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Is Ownership a Good or Bad Move for You? – Episode 317


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Not every dentist is ready to own a practice, but it helps if you know what skills and traits indicate if ownership is a good (or bad) move for you. On this Dentist Money™ Show, Ryan interviews Dr. Richard Low of Shared Practices. There is no such thing as a fail-proof list of skills required to be a successful owner, but Ryan and Richard look at traits they’ve seen that help.

Show notes:
www.sharedpractices.com

 


 

Podcast Transcript

Ryan Isaac:
Hello, everybody, and welcome back to another episode of the Dentist Money Show, sponsored by Dentist Advisors, a no commission, fiduciary, comprehensive financial advisor just for dentists all over the country. Check us out at dentistadvisors.com. Do that right now. Today on the show, I have an actual long-time friend, and probably… Actually, a long-time listener too. Dentist extraordinaire, entrepreneur, army guy, and a lot of other things too; it is Dr. Richard Lowe of Shared Practices and many other things. And man, today on the show, Richard and I just kind of dive into the nuances of practice ownership and entrepreneurship; talking about personality types that maybe shouldn’t own practices, how to go about it, how to slow down, how to avoid some mistakes… It was really good insight, because Richard has been there, done that, and also gets to coach and help other practice owners make those same kinds of decisions all year long, so…

Ryan Isaac:
Many thanks to Richard for his time and his expertise. He’s a long time friend. Great origin story that we get into of how we met a long time ago; it feels like a million years ago. And thank you for being here. If you have any questions, go to dentistadvisors.com and click the Book Free Consultation link and talk to one of our advisors, or go to the Dentist Advisors discussion group on Facebook, post a question, we’ll post an answer; we’ll probably use it for an episode of the Dentist Money Show, actually, so do that, we love it. Thank you for being here, and 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 and avoid the bad ones along the way. I’m your host, Ryan Isaac, and I’m here with an actual very long-term friend and buddy of mine, Dr. Richard Lowe, of Shared Practices and many other things. Richard, what’s up, man? Thanks for joining me here.

Dr. Richard Low:
Ryan, this is incredible. Thank you.

Ryan Isaac:
I feel like maybe… But I’m old, so I have this excuse now, and I’m getting in the age territory where I feel like I can just do dumb things and then just repeat myself, and everyone’s like, “Yeah, he’s old, it’s fine.”

Dr. Richard Low:
I love it.

Ryan Isaac:
I feel like we repeat this story every time we do content together, but I would just like to bring up the fact that I met you when you were interning at…

Dr. Richard Low:
Dentaltown.

Ryan Isaac:
Dentaltown, and it feels like a million years ago.

Dr. Richard Low:
Oh, it’s so long.

Ryan Isaac:
And we were there having a chat with the honcho of Dentaltown himself, and then I was leaving to the elevator bank, and you came out and started asking the most detailed questions I’ve ever heard about mutual fund expense ratios. [chuckle]

Dr. Richard Low:
I was grilling you because…

Ryan Isaac:
I loved it!

Dr. Richard Low:
I am so skeptical of…

Ryan Isaac:
Yes!

Dr. Richard Low:
Most financial advisors, and… I have a series of questions, and you kept answering the questions in the right way, and I was like, “Oh, I’m confused. Usually, I’m fighting with someone by now.”

Ryan Isaac:
Usually, you’re trapping them in their own words. You’re like, “Haha, I got you, you sucker salesman.” It was… I just… I still remember it very vividly. And you had all these really excellent, super detailed questions about asset allocation, and portfolio construction, and costs, and diversification…

Dr. Richard Low:
No, no, no, no! What it was… I know the questions I asked.

Ryan Isaac:
You remember the questions?

Dr. Richard Low:
Oh, totally.

Ryan Isaac:
Oh my gosh.

Dr. Richard Low:
Oh, man. I asked you, number one, “Do you guys sell insurance?” That’s like my… The easiest way that I…

Ryan Isaac:
Did you lead with that?

Dr. Richard Low:
Yeah, totally.

Ryan Isaac:
Yes. Yeah, solid.

Dr. Richard Low:
That’s the number one, like, filter out, “Okay, does this person… Are they truly a fiduciary who’s helping me with my financial investments, or do they also have this sweet little portfolio of invest… Or of insurance products… ”

Ryan Isaac:
Do you do financial planning, but mostly just sell whole life policies.

Dr. Richard Low:
Exactly.

Ryan Isaac:
So I said no, because we don’t; we still don’t.

Dr. Richard Low:
Said no.

Ryan Isaac:
Okay, cool.

Dr. Richard Low:
And then I asked, “What’s your philosophy on index funds… ”

Ryan Isaac:
Cool.

Dr. Richard Low:
“Versus individual stocks, or certain mutual funds that are kinda in your umbrella, and that you recommend, because you get a kickback on them and all these things?”, and you guys were like, “Yeah, index funds. Index funds are great. That’s what we do.”

Ryan Isaac:
Okay, so insurance indexing. Was there another one, or does that… That probably tells you everything you need to know about a lot of advisors.

Dr. Richard Low:
The last one was about e-structures and who you work with, like…

Ryan Isaac:
Oh, yeah. Well, competition; that’s everything.

