply spending time with his wife Andrea, and three kids Evelyn, Morgan, and Brendan.
AUDIO-DUwHF #1108 Jeromy R. Dixson & Ian McNickle
VIDEO-DUwHF #1108 Jeromy R. Dixson & Ian McNickle
Howard: It is just a huge part for me today to be podcasting Jeromy R. Dixson DMD MBA and partner-in-crime Ian McNickle MBA. So we'll start with the introducing the bald beauty on the left Dr. Dixson is a three-time peak magazine five hundred five thousand word entrepreneur and the founder CEO of the DSO project, dentistry's first of all my dental support organization accelerator. Formerly he was the founder and CEO of smiler Services and founder president Smiles Direct Dental group he is a visionary inspirational and transformational leader who builds unified individuals teams cultures and world class organizations. Dr. Dixson became the managing partner Smiles Dental in 2008, in 2010 he finalized a buyout of his former partners assumed the role of president and immediately accomplished a successful relaunch of the organization setting smiles dental on a path to explosive growth the company proceeded to double its number of locations triple revenue and quadruple its valuation in the ensuing three years four in 2013 to 2015 smiles dental roughly triple the number of locations revenue and ebitda and organizational value again. He also concurrently pre developed the dental analytics technology software platform that became practice analytics one of the end of three leaders in real-time don't practice management analytics. Under Dr. Dixson's leadership Smiles Dental was recognized three years in a row by ink magazine as one of the fastest growing privately held companies in the U.S. topping out at number 550. Additionally in 2013 he completed the successful private equity transition in addition to his M&A; advisory and consulting work at the DSO project Dr. Dixson provides bored services the private equity firms. He also currently serves as a trusted DSO dental industry advisor for private equity firms for dental technology companies and global little grams and a variety capacities. Dr. Dixson just returned in mid 2017 from a one year sabbatical where he and his family visited six continents and 35 countries by homeschooling and with only what they carried on their backs. That should be a podcast in itself.
Jeromy: We'll do it again.
Howard: and Ian decided to join us today, Ian McNickle. Ian tell us about yourself.
Ian: You bet thanks Howard, I started my career actually in engineering and high tech and got an MBA eventually and then I decided I wanted to do marketing so I started my first marketing company back in 2005 six timeframe and since 2009 I've been co-founder about weo media it's a national dental marketing agency and I've also partnered with Dr. Dixson here for the DSO project.
Howard: So it's I love having anybody on whos a DSO because I always get the most views and downloads because you are the boogeyman. When I got out of school in 87 the boogeyman was capitation and then it was HIPPA and then it was osha you know it's always something and right now the big bad boogeyman is dsos a lot of dentists on that are my age think you know when we were little every pharmacist worked for his own place and then they all got rolled up into Walgreens. Where do you see the DSO market now where do you see it topping out on what percent someday do you think will dentists work in DSO's?
Jeromy: Yeah I mean obviously this is a little bit of prognostication right now right now but I you know I was also that same dentist coming out of dental school I saw what was happening with corporate dentistry with dsos and I and I just I felt like I looked around and I saw grocery stores and bookstores and tire stores and all of these different stores in my lifetime at that time and I've seen a consolidation happening in those industries and so I when I came out of dental school I was 27, 28 years old and I wanted to I wanted to be able to compete long term and so I didn't necessarily like everything about corporate dentistry and DSOs but I also felt like looking around the landscape at other businesses I felt like this was the future and so I my foray into group practice and dsos originally came from the feeling that at 27, 28 years old when I'm 45 I want to be able to compete and so I felt like my interest in it and my involvement in it could make it better and it may be used some of the things better than what had happened before and so that was really the thing that motivation for me and then as far as you know where I see it going the market right now there is a lot of investment money in a lot of investors interested in emerging group practices and DSO's is very actually investing in groups right now that aren't even fully built it's quite interesting it's not not when I you know when I did my trend transaction five years ago it was totally a different market this wasn't happening to the extent it is now so I think there's a lot of investor interest and the numbers I've seen recently somewhere between 15 and 17 or 18 percent of practices are now affiliated with the DSO or a large group practice and I you know I don't I don't believe I think if we are saying where is this going to go. I think we look at medicine as a guide because there 25 years ahead of us or so and if we look at medicine as a guide there are definitely still practices that are owned by this by the physician and I think that will continue in dentistry. What I see happening is that to compete as a private dentist, the dentist just need to up their game they need to know business they need to understand marketing they need to be investing in themselves as lifelong learners to be able to compete and provide a very high level of quality and service and care and customer experience patient experience. So that's so in in terms of a percentage I'm not sure if you're gonna pin me down on that on a percentage and where it's going to go but I do think that if it's 18, 17 percent now if you look at some of the new trends and some the recent surveys it used to be that 75% of dentists would never be involved with the DSO just like a year or two ago and the most recent the most recent survey I saw was it went from like 73 percent to 52% of dentists would not be involved in a DSO in one year. So I think that there's going to be at least in the short-term more dentists involved in that consolidation process and I don't know where it's going to go but I definitely think in the short term the intermediate term it's going to keep growing Howard.
Howard: So our 1 million MD brothers and sisters in the United States what percent of those are in a DSO equivalent like an MSO?
Jeromy: On the MD side?
Jeronmy: You know I don't know what the exact number would be on that, Ian have you seen any numbers on that?
Ian: I'm not sure what the percentage would be
Jeronmy: I mean just looking around if we all if we all say driving around town, just looking on the internet you know I have to believe it's over 50% 2/3 3/4 somewhere in that range are probably affiliated with the health system.
Howard: When you mind down that 18 percent what is the smallest that you consider a DSO because I mean there's a lot of group practices a lot of practices and small towns having two or three locations. I've been there's so many towns with like 25,000 that'll have a group on the north, south, east, west. What would what is your definition of the smallest DSO it still qualifies a DSO?
Jeronmy: Well I wouldn't do it by number of locations because the DSO is a dental support organization dental service organization and they provide non clinical services to practices and so to be a DSO there's a legal component of it where you have a managed service organization or the MSO that provides the services to non clinical services to the docs and that and that arrangement I'm legal side is a DSO type structure but then if you look at the actual services that are rendered to the practices you're looking at services like having a centralized marketing having centralized billing having a centralized or at least organized and managed call centers and then professional management to assist the practice at the practice level. So you can have a two or three practice group that has those characteristics and actually acts maybe bigger and acts more like a DSO and you can have a seven or eight or ten practice group that's simply a collection of practices that isn't really a DSO even though they're larger so does that does that make sense Howard?
