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How to Hire and Retain Top Dental Talent – Episode #434


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On this episode of the Dentist Money Show™ Ryan talks with Dr. Victoria Peterson, Productive Dental Academy CEO, at the 2023 PDA Productivity Workshop. Dentistry has seen unprecedented staffing shortages and the effect has brought on unforeseen challenges—lower production and falling profits for practices who cannot properly staff and keep their skilled team members.

Show notes:
Productive Dental Academy
Positive Intelligence – the book

 

 

 

 


Podcast Transcript

Ryan Isaac:
Hey, everybody. Welcome back to another episode of The Dentist Money Show, brought to you by Dentist Advisors, a no-commission, comprehensive, fiduciary fee-only advisor just for dentists all over the country. Check us out at dentistadvisors.com. This week on the show, Matt and I and Victoria and Chip, a lot of our team, we’re live with PDA, Productive Dentist Academy at their productivity workshop. It happens a couple times a year. This was in Dallas. And we had the chance to see a lot of friends and clients and meet some new people. And this workshop is three or four days and multiple things going on, such good training on all kinds of things about the team, systems and marketing and productivity, building an investment grade practice. They do such a killer job. Check them out, PDA. Today on the show, I sat down, it’s my pleasure to sit down with Victoria Peterson, and we had a chance to talk about all the things they were learning this week.

Ryan Isaac:
One of the questions I started with that kind of led our discussion today was I just asked her, “What are the biggest questions on dentists’ minds this year, 2023, as we close it out, that you’re dealing with, and how are you answering those questions?” So this span the range of a few topics that I think are really timely and very important. So thanks to Victoria as always, and PDA for having us, spending some time with us. We love being a sponsor and just supporting them in all they do. If you have any questions for us, go to dentistadvisors.com, click the Book Free Consultation link, and let’s have a chat sometime. I’d love to point you in the right direction and answer your money questions. Thanks for being here, everybody. Enjoy the show.

Announcer:
Consult an advisor or conduct your own due diligence when making financial decisions. General principles discussed during this program do not constitute personal advice. This program is furnished by Dentist Advisors, a registered investment advisor. This is Dentist Money. Now here’s your host, Ryan Isaac.

Ryan Isaac:
Welcome to The Dentist Money Show, where we help dentists make smart financial decisions. I’m your host, Ryan, and I’m here live at the PDA, Productive Dentist Academy Productivity Conference in Dallas, Texas with Victoria Peterson. Victoria, what’s up? Thanks for being here.

Victoria Peterson:
Hello, Ryan. Thanks for having me here.

Ryan Isaac:
For anyone who, I don’t know, might, you don’t wanna say living under a rock, but might be, tell us about the conference, tell us about PDA. I assume most people know that are listening who you guys are, but tell us a little bit about what’s going on here in Dallas.

Victoria Peterson:
Surprisingly, not everybody knows about the Productive Dentist Academy. So this is great. This is our 19th year. Next year, Dr. Bruce Baird and myself are celebrating our 20th year in partnership…

Ryan Isaac:
No way.

Victoria Peterson:
And running the Productive Dentist. And it literally started with Bruce and eight doctors in a small office…

Ryan Isaac:
Congratulations.

Victoria Peterson:
Just talking about… Yeah, thank you. They just started talking about, how do you take better care of patients? How do you comprehensively diagnose based on risk factors? And from there we brought in a team program maybe six months later, and we had, oh gosh, I wanna say 15 doctors and 45 people total.

Ryan Isaac:
Yeah.

Victoria Peterson:
And here we are today, fast-forward 20 years with sold-out hotel, sold-out conference, 300 people. We’re actually running three different conferences this weekend. It’s nuts. [laughter]

Ryan Isaac:
Amazing. Amazing. Well, congratulations.

Victoria Peterson:
Thank you.

Ryan Isaac:
20 years is a very long time to stick to anything.

Victoria Peterson:
Exactly.

Ryan Isaac:
And yeah, this is beautiful. I’ve been to a few. I’m always bummed out when I miss them. But it’s just getting bigger and better and… Okay. So three different conferences. What are the focuses of the conferences right now?

Victoria Peterson:
Yeah. Our productivity workshop is the one that’s probably our hallmark program that we’ve been running consistently.

Ryan Isaac:
That’s the word I was thinking of, trying to think of, “productivity workshop”.

Victoria Peterson:
Yes.

Ryan Isaac:
I said event, but okay. Yeah.

Victoria Peterson:
That’s alright. And that one we run two to four times a year. It’s been two times a year since COVID. It’s where you start. It’s like being freshman in college…

Ryan Isaac:
Okay.