Dr. Richard Low:
Yeah, well, and I wanted to know, like…

Ryan Isaac:
Who employs you? What do you think?

Dr. Richard Low:
How are you incentivized to make decisions, and how much do you know about dentistry and running a business versus just like, “Meh, dentists are just… ”

Ryan Isaac:
I work with dentists; I have two.

Dr. Richard Low:
Right.

Ryan Isaac:
[chuckle] They’re my in-laws.

Dr. Richard Low:
Exactly. And you kept checking all the blocks, all the way down, and I was like, “Oh.”

Ryan Isaac:
Crazy.

Dr. Richard Low:
“I could see myself talking to these guys more.” And then you came out with a podcast, and it’s ironic that you’ve got the beach behind you here… On your Zoom background.

Ryan Isaac:
No one can see that, yeah.

Dr. Richard Low:
No one can see that.

Ryan Isaac:
Christmas tree on the beach, yep.

Dr. Richard Low:
Is that how audio podcasts work?

Ryan Isaac:
Yeah. [chuckle] No one can see it? Yeah, a good call.

Dr. Richard Low:
Yeah, yeah. But I remember, when you guys first came out with the Dentist Money show, I binge watched it, and we were on a family trip on South Padre Island, and I went running without my shirt on and got a really bad sunburn listening to the Dentist Money Show. It was like your first 20 episodes of you and Reese, and I was just like, “This is so good.”

Ryan Isaac:
Amazing!

Dr. Richard Low:
And I just kept running and running, and burnt to a crisp.

Ryan Isaac:
That’s such… The story… True or not, the story gets better every time we tell it.

Dr. Richard Low:
This is all true.

Ryan Isaac:
So the next time we do content, we’re gonna bring this all up again, for better for worse, I don’t really care. Thanks for that, that’s really cool. I remember that clearly. And I guess this is all to say that you are a very deep-thinking, question-asking person, and that’s probably led you to a lot of great things in your career, in your life, and we’re gonna get into those, but thanks for the intro, because I think that is… That is so… It was just such a cool time. What year might that have been? If I said it was 2014 that… Correct?

Dr. Richard Low:
2014, 2015; either the fall of 2014 or 2015. I threw myself at Dentaltown over and over; I kept applying for jobs that were full-time positions that were like, “You’re in dental school. Why do you keep applying for these? Stop.”

Ryan Isaac:
“Stop, you can’t come here,” yeah.

Dr. Richard Low:
Like, “We need a community manager. We don’t need you to be annoying us.” And eventually, they took me as a student intern, and then I produced Howard’s show.

Ryan Isaac:
Did you learn a lot from that, or what did you learn interning during dental school into, like, at the time, and maybe still, I don’t know, like… The biggest dental publication in the world?

Dr. Richard Low:
Yeah, I learned a few things. I learned a lot. I got to learn all about podcasting, which was huge for me, and…

Ryan Isaac:
Brand new too, like, such an emerging thing.

Dr. Richard Low:
Yeah, and… So, you know, learning how to run a podcast, and host, and all these things, and… I learned what I do and don’t wanna do in a podcast. I learned that… I really got to know Howard; I got to hang out at his house, and help him set up gear, and record, and talk with him. And one of the first questions, when I got to Dentaltown, I was like, “So, who does Howard’s social media?”, ’cause he’s posting at 3:00 AM, and… There’s a prolific amount of…

Ryan Isaac:
Is there a filter?

Dr. Richard Low:
Well, no, I thought there had to be like an intern or someone else who was doing all the posts, and they were like, “No, it’s him. It’s all him.”

Ryan Isaac:
It kinda makes sense. He’s still… I haven’t followed his stuff for quite a while. Is he still just cranking it out like that, just like a madman? Does…

Dr. Richard Low:
You know, he’s actually… Last time I reached out to him, he’s semi-retired, so he is…

Ryan Isaac:
Really?

Dr. Richard Low:
Yeah, ’cause I was gonna get on his show and talk some more. But I think the other key takeaway was like, oh, Howard is just a little bit crazy and willing to go for it, and had this idea of this brilliant company of Dentaltown. And for me, that was very inspirational of like, okay, he’s a real human being with flaws and amazing qualities all in… Wrapped into one, and what he did was, he had a vision, and he built something, and it’s benefited hundreds and thousands of dentists.

Ryan Isaac:
So cool, and sometimes, it takes posting at 3:00 AM and pumping out three episodes a day, and…

Dr. Richard Low:
Well, he loved it!

Ryan Isaac:
It’s grindy. Yeah.

Dr. Richard Low:
It’s just him!

Ryan Isaac:
And he loved it. Yeah, that’s true. We had him on our show a couple times, and… I mean, he would probably still get on our show. I don’t know, I’d have to reach out. It’d be kinda cool to do, but… That’s cool. That’s cool you did that. So, I’m really interested… So, how about… We were going on such a tangent, but how about we start with Shared Practices? Let’s talk just briefly. We’re gonna get into it more. We’ll talk about it in more detail, more context, really. Just tell us quickly about Shared Practices, and then I wanna reverse and just go… ‘Cause I’m just so fascinated in the process of building these small businesses. That’s what our clients are doing and our audience is doing. So, tell us about Shared Practices, and then reverse and go from intern to Shared Practices. What did you do?