Howard: Yeah now I'm gonna throw you under a bus because you got roots in Utah right you you into BYU right?
Jeromy: I went to BYU, correct.
Howard: and how about you Ian, did you have roots in Utah?
Ian: No I went to Washington State University I'm from Washington.
Howard: Okay well I want to ask is you know when you're running the DSO the central process of it would be your information management system or a practice manager software and Utah is home of Dentrix up in Provo and what if some kid was listen to you right now they were gonna start up don't practice you were a founder of so many of these things that what practice manager system would you recommend a DSO use or a general office use? What do you think gives you the best metrics?
Jeromy: The best metrics?
Howard: What system would you recommend? Dentrix, Eaglesoft. Open Dental, Softdent. There's so many well you know we got three MBA's here.
Jeromy: Yeah my group I used Eaglesoft and Dentrix over the years and and so I'm probably partial to those because I've used them and I know the Dentrix folks have Schein really really well and I have nothing but great things to say about them I will that one of the trends I'm seeing in dsos and especially small and emerging dsos many are going with Open Dental because...
Howard: Which is where you guys both live in Oregon
that's right that's right down the road.
Howard: He's your homie, he's right up the street.
Jeromy: So that's I would say that's emerging as a choice of some of the smaller and emerging groups and DSOs is Open Dental. So I'm partial those I also I know of one that's that's that I'm working with that's using Curve and having a lot of success. So I'm somewhat agnostic when it comes to to the basic practice management system as long as it integrates with some of the analytic software like practice analytics that I like and then in terms of at the DSO level Dentrix Enterprise is probably the standard in terms of embedded analytics and functionality.
Howard: Well you know I physically have been to you know a half-dozen call centers and when you talk about you know what is the DSO supply you said marketing billing central a call center. I firmly believe that that one of the DSOs most secret most powerful weapons is that they have 24-hour seven-day-a-week call centers I mean there's a hundred and sixty hours a week and these dentists are only open 32 hours a week they you know they don't know how many people think on their website they don't know where every 100 they land on their website how many converts actually calling, they don't know when those calls come in what were some of the time they were even open they don't know what percent went to voicemail they don't know what percent of the voicemails were open and when I go into these DSOs and they have 24-hour call centers that can take that incoming call go right to the schedule other stuff but it seems like the call Center for a DSO doesn't matter if they're all on their own system but when I go to pull centers that take calls for multiple dentists with all these different branch management systems that they all say that they love Open Dental the most because it's open and their programs can make it seamless and when they go to Dentrix to Eaglesoft you know and I mean it's not open.
Jeromy: Yeah absolutely to open the open framework of open dental I believe is why it's emerging at the level it is and if you look at some of the legacy DSO's have been around for a while most of them are on on one of the primary practice management software but like I said the new ones they like it and because and those those call centers like like breakaway has a great call center functionality I'm sure your you know you know those guys over there.
Howard: Yeah I've been that I've been there too and when the incoming call came I'm not maybe you can't make this up I was standing there watching for a couple of days when a call center came and it was on Open Dental and if it came from any other they go damn it because they're so much more difficult for them to do their job. So when you're looking at marketing how much of the and we're measuring about new patients coming into the office how much did the marketing do you think really is having a 24-hour call center what percent of the marketing would you say is the call center?
Jeromy: Ian you want to take that one?
Ian: Sure yeah so a lot of these smaller pieces aren't that sophisticated and they and they lose out a lot when you get to the point where you can have a call center or you outsource like some of the breaker or otherwise this some of the reports I've seen you can see as much as 40% increase when you do after-hours conversion so that means call centers and it also means live chat because those are the two ways you're going to convert leads from a website or leads from any marketing effort after hours so the data I've seen is about a 40% book which is very significant.
Jeromy: It's huge and if you think about you know just dentist to a grand practice when the patients called to cancel or reschedule their appointment how many messages you have overnight you know from the time the business closes and so the time you open up that 15 hours or whatever it is or 14 hours you know a lot of patient a lot of people and patients they'd rather call leave a message cancel and that throws your day off right and that's not ideal and so by having that call center and that ability to to chat and call and do it 24/7 it's a huge advantage to the more organized groups for sure.
Howard: So what do you think is the building blocks of the DSO so some my homies eliciting right now and he got out of school five years ago he wants to be like you and he grows up what is the building block what is the foundation of this?
Jeromy: The foundation well you use the right word Howard foundation. The foundation the way I like to look at it is is a framework that's called I call it the DSO house right so you've got the foundation you've got some pillars some primary pillars that are critical to hold everything up and then you have the roof that's you know protecting everything below and so that's kind of the general framework how how I like to look at it and think of you know I mentioned that I was on my sabbatical in 16 and 17 and one of the places we went was Athens Greeks and we visited the Acropolis and the Parthenon up there and and and this this building in this structure its iconic you know people can google it if they haven't seen it before but I'm sure everyone has seen the Parthenon at some point it's this old building there just a foundation there's pillars and there's roof that's kind of how I like to look at the DSO house and it stood for 2,600 years at this point it was built in like 450 BC so been there forever. The foundation the actual foundation of the house is the mission vision and values of the organization you have to have there in my opinion on the mission side it's better be short simple and concise so for instance the smiles dental our mission was ultimate perfect ultimate service superior performance positive impact six words I talked about all the time as a CEO everyone knew what that meant and what that meant for their that what their why was in their job and for their for the company. So that mission of vision values has to drive everything and in my opinion as a leader or even a single practice it doesn't matter any dental practice 1, 5, 10, 300, you run every decision as a leader through that mission vision and values and in the decision the choice are going to make if it's going to be the right thing with organization it has to be congruent and aligned with those mission vision values. So that's the foundation
Howard: What were those six words? Ultimate service
Jeromy: Superior performance superior
Howard: Superior performance and then what was the last two
Jeromy: Positive impact that was our that was our mission
Howard: Ultimate service, superior performance, positive impact, that was your mission
Jeromy: That was it and if you think about it think about it like this I thought about it as a flywheel right, so if you start with ultimate service if you treat if you treat those patients the way and follow the Platinum rule and treat them the way that they wants to be treated then and try to anticipate their needs and try to make everything as easy and smooth as you can for them then and you're gonna you're going they're gonna come back and you're going to have more patients are gonna tell their friends and then the next one is secured performance if you have more patients and you're doing you're providing that service the way that you should and great dentistry quality experience patient experience second to none, then your performance of the business is going to increase and it's going to continue to grow and flourish and then if you have those two pieces in place the the crowning jewel in my opinion of that of that flywheel is the the positive impact and that's ultimately that's why I got up in the morning every day to build and grow my DSO was because I felt like in my single office I could impact positively those patients I saw and my team and by following this mission I have the opportunity to impact positively so many more teams practices patients in multiple states and so that was really what got me going because I feel like my mission on earth is and something I that I really enjoy and provides me fulfillment is making other people's lives better. Having I used to say I want everyone in this organization's life to be better not only from a career standpoint a job standpoint but to learn things that will have them help them to have a better life and to have more enjoyment fulfillment in their life and so and so that's kind of the approach and we had a community service component and so we tried to positively impact with community events and service you know on a monthly or quarterly basis in every practice as well.