Victoria Peterson:
Getting your team on the same page with, what’s our standard of care? When you see a hole in a tooth, what does the doctor do? And from the diagnosis, they learn how to schedule in a way that’s a little bit different than dashes and X’s and trying to fill time. We actually schedule to productivity. We don’t diagnose based on find three crowns to fill the schedule. It’s really discover the need of the patient and then discover a way to fit all that into your schedule.

Ryan Isaac:
Two things come to mind when I hear that. First of all, is that where people begin with PDA? That’s where you said, that’s where the beginning stage is the productivity. Is that where they begin in these events or that’s where they begin in general when they work with you guys?

Victoria Peterson:
Well, we are a consulting firm, that’s for sure. But when we started, we didn’t start as a consulting firm. We didn’t have a product to sell. We still don’t. You can come into coaching or consulting first, but I can tell you our first recommendation’s going to be come here, because you’re surrounded by so many like-minded people. And dentistry is very isolating. And most of the news that you read, or most of the forums you go on are very negative. They’re not uplifting and encouraging. So here you find people who are focused on the same thing.

Ryan Isaac:
Yeah.

Victoria Peterson:
So your office managers can find other office managers to build their support network. Your hygienist can get lifted up by other hygienists who are focused on oral systemic and patient health.

Ryan Isaac:
Right.

Victoria Peterson:
Your assistants realize they’re not just an assistant. I mean, you can’t meet Summer Carroll and not wanna be a better human, you know?

[laughter]

Ryan Isaac:
Yeah, okay. Yeah. Yeah, you’re right. There is a lot of team here this weekend. A lot of team here.

Victoria Peterson:
Yeah.

Ryan Isaac:
Yeah, okay. So the other thing that came to mind, this might be another topic, but you were saying that you don’t do dentistry the right way by starting with the diagnosis in mind like, “I need to make this person have three crowns today in order to fill my schedule.”

Victoria Peterson:
Right.

Ryan Isaac:
Why that strikes me as interesting is because of course, that’s the intuitive right thing to do for people. Our industry and the financial industry is notorious historically for doing just that. My industry begins with the product in mind at the end. “What do we need this person to buy?” A whole life policy. An annuity. [chuckle] Right?

Victoria Peterson:
I was gonna say annuity. [laughter]

Ryan Isaac:
Oh, you’re gonna go annuities?

Victoria Peterson:
‘Cause there’s such good commissions on that. [laughter]

Ryan Isaac:
Because they start with the commission end in mind, and then they say, “What product fits that commission?” and then figure out a way to make that person need it.

Victoria Peterson:
And then profile you into it. Yeah.

Ryan Isaac:
Profile, yeah. “How do we make this person need this thing or want this thing?” You’re describing a process which is the way it should be done, which is, what care does this person need? Maybe they need zero care. Maybe they need this one appointment to say, “You’re good. You don’t need anything.” Maybe they need a ton of care. But I don’t know if you wanna speak to that at all, but that always strikes me as something that’s so wrong with my industry that good dentists do well.

Victoria Peterson:
Yeah. And I think the reason it’s not different is that the system is set up in a payer model where the reimbursement model is 1,500 a year, that’s about a crown, so go find a crown. So it’s not disparaging to anybody out there, however you diagnose. I’m so happy that patients are getting care. And Bruce always says it this way. Patients will say, “Hey doc, can you fix my tooth?” And his response is always, “Well, of course I can fix your tooth. But the better question is, can I fix it in a way that it stands a chance of lasting you the rest of your life?”

Ryan Isaac:
Oh yeah.

Victoria Peterson:
And that’s a different question.

Ryan Isaac:
Yeah.

Victoria Peterson:
And then we get to educate the patient. “So before I restore that tooth, I wanna understand, how did you get here? Are you sipping on Dr. Pepper all day long?”

[chuckle]

Ryan Isaac:
Sure.

Victoria Peterson:
“Are you popping Altoids? You got a Starbucks habit? Are you… ” [laughter]

Ryan Isaac:
Did you just look at my Starbucks cup?

Victoria Peterson:
I did. [laughter] Okay, you gotta gulp it down. You can’t sip it. And then you educate them on acid attacks and you educate them on how to prevent it so you don’t need dentistry. That’s really the goal.

Ryan Isaac:
I really like that. I wanted to ask you today, maybe you could take this as just in this conference, the feedback you’re getting, or through this year. I wanted to ask you, what are the most common things the dentists are asking this year, or bringing to PDA, or talking about? What’s on everyone’s minds this year and how are you responding to those things?

Victoria Peterson:
Great question. I’ve always been a team advocate because I came up through the ranks as an assistant, a hygienist and office manager, went back to business school. I was a dental hygienist for 15 years before I went back to dental school, got a doctorate in spirituality ’cause I just love figuring out what makes us tick and what lifts us up, right? And at PDA, we have the coaching and consulting. We also have an ad agency and we have our live events. But this year, what’s really different is there is more emphasis on team.