Dr. Richard Low:
Totally. So, the modern version of Shared Practices… We are a coaching and consulting company podcast. We just held our first ever course in our new headquarters in Phoenix.

Ryan Isaac:
Cool.

Dr. Richard Low:
And… I had a blast…

Ryan Isaac:
Congrats, man. That’s awesome.

Dr. Richard Low:
Thank you.

Ryan Isaac:
: How many people do you… Do you know?

Dr. Richard Low:
We had 42 pre-owners. So this was a pre-owner… Analytics-based pre-ownership, and this was taking all five years of our coaching and due diligence that we’ve done for people, and updating all of our philosophies that we’ve put out over the years with some new things in mind. And it was electric. It was amazing. I had a blast. The speakers were amazing, the content was amazing, and the participants were just like all in, and it’s amazing to flip the switch for dental students who think like, “Ah, practice ownership, five, 10 years,” and you can say, “No, you can do this in one or two years out of dental school, and here’s the pathway, and here’s all the pitfalls, and here’s what you’re looking for.” And that’s changed. We’ve learned a lot doing this over the last five years. And then, we’ve got… We’ve got about 70 clients… Between mastermind members and coaching clients, and our head of coaching department, Suzanne Rassy, she shared at the course; she said that our average client has had 40% growth in their dental practice over the last six months.

Ryan Isaac:
So cool.

Dr. Richard Low:
Which is just like… That blew us all away. We were like, “Holy cow, we have the data now.”

Ryan Isaac:
What demographic are we talking about, like age or time in dentistry?

Dr. Richard Low:
Yeah, we tend to… I mean, the philosophy of our show, we really focused on my generation of dentists, so dentists who’ve graduated in the last 10 years who want to be entrepreneurs and business owners and grow practices. And so… Really, the thing that we do the best right now is helping people get into practices that can grow, and helping people grow practices, so going from a single-doctor practice, transitioning to a two-doctor practice, four-hygienist… All of the pitfalls, and we have a couple different tracks that people can take, because you have to shift some gears and become unprofitable for a while to come out on the other side. And if you don’t know what you’re doing, you can get stuck in this middle zone of one and a half doctors’ worth of work and hygiene, and it kills the practice, because you linger in this weird state. So, you have to be purposeful about, “Okay, this is… I have a one-doctor practice. Here’s… I’ve got two hygienists. I’m ready. I think I’m ready to hire the third. I think I’m ready to go through all these steps,” and take them through that journey. And we tell them ’em upfront, “It’s gonna be painful, here’s all the problems and the challenges you’re gonna encounter. And this is what you can expect on the other side of that, and here’s what is available too.”

Ryan Isaac:
Such a big thing. We’ll probably jump into that a little bit, so… How did you go from intern to Shared Practices? You’ve been in the dentist journey seat yourself a little bit, right?

Dr. Richard Low:
Yeah. I was a year out from graduating from dental school, and talking with Mark Costes, and Alan Mead, and Howard Farran, and all of these people encouraged me to start my own podcast. And I had some ideas, but I definitely felt like I’m a new grad stuck in the Army for another five years. How is anyone gonna listen to me or take me seriously if we’re talking about practice ownership over here, because this just doesn’t seem like… Like we could make a difference here. So we very purposefully, at the beginning, structured this as a leading learner situation, so it’s like I want to go on the journey of new grad from dental school to successful practice owner, and I wanna take anyone who wants to go with me along that journey… And didn’t wanna oversell practice ownership. Practise ownership is not for everyone. Practice ownership sometimes requires your soul, it seems like.

Ryan Isaac:
Can you talk about this? Can we… Can we stay here for a second, because this… You just said… You don’t wanna oversell practice ownership. There’s no debate on the financials, the financial outcomes of owning a practice, right? I mean, you can collect more, produce more, you can earn more…

Dr. Richard Low:
Pay less taxes… You know, the revenue from hygiene, all of… You know, build equity in your asset, all those things.

Ryan Isaac:
But… But you don’t wanna oversell it why? And… Why… Like, who isn’t cut out for practice ownership?

Dr. Richard Low:
There’s three main things that I feel like I could distill it down to. One is someone who’s willing to manage people. If you just love clinical dentistry and you don’t wanna be a leader, then practice ownership is gonna be painful, because you’re gonna have to hold people accountable, hire, fire, train, teach, inspire, coach…

Ryan Isaac:
Constantly. Constantly.

Dr. Richard Low:
All the time. All the time.

Ryan Isaac:
Yeah. We… And I was just talking to someone this morning. This might not be true, but I feel like this is true, just even in our own business. You can have the best processes and systems in the world, but you switch people in and out, and then it breaks everything. It’s just like… It never ends.

Dr. Richard Low:
Yeah. Especially in a practice of a certain size, like when you’ve got a smaller business and you’ve got one hygienist, one assistant, one person at the desk…

Ryan Isaac:
One person is like 12% of the entire team, you’re like, “Yeah, that’s a big… ”

Dr. Richard Low:
They are all the systems at that point, yeah.

Ryan Isaac:
Yes, yeah. Okay, yeah.

