Consulting across hundreds of offices means the Dental A-Team has seen a thing or two when it comes to scaling strategies, and in this episode, Kiera shares the secret to what type of quantity works best for you. Specifically, she connects why practice success should start with what you want as an individual.
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Transcript:
Kiera Dent- Dental A Team (00:00)
Hello, Dental A Team listeners. This is Kiera and today's topic is a freaking fun topic. ? I think it's something people ask all the time, should I have like one mega practice or like three littles? And so today the topic is going to be, should I run a $3 million office or three $1 million offices? So it's kind of this like different ways to scale and to grow and in Dental A Team, if you've been a listener, welcome. I'm so happy to hang out with you. If you're new, welcome. I'm Kiera Dent.
And our job is to positively impact the world of dentistry in the greatest way possible. And really it's to just talk about these things, about what you're dealing with. Cause a lot of times it's like, do I just expand my practice and have this mega Montropolis or do I have multiple littles? And I think just talking pros and cons of what we've seen as a consulting company, of working with hundreds of offices that have this. And I think there's, there isn't a better, it's more of what is your preference. And so I just wanted to go like,
what this is gonna look like, different ways to talk about it. And Dental A Team, we love to do this. We love to talk about scaling strategies that are going to match your leadership style, your lifestyle and your financial goals. And that's what we're about. And in consulting, we'd call it the yes model. So we focus on you as a person and what you individually want, earnings and profitability. Like what does this look like? How do we make sure that you're profitable and successful financially? And then implement systems and team development based on what we're finding in that. So you can say yes to more in your life. So I really wanna talk about like,
We're gonna just help you hopefully tickle your brain, tickle your fancy on what is the best way to do it. Do I do that one powerhouse or do I have multiple streamlined ones? So I think here what happens is when I see practices like this and I have consulted mega-montropolis, I have consulted multiple littles. And I think that there's different things. Like I found that like to the three million mark, it's usually sometimes easier under one umbrella if you've got the space.
Now when we're pushing the five to seven to 10, I've got one practice that's producing 14 million in one location. And what I find is like, these are just big offices. So you got a lot of team, you got a lot of patients, you got to have a tight culture, you got to have team depth, you got to have high leadership presence. And it just like, there's just more players involved, but at the same time, it's all under one roof. Whereas when I've got multiple little offices, we got to have systems, we got to have
decentralized leadership and you got to have trust in your people because you're not able to oversee everything. Like I can't have one manager sitting in the office overseeing everything. I've got to have a regional that's popping into all the offices people reporting up. again, there's like no one or right. It's more like what's your preference? Do you like depth or duplication? So I think people who like depth have a larger practice. Those who like to duplicate and think in systems and processes multi offices are usually for it.
I've got an office, are in, gosh, they're in Texas and he's freaking checklist manifest. So he's built an app, he's built these things. That man is built for duplication. I have another doctor who is very, ? loves to be involved, wants to grow and develop a team. He is more for depth. So two different practices, two different styles. They're both producing about the same. I got five locations doing 5 million and I've got one location doing 5 million. So it's just more what is it? And I think for you, like, are you hands on?
or use strategic oversight. The one who's got five locations, they're strategic oversight all day long. Like they don't love to be a clinician. They like to go and like systematize. They love the operations. They think like that. The one who's got hands-on is the 5,000,001 location and very much hands-on, wants to mentor all the doctors, wants to mentor the team, wants to be a part of things, loves being a part of it. And I think their personality is once more like...
It's interesting, my meetings, my meetings with the one with five locations, it was very much like, Kiera, what are the systems? What are the processes? What do need to be doing? How do I fix this versus my one who's five million is like, Kiera, I want to build a leadership team. I want to develop these people. I want to help them get to their next levels. And there's no right or wrong. So I hope as you listen to this, you're just able to see yourself of, you more this depth or you more this duplication? Are you more systems processes? That's usually a multi-location versus depth build a monstrosity.
And the one that I've got that's producing 14 million, that doctor is more of a depth. And the reason why that they ended up building more practices is because they wanted their impact to reach further. But I would say if they could, they would actually build and they are building. This practice is basically building a mini dental hospital. So it's going to have, think right now they're at 20 ops in the $14 million practice. And I think they're looking to build a 50 op practice. So by default, this person was adept, but then out of necessity to serve more.
and to give back more, they made multiple. So I just think it's a space of what do you like to do? Do you want to mentor single large offices? Or do you wanna have like three doctors under one roof? Or do you wanna have three doctors that you gotta travel to and mentor them virtually? Neither one's right or wrong. I think it's know thyself and be true. And that's gonna help you just figure out where you wanna go. So that's gonna be like step one. Step two is systems. You've gotta have systems. And especially if you're going into the multi.