Ryan Isaac:
Okay.

Victoria Peterson:
And I don’t know if it’s quite at the, “Let’s build a great team,” that’s my hope, but it is about attracting talent and keeping talent. There’s a real talent war out there.

Ryan Isaac:
Yeah.

Victoria Peterson:
So the big shifts we’ve made is we actually have a whole division now that focuses on employer branding. And so I think we’re one of the first to bring the concept of marketing as an employer in your community, being a good chamber of commerce member, if you will, a good member of the community so that you always have a stack of resumes when an opening comes up.

Ryan Isaac:
What’s the phrase again? Employer branding?

Victoria Peterson:
Employer branding.

Ryan Isaac:
Does this fit into your… What’s the other phrase I love? The investment grade…

Victoria Peterson:
Grade practice.

Ryan Isaac:

Practice?

Victoria Peterson:
Yes.

Ryan Isaac:
Yeah, to become an investment grade employer.

Victoria Peterson:
Yeah. So that’s the second conference we have on for our alumni.

Ryan Isaac:
Oh, okay. [chuckle]

Victoria Peterson:
There is the IGP Summit. They’re learning how to build investment grade practices.

Ryan Isaac:
Right.

Victoria Peterson:
So we’re used to the practice management optimization part. We’re used to marketing to attract patients part. But there’s a whole another area of focus called your culture index. So how would your team rank you as a boss in the same way that your patients rank you as a dentist?

Ryan Isaac:
And showing up to your team to be a good leader is different than showing up as being a good dentist to your patients. It’s totally different, right?

Victoria Peterson:
Exactly. And I will say until the explosion of the internet, explosion of social media… And we’ve been beta testing. I ask all my clients, “Hey, when’s the last time you updated your Indeed and Glassdoor?”

Ryan Isaac:
Oh, yeah.

Victoria Peterson:
They went, “What is Indeed?” [laughter]

Ryan Isaac:
“What’s the Glassdoor?”

Victoria Peterson:
“What is Glassdoor?”

Ryan Isaac:
They’re thinking of like the literal front door. Yeah.

Victoria Peterson:
Yeah. So it’s just like you Google my business, if you don’t claim it, somebody else can…

Ryan Isaac:
No way.

Victoria Peterson:
And they can hijack your Indeed and put some really wicked stuff out there about you.

Ryan Isaac:
Geez. Okay.

Victoria Peterson:
So… [chuckle]

Ryan Isaac:
No idea.

Victoria Peterson:
Right?

Ryan Isaac:
I didn’t know that was possible.

Victoria Peterson:
So that’s what employer branding is all about. What does my office look like from an employee standpoint? And you can put photos, you can put team testimonials, you can put your job postings, all of that. Most of the time we just wait till there’s an opening, we throw up an ad and hope we get somebody.

Ryan Isaac:
Uh-huh.

Victoria Peterson:
But…

Ryan Isaac:
Not today.

Victoria Peterson:
Not today.

Ryan Isaac:
Yeah.

Victoria Peterson:
‘Cause people wanna know, “What’s your culture? What’s my work life gonna be like? Is this environment harassing, or is it uplifting? What do your people say?”

Ryan Isaac:
Yeah, it’s more than just hours in pay nowadays.

Victoria Peterson:
Yeah, way more than hours in pay.

Ryan Isaac:
You said this is something that’s been prevalent this year. You have more insight to practices than we do. But just anecdotally, I think since the pandemic, I get this question often, since the pandemic, I think practices are performing well in terms of revenue and productivity. They’re producing…

Victoria Peterson:
Yes. Yes.

Ryan Isaac:
But their expenses are up, and mostly people expenses.

Victoria Peterson:
Yes.

Ryan Isaac:
And it’s not just those numbers which tell a story, which they do on the P&L with profitability, but it’s this whole, “How do I get the right people here and how do I get them to stay?”

Victoria Peterson:
Right.

Ryan Isaac:
And so you’re probably just seeing this become a big, big issue.

Victoria Peterson:
Oh, absolutely. So we actually do… We’ve had a couple of offices that we actually calculated the cost of turnover.

Ryan Isaac:
Oh, okay.

Victoria Peterson:
And so… [chuckle] And this was a bigger office, like multi-doctor office, but they turned over 14 employees in one year.

Ryan Isaac:
Okay.

Victoria Peterson:
So a few assistants go out on maternity leave, this and that…

Ryan Isaac:
Yeah. How big the office did you say, in people?

Victoria Peterson:
Oh, let’s say three doctors, four hygienists and administrators, some assistants.

Ryan Isaac:
Maybe 25, 30 people?

Victoria Peterson:
Yeah.

Ryan Isaac:
40? Okay.

Victoria Peterson:
Yeah.