Dr. Richard Low:
So that’s number one, is… And that’s huge, and sometimes, you don’t know until you get in that situation, and sometimes, you need help. Sometimes, you get into being a leader and managing people, and realize like, “Crap, I thought I would be good at this, and actually, I really suck,” which all of us do, and if you think you don’t suck at leading people, then you probably need to work on it.

Ryan Isaac:
Yeah. [chuckle] Yeah. We’ll use that clip at the beginning, you know. If you don’t think you suck at leading people, you need to work… And it’s true. It’s… That’s the hardest job.

Dr. Richard Low:
Totally.

Ryan Isaac:
And it’s never ending. Yep.

Dr. Richard Low:
So, the second characteristic that would help you determine if practice ownership is a good fit is whether or not you’re willing to learn and… Like, learn how to become a business owner. Like, if you don’t wanna look at numbers, you don’t want to make hard decisions, you don’t wanna educate yourself, you just wanna stick your head in the sand and delegate all your problems away, it’s just… It’s not gonna work. So, it’s the willingness to invest in yourself and learn and become a business owner, and if that just sounds disgusting to you, if you’re like, “Ugh, I never would take a business CE course,” probably…

Ryan Isaac:
Yeah, ever.

Dr. Richard Low:
Probably a good indicator that you shouldn’t own a practice, and that’s okay.

Ryan Isaac:
Yeah. Let me ask you this. Nowadays, there’s so many ways to own a practice. I feel like, even 10 years ago, it was pretty cut and dried: You own it, 100%. For the most part, you’re maybe the only owner ever; maybe the only doctor ever in the practice. Nowadays, there’s group models, and multi-associate, multi-partner models, multi-location models, like… It feels like it varies a lot; there’s more opportunity for diversity in ownership styles. Do you… For someone who isn’t cut out for ownership, does that mean no ownership period, or do you see situations where minor ownership, or ownership with partners who have other skillsets that you don’t have maybe is a solution before it’s no ownership at all?

Dr. Richard Low:
Totally. And… Those situations… Like, partnerships and all of those situations you described can be great opportunities. They’re also a marriage, like, you’re marrying yourself to…

Ryan Isaac:
Totally.

Dr. Richard Low:
People in a company, and you gotta know what the goals of that company are, of where they’re going and why they’re forming this together. Is this “Let’s band-aid practices together and ship ’em off to private equity,” or is this “Let’s build something sustainable.”?

Ryan Isaac:
[chuckle] Yeah.

Dr. Richard Low:
So… Those can absolutely work, and there are fantastic alternatives to owning a practice outright, if you know that about yourself, and you really trust the people that you’re with, and you see the vision of what they’re building, and you wanna be part of it.

Ryan Isaac:
Yeah, like, I can just think… I’m just thinking of… Clients that I’ve known who were in that camp of not cut out to be the sole owner, at least. Like, the people, the team, the leadership part was draining them of their actual souls.

Dr. Richard Low:
Totally!

Ryan Isaac:
Like, completely, and the people I’m thinking of, they divested, and some people moved to entirely different cities and states, but they divested themselves of 100% ownership. Some people sold their practices and then joined a group where there’s five doctors or something, and it really… It made all of the difference in the world, because a bigger… A bigger practice had more people working on administrative stuff and team stuff, and then some owners had other skills, and you could just be a little bit of an owner… Have, I guess, the upside of ownership, but not have to do all of the leadership work, you know. Or the non-clinical work, so… I dunno. There’s probably some opportunities out there, but also… I mean, we talk about this all the time, there’s plenty of opportunity in the career of dentistry to just be a career dentist for a good practice, right?

Dr. Richard Low:
That’s great, and I… I even… When I was in the Army, I realized like, “Man, I really like practicing in a practice with other dentists.” Like, it was really nice. I didn’t expect that, like, the camaraderie I had with other dentists, and just getting to do the dentistry, working with people you liked, and commiserate with other dentists, rather than as a solo owner, you’re on your own, and you have no one to whine to when crap goes wrong and patients are awful and team members are difficult, like… It’s kind of nice to be in a group setting.

Ryan Isaac:
Yeah, that’s… I just think that’s a really interesting point. Is there any specific advice you would give to someone who finds themselves mid-life, mid-career ownership, and just hating every single Monday morning, and Tuesday and Wednesday and Thursday and Friday morning as well?

Dr. Richard Low:
Yeah.

Ryan Isaac:
Like, what do you do when you wake up, and you know that’s you, but you’re… You’re a million dollars in debt, [0:18:52.2] ____ mostly, and you’ve got 15 people relying on you, and 1000 patients or something. What do you do?

Dr. Richard Low:
So… One thing that we’ve done at Shared Practices a lot, and our listeners who’ve kinda been with us from the beginning know this, is that we have pivoted personally, professionally, as a company, quite a bit. And so, you start out in one direction, and you think, “Okay, this is my hypothesis for what I want and what’s gonna be best.” And you get to a certain point where you realize like, “Man, this is not what I thought I was gonna be,” or… Maybe there’s a better adjacent thing, and I talked with a dentist here locally, who did a startup, and he did a startup with a company kinda known for startups, and it did not go well, and he’s hated it, and felt very trapped, and it’s been three or four years, and he’s like, “I’m not making money in my practice.” And I was like, “You know what I bet? I bet you could turn around and sell it as a built-out,” ’cause he had the good… He had eight potential operatories; only three of ’em were kinda built out, or four of ’em were built out. And I was like, “I bet you could list this with a broker and at least break even and get free.” And sure enough, they found a buyer really quick.

