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Perhaps nothing in dentistry is more important than surrounding yourself with the right people. It’s also one of the most difficult things to do. Hiring is never an exact science, firing is no picnic, and outsourcing can feel like a crapshoot. So how do you put together a winning team? In this Dentist Money™ interview, Pat Rosenzweig, co-owner of Mosaic Management Professionals, discusses the process of elevating your human capital. Drawing from her 30+ years in the industry, she explains the mindset you should cultivate within your staff, the value to place on technical versus people skills, and how to maximize each person’s contributions.
Reese Harper: Hi Pat, how are you doing this morning?
Pat Rosenzweig: I am doing wonderful. How about yourself, Reese?
Reese Harper: I am great. I have been excited for this because I know we have a lot of really cool things planned to discuss today. You have a lot of experience in dentistry that I think people will be able to draw on and you are one of the hidden gems in the industry that I think a lot of people don’t know about. I am really excited to have a lot of our listeners get to know you.
Pat Rosenzweig: I also am excited about this because I have a great deal of respect for what you do, and your work. I think this is going to be a great conversation.
Reese Harper: Well thanks! Let’s start by talking about what led you into dentistry because a lot of people don’t know that you and I have a little bit of background in a way that we can relate that is kind of unique. You tell a little bit about your background.
Pat Rosenzweig: I have what I have come to think of as sort of the useless piece of paper. I have a BA in English, so we are both liberal arts majors, and I have a dual minor in math and education. That was always where I was going. I was going to teach. I come from a family of teachers. I wanted to teach. That was my big plan.
Reese Harper: You would be the best teacher. If one of my son’s was getting you in high school or elementary school he would be so stoked right now.
Pat Rosenzweig: Well thank you, I appreciate that.
Reese Harper: Ya!
Pat Rosenzweig: You know and just to digress a second, I am now in a career where I get to use it again finally.
Reese Harper: Totally!
Pat Rosenzweig: Initially I stayed home. I was a stay at home mom, as many ladies were, and raised my daughter. At about age thirteen or so she really was ready to have me go back to work. I was driving her absolutely crazy.
Reese Harper: It is time, mom!
Pat Rosenzweig: She would walk in the door and I would say, “How was your day? Who did you meet? What did you say?” And you know, the poor kid just wanted to go lay on her bed and listen to music. That’s when I thought, “ok, I have got to go back to work.” I started looking into teaching, and unlike now and most times in our countries history, at that time there was an absolute glut of teachers on the market. It was absolutely amazing. You could not find a teaching job to save your life.
Reese Harper: You were in Colorado at that time?
Pat Rosenzweig: No, I apologize, I was in Massachusetts at that point.
Reese Harper: Oh, interesting, ok. Is that where you raised your daughter?
Pat Rosenzweig: Yes, I am from the East Coast originally and she is still back there. I wanted to get back into work, and considering I have such a passion for dentistry now, it is funny that I fell into it. I did what everyone does back then and I searched the classifieds. I saw an endodontist looking for a front desk person and I thought I am smart, I can do that. First I looked up what an endodontist was because I had absolutely no clue. I thought, “ok, the guy does root canals.” I don’t like going to the dentist, but I could do that. I would just be at the front desk. I went and applied, great interview, and I get turned down. I thought, “ok, that’s not going to work.” So I went and did something else for awhile and about two months later I got a call from this guy at 8:30 at night and he said, “you know what, I made a mistake. I hired somebody. They were a bad choice. Come work for me.” The rest was history. I have been in dentistry since then. I have hit just about every specialty. I have actually, heaven help us, worked in corporate for a while. I have really been in all sorts of dentistry. When I came to Colorado I found my passion within a passion because when I got here I started working full time for an orthodontist as his office manager. I am sure he wouldn’t mind me mentioning his name, Dr. Daryl Havener. That man taught me so much about ortho, and so much good ortho. That really became my passion. I work with all specialties and all doctors, but if we get an ortho client it is pretty much guaranteed that it is Pat’s clients.
Reese Harper: I know that you work with all specialists and GP’s, but I knew that ortho has been a passion for you in that firm. One thing I thought you said that was interesting is that sometimes people pass up on the right hire the first time. You know what I mean? You were the right hire for that practice, but you weren’t the first person that they picked!
Pat Rosenzweig: Ya, right?
Reese Harper: I think that happens quite often. I know it has happened in my life. I have gone back and actually hired the person that was a close second after a period of time with the first person and it is always something that is interesting. Even the best hiring managers sometimes don’t get it right every time. Sometimes you have to branch back out and say, “even though I said no would you still be willing to try?”