Ryan Isaac:
But they turned over almost half of their people in the whole year?

Victoria Peterson:
They turned over 14.

Ryan Isaac:
Yeah, okay.

Victoria Peterson:
And there were like, almost every… It doesn’t matter the size of the dental office. There’s always like one position that’s like a revolving door.

Ryan Isaac:
Constantly, yeah.

Victoria Peterson:
It’s that third assistant or something like that. So the way to calculate that is take your average per hour, say it’s 25 bucks an hour, multiply that by six months’ wages. ‘Cause it takes about 26 weeks to get a new person in, orient them to your software, orient them to your flow, a full cycle, the patients are coming through to meet them. They’re helpful in the beginning, but they don’t really become productive until about month four.

Ryan Isaac:
Wait. I’m pulling my calculator. Okay. So how many weeks did you say is that?

Victoria Peterson:
26.

Ryan Isaac:
26 weeks average wage?

Victoria Peterson:
25 bucks.

Ryan Isaac:
25 bucks. Okay.

Victoria Peterson:
We’ll call it 32 hours, just to be helpful.

Ryan Isaac:
Yeah. Yeah, you’re talking over $20,000 per person?

Victoria Peterson:
Per person. So multiply that by 14.

Ryan Isaac:
Oh, yeah. Let me go back to my calculator. Times 14, and we’ve got almost $300,000.

Victoria Peterson:
$300,000. So this is what I mean by employer…

Ryan Isaac:
That would be… Sorry to cut you off. I’m just… The numbers are sinking in. That’s $300,000 of what would’ve been pure profit to the owner, income.

Victoria Peterson:
It’s lost productivity. Yeah.

Ryan Isaac:
Wow.

Victoria Peterson:
‘Cause you slow down with new people.

Ryan Isaac:
You slow down, yeah.

Victoria Peterson:
You can’t move as fast. Patients leave “‘Cause my favorite is not there.” And this particular office, the dentist had anger management issues. Great, great person until, snap, ’cause he didn’t have any stress release mechanisms, right? And I will say that when I began dentistry, that was expected. Dentists threw instruments all the time. You just learned to duck.

Ryan Isaac:
Really? That was just normal. Yeah.

Victoria Peterson:
And it was just part of the culture. We weren’t wearing gloves. I mean, it was…

Ryan Isaac:
Yeah, yeah, yeah. Yeah. [chuckle]

Victoria Peterson:
Moses was still…

Ryan Isaac:
Wild, wild west. Moses was… [chuckle]

Victoria Peterson:
Chiseling the tablets, all of that.

Ryan Isaac:
Yeah, [laughter] back in the day.

Victoria Peterson:
But the culture has changed, particularly with more diversity, more inclusion, the Me Too Movement, women are stepping up and finding their voice and they pretty much… They say that there was a war between management employees and the employees won.

Ryan Isaac:
Okay. Yeah.

Victoria Peterson:
And so pay attention to it, doctor, because if you’re constantly angry with your staff, there’s some underlying conditions to be addressed. Maybe you have high blood pressure. But maybe you just need to have the right team pulling in the same direction you wanna go. So I’m not saying being a doormat to your team at all, but recognize that your reputation as an employer has an impact on your bottom line. For this particular office, we also added up what was the revenue from all new patients in that six-month period of time. It wiped out all profit from all the marketing and all the new patients.

Ryan Isaac:
Oh, no way. Wow.

Victoria Peterson:
So that’s a bummer. [laughter]

Ryan Isaac:
Yeah.

Victoria Peterson:
That’s a bummer.

Ryan Isaac:
Back up a bit. What did you… You got a doctorate in?

Victoria Peterson:
Spirituality.

Ryan Isaac:
Okay. I feel like we could do a whole episode on what that… How you’ve implemented that. But I’m really fascinated at this point in my life with, call it psychology therapy. When I hear things like this, like a person who is struggling to control some kind of like anger triggers that’s causing half of the staff to leave, I just think like, you probably need some therapy. [chuckle]

Victoria Peterson:
Well, I’ll tell you…

Ryan Isaac:
We used to like, “Go work on… ” There’s like something in your life that you need to go work on that is probably deeper than just even in the practice.

Victoria Peterson:
Oh, absolutely. And there’s so much more help for it. I mean, I’ve been through every therapy there, I think.

Ryan Isaac:
Yes, for sure. And the stigmas are being removed around this… Yeah, totally. Yeah.

Victoria Peterson:
But let me give you a great resource that anybody can do today and it’ll change your life.

Ryan Isaac:
Okay.

Victoria Peterson:
We’ve got IQ, right? Our intellectual quotient. We’ve got… There’s another one called… And there’s EQ, right? Emotional intelligence. But there’s also PQ, your positivity quotient.

Ryan Isaac:
Okay.