Dr. Richard Low:
And I think if people have bought right, and that’s one of our biggest things on our show is, if you’re gonna do an acquisition, or if you’re gonna do a startup, make sure you’re intelligent about it. You don’t just buy the first dentist from your hometown that has two chairs and isn’t really making any money. Buy right, and then you’ll have options that, you know, if you can not drive the practice into the ground, then you have choices, and I have made plenty of mistakes, and I’ve had to pivot multiple times, and some of those have been painful: Away from partnerships… I’ve had to… Ownership involves people’s livelihoods and how they’re supporting theirselves, and sometimes, you have to make really awful, gut-wrenching decisions to move forward and make your business what it needs to be. So… And that includes, if you realize I’m in practice ownership, I would much rather someone tries practice ownership and then discovers for themselves…

Ryan Isaac:
Okay, yeah.

Dr. Richard Low:
“This is not for me.”

Ryan Isaac:
Than never try it.

Dr. Richard Low:
Than never try it, than sit on the fence. Because then, you can practice the whole rest of your career in another setting and feel great about it; feel amazing that you don’t own a dental practice. That’s… That’s my philosophy of, like, just go for it.

Ryan Isaac:
It feels super good, like, I already know. I already know, so I don’t even care. I don’t need to question it.

Dr. Richard Low:
No, and you don’t need to feel like less than, or like you didn’t live up to. You’re just like, “No, that’s not for me. I can do dentistry this way, and I’m providing for my family, I’ve got a great future, and I love it.”

Ryan Isaac:
What are you finding with like, the labor market, and hiring shortages, and team shortages right now? What are you coaching people through to get through some of this? What are people doing when they’re short team, and they’ve gotta just keep on cranking?

Dr. Richard Low:
It’s brutal. And…

Ryan Isaac:
Do you have a percentage, by the way? Like, is there… I know there’s national averages of people that have bowed out of the workforces nationally across all kinds of industries, but any stab at a percentage of the dental workforce that’s gone?

Dr. Richard Low:
No, and… You know, I’ve seen some stats on, like, we’ve had some of the highest wage increases in the last six or nine months compared to the last 12 or so years, like, it’s just… The wage inflation is real, and so, you think about a dental assistant who is kind of an entry-level worker, and they’ve got Walmart offering them a $25 or $22 an hour manager spot if… We had an assistant who quit, and she had previously been working at Walmart, and they offered her some sweet salary to come on back, and corporate chains are throwing all sorts of benefits and pay at… And bonuses at people, and so… It’s a time where, if you don’t have a good culture in your office, if you don’t have a team that feels cared about and feels like they’ve got an amazing experience and opportunity, you’re gonna lose people really quick, and even if you have all those things, you’re still gonna lose some people.

Ryan Isaac:
You will, yeah.

Dr. Richard Low:
And that’s just part of the deal right now. And we’re… I’m just accepting that our staff costs are gonna be higher moving forward; like, that is the reality of… It is going to cost more to employ people moving forward. It’s hard.

Ryan Isaac:
Yeah, it’s hard. Don’t you think… I just keep thinking of all the people in hygiene school in training right now that are gonna be coming out over the next few years. They’re just gonna be able to name their price, name their city, name their job, right? [chuckle] People will be glad to have them, like, “Oh, thank you. Thanks for being here.”

Dr. Richard Low:
Totally. Totally.

Ryan Isaac:
Yeah, that’s really interesting, man. What about… Where does… This is like rapid fire. I wish I had you for four hours, because… But we don’t, so we’re gonna fly through this.

Dr. Richard Low:
We can do this all night long.

Ryan Isaac:
Huge thing right now… I’m sure this gets talked about. DSO and acquisitions and offers; a couple questions here. This is just opinions and taking some stabs at things, but where do you think this goes for the industry? DSO, consolidation, like, just big group consolidation, and good or bad for the industry?

Dr. Richard Low:
I think it’s here to stay. We know that. I’ve seen local DSOs kinda go belly up on a number of practices, or have to close practices.

Ryan Isaac:
Yes.

Dr. Richard Low:
The thing I worry about is that it feels like a shell game right now, of…

Ryan Isaac:
Yeah.

Dr. Richard Low:
The greater fool of, like, you just kinda keep strapping ’em together.

Ryan Isaac:
Well, who ends up with… And this is what I’m… I’ve been thinking lately, like last week, literally, I’ve just been sitting around thinking, “Well, who ends up with this giant conglomerate of 300 locations one day? Who’s the final holder of all these things, and then, where do they go from there, because they won’t just… I mean, they’ll just get sold off again, piece by piece, or something like from there, right? Who holds all this in the… And the further away it gets from the original owners, the small DSOs, even the first recap or whatever. Probably the less interest and less knowledge about the dental industry and what’s good for patients, they just get further removed, right?

