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Dr. Mark Costes is founder of the Dental Success Institute, Horizon Schools of Dental Assisting, and author of Pillars of Dental Success. He runs multiple practices, speaks at dental forums around the world, and coaches over 50 practice owners to help maximize profits. In this Dentist Money™ interview, Dr. Costes talks about the bumps and bruises he’s experienced while acquiring multiple practices and expanding his entrepreneurial reach. He also offers a fresh take on work life balance, the truth about getting rich, and the personality traits that succeed in dentistry.
Speaker:This is dentist money, now here is your host, Reese Harper.
Reese Harper: Welcome to the Dentist Money Show, I am your host, Reese Harper. We are here today with a fellow podcaster that I admire very much, Dr. Mark Costes. He is the founder of the Dental Success Institute and needs no introduction. Most of you have probably listened to his shows or heard him speak. I have had a lot of clients tell me that they really admire your work, Mark, so we are really glad to have you here.
Dr. Mark Costes: Thanks Reese, it is great to be here. I have to say that you are one of the few dental podcasts, it’s hard to keep up now, where I am almost caught up. I think I only have two more episodes to go in order to have listened to 100% of your podcasts.
Reese Harper: You are a good man for doing that. So you have listened to all three of them then?
Dr. Mark Costes: Yes, you guys are kicking it off with episode three.
Reese Harper: I have got some great questions planned for today because you are somebody that can have a really unique perspective on entrepreneurship and managing a practice and expansion and the good and bad things that come with that. I am really excited for this. Why don’t you take a few minutes to give some of my listeners your background, incase they have had their head in the sand. Just give us a few minutes of background and how you got started. Where you are from, where you grew up, etc.
Dr. Mark Costes: Ya, sure, sure. I graduated from Marquette University School of Dentistry in 2002. Prior to that I was a collegiate athlete for one year. I played college football for a small college in Southern California.
Reese Harper: That’s cool.
Dr. Mark Costes: I was the spot receiver. I was too short to be a traditional wide receiver.
Reese Harper: Slant route.
Dr. Mark Costes: That’s right, across the middle. I hated linebackers and safeties.
Reese Harper: That is a scary route to run!
Dr. Mark Costes: It is. Always dragging across the middle is a scary thing. When you are short and not super fast though, that’s what you end up with if you want to play football.
Reese Harper: Totally.
Dr. Mark Costes: Then I transferred to UC San Diego when I decided I wanted to be a dentist. I was working full time, working to put myself through undergrad. I didn’t have a scholarship after that and my grades suffered a bit. I graduated with no undergraduate debt, and all of my pre dental classes finished, but my GPA was average at best. Fast forward, it took me three years and 21 attempts to get a single acceptance to dental school.
Reese Harper: Good for you for admitting that, dude. I don’t have a problem admitting my academic failures on occasion, so I think that it is a good thing to be able to own up to it. It shows people that you can still succeed without having a perfect resume when it comes to academics ya know?
Dr. Mark Costes: Ya, have you ever seen that movie 8 Mile with M & M? He does those competitive raps and stuff and the whole thing is how his back story leads up to this one rap off, I guess you would call it. He is going against this other guy who is a huge favorite in the neighborhood, he is expected to win, and M & M is a huge underdog and he gets up there and he just starts saying all of the things. My mom was a prostitute, my girlfriend cheated on me, he just brought all of his weaknesses out to the forefront in his rap and the other guy had nothing to talk about after that. I feel like if I lead with all my weaknesses, I just tell anybody that it took me 21 tries to get into dental school and I’ve done all right, then anyone can do it. So I start with that.
Reese Harper: That’s really cool.
Dr. Mark Costes: While I was trying to get into dental school that was when my entrepreneurial journey started. I couldn’t get a real job because I was a psychology major with an average GPA and I was getting my MBA at night, but I couldn’t get a real job. So I bought a food truck franchise. I learned business by driving food trucks.
Reese Harper: Are we talking tacos? I mean now you got me interested. What are we talking here?
Dr. Mark Costes: Ya, we are talking about tacos.
Reese Harper: You really had tacos??
Dr. Mark Costes: Yes, I had tacos and carne asada burritos and burgers and fries. I would drive the food truck to different construction sites and I would honk the horn, just like a glorified ice cream truck driver, and flip open the door and my cook in the back would be making burritos and tacos. That is how I made a living for three years while I tried to get into dental school.