Howard: How many children did you drag all around the world?
Jeromy: Three, three Howard so I have a so now I have three boys so we don't have any princesses or anything like that but probably 75 nerf guns right now so that's kind of how we roll with my house. My boys right now when we left on the trip they were they were 6 ,11 and 13. So first grader and first fifth and eighth graders and we carried we each had a backpack and that's it and it was the carry-on sized backpack not a giant hiking camping trekking backpack it was a the largest backpack we had was 44 litres easily fit in a carry on compartment and we had all of our we had that was all we had I had one week's worth of clothes few electronics very very simple life for a year.
Howard: Well you know the reason I asked is because you know for me you know the only common thing you can find in all of the major religions written and translate you won't find a name of a person a place a city a town the only thing you'll find exact in all major original works is treat other people like you want to be treated and I have four boys and they've made me five grandchildren now or with your boys and I feel so sorry for my little Taylor because she's such a tomboy because all of her uncles and brothers or they're all boys but I always look at these DSO's, I always look at these dentists and say make sure you're working someplace that treats those patients like you want to be treated. So when you're working at some place and what's starting to scare me a little bit is when non dentists own DSOs because then you have you know the greatest engineering companies in the world like say Hewlett Packard, I mean Hewlett Packard were both engineers I mean Henry Ford was an engineer and they they have non dental people telling them that they got a place this many perio chips if the pockets over six millimeters in this and I'm like well you're not a periodontist and I get on dentaltown and the periodontist they don't recommend that and I don't want to do something because a non clinical person and now that you know that I got grandchildren I know I'm the next one dead and the great-great grandchildren, there the next ones up. I don't want dentistry to turn into a place that my grandchildren can't go I mean that's always been my litmus dis for today's know what I love the most about my dental office is I can be in Africa and my granddaughter can go to Today's Dental and I don't have to see the treatment plan I don't have to worry about it I know she couldn't be in a better place and that's where the initial DSO people were afraid and that's why a lot of states set up a lot of regulatory barriers that you had to be a dentist. So you know as long as as long as the dentistry the way you would want done on yourself and your children and your grandchildren and as long as you own something that you could die and the six feet underground and you're chilled and your great-grandchildren can go in there and you know they're not going to be shoving doing things for insurance billing codes and revenue and ebitda and return my investment and they're doing it here they put dentistry first. How do you feel that mission is being accomplished now naturally as far as the DSOs in the united states?
Jeromy: Well there's definitely some bad actors I think there are in any profession there are private dentists that do that same thing, I won't name names but...
Howard: Oh you got to it's Dentistry Uncensored name the names...
Jeromy: There was a practice that I looked at purchase and the guy was doing 60, 65 percent of his revenue was coming just from crowns. So you know typically that number should be probably somewhere in the 20 to 30 percent max you know ten max and so obviously there were some issues in that in that practice. So I think that piece you're absolutely right that scares me too that scares everybody and the reason I got into it and with my company I wanted to take the best of the hometown dentist like cheers where everybody knows your name and that type quality is great and it's about people first and then it's processing systems and then it's profit and any time I've seen Howard any time I've seen a company whether it's a DSO or you know mechanic it doesn't matter if they're putting money first if they're putting that profitability first and that's what it's all about then it's not sustainable and in my opinion it eventually is going to fail or fall or falter and so I think that's a real issue and that's why we need more we need more people who are doing it right and that's what Ian and I are trying are trying to accomplish here, is to try to build because we know that's the way the industry is going and if we have great founders who are trying to to build something that they can be proud of long term and can and now this is something that's new that your listeners probably haven't heard because I don't really connect to people in the industry who don't know this is an option but privately because they're so interested in dentistry they are willing to do a minority investment a non control investment and that has traditionally not been the case. So now if you're a small and emerging group and you want to maximize your positive impact you have the ability to get growth capital but don't not having the strings attached to the same levels they were before where you have to give up control of your of your group and control of the board and so what when it's done right I think what it looks like is you have you have a doctor leader whether that's the president CEO just like in a primary practice, the DSO is that I've seen that don't have doctor leaders unless they've been around for a long time there's a couple that I can think of that starting with the doctor leader is not a dentist really guessing in this room for 20 30 years for that position and those of those can be okay but generally non dentist CEOs especially if there they have a financial background there like a CFO controller background finance background those people tend to drive the numbers and and obviously it's illegal to have quotas that sort of thing but it had it happens and it has happened and that's why we had some of the bounce back the kind of the rebound regulation 15 you know years ago on that and so I do think you as a member of the a DSO previously I'm not now but as a member I was on some committees, I know that you know that they're trying to most DSO's are trying to learn from the bad actors in the past and do it right and I do share your concern when you get investors involved that don't understand the nuances of dentistry and that's actually something you mentioned before that I provide more services so our that's what I do is especially firms that happen and I sit on the board with them as an independent advisor and so you have the DSO founder and you have the investors and you have me I know both sides and I can help both sides navigate that issue and make sure that stays right. So does that answer your question Howard?