Dr. Richard Low:
Yeah. And I think one of the hardest things in dentistry is that culture doesn’t scale from office to office. Every office is its own silo of, you know, good people, bad people, struggles, successes, culture, misery, all of the things, and it is not easy to copy and paste it. I also think that the acquisition model, the hard part is you go out and you buy a practice, if the owner stays on and kinda like partners, then you can get around some of these challenges, but the immediate challenge is, if a DSO acquires a dental practice and the owner leaves… Either stays on for a little bit and then leaves, or just kinda leaves… You’ve taken a very high-performing asset and removed this key player at some point, whether they stick around for a little while or a longer while. And the value is just not retained. Like, the… So I know a dental office where the owner sold to a DSO, stayed on for a year and a half, and then they put an associate. And within a year and a half, the practice was belly up, like it tanked, almost immediately, of a successful 30-40 year practice. So… I think that the one thing that people shouldn’t fear is that private practice ownership is not dead.

Ryan Isaac:
I agree with that. I totally agree with that. Is that an unpopular opinion? Is that a hot take now, because I… In this DSO craze, that time that we’re in, it feels like a bit of an unpopular, controversial opinion, but I totally agree with that. It’s not dead, and it’s not going to die. It’s not gonna be killed off.

Dr. Richard Low:
It’s not going anywhere. Because… Almost… Nothing can beat an owner-driven, culture-centered, intelligently-run practice. And even with all of this, kinda… The stuff we’re… We’ve talked about DSO, like, we are… Me and some partners are looking at merging up some practices and doing denture and implants, which is the model I’m in right now, in some different markets, and it’s an experiment, and we’ve had success, and we’re gonna try it out, but… I’m not going into this with any sort of misconception of how easy this is, or you just copy and paste.

Ryan Isaac:
Yeah. Yeah. Just add water.

Dr. Richard Low:
It’s hard! It’s hard!

Ryan Isaac:
Just add dentists, yeah. It’s very hard. I will say… I mean, it’s just my own experience with dentists, but I’m finding that there’s almost as many multi-location owners out there that will not sell to a DSO, that… Their exit plan is to… It isn’t an exit plan. And almost more and more, there’s people who… Their plan is to just hold a practice or a group of practices that they own, or maybe co-own with other people and associates forever, as long as they possibly can, and just be involved as an owner, and they have no interest. They turn down some pretty big offers, so, I think that’s almost as common as people who are like, “Oh, we’re building this, and we’re gonna sell it, and that’s our exit.”

Dr. Richard Low:
And that’s… Like, my leaning is, I actually, locally, personally, don’t love running multiple offices. It’s a challenge, and it’s really hard, but if we’re gonna build something, I wanna build it to be a business that we’d wanna keep for the rest of our careers rather than something to ship off.

Matt Mulcock:
On the Dentist Money Show, we teach dentists how to make smart financial decisions.

Ryan Isaac:
You’re correct.

Matt Mulcock:
I mean, is that at all it takes, Ryan, to make smart financial decisions, listening to our show?

Ryan Isaac:
Matt, it’s a good first step. But to put your financial future on the fast track, the next smart decision is to go to dentistadvisors.com. What you do there is you click on the Book Free Consultation button right in the middle of the home screen. And then, you schedule a time to talk with one of our very friendly, dental-specific financial advisors today.

Ryan Isaac:
Because our economy is so much as tech-driven, and because of the nature of the tech world, just the… The life cycle of a business, a founder, a startup, they build it, they raise capital, they bring on partners to get aboard, they divest themselves, and then they sell it in five years, and you hear the big stories, and… It’s kind of like… That’s how our… It’s a normal thing now in our economy, for businesses to just get start-up mode, founder’s gone in five years, and it’s in new hands, and it exchanges hands four different times, then multiples grow, and it’s sold off, everyone’s rich, whatever. And so, it almost seems weird for people to say, “I’m gonna build a business; I’m gonna just ride this thing for 40 years,” in some capacity, you know?

Dr. Richard Low:
Right.

Ryan Isaac:
But I don’t think that’s going anywhere. And I don’t.

Dr. Richard Low:
Well, and… Dentistry doesn’t scale like software or product does, or all of these other things at all.

Ryan Isaac:
No, yeah. Yeah, not at all, not even close.

Dr. Richard Low:
That makes sense. You can do the five-year cycle if you’re a founder who founds a business that can scale without you. But dentistry has to be done with your own two hands, and it is a people business.

Ryan Isaac:
It’s your personality, it’s your relationship, yeah. Your network.

Dr. Richard Low:
However, that being said, I will say my recommendation, any time a dental student or a young dentist talks to me about multi-practice ownership, I tell them, before you even think about multi-practice ownership, get yourself to the point where you have a large single-site location, two…

Ryan Isaac:
That’s profitable as all get out.

Dr. Richard Low:
Three doctors… Yeah, exactly. If you can build and run a multi-doc… One multi-doc location, my first hypothesis is that by the time you’ve done that…

Ryan Isaac:
You won’t wanna do another one! [chuckle]

Dr. Richard Low:
You won’t wanna do another one! You won’t wanna…

Ryan Isaac:
You won’t need to. Yeah.

Dr. Richard Low:
And… That’s the second part, is you won’t need to, is you’re gonna be successful enough off of one…

Ryan Isaac:
Like, this is enough, yeah.