Reese Harper: You guys mixed tacos with hamburgers and french fries?
Dr. Mark Costes: Ya, we did it all, man.
Reese Harper: I like that, it’s like, why not? That is how Del Taco does it. I am always confused when I go to get some fish tacos or carne asada tacos and there is always this burger in the corner. I just never know what it’s even doing there. Literally, it has probably been ten years and I have never ordered that burger. I was in Park City driving home the other night, and I thought, “I am going to order the freaking Del burger”. I figured it cannot be good, it is a burger at a taco place, but it was actually really good! I was so surprised, these little mexi fries and this burger really did it for me at 11:00 at night in my commute home from 30 miles away. So anyway, burgers, fries, burritos, and tacos can live in harmony in one food truck. You heard it on the Dentist Money Show, people.
Dr. Mark Costes: I am living proof! I am living proof! We can all live in harmony.
Reese Harper: Ok, alright, moving on from this tangent. We will get to finances eventually, people. Let’s be patient, food is good.
Dr. Mark Costes: Ya, so even though I had a difficult time getting into dental school, after that second year, I really blossomed. When I got to work with patients and I got my hands on patients is when I kind of put all of the challenges of the academic past in the past and I just really started to enjoy the profession. Ever since then I have been really passionate about working with patients and working with my hands, but also the business side of stuff too.
Reese Harper: Tell me a little bit about when you kind of knew that you wanted to become more than just a dentist. You probably knew a little bit that you had an entrepreneurial side if you are selling tacos and burgers at construction sites. You started a food truck and you were getting your MBA at the time right? So when did you know when you were going to be an entrepreneur and not just a “technician”. In entrepreneurial circles we call a technician a person who just enjoys the work and the technical side of their career and just doing that without being bothered by business. Then there is someone who really enjoys the systems and processes, the vision that comes from creating a product and a service. When did you know you were tilting that direction? People who are listening know that you own multiple practices and have kind of been on a tear for a long time now?
Dr. Mark Costes: Ya, Michael Gerber, from the E-Myth would call that the technician, versus the manger, versus the entrepreneur. We all know to be a successful dental practice owner you have to master all three of those personalities really.
Reese Harper: It is tough!
Dr. Mark Costes: It is, it is really tough. I got out of school and the first year I worked as an associate. I did know that I wanted to own one dental practice, so I considered that associateship my residency. That was my financial residency. I worked really hard on developing my clinical skill and my speed. He accepted medicaid at that practice and a lot of PPOs so we had to learn how to move really fast and be efficient and produce really, really good quality dentistry. I focused on that. After hours, I was just the biggest pest in the world to the office manager. I would just stay after and I would help her process claims, confirm appointments, post checks, and do all of the stuff that it takes to be a manager/business owner. I learned how to do that. Then when we bought the first practice, a partner and I, certain circumstances led to us being able to us go in to another practice almost for no money. It was a totally distressed practice. Then to another. My partner and I within a year and half owned three practices. There was a big learning curve there too! Watching somebody else do it during my financial residency first year and then actually implementing the stuff was a whole different ball game. There is a lot of bumps and bruises and challenges along the way. This year I will buy my eleventh practice and still, honestly, I still feel like I am figuring it out. I have the benefit, and I guess the luxury, of being able to look behind the scenes of a lot of different dental practices now. I have over fifty coaching clients where I help them maximize their dental practices. So between analyzing their practices, the numbers, the management, and those three personalities: the entrepreneur, the clinician, and the manager, I can apply what I have learned to my own and visa versa. That is kind of where I have ended up in this since 2002.
Reese Harper: Let’s talk about something I think people will be able to relate to. What are things that you dislike the most about being a business owner? What is the hardest and most frustrating things for you?
Dr. Mark Costes: Oh, gosh, right now is probably a bad time to ask because everything is bothering me.
Dr. Mark Costes: This year, we are in massive growth mode, we are acquiring practices very quickly. I am dealing with a lot of egos right now as far as new doctors and new office managers. I am also dealing with things like trying to control clinical quality and a lot of times that is out of my hands. You know, we have a very systematic process of how we like everything done in the practice and a lot of times when you are acquiring a practice that has been doing it their way for twenty five years it is a difficult transition to make. The toughest thing about multiple practice ownership and business in general is assembling a good team, a good quality team, creating a good culture, and dealing with human beings. It is very, very difficult.