Howard: Yeah it does and I just want to say one thing and that one thing is I posted a story about Dso's and they look at this big aquarium that everybody looks at and when there's a bad actors I saw everybody focuses on it and it's harness is the DSO brand but look at all the bad actors in the private field I mean just this just this month coming you got arrested for having a secret camera in the bathroom that's only like the third time this year there was another one in Canada there was a good boy in Oklahoma where they you know wasn't sterilizing his instruments. I mean how many pediatric fatalities have we had in the last five years that are blown all over social media because private practice someone was doing IV sedation because they didn't know what they're doing and somebody loss their three-year-old but man when it happens to a DSO there's just a black hole. So I want to ask another tough question...
Jeromy: Hey Howard before you ask that there's one more thing that you just you just brought to my mind which is that one thing I have seen that is a real win for the patients with a larger more organized group or DSO is on the the service sterilization and infection control side of an office most because I used to acquire and bring in dentists and practices that were that were really high quality top 10% type practices and even in those practices it's easy for the infection control procedures and nuances to kind of to not be followed to a tee and because DSO's and larger organizations are a larger target and if something happens it's a bigger deal and we tend to be audited a little bit more I do believe that the infection control in the sterilization standards of most DSOs tends to be you know toward the leading edge of the industry for sure because of which I think is really a win.
Howard: Absolutely and the boy in Oklahoma that failed miserably didn't know everybody had to be called every all the dentist down there loved him great guy great dentist great everything but his autoclave and his for testing machine that protocol died and probably you know it just died and but anyway yeah that's a hot topic. I want to ask you one more hard hitting question though, one thing where people question the whole DSO model is why are you know when you talk about private equity what's their exit strategy seems like people will master the the five to 15 million dollar range and three to five years later they'll open to someone at the fifty to a hundred and then when they're done it'll be the 100 it's like a hot potato why can't they go public? I mean if snapchat you go public because the reason when you're talking to I'm much older than you I'm 56 your 41 and when I got this school orthodontics of America's was publicly traded and there was a dozen on the Nasdaq as that every last one of them and seems to empload and then the financial you know the Wall Street boys they don't seem to want to touch any of these and one of the biggest banks that in a moat of these people remember East West Bank?
Howard: and do they still loan to DSO's?
Howard: No they do not so if the east-west said you know we played with this and then you're talking to old old grandpas that say I've already seen this rodeo I don't need to see it again and again at the Nasdaq once we get probably they've done over a hundred IPOs this year why is not one of these DSO's not publicly traded on NASDAQ?
Jeromy: That is that is a great question Howard I'm not sure I have a great answer but I've hypothesized on it a little bit. I mean I imagine that some of the early DSO's especially on the pediatric side there were some real bad actors Medicaid Mill type DOS's got really bad publicity I imagine that that is going to scare them away a little bit so that's part of it and I believe I know that back in the 90s Berta dental management went public. So I think they may be the only one that went public and their still public.
Howard: Right but they're a penny stock I mean it's not...
Jeromy: Right it's not right so maybe you know that because of the performance there maybe there's an issue and then I imagine that because it's primarily in my opinion if you can keep it private as a company it's much less onerous much less regulation the flipside of that the patience and the industry is if it's a privately held company it's less transparent right there's less transparency. So there's a trade-off and I think if I had to put a guess on one reason why it's that way it would be because the DSOs have chosen to keep it private and just not going down that route I know if you look at the largest ones Heartland dental care oh by KKR and they they've stayed private the whole time and then Pacific dental services is owned by obviously by Steve thorne and he's kept it completely private those are the largest two and so I'm sure that if they wanted to they those larger DSO's could absolutely take it public I just think they're looking at saying we can keep it private we can keep we can get growth capital we can keep growing you know it's why do I take on an additional burden of having to go public. So I don't I don't have insider knowledge on why that is that's just my opinion okay that's that's my thought.
Ian: There's actually another thing too that it could hit on, traditionally when companies do an IPO is to raise capital if you need capital you don't need capital there's no reason to do IPO there's a reason to subject yourself all that sarbanes-oxley nonsense so that might be a recent because there's so much profitability in cash flow in these entities they don't need to do IPOs that could be the other reason to.
Jeromy: Right the margins on a good DSO you know can hit you know 18 to 20 percent or above and I've seen specialty DSOs in the 30, 40 percent range on margins so the margins are there it's you know grocery store or large and sure you know they might have 1% margins on a good day and so there's more you know the margins are better and more profitability that I think there's more ability to obtain capital.
Howard: So tell us your journey on the DSO project come up what is the DSO project and what should my homies I know about it?
Jeromy: Sure so I was actually I took my sabbatical first of all and I was inspired by Stefan Sagmeister if you've heard of that have you heard of him Howard?
Howard: No I have not
Jeromy: Okay he is not a dentist not involved with dentistry at all but he owns a design firm in New York and I heard a TED talk by him probably six or seven years ago and he talked about taking a stag myster which is a sabbatical every seven years he takes he closes his firm every seven years takes one year off and he's found that he his inspiration and the ideas he comes up with when he's not in the grind really fueled a success for his firm for that next seven years and so that really intrigued me because I noticed for myself that when I was on vacation when I was away from the office when I was you know hanging out with the family or playing golf somewhere once in a while that I had my best ideas for the business because I was out of the grind and so that was one of the things that inspired me taking that idea of a Sagmeister and also comparing that with the idea of from the 4-hour workweek Tim Ferris many kind of mini retirements I'm taking that and what I found was I had all these ideas when I was when I stepped away and so I actually came up with an idea and put it on paper when I was recovering from altitude sickness in Lima, Peru. So I was in Cusco, Peru at 11,500 feet and I had severe altitude sickness coupled with asymptomatic pneumonia. So I was getting no oxygen my blood oxygen Howard after about six hours of oxygen therapy at the hospital was (inaudible 36:27) percent I got evacuated out of Cusco and went to Lima, my family was gone for 17 days and I had time I would go to the Starbucks in Lima and I would sit there with my iPad and my pad and I would just put all the thoughts in my head I had over the last six months down on paper and I came up with the DSO project. So what it is I saw an opportunity and in need in the industry to help a lot of these small and emerging groups they might have two practices or three practices or four or five practices and they have this nice group they have energy they have a vision but they don't have some of the tools and they don't have a group of people around them who are in the same boat who are who are wanting to do the same thing where they can learn from each other. So I came up with this DSO project ecosystem what it is is we take it's very exclusive we take a small number limited cohort of high potential entrepreneurs that have generally two practices to maybe seven practices is sort of the sweet spot but I've worked we don't we work with more than less than that and we provide the mentorship, we provide them resources, a playbook of some manuals and trainings and that helped our that are the building blocks of that DSO from a systems and process to that point and then most importantly or not most importantly but additionally we have there's a mastermind piece of this they have a community we get together annually and quarterly for different events and they're learning from each other. So we in and I take our collective experiences both building a DSO having been involved in group practices since I started as an associate a group practice in 2004 when I graduated and leveraging the experiences that I've had leveraging and learning from the mistakes that I that I made is well it wasn't a perfectly clear path to success, so I made some mistakes and so basically people who come in and join the DSO project can stand on our shoulders of what we've learned and and Ian has worked with with countless numbers of single practices, small group practices and DSOs and in fact we met because he was I would work together and marketing my DSO so we've known each other for years and I've known him through that. So that's in a nutshell that's what we provide for people and then you know we have a dedicated channel for all of our documents and all of our communication that's a closed group that we that we provide for our for those we work with and then we have we're engaged with them on a weekly basis or even sometimes a daily basis depending on where they are to help make sure they're on the right track and we're providing the resources they need and then the cool thing is, is when they're ready to get to get growth capital or take that next step of growth in this ecosystem on the I also do M&A; advising so I have vetted firms that I've worked with that I know understand dentistry and understand they don't know what they don't know and I can help provide that the right fit when the time is right and being that typical you know if the groups looking for capital Howard typically it's sort of like an auction which doesn't necessarily finding the right fit it's like finding the highest bidder and in my opinion it's the success of insuring those things we talked about previously then it's a place you want to bring your kids in your family assuring that best practice to stay in place and they understand that it's not just about profit to find that right partner you're probably not going to find that right partner through a bidding process. So that's one of the things we do is we we I work very closely with about its coming up on a dozen firms but I have a network of 40, 50 firms that I'd know and work with and I can introduce this selectively assist in helping them find the right the right fit not just not just capital from somewhere that's not going to add value.