Dr. Richard Low:
Large practice that… That’ll keep you going for the rest of your career, in any way, shape, or form, and at that point, you can replace yourself clinically and still be the owner, and still be profitable, and… Or take time off, or practice three days a week, or two days a week, whatever…

Ryan Isaac:
And still have a good income.

Dr. Richard Low:
Whatever you wanna do.

Ryan Isaac:
Yeah.

Dr. Richard Low:
So that’s our niche that we have found is, is we have a lot of these entrepreneurial-type dentists, and we have gone on that journey of, “Okay, how can you get to that larger single site and do it intelligently?” And now, it’s even changed, how… Now that we know that growth is possible, that revenue and collections isn’t like a fixed number when you’re looking at an acquisition, we’ve changed how we look at startups and acquisitions, because if you’ve solved the growth problem of like, “Okay, I can grow a practice,” then, all of a sudden, the real estate and the operatories become your hard limit really quick. It’s like, okay, I have a three-op practice. I can never be a two-doctor practice unless I move locations, and if I just bought this or just started this three-op location, I’m not going anywhere with my five or 10 year lease, or it’s gonna have to be a really painful move and a reinvestment when I just…

Ryan Isaac:
You don’t wanna do it, yeah.

Dr. Richard Low:
You don’t wanna do it! So, it changes the way that you look at acquisitions, and we’ve built out a whole framework of types of practices. We’ve got five main practice avatars, that if you look at 95% of practices, they’re gonna fall into one of these practice types. They’re gonna be either a true solo practice; we call that a 1-1-1: That’s one doctor, one assistant, one hygienist, one front desk team member. Three, maybe four operatories, that’s a solo office. The next step up from that is the productive solo. So a productive solo is one doctor, but now, we have two assistants, two hygienists…

Ryan Isaac:
Got it.

Dr. Richard Low:
And two front desk team members. And that checking for double the hygiene is just double the at bats for you to be able to talk to patients about their needs. That’s double the kind of passive hygiene revenue that you’re not having to do with your own two hands. And we’ve found that if someone wants to be an owner, but they really love clinical dentistry, they don’t even have to do crazy specialty work. If they can just get themselves into like a true two full-time hygienist situation, that productive solo office can be fantastic for people. I’ve got a buddy who I went to undergrad with, and he listened to the podcast; I told him to listen to the podcast like two years out, and he goes and he buys a practice in South Carolina. Or North Carolina, Scott, I’m sorry, I always forget.

Ryan Isaac:
[chuckle] We’re outing people.

Dr. Richard Low:
We are.

Ryan Isaac:
I mean, that’s fine. He’s cool.

Dr. Richard Low:
And he… He texted me at the end of his first year, and he said I paid more in taxes this year as a practice owner than I made as an associate, and that’s a good thing. He wasn’t complaining about this. It was a very good thing. And a year later, he said, “I am now a millionaire because of Shared Practices and because of buying the right practice.”

Ryan Isaac:
Cool, so cool.

Dr. Richard Low:
And he refers everything out, and he doesn’t wanna grow, and he doesn’t wanna grow crazy, but he just bought that right, healthy, great practice with a great team, and just doing bread and butter dentistry and loving it.

Ryan Isaac:
And do you think… You’ve seen so many practices and styles. I believe it’s so personality-driven. We get that question a lot, like what’s the right way to do this so that I… What’s the right way to build a dental career? And it’s just… There are some people who will build that killer one-location practice, and then they’ll make enough money, or they’ll make more than enough money. But it’s enough for them, and then they’re like, “Eh, that’s it,” you know? And then there’s some people, not even for the money, they’re just like, “I just wanna keep growing, and I wanna scale, ’cause I just wanna see what it’s like, and I just wanna do it,” and it’s so personality-driven that you kinda have to… You gotta push yourself, like you can’t sit on your… Like you were saying earlier, you gotta jump in; you gotta try.

Dr. Richard Low:
Right.

Ryan Isaac:
You can’t never push the boundaries of your comfort limits in your personality style, but when you’ve tested it in healthy ways for long enough to really know the difference, it’s like… It’s really personality-driven, whether you’re gonna put five, or just one practice, or multiple partners, or none, or clinical or no clinical, right?

Dr. Richard Low:
Well, and that’s what we wanted to provide the solution to, was that so often like, coaches and consulting companies, they discover a model, and they’re like, “This is the model of what… ”

Ryan Isaac:
Do this, yeah.

Dr. Richard Low:
Do this. Here’s… Copy and paste. And in reality…

Ryan Isaac:
Yeah, fit into this model.

Dr. Richard Low:
People don’t fit into these tight little categories, and so, figuring out what you are inclined to, and then matching that up with the right model, and then all of the metrics and the growth into that model purposefully.

Ryan Isaac:
Yeah.

Dr. Richard Low:
We’re very analytics-based; all of our courses are called analytics-based practice management, or analytics-based pre-ownership. We have data on every single one of these avatars, of the numbers, and what’s the difference between a successful practice here and an unsuccessful one, and that makes all the difference, of like, we’re not coaching you to one specific “Here’s the way to do it.” It’s like, what do you want?

Ryan Isaac:
Yeah.

Dr. Richard Low:
And why are you here?