Victoria Peterson:
And you can look up on the PQ assessment, and it’s by Dr. Shirzad Chamine. And I studied with him, he’s out of university, maybe at Stanford. And he really studied what makes you personable really. And he came up with, and we all know this through neuro-linguistics and neuro-coaching, that we have our reptile brain, our fight-flight-freeze-fear, but we also have our sage mind, our executive thinking, the one that makes compassionate, well-informed choices.

Ryan Isaac:
Okay.

Victoria Peterson:
So PQ helps you identify the saboteurs that keep you away from being your best.

Ryan Isaac:
Ooh, it sounds a little bit like internal family systems therapy.

[laughter]

Victoria Peterson:
Maybe a little bit.

Ryan Isaac:
Yeah.

Victoria Peterson:
But are you a control freak? Are you an avoider? Are you hyper alert?

Ryan Isaac:
And what’s that protecting behind that layer?

Victoria Peterson:
What’s it protecting? So…

Ryan Isaac:
Fascinating.

Victoria Peterson:
Through his program… And we’ve had several doctors just read the book, this doctor I was talking about. I said, “Do the test… ”

Ryan Isaac:
The name of the book is called what?

Victoria Peterson:
Positivity Quotient by Shirzod Chamine.

Ryan Isaac:
Okay.

Victoria Peterson:
And you can go online and do PQ assessments.

Ryan Isaac:
Yeah.

Victoria Peterson:
And I said, “Just go on and identify your saboteurs. There’s nine of them.” So he found out he was hyper-controlling, he was hyper-alert, and he was also a procrastinator. So he’s always looking around for what’s going wrong and, “How do I control the process so I’m not disappointed?”

Ryan Isaac:
But somehow not engaging with fixing and… Like scared to engage and fail.

Victoria Peterson:
“But not engaging ’cause I’m avoiding… ” Yes, all of that.

Ryan Isaac:
Woah, okay.

Victoria Peterson:
And just reading through the book about, how do we engage these saboteurs and say, “Thank you for what you’re trying to show me”?

Ryan Isaac:
Yeah.

Victoria Peterson:
Within three months, he turned it around. And we tried it again for the next six months. They had two positions turned over, not 14.

Ryan Isaac:
So just the awareness from reading these things was enough him to check himself in those moments maybe and go, “Okay.”

Victoria Peterson:
Right. Sometimes dentists, you are the biggest risk in the practice. I know you talk about risk a lot in financial, but take care of yourself.

Ryan Isaac:
Yeah.

Victoria Peterson:
You have gallstones, you’re out. You break your arm, you’re out. You have unprocessed emotions, you can inadvertently take yourself out.

Ryan Isaac:
Yeah. I’m glad you said that. I think one of the, probably the greatest financial tool, no question, the dentists have is their career.

Victoria Peterson:
Right.

Ryan Isaac:
And the biggest threat to that is the threat to their longevity. And that could be mental, emotional, physical, it could be all of those things.

Victoria Peterson:
Right.

Ryan Isaac:
Breaking down too early, where… And not that you have to do clinical work five days a week until you’re 70, but being involved in the field of dentistry as long as you can in your life that still gives you fulfilment enjoyment and health, that is the biggest financial asset that you own. That’s it. And you have complete control over it. It’s not some external… You control all of that.

Victoria Peterson:
When you hear Productive Dentist Academy, you might first think, “Oh, they’re gonna teach me how to do 10-minute crown preps,” or something like that. It has nothing to do with that. It has to do with comprehensive care. But my invitation, and everybody listen to this, is treat yourself as if you were a multi-million-dollar athlete, ’cause it’s truly what you are. Dentistry is very physical. So why don’t you have a massage therapist, a physical trainer, somebody to stretch you out? Have your team make you smoothies so that your blood sugar stays stable. You deserve the support. The more successful you are, the more support is required.

Victoria Peterson:
You look at the President of the United States, they probably don’t even cut their own meat. Somebody is doing so many things for them that help them become more productive. So think about your work team, but think about your life team, particularly female dentists. Do you need a housekeeper? Don’t feel guilty about that. Do you need a nanny or someone to go pick your kids up to and from school so you have more quality time? As you become more productive, invest in…

Ryan Isaac:
In outsourcing, yes.

Victoria Peterson:
In outsourcing parts of your personal life as well. It makes a difference.

Ryan Isaac:
Why do you think people struggle with outsourcing? Because that does seem to be…

Victoria Peterson:
Guilt.

Ryan Isaac:
Guilt? Okay.

Victoria Peterson:
Guilt, like… I think…

Ryan Isaac:
Control?

Victoria Peterson:
Well, maybe my parents weren’t like that. “Don’t get too high for your station” is the garbage in your head that makes you feel like you don’t deserve, right? So it’s a deserve issue. And maybe we just never thought about it.