system, system, systems, because if you grow without systems, you're gonna have burnout. Ask me how I know, oh, because I did this. And it freaking is annihilating and it's hard and it's awful. So when you have one large office, you've got to have advanced scheduling, you've got to have clinical efficiency, and you've got to have strong communication loops. It is massive. And like the biggest thing we have in these large practices, our team members feeling like they're not in the loop, they don't know what's going on. I mean, we have so many assistants, we've got our lead assistant in the $5 million practice.
and we're working on having a second because they've got like 14 dental assistants in this practice. Whereas multi locations, you have to like build like centralized billing, centralized reporting, leadership infrastructure, everything's reporting up to it. You've got to have office managers that you can trust with minimal oversight. And so I think for you, it would be as you're listening to this, like, who am I? Do I enjoy like, like I kid you not these 5 million for like stressing, I'm like pushing my
my piece, my temples here, because I'm like, gosh, the 5 million and the 14 million, I do think that there's some easy when it's all under one roof because you can talk to people, you can see them, but you also have just a lot of bodies moving. So our scheduling, we've every person in these practices works four days a week. So you now have a scheduling nightmare of how do get everybody on the same page for meetings, for this, for that, for trainings. So we have to be very strategic in our scheduling and
You've got to think about how we do checkouts and how we do the flow because now we've got eight hygienists checking in. So I've got eight profies coming in. I've got three doctors working. So I've got 15 people possibly checking out at one time. That's a lot of people versus my 1 million. I usually have five operatories. I've got two hygienists. I've got three patients checking in, checking out usually at the same time. So there's just this like
There's ease because everybody's under one roof, but it's hard because there's so many and it's like just duplicated. So you've got to be really, really strong. Things can slip through the cracks. Our treatment planning has got to be strong. Like, and it happens in all of them, but I really think it's a what do you look at and how do I set up the systems and structure of and both of them require it. Both of them just have different types of systemization and what's required for both of them. So when I see like doctors expand before they have like billing that set up.
When you're in one location, I do think you can have more gaps because people can quickly fill in and you can catch them versus when you're in multi locations. I feel like those gaps hit so much harder and faster and it's harder to pick them up because like, shoot, we don't have billing. This practice is drowning. This one's not, and we're running amongst four locations. So I do think sometimes the multi locations tend to have a bit more exhaustion, but if you're built for the systemization, it's okay. But if you're not built for that and you don't live in that,
it is easier oftentimes to maintain under one roof. So I think like, look at you of like, what systems would I need to upgrade for either path? Whether I'm 15 checkout patients versus three checkout patients, but at four different or five different locations at one time. Same amount of people, right? I've got 15 in the 5 million and I got 15 technically checking out in the five practices, three of each location at a time, three times five is 15. So it's the same. It's just, I think the flow,
and also being able to oversee. I think in a large practice, having the patient experience is usually easier to maintain and sustain because you've got, it's all centralized there. In the smaller practices, sometimes that patient experience is harder to have, but I don't have to be perfect and like choreographed in the smaller practices. I think some things can slip and slide. So it really, again, is just, do I like a large operation or do I like smaller ones that I'm overseeing? Now, the step three would be what kind of a lifestyle do you wanna have?
So we are big in Dental A Team that your business should work for you and not the other way around. So business should serve your life. And so one office, single location, oftentimes deeper daily involvement, but I have seen these owners be able to scale back easier. Multi-practices, more flexibility, but I think there's a lot more team oversight and travel. So the offices that I work with that have eight locations, that owner doctor was like running.
full steam until about three years ago. Eight locations, they're going between all of them, they're mentoring all the doctors, like until they were able to build up the leadership infrastructure versus sitting at a $14 million, they were able to scale back to only working two or three days. And then they would pop in maybe for an admin. So I think for you, like if you want more time off, one location typically is able to provide that sooner, easier, faster. But with that said, if you lose a doctor and they're not partners,
you are jumping in and you're covering. That can be the exact same for multi locations as well. You lose a doctor, you gotta go freaking pinch it over there, cover for that, scale it back, whatever you've gotta do. So sometimes having them under one location, you're able to have these doctors cover for each other because they're all working in one location versus usually the five, $1 million practices or the three $1 million, usually I've only got one provider in each. If I lose a provider, someone's gotta go jump in and cover. So.