Pat Rosenzweig: We have done that in offices. I do tell doctors that. I have a lot more experience with hiring than they do, but nobody gets it 100%. You just can’t. I don’t care how good you think you are, nobody gets it 100%. Someone will fool you.
Reese Harper: Ya, that is true.
Pat Rosenzweig: You will think that you have got the right person and as they start doing the job you think, “oh boy, I made a big mistake.” I am a big believer in hire slowly, fire quickly. It is like once you figure it out, move on. Thank goodness Chip Garnett in Massachusetts, the doctor who hired me, believed in that also. Hiring is a tough one. That is one of those areas we talk a lot about. I think every consultant does. We try to teach the doctor how to do the best possible hire, but you know, that is sort of a whole additional avenue.
Reese Harper: The rest was history. After that job, it just slowly resulted in, I mean how long have you been doing this now?
Pat Rosenzweig: Let’s say thirty plus years, how about that?
Reese Harper: So just a couple, which is good. You have had a few clients. What would you say some of the most common mistakes that younger doctors make as they start out their practices? What are some of the things that you kind of expect to see that are repeated pieces of advice that you have to kind of focus on?
Pat Rosenzweig: Ok, the ouch factor. There are so many. I think one of the big mistakes that they make is, and I am not trying to put down anybody, I love all of the vendors I work with, but some are better than others. Sometimes the doc listens to the wrong people. They might listen to the architect. Now, the architect is a great guy.
Reese Harper: Or girl.
Pat Rosenzweig: Sorry, I work with so many male architects, but yes, I do work with females also. The architect is a great person but you know they don’t understand what really goes into opening a new practice. Their focus is, “doctor, if we create you a beautiful practice, everyone will want to come.” They want the doctor to spend all of his or her money on that beautiful practice. They don’t think about marketing, getting the right equipment in there, getting the right software in there, they just care about that. Sometimes the equipment person is so involved in, “oh, if we get you the most modern technology, they will come.” And some of that modern technology can cost a small fortune. What I am all about, and every good consultant is all about, is budget. You just have to say, “doc, set up a budget so you know what you are doing.”
Reese Harper: There are two things you said that I just have to highlight. One is that you have to follow the money before you take advice from somebody. You follow the money to say how is this person compensated? How does that influence what they tell me? Now, a person like a consultant, or lets pick on me ok? A financial advisor is compensated in a lot of different ways. In our firm, we get paid for advice and time. We don’t get paid to sell people things, but a lot of financial advisors do get paid to sell people things. They might make the most money if they sell a particular insurance policy or maybe an annuity or setting up a 401 k plan or something. If that is how your financial advisor is getting paid you have to be very cautious about their advice because if it is November and your sales person/advisor is getting ready for Christmas and they are trying to figure out how to get Christmas paid for, there might be a stronger recommendation there than they would have had in March of that year. If you are a realtor, an equipment sales person, an architect, a consultant, everyone gets paid a certain way. Be careful to separate out advice from what we will call “free advice” that comes as a free product that you are buying from someone. There is advice that is free and there is advice that you are paying for. Typically, from a consultant or a fee only financial advisor, like myself. They don’t have anything to gain except for telling you the best possible advice they could ever tell you because you have already purchased their services. Now they have to deliver the best possible advice they can so that you will tell other people how good their advice is. Where sometimes other people that you will interact with, I am not saying they can’t be objective and they can’t give advice. Some people do a really good job still giving advice and forgetting how they are getting paid. I have seen it with equipment, realtor, insurance…
Pat Rosenzweig: As have I.
Reese Harper: You can see it, but it isn’t as common. It is a diamond in the rough type of thing. When you find that person that you say, “holy cow, how are you so client focused and objective and not focused on your own commission even though that is your livelihood.” It takes a lot of maturity and a lot of financial stability in order to be able to afford to do that. Early on, especially if someone is trying to survive and make a living, it’s different. Remember that, this point is really important. Especially early on in your practice. You will be taking the key advice from people who may influenced by the way they are paid. You have to be really careful about that. It can send you down a complete rabbit hole that wasn’t even good advice to begin with.
Pat Rosenzweig: One of the best things that I ever heard, one of my clients said it, he said, “you know, from the day I started talking about opening a practice everybody has had their hand in my pocket.”
Reese Harper: That is just the way it is! I did a podcast called, “The nine people every dentist needs to know.”
Pat Rosenzweig: That was a great one.
Reese Harper: I think that most dentists need to be aware of who they are actually hiring. Who are you paying directly and who are you paying indirectly because if you are paying someone indirectly it is going to be harder to get straight shooter advice. I forgot my second point already, I don’t remember what it was.