Ryan Isaac:
Yeah, never occurred to us.

Victoria Peterson:
It seems so decadent to have.

Ryan Isaac:
“Why would you pay for that? I could do it myself.”

Victoria Peterson:
“Why would you have a chef?”

[chuckle]

Ryan Isaac:
Yeah. I would love to have a chef. Yeah.

Victoria Peterson:
Decadent. Right? I know.

Ryan Isaac:
Yeah.

Victoria Peterson:
But take a portion of all your income, not all of it, but take 10%.

Ryan Isaac:
Yeah.

Victoria Peterson:
Invest it into something extravagant.

Ryan Isaac:
Reasonable as your income grows.

Victoria Peterson:
Yeah.

Ryan Isaac:
So back to this idea of… So would you say that the team structure is probably the most prevalent thing this year that a lot of focus is just driving towards?

Victoria Peterson:
Yeah. Some doctors have given up.

Ryan Isaac:
Oh, yeah.

Victoria Peterson:
There’s like a hygienist for 60 bucks an hour, I’m not hiring one. And if you’re in a PPO model, I could see why that would be true. But if you are in a comprehensive health model, hygienists are producing $3,000 and $4,000 a day. So it depends on the model that you’re in on whether that labor cost fits for you or not.

Ryan Isaac:
Does that mean that… And this is probably always true. Economy evolves. Society evolves. Expectations of employers, works, employees evolve. Is it just time for people to evolve the way they’ve thought about how they’re hiring team and keeping team and what team like hygiene is even supposed to do in a practice?

Victoria Peterson:
Yeah.

Ryan Isaac:
Yeah, okay.

Victoria Peterson:
I think I do see a huge exodus from insurance plan acceptance and PPO. I don’t know what you’re seeing, but we see it a lot.

Ryan Isaac:
Yeah. I mean, they’re very, very common. I hear that all the time.

Victoria Peterson:
Just like, “I’m done.” And we actually… We’ve so upped our team. So within our employer branding, we do photography and we gather your story, but we’re really going deep into, what is your mission? What’s your internal mission? Doesn’t have to be published to the world, but…

Ryan Isaac:
Yeah. It’s gonna drive you though.

Victoria Peterson:
It’s gonna drive you and it’s gonna drive the team. And what really drives the team is the why behind it. Why is this important? So working on that and working on… I guess the best question you could ask yourself to shift the culture is, who is your favorite employee, anybody that you’ve ever worked with?

Ryan Isaac:
Okay.

Victoria Peterson:
And then start to describe that person. Did they show up on time? Were they reliable? Were they intuitive? Did they just get things done? Were they pleasant? And start describing the characteristics of it and you’ll start to see what your ideal employee would look like, and then you can start hiring towards that. So if you want a pleasant, responsive person who likes details, when you’re interviewing, you look for, “Are they detail-oriented?” You scan that resume to see if there are spelling errors or bad punctuation, [chuckle] and you’ll immediately go, “Reject, reject, reject.”

Ryan Isaac:
Yeah, yeah. “No, no, no, no.” Yeah.

Victoria Peterson:
So get clear about… You want more than just a warm body. You want more than just a happy person. And it’s time to start interviewing beyond the skill set.

Ryan Isaac:
And that used to be the norm, right? Hiring was a lot easier. It was cheaper.

Victoria Peterson:
Right.

Ryan Isaac:
So yeah, you’re just talking about things that have maybe changed permanently. I mean, to say, I don’t know what the scale would be from… You guys have a ton of data, but to say that average employee overhead not including payroll taxes was in the low 20s for team is now hovering close to the high 20s and 30% range…

Victoria Peterson:
Is that what you’re seeing?

Ryan Isaac:
Yeah.

Victoria Peterson:
Yeah.

Ryan Isaac:
I mean, is this permanent? Is this just the way… Now, and the reverse… The way I think about this is, there used to be kind of a breakeven collections number where a doctor is just gonna make a very minimum amount before there’s profit. And it feels like that number is getting higher and higher. If you had $1 million practice, it felt like you have a pretty good amount of profit, but now I’m meeting people who have $1 million practice and there’s no obvious problems except for just people cost them a lot of money, and $1 million practice isn’t netting as much as it used to. Is that a permanent thing? Is that… It is what it is.

Victoria Peterson:
Oh yeah. I don’t think inflation is gonna roll back.

Ryan Isaac:
So now we just have to produce more. Yeah. We just have to produce more and grow more.

Victoria Peterson:
Well, no, if orange is the the new black… [laughter]

Ryan Isaac:
Yeah, okay. [laughter]

Victoria Peterson:
I say 1.5 is the new million.

Ryan Isaac:
Yeah, okay. I would totally agree with that. Yeah.