Ryan Isaac:
What do you want? What do you want? And then, reserve the right to change your mind halfway through. It’s okay.

Dr. Richard Low:
Pivot. And that’s fine.

Ryan Isaac:
Pivot. Life is a bunch of pivots, and it’s usually more exciting when there are more pivots than not.

Dr. Richard Low:
Totally.

Ryan Isaac:
In my experience. Alright, two more things. Number one, heading into 2022, which feels nuts, so crazy. Are there any general principles you would love people to focus on coming into this new year?

Dr. Richard Low:
What a broad question, Ryan. I feel like that is a…

Ryan Isaac:
Can you tell me about dentistry in five sentences or less?

Dr. Richard Low:
That is just a trash question. I ask, like…

Ryan Isaac:
Take the most common mistakes you saw this year, and how would you help someone avoid one of those going into 2022?

Dr. Richard Low:
Yeah. I would say one of… So I’ll out myself here. I have bought… I bought three practices with some amazing partners a few years back, I walked away from that partnership, and then I bought two practices. All of this, technically, while I was still in the Army.

Ryan Isaac:
Like you did… Working full-time at Dentaltown while still in dental school, so, yeah.

Dr. Richard Low:
I don’t advise this. This is…

Ryan Isaac:
Yeah. This is a pattern for you now, by the way.

Dr. Richard Low:
Five dental practices while still in the Army is not a takeaway from Shared Practices, and in fact, I got investigated by the Army… It was fine. We were cleared.

Ryan Isaac:
It’s fine, you made it. You made it. Yeah.

Dr. Richard Low:
We were good. Commander approved.

Ryan Isaac:
Fun ride.

Dr. Richard Low:
Yeah. But this year, I definitely expanded too quickly.

Ryan Isaac:
Okay.

Dr. Richard Low:
And I took on too much at the same time, and I’ve had to make some really, really hard decisions. That’s the hardest part about practice ownership, is having to make hard decisions and let people down when you’ve set their expectations one way…

Ryan Isaac:
That’s leadership, right? I mean, that…

Dr. Richard Low:
It goes another.

Ryan Isaac:
That is leadership. You… ‘Cause it stops with you. You’re the one who make… Will make things happen good for people, and you’re probably the one who’ll make things… Bad things happen for people, in their eyes, and that’s part of being the person in charge. Which is also why a lotta times, the people in charge can get paid more money. Or have other benefits of it, because that cost is really high. I mean, it’s a high price to pay. Tell us where people can find Shared Practices, and what do you have coming up? You guys doing anything, any events?

Dr. Richard Low:
Yeah.

Ryan Isaac:
How do they get in touch?

Dr. Richard Low:
Yeah, so sharedpractices.com, and listen to the podcast; there’s a podcast. We’re the number one rated dental podcast in the industry.

Ryan Isaac:
Oh, you had to throw that in there.

Dr. Richard Low:
Just, you know, throwing that in there.

Ryan Isaac:
That’s really cool, man! Are you…

Dr. Richard Low:
We’re about to hit 500 Apple reviews, which is the only place that reviews really aggregate for podcast.

Ryan Isaac:
That’s insanity. That is really cool.

Dr. Richard Low:
It’s been exciting to see…

Ryan Isaac:
That is hard to do.

Dr. Richard Low:
We had our very first course in Minneapolis this past summer, and there’s over 100 people there, and it wasn’t at our headquarters, it was at a hotel. It was just people coming up and saying like, “Shared Practices changed my life. Like, you guys gave me the road map to practice ownership, and… ”

Ryan Isaac:
So cool. So cool.

Dr. Richard Low:
Really, really grateful for the people that have done this in Shared Practices, and our listeners and audience. We do have courses coming up, so we’ve got a case acceptance course here in January coming up pretty quick, the 14th and 15th, in Phoenix. Our flagship course, analytics-based practice management, in February 25th and 26th, and then we have an office manager course in March. So, sharedpractices.com, all the events are on there as well, but…

Ryan Isaac:
It’s very cool, man. Life is funny. Life is just funny where it takes you, from standing outside of an elevator talking to an intern, and me… I mean, you know. We were probably seven years into our business, but still felt as clueless as it possibly could be, you know? Just felt like… It felt like a million years ago, and then here we are: Just a couple old dudes reminiscing on some mistakes, and… And some good times too.

Dr. Richard Low:
And I have to say, I… My advisor is Will Gakner.

Ryan Isaac:
Oh yeah, shout out to Will.

Dr. Richard Low:
Will’s the best. And any time that I can talk with you guys, or get on the air with you guys, or have you guys on our show, it’s amazing.

Ryan Isaac:
I love it. Now we’re gonna out Will. My nickname for Will is “Brain”. You can call him Brain, and he loves it, so if you’re listening, you know, Will, you just call him Brain from now on.

Dr. Richard Low:
Okay, I’ll… Next time I see him, I’ll call him that.

Ryan Isaac:
Hey, Richard, thanks for taking some time, man, really appreciate it, thanks for being here, thanks for everyone for listening, and good luck with all of you guys have going on. Happy New Year to you. We’ll see you at an event here soon, and do some more content soon, and… Thanks, everyone, for being here. We’ll catch you next time. Take care, bye-bye.

Practice Management

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