Reese Harper: Pretty much everything you just said was about people.
Dr. Mark Costes: That is right.
Reese Harper: I think that if I were posed that same question, that would be the hardest thing for me too. In a service business, whether it is dentistry or financial planning or tax preparation or legal or medical, you are delivering a service. Most of your overhead, cost, and product is the service and the people. It is really, really hard to build a good team and it is really hard to retain a team. It is hard to compensate them effectively and to select the right people to begin with and do it at the right time. When you need people, and to have enough time to select the right person when you are in a rush, sometimes you just have to take who is there and not who is the best prepared for the job, it just might be the person that is there that day and can take it.
Dr. Mark Costes: The other challenge is, and I don’t think people talk about this enough, there is a huge, huge gap between what the doctor and the owner of the practice is taking home and what his key staff people are making. So if you think about it, a good doctor is compensated 30% for his production and then we are hoping that they make another 15% profit. They are making 45% of the revenue that comes through the door of the practice. We are hoping to get the entire accumulated total of the staff payroll to be 25%. Combined all of those people are going to make 25% and the doctor is going to make 45%, and we are basically counting on them to run the entire business minus the clinical stuff that we are doing. That is challenging to do! To make those numbers work and retain really good people, at that gap of in deferential earning. It is tough to do!
Reese Harper: When you say it is difficult, do you mean the effort of getting the numbers to actually fit that performa or model is difficult or that sometimes there is a psychology there where the staff kind of resent that reality as well?
Dr. Mark Costes: Oh, I think from both perspectives. From both angles it is difficult. The staff realize that there is a big differential in income. Of course, from the doctors perspective, they didn’t go to twelve years of school, they are not taking the financial risk, their license isn’t on the line, so it makes perfect sense and I get it. But balancing that and retaining really good people that have a huge amount of responsibility in your organization and being under the constraints of being able to pay them what is fair market value is a difficult balancing act for sure.
Reese Harper: We have talked about the people challenge here for a minute, and I want to stick with it. Talk to me for a minute about hiring. How do you hire the right people?
Dr. Mark Costes: Are you talking about the doctors or for the team?
Reese Harper: For the team. What is the team hiring process like? When you are trying to select an office manger what attributes are you looking for in that office manager? How much time do you spend trying to find the right fit if you have to replace one? Or if you are looking at one that you have acquired, how do you analyze whether they are the right fit and whether you want to continue to move forward with that person?
Dr. Mark Costes: We have a pretty robust process. The mechanics of it are pretty robust, I would say. We do an initial ten minute conversation with my C.O.O. Then they come in and they have an interview with the C.O.O and the division head and another one of their peers. Then they come in for a working interview, and then they talk to me. So there is a pretty robust process involved there, but I like to think that we hire for culture and personality over the strength of the resume and their clinical ability. I believe that we can train that. We have a very, very predictable training process which I think a lot of dentists skip. If you think about when you get hired on as a bank teller, you are going to go through two weeks of intense training before you actually stand behind there and greet people. The way we do it in dentistry is that you follow the person around that is your supervisor or one of your peers and you copy what they do for a two week period of time. Then they let you loose. That is probably the most inefficient way of training someone in the world. That is how 99% of us do it. I was guilty of that for years and years! My sister is one of the V.P’s for TD Ameritrade and she just left Charles Schwab and she is in charge of training the new agents. She takes a month, a month, of intense lecturing with testing along the way, then simulation labs, then videos in from of different speakers, before they pick up the phone and get to call a client. That is the depth of training that we need to be thinking about when we are bringing people into our organization.
Reese Harper: It is interesting to see how much effort a large company puts into training people that are kind of routine! In terms of the tasks that they complete. I don’t know man, it is amazing to see how much we discount training in small business. We just don’t have the resources and the time, it is really hard.
Dr. Mark Costes: Absolutely, but I mean we should look at putting an operations manual together to systemize your practice. What a lot of people skip is systemizing the training. I have a lucky excuse, I have a dental assisting school that runs through my practice so we always see people that are fresh, right off of the street, that don’t even know the tooth numbers and we take them through the battery of everything. Then when they walk out of our office and go get hired on at another dental practice, they are ready to go. We make sure that all of them are capable of doing that when they graduate, but all of our staff has to go through a rigorous training process too every time we turn over.