Victoria Peterson:
It really comes to your write-off. So I would challenge any doctor who’s got 28%-33%, 35% labor cost, look at your write-off. And it’s surprising to me. I just talked to a doctor last month. He had a 40% write-off, 40% on a $3 million practice.

Ryan Isaac:
Okay.

Victoria Peterson:
Like 1.2 million goes a long ways in my neighborhood. [laughter]

Ryan Isaac:
Yeah. Yeah. Wow.

Victoria Peterson:
And so on $4 million, he was taking $1.2 million in write-offs, and then collecting 98% of that. His goal was… And his net on that $3 million was about about $500,000, right? So a pretty low EBITDA on that type of practice. His goal was to have $1 million in EBITDA.

Ryan Isaac:
Okay.

Victoria Peterson:
And I said, “Well, let’s run the numbers.” So I ran it, I said, “If you continue taking insurances the way you are today, you need to build a $7 million practice to net a million.”

Ryan Isaac:
Yeah.

Victoria Peterson:
And he’s like, “No problem. We’ve got so many operatories.” And I said, “Okay, if we say that each operatory is worth 40 grand a month, you’re gonna tap out at $6.2 million.”

Ryan Isaac:
Yeah.

Victoria Peterson:
“So what will you do to get that other $800,000? ‘Cause that’s all your million-dollar profit.” It really is a numbers game and you need to reverse-engineer it. So the two things that go together with profitability are your write-offs.

Ryan Isaac:
Okay.

Victoria Peterson:
Honestly, get rid of some of those insurances and market 3% or 4%.

Ryan Isaac:
Can I pause there for a second? I feel like it is a very popular… It’s an increasing trend, people dropping insurances. I do feel like some people step into that haphazardly, and then they regret it and then jump back into insurances and they’re just like, “That was the worst thing I could have ever done that destroyed us for six months.” And it…

Victoria Peterson:
It could take you six months to get your team prepared.

Ryan Isaac:
Yeah. Okay. So any advice for people even beginning that journey of getting rid of insurances?

Victoria Peterson:
Oh yeah. There’s a whole system. We’ve got a whole system from PPO to fee-for-service, but…

Ryan Isaac:
I say hire someone who knows how to do this. That’s what I tell people to do.

Victoria Peterson:
That’s what I would do ’cause there’s a lot of land mines. But number one, find somebody who can evaluate the impact. So you probably had three or four insurances that have 50 people, 100 people, 200 people, and you got 4,000 patients’ records. So cull their worst offenders, don’t worry about that, but then work with someone like Five Lakes or Vivek or somebody that really knows how the insurances are connected, ’cause they’re all umbrellaed now and you can’t really do that yourself. So you’re gonna need to spend a little bit of money and really develop a fee philosophy.

Ryan Isaac:
Okay.

Victoria Peterson:
So it’s okay to have some people paying higher, some paying lower, but you gotta have some controls and a philosophy about that. That’s the haphazard part.

Ryan Isaac:
It’s like an impact study. It’s like before they build something on any piece of land, there’s an impact study.

Victoria Peterson:
Absolutely.

Ryan Isaac:
You have to have an impact study in your practice. Because people do… They go… I swear, sometimes they’ll just drop it and be like, “I think we’re okay now,” [chuckle] and then…

Victoria Peterson:
Well, before you drop it, now, you gotta remember, insurance is a method of payment. It’s not a method of diagnosis. It’s not a method of treatment. It’s a method of payment. So step number one is identify how you can expand your payment options. So if you wanna stick with “Pay me upfront and I don’t take your insurance,” you’re gonna fail.

Ryan Isaac:
Yeah.

Victoria Peterson:
But if you have like… I love Accept Care and their new platform. So for the first time there’s like an… And we’ve done this in PDA forever. In fact, Accept Care called me and said, “You’ve got these financial option sheets and they look a lot like our software,” and I was like, “That’s because you got it from us and you just didn’t know it.” But the waterfall has always been wrong for presenting financial options to patients. So we might need to put this at the beginning of the podcast.

[laughter]

Ryan Isaac:
Yeah.

Victoria Peterson:
The number one reason patients don’t say yes to treatment is because they’re embarrassed to discover if they can pay for it.

Ryan Isaac:
Oh yeah.

Victoria Peterson:
So they’re nervous about the price tag, but then they’re even more nervous that you’re gonna run a credit check on them, right? I mean, that is very vulnerable. Very vulnerable. So with Accept Care, and I’m not paid by Accept Care, but what’s different about their platform is you could approve as a soft approval for up to four different lenders like bank lending, it shows you if you want to pay upfront and get a cash discount, and it can show in-house finance options.

Ryan Isaac:
Okay. Yeah.