Howard: Another thing and yeah when you're planning on starting your first office or you're going to your second or third location do demographics matter and does the target matter? like you look at Danaher which is the largest dental publicly traded dental company in the world who's currently now splitting up their dental division I think, I think the parent company so they own all the stock they just want to separate the dental division stock from the medical I can see that because the dental stock is a lower return stock and it's dragging down they're more highly profitable medical holdings but like Danaher though has the low-cost implants direct value and then they have the high cost premium Nobel Biocare. When you're thinking about setting up your dental office or spending your DSO do demographics matter and we you recommend targeting the value line like implants direct are the premium side of the dental equation like no out there?
Jeromy: Yeah yeah so first question demographics and Ian you can also add to this at once I'm done. In my opinion demographics absolutely 100% are some of the most that those metrics are them are some of the most important when you're looking at acquiring or starting a practice a denovo and the main the main KPI that I looked at key performance indicator KPI that I like to look at is dentist to population ratio. So that to me is the number one metric I used to do it in-house now I typically work and recommend to my clients to work with Dentagraphics they provide a wonderful generally pretty I in my opinion or low-cost report that goes through not only dentist to population ratio but incomes a variety of other factors and metrics and then what they do is if you say you say you're looking at one metropolitan area they're going to break that metropolitan area into 50 or 75 different neighborhoods and zip codes and then they're going to rank order those based on what you prioritize as the most important metrics and then give you the number one you know option neighborhood zip code and number two number three and I love that approach and so I have nothing but good things to say about Dentagraphics love them and and they absolutely do matter and then to get to your second the second question which is what you're targeting you know are you targeting value targeting premium. I think it all depends on what type of what what is your why and what is the purpose of your business and where are you positioned in the market. So if your position as kind of you know you you're very high-end customer experience, patient experience you're going to want to match that with high quality you know high quality and high-quality supplies and equipment and so in my mind there's a balance between value and performance and that's there's no there's no right answer I think most of the larger DSO's probably go to see you more toward the value side however some of the larger suppliers are really wanting to target the DSO's and giving good and negotiating good enough discounts this isn't negotiated good enough discounts with those suppliers to be able to be really competitive for some of the more value lines that are out there. So it really depends on what level of service and what level of body where you position more gives my opinion in terms of targets.
Howard: We did Kent Miller president of Dentagraphics he was episode on I'm not sure what episode he was I'll just I'll just retweet thank you to the 25,000 I dentist you follow me on Twitter they're driving to work right now 85% driving to work so they can't take notes or you put the notes on the dental town podcast so if some people read faster, most people tell me they listen to my show at 1.5 X you're really young and hopped up on caffince they listener to1.5X but what I do is I retweet these side notes by the way I don't see you on Twitter are you not on Twitter yet?
Jeromy: I am on Twitter but not with DSO Project just personally but Jeromy Dixson if you search me I'm sure you can find me but I'm not very active very active on twitter, very active on Linkedin and somewhat active on Facebook and actually Ian and I are working on wrapping the Facebook piece up so you'll be seeing us much more on there.
Howard: Well for demographics you they absolutely matter, what was the number though what do you think the numbers of the United States and what is the number you want for your location?
Jeromy: Yeah so the averages i've seen for the US are about one to fifteen hundred or one to two thousand somewhere in that range is sort of an average. I know that there are some areas you just talk about Utah earlier there are areas that are one one dentist for every three or four hundred people and some of those metropolitan areas like...
Howard: and that is what Utah has the lowest median income for dentists in all 50 states and they you know you just you know and I get it you know probably 20% of my dentist friends in Phoenix are LDS and you just gotta realize you know if you want to raise your kid LDS community come out here to Gilbert come out here to Queen Creek come to Mesa, go to Idaho but don't go to Salt Lake City
Howar: My gosh cause if you do you're not gonna pay back your student loans.
Jeromy: That's right and I've seen I had a classmate that that was the case, you know it's tough when you see that but yeah I like to I like to see anything over one to two thousand one to twenty five hundred still above average obviously the higher the better one of my primary practices actually my primary practice when I practiced was in a location about an hour north of Portland Oregon and we had a won to 45-hundred dentist to population ratio and that practice just grew and grew and grew and had you know huge amounts of opportunity and in my opinion if you're going to pick one metric or one KPI when you're looking to locate a practice whether that's my acquisition as a single dentist or as a DSO or you want to start up a location look for those dentist the population ratios as high as possible and hopefully over one to 2500.