I see it work in all different ways. I see sometimes the multi-offices are great, but I will say the multi-offices, you are needing to go to them. Now, sometimes there's not options to expand, but I wanna just like caveat that because like I said, I got a practice who's got 20 ops and they have found a location, they're moving and they're gonna build 50. So I wanna challenge you before you say that there's not space for that, that you look like this, you like you look at it to see,
Is this just a limiting belief or is this a real limit? What is that? You've got to be able to figure that out. You've got to be able to see what that is for you because there are options. Like I've got doctors who expand in weird spaces. I've got doctors who will like they're in a strip mall and they have their one location. They're able to buy another location, but the middle spot isn't available today. So they buy two and I've got to like have patients go in two different doors. Like there's ways to do it and expand in quote unquote one location.
But then other people want to serve other neighborhoods in different parts and they don't want to just be this Montropolis. And so they're like, hey, we're going to build it out in multi locations. I have seen, and I think through this podcast, one location tends to have air quotes, headaches, just because it's more controllable under one roof. When you start to get the multiples, you got to drive between them. You've got to have it. But again, multi locations have space to expand, have other pieces. But I do think typically when I have multi offices, they tend to have them as partners.
where in a large office, you still might have to have partners, but oftentimes it's not as required because you're able to fill the gap sooner. So I think just like looking at that, I would look at my leadership style. I would look at my systems and I'd look at my lifestyle and say, what do I want? I have a doctor that had three locations. One of them was not profitable and we ended up selling them. They just have two locations and they're so freaking happy. I think sometimes as people grow in scale, feel like, like I have another office and he's got,
15 operatories and he's got space to expand out and add eight more in. ? I think as you scale and you're under one roof, both of them like scaling back and scaling at the right time I think is one of the biggest things. Like I put my hands like up and down if you can't see the video because I think there's an expansion and a contraction that needs to happen in both. ? Sometimes expanding and having a market not work out and you've got multiple locations, contracting back to be profitable is not wrong.
Same thing with a large practice sometimes expanding for operatories Let's make sure we've got the patient base before we expand it all the way out and then we might need to contract in and like let's just do like two chairs versus doing all eight chairs So there's ways I think that both can expand and contract I think it's just your lifestyle your leadership style what you want your life to look like and I just think that Really giving yourself the grace that there is no right answer. There's just a right answer for you. And so how can you do this? And so
I think like, I love consulting on this. Like my hands get all excited and I like, it's almost like getting the pixel dust and the pixie dust out and ? granting little wishes and maybe talking through some of the complications and the problems and what we want. And I found them, people have multi-locations. They always feel the guilt of their primary location that they're not able to get to. That is something I see constantly in the multi, in the large ones. It's just like, I think the weight of such a big organization on them.
? I think I tend to see less struggles with practices that are under one roof if they have the space to expand it. I tend to see more struggles with multi offices than I do with one, but that does not mean that that's always permanent. ? I think just in the multis, it's harder to staff to scale, but then I've got practices that are doing like 29 plus million and they've got five locations because they're able to serve bigger populations and have more people and they're not just dependent on one market, one area.
So I think for you, there are lots of fun things. And this is what I get excited about being a consultant for is like, let's talk through this. Let's have someone on your team that has done this, that has grown multiples, that have worked with multi locations, that have worked with one large practice, pros and cons of it. I mean, my $5 million practice, we're now having to expand their systems because their systems have outgrown based on the size of practice they were in. So I think with the biggest takeaway that I hope you're taking from today is they almost have the exact same.
problems, issues, pros and cons. They just are packaged differently. And so for you to recognize what package do I want to buy? Do I want the red or do I want the blue? Do I want the silver or do I want the gold? ? Whichever one it is, it's more personal preference versus it being one's going to be better than not. Now, of course, there are other things like patient base factor and how many dentists are around that area and can we drive this many patients there? ? So I really think it's just up to you. And this is something that I love to like, let's have
Let's talk about it. If you've got a friend thinking about this, like just reach out Hello@TheDentalATeam.com or book a call. I love to chat with new doctors that I haven't gotten to talk with personally about this. And we do a free assessment call. Like we, I will literally work through this with you on an assessment call, whether you work with us or don't like let's just chat shop and like let's, let's explore because there is no right answer. It's just what's the right answer for you. So whether this is you or a friend on this, send them on over, let's chat because this is what we like to do is to help you have
Customize growth strategies that fit you and your practice so you can make the best call for you in the future. So reach out, Hello@TheDentalATeam.com. And as always, I love this stuff. I love the impact we're able to do. I love the community outreach we're able to have. And I think for each of you recognizing that like this is your path, this is your opportunity, but growth does not mean success. Having a large practice or multi-offices is not necessary. It is what do you want your life to look like first? Who do you wanna be in this?
And that's ultimately what's going to determine all of these decisions. And if you can remember that, you'll be set up for success. Just know I'm giving you a huge hug. I'm rooting you on, and I can't wait to chat with you. So reach out. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.