Pat Rosenzweig: I will tell you, I heard the best thing last night. It came in as a text message from one of my doc’s and he said, “Pat, I am so comfortable because we have such a good team. I sleep well at night.” That is the important thing. You have to have a good team of honest people around you.
Reese Harper: That is so true, ya know? A lot of my research into the stuff I am interested in has to do with startup businesses and how companies get off the ground. It is about silicon valley, capital, and venture capital. One of the primary things a venture capitalist is concerned about is the team that is established. In a V.C.’s pitch deck, when you go to raise money from a venture capital firm, one of the primary things that they want to see in our pitch deck is a section where you talk about the team that you are building for the business you are about to launch. That includes everything from an advisory board from people who are seasoned and have experience that are your advisors. That includes your core employees, your subcontractors, your managers, etc. It needs to be extremely thorough. If you ask any entrepreneur or venture capital firm what slide in the deck is the most important, that team slide is the one that they base a lot of their decisions off of. If not, the most important decision is based on that slide. It is less about the product, the financial projections, or where the company is headed, they just want to know if that team that has been put in place is the right one. That is very telling. I think it translates really well down to the dental world.
Pat Rosenzweig: Absolutely.
Reese Harper: Dentists often just don’t think that much about the quality of the team they are building. I think that is something that can be the difference between hundreds of thousands of dollars in extra collections plus peace of mind, plus an increased personal financial statement net worth balance sheet, earlier retirement, all of these things are a product of getting the right team. The wrong team can be literally ten to twelve years of de-railing and pushing you down the wrong road and burning you out, working you too hard, losing money, embezzlement, theft, and loss. We don’t take enough time to pick our team.
Pat Rosenzweig: And it is no longer your father’s dental office, ya know? It has changed so much over the years. I remember early in my career, I was one of those silly go getters who was just into marketing and brainstorming. I had an office manger stand up and look at me and say, “dentistry, is a profession. Not a business.” You know, that has changed so much! Doctors have to see that. Yes, it is a profession, of course. It is a wonderful profession. But if you don’t see it as a business as well, then you have a problem.
Reese Harper: Oh yes, I agree.
Pat Rosenzweig: Either you or I have got to get into the head of every new doc and whether the financial planner does it or whether the consultant does it, someone needs to do it.
Reese Harper: Hopefully their whole team has that mentality. It takes awhile. Young entrepreneurs or even seasoned business owners have a hard time really looking at their company and objectively making decisions about it that make sense. People tend to get emotional, or loyal to certain vendors, or employees, or loyal to certain patients. Perhaps you feel inclined to provide a lifestyle, house, cars, vacations, and time off that you can’t justify. It can become a mess.
Pat Rosenzweig: Yes, I felt this resistance when I wanted one of my clients to switch equipment vendors. I felt like the equipment vendor was not looking for specials or deals and was just not giving him the best prices. He was just coasting and really was not trying hard for him. He said, “oh my gosh, I feel like I’m cheating on him.”
Reese Harper: Like I’m dirty, I need to take a shower!
Pat Rosenzweig: That is again one of those things.
Reese Harper: It is a compliment on one hand, generally, they are so loyal. They love people and they are kind, for the most part. I think that is a compliment to them, but it is also one of the things that hurts them and stops them from making smart decisions. They will do a lot for loyalty. I am ok with that, loyalty is important. You don’t only make decisions because it makes you the most money, but there has to be value there. Value is not always the cheapest thing.
Pat Rosenzweig: I very rarely say, “doctor, lighten up and be nicer.” Most of the time I am saying, “doctor, you are too darn nice, and you are creating your own darn problems here.”
Reese Harper: Let’s talk about that. We have talked about some of these common mistakes, such as advice from the wrong people or maybe the wrong incentives or not having the right team.
What is another thing that you feel is a mistake for people to make in their practice? What is another common setback?
Pat Rosenzweig: Well, it kind of ties in with what you said about listening to ideas from other people. Doctors who have larger offices have this tendency to put one person in charge of marketing. What I say to them is, “let’s create marketing consortium in your office. Let’s pick your four or five really smart good people here in the office. One might be an assistant, one might be a front desk person and let’s put them all in a room together and start brainstorming.” That is where some of the best marketing comes from.
Reese Harper: One of the mistakes I see additionally is that they put people in charge of marketing that aren’t marketers. You can’t just give people a title and expect them to be a marketer.
Pat Rosenzweig: Yes, and typically they don’t even want to do it!