Howard: So you recommended Dentagraphics Kent Miller and listen to the podcast it's great. I also recommend the Scott McDonald up in Utah. Did a podcast with him he's amazing. Another one is just Few. I mean the Few organization all the dentist hate them because they're always trying to sponsor a dental therapist whatever I don't care about any of that stuff they had the best research of all 50 states if you can find a dentist per six thousand in any flyover state any flyover state Ohio to Arizona you can find locate and then the end and if you're really really committed to demographics you're really committed to having a million dollar practice out of the gate with overheads they get on 350 out of the gate you can find population dentists for every six thousand people on few.org. I didn't get a recommendation from you for a call center to. You mentioned Scott Loon, is there any call center that you recommend or someone listening to you or starting a DSO?
Jeromy: It would be Scott Loon and Breakaway that's that is my primary recommendation I really like what they're doing over there I love how they report and analytics so that's my recognition. Ian do you have anything to add on the call center side?
Ian: No, no I think that's a good one
Jeromy: Yeah that's the one I use Howard and you know if you want to share others with listeners that's great too but that's the one that I like to work with recommend.
Howard: Okay and then for marketing so demographics do matter I'm not huge when people tell me demographics don't matter I say great man move Somalia they really need dentist and if you don't like that move to somalia, afghanistan. Demographics truly matter more than anything that's why everybody born in the United States as human you're just lucky. I mean they could have lectured in 50 countries but I've only seen about 20 but I didn't want to live in and the other 200 you have to realize you were just born lucky. I mean
Howard: Just if your street lights come on you have an internet connection and nine-one-one works you just eliminated 200 countries and when these people tell me in Arizona that they want to retire in costa rica in these other countries and i say yeah it's just it's just amazing until you have a heart attack at two o'clock in the morning and then you're wondering why the hell are you in costa rica you know I mean it just it just is what it is you know it's not it's not anything other than it just is what it is marketing what is what is what do you recommend for marketing?
Ian: You want me to take that Jeromy?
Jeromy: Yeah absolutely, it's pretty unique to your wheelhouse.
Ian: Yeah kinda my thing.
Howard: You just a pretty face on this show, you're not not say anything...
Ian: Yeah yeah well so with marketing absolutely so once you kind of got the location set and we pick the right demographics okay let's assume that's all behind us now your practice is open in this time to market. So what I always recommend is starting first with getting the online marketing dialed in you know that's website that's online reviews it's social media and of course SEO and PPC to really drive rankings in traffic and so then once that's kind of dialed in then we want to focus on some of the direct consumer whether that's mailers, TV, radio, you know whatever billboards and the reason is if you start with direct consumer first a lot of those people are going to do what when they see your ad right they're going to go online and check you out and do more research so if you do it backwards and you do direct consumer first you risk losing a lot of money a lot of leads so we recommend is starting with online get that dialed in first and then tracking is hugely important right so what we want to do is make sure we're using you know tracking phone numbers we're using tracking data with the websites and trying to understand as much as we can where patients are coming from where the leads are coming from online and then of course you're using tracking phone numbers so when people call whether it's if they're using a call center great but most people don't so if you're doing it yourself you want to use a tracking number which we always recommend then you can record those calls listen to them and I've done studies in the past. So Weo Media we work with hundreds we worked with over a thousand dental practices at Weo Media and I've got gobs and gobs of data on phone tracking information so I've gone and I punched his stuff in spreadsheets and so what I found was it was it was right around 35 to 40 percent of all phone calls went straight to voicemail and I was just kind of across the board which was horrifying because these doctors are paying a thousands of dollars for marketing and literally a third of what they're you know we're generating for them is just getting flushed down the toilet so answering the phone is critical that's why the call center thing can be huge but you've got to track the data right so that we do online first and direct consumer and then making sure that the tracking is important too so you mentioned earlier about practice management systems and practice analytics and some of these other things it's really critical for when that patient comes in the door you guys are dentists you know this it's critical that you ask hey how did you hear about us where did you come from try to understand so you can enter that into your Dentrix or whatever. So at a high level without getting to the nuts and bolts of how these things work that's the strategy I would recommend.
Howard: Yeah but I couldn't agree I mean I what you said was so profound I think that they all missed I mean what percent of dentist tracked your phone numbers?
Ian: Not a lot I don't know the percent but not alot.
Howard: What would be your guess?
Ian: 20% probably
Howard: Oh no way
Jeromy: I think that's too high
Ian: 10% maybe
Ian: 8% Its low
Howard: I live in Arizona they call it the Florida of the west coast. I mean I don't know a sole, I mean I don't know anybody does that any time I call my family the first thing I hear is this call may be recorded any time I call a dental office I mean I just this morning I just returned two dentists calls tonight about meet up for a beer and burgers at 7:00 and both of them their office is open both went to voicemail.
Ian: Yeah it's terrible.
Howard: This is why DSO's are going to rule because I mean that they're out there they're number one God in dentistry Gordon Christian they want to learn what's the best bonding agent so they they travel anguish Provo Utah to see which which body aging Gordon blesses and they don't even realize a third of the filling so they could have done will never even done because they never even answered the damn phone call and then with us with these smartphones people don't leave a message you know your voice smell they just call the next one I mean if I google dentists near me in Phoenix there's 1 million 1 million things up. I mean literally it's not and and you go to the first page at 3 to 5 so who do you recommend is there someone you recommend that does that is that your one site your are use your website?
Ian: Yeah that's that's that's one of the things that Weo Media does. Its www.weomedia.com So yeah the the what that company what we provide is just really a range of marketing services it's a full-service marketing agency but it's just dentistry that's all we do (inaudible 54:48) What's that?
Howard: So you have all these you can everything you just mentioned weomedia.com and what is Weo stand for?
Ian: That's a good question it actually doesn't stand for anything we came up with that years ago as a goofy little acronym so but it isin doesn't stand for anything
Howard: Well SEO search engine optimization you should call it Wow engine optimization
Jeromy: There you go
Howard: Media or find out if Star Wars had a character that starts with W.
Ian: There you go we'll pay a royalty Howard.