Reese Harper: Did you ever hit a point where you felt like, I am not cut out for this. This is too hard. I don’t know that I am wired for this. Knowing you, you’ve likely never got to that point.
Dr. Mark Costes: Oh yes, I have.
Reese Harper: I don’t know. In the darkest moment when you felt like this is too much pressure, I just want to keep it simple. I don’t want to keep pushing. It would be easier to just do your thing as a doctor and have one location. Or does that happen every week?
Dr. Mark Costes: I was just talking to one of my partners last night at about midnight and we were talking about all of these struggles and wouldn’t it be easier if we just had one. It came to a head about seven years after I graduated from dental school. I had six practices and I hadn’t discovered systems yet. I was the superman. I was putting out fires at every practice and practicing dentistry fifty hours a week and driving around the state from practice to practice to practice. My marriage was on the rocks, my kids weren’t seeing me, I was not a happy person. I was not a good person to be around. I still remember my goal in my life was always that I wanted to have a seven figure net income. The day that I realized that I had that seven figure net income, my tax return came across, I was reviewing it and I was like, “oh, I made seven figures this year.” I shut my laptop and realized that this was not worth that ultimate goal. Somehow that didn’t feel good, it was one of those, “is this all that there is” moments.
Reese Harper: Then you realized that you gave $500,000 of that to the government so that sucked. Basically I worked like ten times harder and I only have like an extra $100,000. It is not worth it.
Dr. Mark Costes: Oh my gosh, it is so true. At that point, I sold four of the six practices. I got down to two practices and I worked really hard at those two at that point.
Reese Harper: Was the selling of those practices a reaction to that moment? Did it stem from a desire to simplify? We missed the connection there, I just want to understand that connection. Were you planning on selling them anyway or was that the moment that you simplified?
Dr. Mark Costes: My ultimate goal was to have a big stable of dental practices, and the answer to your question is, yes, it was a reaction to the point I was at in my life.
Reese Harper: I would have guessed that as a psychology thing, knowing what I have gone through. What is pretty common is entrepreneurs make pretty large shifts based on massive amounts of pressure that they are going through. That is not uncommon, right? Looking back though, it was a good decision. My question, which is a hard one, that reaction that you had that caused you to say, “I am working so hard, I am just going to dump these and simplify things and try to get this thing under control.” Looking back could you have handled that situation differently and still been ok?
Dr. Mark Costes: Absolutely. It was great, it was a financial windfall for our family, but it was what my family needed. They needed me.
Reese Harper: So at the time it kind of regrouped and refocused. I could have done it better financially if I would have held onto those practices. Had I held on to them, things would have been different financially for us. We paid a ton of taxes like you just said, but it was the right thing to do at that point in my career. If I hadn’t have done that I wouldn’t have developed the dental success institute, I wouldn’t have written my book, I wouldn’t have developed the assisting programs.
Reese Harper: In a sense, you could have handled it differently but it did pivot you to this other group of activities that you wouldn’t have had the bandwidth to even focus on at all.
Dr. Mark Costes: That is right. Now, if you think about it, back then I had six practices, I will have seven practices by the end of this year. I am back exactly where I was but now that I know how to systemized and delegate. Now in addition to those seven practices I also have a dental assisting school company, a consulting company, I am also speaking all over the world, so I never would have been able to do that before because I hadn’t realized how to systemize and delegate.
Reese Harper: Ultimately, sometimes the decision that we make along the way are not ideal but they lead us to a place that we couldn’t have gotten to otherwise.
Dr. Mark Costes: Absolutely, I agree 100%.
Reese Harper: The dark moment, would you describe it as being spread way too thin? Like you said, you are superman, putting out every fire, taking on every job yourself, not enough team or people to help you? Were you just trying to do it all yourself? How would you define it?
Dr. Mark Costes: Absolutely. I was doing everything myself. I was doing the dental work at three practices. I was basically the office manager in six of the practices. I didn’t have systemized protocol so anytime anything happened it came directly to me. My phone blew up all day long. It was all on me. It was just set up incorrectly. By nature of dentistry, by good location selection, and dentistry being a very profitable profession even if you are doing everything wrong, I was successful. It was not because I was a genius, by any stretch. That’s for sure.