Reese Harper: “I’m a hygienist, you didn’t tell me I was going to be doing marketing!” Sometimes it’s inefficient to do that! If you are going to have a consortium sometimes that might be five or six people that are external to your office but you are picking from a variety of ideas. One person’s idea is never the answer. If you pick one marketing vendor they come from a certain experience that they have had throughout their life that resulted in success from the experiences they have. Other’s have a different perspective. Like you said, a consortium of ideas. What is another key mistake you think of?
Pat Rosenzweig: Another mistake I think of, or it can be a mistake, is hiring more for experience than personality. There is nothing wrong with having experience in your office. We should have experience, but sometimes doctors will hire based on someone’s experience. Then I meet the lady and I realize that she has absolutely no personality with the patients. We have touched on this a little earlier, but it’s worth repeating. When someone walks through your door, with the exception of someone like me or my partner Anne, they don’t know dentistry. They don’t know whether you are good, bad, or indifferent.
Reese Harper: They just know the people right?
Pat Rosenzweig: Right, and they have to really like that lady at the front desk. They have to really like the assistant that works on them including liking the doctor. Those people, no matter how likable the doctor is, if those people haven’t got that people person attitude that you need it’s going to be trouble. One of my doctors says, “treat your patients right and they will leave a big pot of money on your back door.” That is true. We don’t see much of that these days because customer service has just gone to heck in a handbasket.
Reese Harper: Ya, it truly has.
Pat Rosenzweig: You know you go anywhere, even the grocery store, they are more interested in their personal conversations than they are in you. One of the things you just have to really work on is getting those people who understand how important that customer service is and then teaching them how to do it well. I don’t believe in rock solid scripts ok? I think people who use rock solid scripts make them sound like the people we outsource too. They are turning a page.
Reese Harper: Ya, or robotic.
Pat Rosenzweig: I do think a script where they can look at it and then say, “now put this into your own words”, can be helpful.
Reese Harper: Humanize this a little bit.
Pat Rosenzweig: I am training a lady right now who has absolutely no experience in dentistry. She is going to be killer in this new office because she has the right attitude. I am so excited about her I told her I want to clone her. I mean, you know, this is something that doctors miss. They miss the personality aspect. That is a big mistake.
Reese Harper: Let’s summarize that and say you think people hire sometimes based on experience and they overlook the importance of personality, right? Ideally you have experience plus personality, but you would opt for less experience and a personality that is relatable and an individual that patients can engage with? That could be front desk, hygiene, whatever?
Pat Rosenzweig: Yes, absolutely.
Reese Harper: Everyone is on show all the time right? You don’t need to have personality in your CPA, and financial planner, and your lawyer, they can all be dull like us. That is ok. We are not facing your patients! Everyone else has to have a personality. That is marketing! You should spend five grand more for a salary on marketing.
Pat Rosenzweig: Exactly, yes, exactly.
Reese Harper: I know just as a patient, I know the difference between a hygienist that I like to see and one I don’t. I mean to get me to go in every six months is a pretty big deal. You typically have to drag me in, I have to have a root canal or I am not going in. It is not that bad, I do respect my dental hygiene.
Pat Rosenzweig: I know, I know…
Reese Harper: Every six months at least, I go. Right now I’m going three times a year just because I like to see the people there! Don’t tell me I didn’t floss perfectly just tell me that maybe my flossing is still at level one or two phase.
Pat Rosenzweig: You are making progress though…
Reese Harper: Exactly, just tell me I’m doing ok. I do think that this personality thing is really crucial. It is the most negative service experience. It is almost as bad as paying taxes, not quite, but pretty close!
Pat Rosenzweig: It really is, it’s tough.
Reese Harper: No offense to my CPA friends, all of you out there no it’s true though. It is very hard to pay taxes. Going to see the dentist is a pain and it is just nice to have a personality there to meet you.
Pat Rosenzweig: It’s like when you go to the grocery story and you are spending $100 on groceries an this person is throwing them down the conveyer belt like they are garbage.
Reese Harper: You are going, “Dude, I spent five minutes to pick out that mango! I am having mango sticky rice with that mango, and you just bruised it!”
Pat Rosenzweig: Anytime I bring up customer service I can get anyone in the room to tell me a horrible story and then I ask them what they are doing to make the customers happy. It’s just something we really, really have to work at. That and marketing. Those are some of my biggies.
Reese Harper: It is challenging, I can relate to this, you are trying to build a professional business that requires technical competency as its core value proposition. That is your core offering. On top of that, those people that generally have really good technical skills don’t always come with the best personalities. I think one of the morals of this story that I have seen is that 10% more in payroll for a person could possibly result in a slightly lower profitability. 10% more in payroll does not result in 10% less in profits, but do the math here and it is probably like 2% less in profit or maybe 3% less for a 10% increase in payroll.