Howard: I mean I love this I do I love them I mean I just love them love love them but my god they just want to talk about bone grafting implants. Last week Phoenix had a digital dental conference and I mean 690 dentists showed up 40 percent of more prosthodontist and they're just drooling on this stuff and I'm sitting here thinking of what Warren Buffett's that where Warren Buffett said that 95% of the CEO's just go to work every day and and just try to work on how they can make everything more complicated more expensive they say their hard-earned drop the dollars and instead of distributing it to the owners and investors and shareholders they buy all this fancy stuff. So this whole conference was about how to go from taking an alginate impression to buying a gazillion dollars worth of equipment taking a gazillion dollars scan sending it to some company that charges $400 to pour up these up good site it's like they get I mean they travel a thousand miles trying to say what can I do to increase my overhead I don't want to put 100000 dollars in my 401 K I don't want to retire early I just want to take a standard denture and see if I can double the cost of this because these dentures they just love it I get it it's cool anything digital technology is cool is what it's like it's like setting up in you time I have to those who my backyard no one in Mesa AT Still one in Glendale, Midwestern and you know I don't know what percent probably 20% of each class is Mormon they all want to go back to Utah I say you can go back there as long as you know you'll be a peasant do you want to be, it's the same thing I say about digital dentistry,if you just want to practice in Salt Lake knock yourself out but don't go back there thinking you're gonna get rich off dentistry. Same thing digital dentistry it's like and people of digital notice really that once you learn it once and you want to die with an enroll scam in your hand knock yourself out but don't sit there and think you could get rich with it you're gonna give them your in fact this is the funniest thing at all that if they want to buy any of that digital dentistry equipment I always tell them take the money you're gonna buy and buy stock in the company then you can make money get your money back because all your crazy ass peers are gonna give all their profit dollars away to buy this stuff you know and if you're ever done here orthodontist bitching about Invisalign I said well how much stock do you have in Invisalign? I mean if every orthodontist is bitching about Invisalign don't you think that's a buying recommendation in the ninth degree. So what do my homies listening right now if he just went too wow Enterprise opportunity www.weomedia.com you can do the full service you can record his phone calls I'll be with online reviews build with website do as SEO with social media, it's a one-stop shop?
Ian: It's a one-stop shop and we built it that way on purpose because what we found when I started the company I studied a lot of what was out there as very piecemeal kind of a scattered shotgun approach to marketing you know you go to a conference and you hire somebody buy a website and then you have your an office person doing some Facebook and the get a guy on Craigslist to shoot a video and it's just this really piecemeal approach that doesn't work and none of these people understand dentistry and so we built this company over the years to do exactly that and it kind of like what you know what Jeremy's saying the reason that I partnered with him on the DSO project is I've become really passionate about the business side of Dentistry the as a marketer for these dentists I get involved with a lot of their their financials so I talk to their CPAs and I understand what are they spending on marketing they should be spending three to seven percent on marketing if they want to grow that's what the Academy Dental cpa recommends. So how many dentists are actually doing that very few and so with our clients you know and this is where I love what we can do with the DSO project as well we can coach these guys on not only the operational piece the financial peace we can advise them on the marketing piece and we can help them if they want to use my other company Weo for marketing that's fantastic the DSO project can really coach them along on all these are various aspects of what's going to be important because as you noted Howard we've got three MBAs here on this podcast but a lot of dentists don't have that MBA in that in that business background I think that's what's really valuable about what you do with your podcast is you're educating them on this stuff because you're both right yes great.
Howard: Well what I'm trying to 59:57 do I'm trying to be a leader and I know their first love is to do a wisdom tooth I get it and I like in Phoenix Arizona With 260 golf courses and I'd rather do a molar root canal than play golf I mean I get that but I have to be a leader and I'm trying to seduce them that well if you want to place more implants and do more work canals and you want to do all this stuff you got it I gotta take their nose and stick it in the business pie you know what I mean, they didn't go to school to get a be a businessman they went to school to be a dentist. It's like a chef man they work with their hands my oldest son's a welder he works with his hands. Dentists are all surgeons they just want to work with their hands they fantasize about someone coming into the front door holding your face swollen in pain and they're like you know it's like a fireman looking out a five-story fire, a policeman wants to see a bad guy not his grandma and but they have to nail this. So do you also have a call center for them?
Ian: We are working on that at this one I would definitely recommend Breakaway I think they're really good,
Howard: Okay and then I got to tell another thing to all the males listening is I do believe that boys and girls are very different in the fact that all the data I see is still 91 92 percent of all the appointments are made by women and women are a different beast and they really want that digital online confirmation. I know more dentists who have exploded their new patients by getting on top of their online reviews and a lot of the dentists I'll talk to you know I just Candida the other day and you're sitting there and while you're talking was done is I'm asking him how do you spell your name and he I'm typing it in I pull up his website right there next to him I say how many online reviews do you have they don't even know, I said have you read these and it's like okay you're a man and that girl you know female eights a monkey's talked to five other apes some monkeys for every time a man talks to one girl's say over seventy five hundred words a day men are less than 15 hunder that comes from the University of Chicago where they're the most Nobel Prize winning economist and men just don't get how important online reviews are I can't think I mean it's got to be one the top three most powerful things in marketing. Talk Ian, about what you think about online reviews?
Ian: Yeah I mean absolutely that that's one of the core tenets that we that we build into a marketing program because there's just the Internet has really allowed everyone to get so much more easy information access right. So people I mean and dentists doctors don't like to hear this and I give a ton of lectures I do a lot of speaking at you know conferences and study clubs all over the country and this is always one of the most popular topics and one of the most heated topics we get into as well as like how do I deal with negative reviews and all that's but what I tell them is look you may not like being equated to a tablet because if I'm on Amazon I'm going to buy a tablet I'm going to look at the reviews if I'm looking for a chiropractor I'm looking at reviews from looking for a dentist and looking for an oral surgeon looking for anybody an attorney what am i doing I'm looking at reviews. I mean yes you go to the website you might take out their facebook and get a feel for them but when it comes time to decision making its reviews there's a slide I show that's one of the most important slides I showed in my presentations that I call it the marketing funnel and at the top of the funnel we've got awareness right you've got newspaper TV this type of stuff conversion rates typically 1 to 3% and that's being generous right of the leads that you generate. The conversion rate then you get into the website and social media websites you know they typically convert between seven and fifteen percent of the traffic typically gets converted to two leads lead meaning phone calls chat appointment request something like that however when you get into review sites between Yelp and health grades and Facebook and Google those are the big four in dentistry those are the four we say are critical every dentist has to pay attention to those four they typically convert between 50 to 75 percent of the leads that people hit those sites so with with Weah what was cool is for a while we were at Yale partner agency or six years we've been at Google partner a decision for the last two years has been a health trades Department agency as a result of that I get a lot of insight information from those companies about the conversion rate on those platforms I can tell you that they're pretty much typical between 65 and 75 percent what that means is when people hit a health grade spayed or your Yelp page or your Google page then look at the reviews about two-thirds of the time they're going to make a decision through they're calling you or they're calling somebody else later that day but that day they're gonna make a decision two-thirds of the time so in terms of this marketing funnel it's insane not to pay attention to your reviews because everybody says oh I want to rank on page one of Google yeah absolutely of course you should want to rank on page one of Google but realize a lot of those people that are coming to you from Google are going to check out your reviews and if you don't have solid reviews dialed in you are really missing the boat here. So when we designed these marketing programs you got to have the website yes social media yes but of course reviews is a major major component of that so I couldn't agree with you more Howard it's one of the most important things that they gotta pay attention to.