Reese Harper: This is really insightful stuff, I hope people realize how powerful this information is. My journey has been a little bit different but I want to contrast it just slightly because I think it is important. When you start earning a lot more money, let’s say you go from $150,000 to $250,000 that feels pretty significant. If you have ever earned both of those incomes you know what I am talking about. At $150,000 you are basically paying like $5,000 in taxes. So I know you don’t really think that out there and if your friends are making that kind of income they will tell you they are paying so much taxes. But with all the tax credits, earned income credits, mortgage interest deduction, you just don’t pay a lot of income tax at that level. When you go up to about $250,000 your income tax goes up slightly but you still have a relatively low effective tax rate. That means maybe your total tax about doubles but your rate doesn’t double, you might go from paying $5-7,000 in taxes to $20,00-22,000 in taxes. So you doubled your income and your taxes. You have an extra $90,000 of cash flow that you didn’t have before because all of your living expenses are pretty much cared for under that $150,000. Most people can live on under $15,000 a month. Most people that are dentists can live on that. Our average client spends somewhere around the $16,000 a month range. That is probably because we got some guys that you cannot believe how much money they spend. You might not be surprised. Anyway, some people spend more in a month then some spend in a year. I will just put it that way. The difference between going from $250,000 to $500,000 now it is significant. It is significant, but it is not that significant. You would think for someone that made an extra $250,000 you would have a lot of money left over, but you don’t. You don’t have a ton left over because the government at that point is taking about half of it between federal and state. You are losing half of that income. The more money you make in current income cash flow day to day, the more that the government takes as a percentage of what you had. Those incremental gains in income are not always as fulfilling as we want them to be just because we don’t have as much left over as we assumed we would. I am going to stop there, but do you think that that resonates with you at all? In your experience? How would you frame it a little bit differently?
Dr. Mark Costes: No, it is true. There was a huge difference in the way things felt when we went from say $150,000 to $250,000. Anything above $500,000 I would say that it doesn’t feel much different then $250,000. The funny thing is once you make a certain amount of money, I don’t even really think about those numbers.
Reese Harper: Ya, they kind of go away. It is like, ya, plus or minus a few grand. You don’t obsess over it.
Dr. Mark Costes: I always go back to something my dad said. This has stuck with me. He said, “I just want to have enough money where I don’t look at the prices on the right side of the menu.” Once you don’t have to worry about the prices on the right side of the menu everything else is just gravy. I do have to say that pushing from $750,000 to a million. That is just an ego thing. That doesn’t change your lifestyle very much unless you have a ridiculous, opulent lifestyle.
Reese Harper: When you get to that top 1% range you are earning more than $300,000 you start to see how much taxes affect what you can take home. I see people killing themselves to raise their incomes, to this kind of ethereal point, whether it is 250, 700, or a million plus, and along the way they really put pressure on their marriages, on their families, they don’t have a lot of balance. They are doing every job and if they just hired a sixty thousand dollar person, who by the way, would love that job and is dying to have that job and would be very grateful of that position, they help you do some of the marketing initiatives that you are neglecting or to help you operate your practice with a little less stress. If you keep expanding instead of just taking home more money you are going to create more jobs, help the economy, and have less stress. I am really big into that. That’s just a big value for me. I think too many entrepreneurs burn themselves out because they are reaching income goals. They are pushing for income goals when they don’t realize that they should be pushing to build an organization. They should be pushing to build infrastructure and a team. That will be worth way more money than your annual income. Get to the point where you are earning enough to feel comfortable and where you are enjoying life, and that is different for all of us. I eat an 8 oz. filet, as often as I can, on a Friday night. A burger isn’t my definition of success on a Friday night, I have to have a little bit more income than someone else to feel comfortable. However, I still think you need to stop at some point earning more money every year and you need to grow your organization. Sorry, I’ll stop talking, Mark—Go.
Dr. Mark Costes: I love it. There is very valuable insight in that, in what you just said there. As so many people contact me now because they hear that I am a multiple practice guy they contact me to coach them through this. You alluded to something that is so valuable. I do not see a tick up in my income when I buy another practice. I increase my level of debt, but I also increase the equity and the value of my overall organization. I don’t buy three practices because I expect to make another $300,000 in a year. In fact every ounce of profit goes into an account so we can acquire another practice. So that doesn’t increase the level of my lifestyle one bit. In fact, as I acquire more assets and build my company as you said, maybe I have to watch my pennies a little bit more. I have to make sure that I’m ok if there is an emergency in one of the practices.