Victoria Peterson:
So on this platform, nine out of 10 people can get approved, and they can get approved for almost the entire treatment plan up to $50,000.

Ryan Isaac:
Okay.

Victoria Peterson:
So there’s almost always a way. So when your team has the confidence that no matter what their credit score is, no matter what their treatment plan size is, they could get approved. I was an office manager back in the day where we had to submit through fax, to Equifax, and check the credit scores, and then I was the one telling them, “Hey, Ryan, your credit is lousy, so we’re only gonna do part of the treatment. If you can prove you can… ” So those were hard conversations.

Ryan Isaac:
Oh yeah.

Victoria Peterson:
But this is two minutes and it’s an app, and patients know right away, “Here’s three options to fit it into my budget.” And that’s what they’re looking. It’s not about the interest rates. It’s not about that. It’s like, “Which one of this numbers fit in my budget?”

Ryan Isaac:
“Can you make this work?” Yeah. “Now that’s behind us, let’s talk about what you actually need from a health perspective.” Yeah, okay.

Victoria Peterson:
Yeah. We beta tested this for a while in some of our higher level PDA offices think and their case acceptance is amazing. Their communication skills are great. Their financial options are doing everything we told them to do. We put Accept Care in there. Their case acceptance went up 30% on their already good acceptance.

Ryan Isaac:
Wow.

Victoria Peterson:
So when it comes to overhead, with labor costs, the two biggest variables are, do you have a large write-off? Because you have to staff for the production level. You’re not staffing 40% less for what you can collect. So you’re inflated in your labor needs, so that drives it up but you can’t collect it. The other piece is open time. So now I’m staffed… So let’s say you collect a million, but you gotta produce 1.4 million to get there. I’m staffed to the $1.4 million, so now my labor costs are ridiculous. If I’m staffed at that 1.4 million, I can only collect a million and I have 20% open time, well, now I’ve really just smashed my profitability ’cause there’s no revenues to cover it.

Ryan Isaac:
Yep. And then you are scratching your head like, “I produce seven-plus figures and where is my money?”

Victoria Peterson:
Right. “How can I have no money?” Right. [chuckle]

Ryan Isaac:
“Why I am broke every month?” Yeah. I know you are running this giant multi-300, 400, 500-person event right now, so we’ll let you go. [chuckle]

Victoria Peterson:
Thank you, Ryan. This is fun.

Ryan Isaac:
You’re like running back from room to room like, “Are we good? Are we good?”

[laughter]

Ryan Isaac:
It’s running so beautifully. Thank you for having us. Every year, you invite us here and we’re so excited. I’m glad I got to come back. I haven’t been to one since pre-pandemic.

Victoria Peterson:
I know. You guys have…

Ryan Isaac:
I’m always gone. And then everyone else gets to enjoy it.

Victoria Peterson:
You’ve been our educational sponsors and supporters for over six years and I love having you here.

Ryan Isaac:
I’m so happy. There’s so much more to do. Thank you for… I swear we could do episodes on some of these individual things and maybe we’ll just do. I’d love to follow up not too long down the road on some of this team stuff you’re working on.

Victoria Peterson:
Yeah.

Ryan Isaac:
And what was the book again that you mentioned? I’m gonna go get it. I’m gonna take the test.

Victoria Peterson:
Oh, yeah. It’s Positivity Quotient…

Ryan Isaac:
Okay. It’s amazing.

Victoria Peterson:
By Shirzod, which is like S-H-I-R-Z-O-D Chamine. And you just go “PQ Assessment” and it’ll pull up. [chuckle]

Ryan Isaac:
Okay. I’m gonna go find that too. Where can people find PDA?

Victoria Peterson:
Oh, that’s so easy. It’s productivedentist.com.

Ryan Isaac:
Okay. That is easy. And what’s the next conference you have? What’s the next…

Victoria Peterson:
Next conference will be in March.

Ryan Isaac:
Oh, cool. Okay.

Victoria Peterson:
And the next September, we are throwing a huge gala, 20 years’ celebration. [chuckle]

Ryan Isaac:
20 years. I’m not missing that. I’m blocking it out right now. I’m not missing that.

Victoria Peterson:
Block it out. [laughter]

Ryan Isaac:
Where’s the March one at? Do you know?

Victoria Peterson:
We’re gonna be back here in Frisco at the Omni Hotel.

Ryan Isaac:
Cool. Love this place.

Victoria Peterson:
Yeah.

Ryan Isaac:
Victoria Peterson, thank you for having us.

Victoria Peterson:
Thank you.

Ryan Isaac:
Thanks for putting this on. Good luck to you the rest of the weekend.

Victoria Peterson:
You’re awesome.

Ryan Isaac:
Okay. Thanks everyone for tuning in. We’ll catch you next time on another episode of The Dentist Money Show. Bye-bye now.

Practice Management

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