Howard: I when I go to dentaltown there's a quarter million dentist they posted coming up on six one times I just put in W e o media and there's several threads discussing your company and
Ian: Usually they're good.
Howard: Yeah they are good and they love it when the owner talks to them. The reason Jobs was a genius he did not invent any of that stuff he tried to promote himself like he was Tesla but he wasn't even if the genius marketer and people were buying into Steve Jobs the same thing with Microsoft I knew it's Bill Gates and the reason they don't like so many government agencies they don't know who's the CEO of the post office or the IRS or any of that. So you guys should get you should get on there or cuz you're the founder right the founder and CEO of Weo Media.
Howard: I tell you the best thing for your brand yourself use your avatar as your face and get on there and if you're shy and humble just say Howard told me to do it you know your favorite self-promotion. So as the DSO project you work a lot with Weo Media?
Ian: Yeah I'm an owner of both companies so I co-founded Weo Media then I'm a partner with Jeromy in the DSO project. So with the DSO project we certainly would recommend people to use we are looking for a marketing solution but they don't have to use Weo Media to use DSO project we would recommend them obviously I'm biased there but it's not a requirement there's separate companies.
Jeromy: Yeah and Howard I'm biased a little bit as well although there are other great companies out there. I built my DSO working with Ian and Weo Media as well so I mean I can't if he's he's humble but they've won best of class in dentistry the last three years for dental marketing at Weo. So it's a wonderful company and we didn't necessary come on here to talk about that but...
Ian: Right right
Jeromy: We're talking about it I can definitely put forth my recommendation.
Howard: I want to talk about stuff that dentists can learn while they're commuting to work and they can go back and get her done and I know they have no interest in building a website recording their phone calls I know they're not. You should have seen them at the digital dental conference when they showed any machine that costs over a hundred thousand there would you start drooling guy said yeah our lab charges four hundred dollars an arch to pour up that model all digital they were still drooling. I mean I had like a knot in my stomach we was ready to throw up they think this in fact he should have said it costs four thousand arch support and then he probably would have had everybody buy the machine. I just want these guys to get the business side done so they can do more of what they went to school eight years for. I'm going on we over this brands an hour we're at hour and fifteen everyone's telling me to shut up and get off final-final advice, a twenty five were you know podcasters all my dentist friends that over fifty five I mean they couldn't find the podcasts on their iPhone if I could get into their head the quarter of our listeners are still in dental school what advice you have them. Spend a couple minutes give parting the words what advice you had these kids can underscore they're coming out three hundred fifty four hundred thousand yeah talk to those guys?
Jeromy: You know Ian I'll let you go first and I'll wrap up if you don't mind?
Ian: I can go real quick yeah I think when they are coming out of school some of the things that they need to consider are how are they going to pay back that debt how are they going to get experience this is why a lot of people end up going into DSO is at least for a while to get that initial training but I think that they would be wise to get advice from people further down the road than themselves and that's I would defer to Jeromy on this one because you guys are our dentists and so I think that would be I think that would be some pretty wise advice to seek counsel people who are more experienced.
Jeromy: Absolutely yeah yeah make sure you know find a mentor, find somebody or another dentist in town that you can call up when you have issues and you're not all alone. That's one of the things with dentistry that can be tough is that if you're in especially if you're in a solo practice you're really siloed it's you're on your own and and your dental societies and conferences can only do so much and I know that Howard dentaltown has been a huge you know collaborative tool for dentists and made that world smaller and it's been you know that's why it's grown and blow up blowing up the way that it is and and you know a great four-sided vision from you to be able to see that and bring that together because so many dentists it can be quite lonely and I was lucky enough that from day one I was in a small group so I always had some of those mentors built-in but not everybody has that. So I think that's you know absolutely number one as far as financially coming out of school with so much debt you know be wise go out you know you graduate from dental school and you just start your job don't go buy a hundred thousand dollar car don't go buy no don't go you know buy a million-dollar house like you yeah your doctor now but you're you're just your doctor because you're still dangerous but you're not as dangerous and so you still have a lot to learn you have loans to pay off don't put yourself in a hole right from the beginning you're already in a hole and I think coming out of school I would want to be aware of what's happening. I'm gonna make one recommendation I know we're short on time here if dentists haven't read it read Marco Vujicic, he's the chief economist of the ADA, another article I would read is June 2014 Harvard Business Review it's called engaging doctors and health care revolution and if you have one associate or you're you have other Doc's that you're leading it's a must read you have to read it and it talks about medicine but you can apply those same principles to dentistry and then the other thing I see a lot of people just aren't organized have a task lists have a calendar prioritize it make sure that you're getting things that are most important done on a daily basis and then last point is only surround yourself with the best whether that like that's why Ian's here he's the best dental marketer I know great experience broad range I love it also companies also people you you have around you and your team so.
Howard: and I just want to say one thing and all three of us have our MBA that was a totally vector point for me it was when I bought my first laptop and what I did it was the two-year MBA I took my laptop with the in mind what I did I took all notes that apply to dentistry I made all of those is perfect and it turned out thirty hours long it's called the 30 day dental MBA it's free on YouTube. I also have your right now your on iTunes listening to Dentistry Uncensored, there's also the 30-day Dental MBA on iTunes and that took me two years I convinced it all for you and I think he was not either won't leave you get your MBA or to motivate yet to go get your MBA but gentlemen I'm out of time thank you so much for coming on the show today, I hope you guys have a rockin hot day.
Jeromy: Thanks a lot you too Howard.