Reese Harper: Yes, that has been my experience. Growing the organization can put pressure on your lifestyle.
Dr. Mark Costes: Absolutely, and another thing that I want to bring up. I do this presentation called, “the tale of two practices”. This is from two of my actual clients. One is producing $750,000 in a practice and one of them is producing 1.7 million in the practice. The 1.7 million dollar practice owner was taking home less than the $750,000 guy. It was just the mindset that was different. The 1.7 million owner wasn’t watching the holes in his bucket so he just felt like he had to produce, produce, produce. The $750,000 guy was bringing more money home because they were really minding the business without just watching that top line number.
Reese Harper: That is really important.
Dr. Mark Costes: It is hugely important! When you get focussed on production and income, what happens is you take your mind of the infrastructure and building the actual business.
Reese Harper: I think that is totally crucial. I would say the takeaway is to try to start realizing that the more profit you earn and the more income that you have in a calendar year does not necessarily reflect success. I love to see that if someone doesn’t really have the temperament or the desire, or maybe the time frame even to start thinking about expansion. Some of the most successful clients that I have are just doing millions and millions and millions of dollars out of production from one location, just their production. There is a big risk to start stepping into that world of entrepreneurship and growth and scale and expansion. There is a big risk and you shouldn’t take it lightly and it is not a decision that I would say applies to the entire population of dentists. If anything, it is actually a very small percentage. That being said, the mind set and the principles that allow Mark to grow to ten plus locations are the same principles that can guide a single location to get to three million off of one doctor’s production. Or to hit a five million dollar single location goal. You still need to think about reducing your income slightly in order to hire the right people with the bandwidth to do the right jobs to help your organization grow. That is what it is going to take. There are people who are listening that imagine these numbers to be so foreign because they are not hitting those targets. My first year in business, I did $178,000 in collections. That is what I did in my first year of business. I remember it to this day. Most of you probably did more than that in your first year. We all start somewhere and it takes this kind of mindset to get to be a little bit larger. It is super important, man. I appreciate you sharing all of that insight from where you came from, how income went, and how you got crunched and you sold some things and have refocused. You have also started investing in an organization and grew an enterprise. That is the way that you create more value in the market that is the way our economy gets healthier. That is the way that we help create jobs and improve society. It is just everything about that is just the optimal mindset in which to approach things, in my opinion. Anyway, congratulations. It has been a great interview. I want you to tell us a little bit about what life balance has been like throughout your career and kind of end with some thoughts that people might be able to take away. How you have been able to balance this and how life feels at this point now that you have kind of been able to put all of these things in order?
Dr. Mark Costes: Ya, thank you so much for having me on the show. I will close with this. It goes back to my near collapse, my mental and emotional breakdown where I sold the four practices. When I realized that my financial goal really wasn’t going to lead me down the path to true happiness and fulfillment. Now I am much more balanced. I still have a lot going on with the business, but like you said, I have spent more money on the infrastructure and I have spent more money on the right team to help me run the practices. My life is much more balanced. My relationship with my wife has never been better. My kids, I coach them in soccer and baseball. I have three boys. I coach them in whatever sport they want me to and they want me to coach them in every season. That is what I do, and that is what my life is all about now. I continue to grow all facets of my business, but within reason. I have my non-negotiables and that is a date night with my wife once a week and being able to coach the boys. If I can do those things and be home the majority of the time at 5:30 at night and give good quality time and have the energy to spend with my family when I get home and not me totally preoccupied then I know that I am doing a good thing. If it ever gets out of whack, I already know the consequences of that getting out of whack and I know what to look for when that begins to happen. I learned some hard lessons about balance. Thank God that my wife is a patient person and my kids still love me.
Reese Harper: That is awesome man, ya.
Dr. Mark Costes: So ya, that is where I am at now.
Reese Harper: That is such a great takeaway. I really appreciate you taking the time Mark. You do a lot of really great things for the industry, thanks for being vulnerable and putting your story out there. You do a great job on your show and with your coaching. You are a very authentic voice and a very good influence for a lot of people. Thanks so much. We look forward to having you again, we will stay in touch!
Dr. Mark Costes: Thanks so much Reese, it has been fun.Practice Value, Work Life Balance