Pat Rosenzweig: It is worth it. It is worth it.
Reese Harper: Ya, way worth it, because that is part of marketing for your practice at some level.
Pat Rosenzweig: Especially in our current economy. I don’t know, well yes I do know about Utah, its the same, but here in Colorado it is a monster to find good people.
Reese Harper: Unemployment here is, like 0. Everyone is employed. It sucks!
Pat Rosenzweig: Colorado is the same way. It is really difficult. The doctor will give you a list of what he or she wants in people and you are looking at this going, “well, I can try to get you this and this.” I mean you talk about the technology competence. They want the ladies or a gentlemen not to be afraid of a computer. They want them to be able to learn the computer software. He will be the guy that crawls around under the desk when something needs to be fixed, or they can call their IT person. I don’t care if they can deal with the cabling and all that. I just need them to be able to run the computer and be nice at the same time so we can be happy.
Reese Harper: Let’s hit one other question here that I think is a really important one. What makes a good and a bad consultant? I don’t want to say there is any really bad consulting out there. All consulting should give you some benefit but you are going to get incrementally better out there. You could argue some bad consulting could send you down a crazy rabbit hole, but I don’t know. Tell me how you view that? What’s your paradigm?
Pat Rosenzweig: There are many, many more good consultants than bad. That is the first part of it. However, yes, there are bad consultants out there. When I am talking to a new client potentially, I say, “please, call my references. Not only call my references, but talk to vendors you know, and ask them what they think of me.” I want you to do that for every consultant you are considering. Yes, there are the occasional bad apples. Now, what makes for good ones? A lot of it depends on what you want from a consultant. Some doctors want a great deal more interaction from a consultant. Some do not.
Reese Harper: You mean with themselves personally? The doctor want’s to get involved?
Pat Rosenzweig: Well, some doctors want the consultant to be involved more. For instance, there is a very good consultant out here in Colorado. The only thing she does is she starts when the office opens. She does nothing with the construction, or loan process, or getting the PPO’s signed up. She does none of that. We start from day one. That really depends on the doctor. I have had doctors say, “yes, I like you because you do that.” Some might say, “you know what, I don’t want you to do that. I want to get things off the ground and then bring you in once I’ve given it my best effort and seen what I can do.” Really, their job as a consumer is to ask us tons and tons of questions and get tons and tons of references. A good consultant is going to come across as someone who the staff can interact with. The doctor can interact with. Honestly, I mean, there is that bottom line. Who makes the office money? Who gets the office kicked into gear? I just had one of my docs say something that is kind of a running joke. He was so hesitant to get started in his own practice and every time he would make more and more every month I would laugh. He just sen me a text and said, “I hope you are still laughing, I just grossed a million after three years.” I mean, this is just the kind of thing where you have to find that right person who is going to do that for you ad personalities are important. You know, some people like me, some people don’t. That is ok!
Reese Harper: Ya, that is ok. I think it is good if someone has deliberate style about them that you can read and understand. Then you know who you are going to get along with and you are going to be able to be the person that someone wants to talk to…
Pat Rosenzweig: But really the biggest thing is asking around. Yes, the reference list is good, but ask other people what these people really do.
Reese Harper: Talk to them, right?
Pat Rosenzweig: Do you want someone like my partner and myself that if your phone rings we pick it up, answer it, and make an appointment. I know eleven different dental software programs. Is that important to you? Or do you want someone who comes in once a month and does a really motivational meeting and gets your staff really psyched and ready to jump? Is that what you want?
Reese Harper: What level of involvement is good for you? Two things that I feel passionate about and have been challenges for me regarding good and bad consulting. Sometimes people don’t do enough questions like you are saying. They don’t ask enough questions and they diagnose their practice needing problem A but really it is problem B that is the more important or pressing issue. For example, let me say we have somebody who spent a lot of money on consulting that helped them grow their collections ok? And they were able to do better and the consultant leaves that interaction feeling really good because they had left behind a practice that had made a lot of progress on the top line, but when I got involved and went back and looked at it there was a lot of growth, almost a half a million dollars in increased collections. You would assume that this is something we should all be celebrating, and I was for six months, until I started looking at it and realized that they hired two associates during that process and added compensation planning that was different from your hygiene that is now making you break even on hygiene and you used to be profitable! Sometimes my concern is if consulting doesn’t go beyond just growth then sometimes you just get bigger but you aren’t making more money necessarily. You are bigger, but that is a serious worry for me. If I knew that I could have a consultant that could help drive growth but then also have some level of accountability for the profitability that was there then you would feel ok about it, but sometimes I think it is more lip service to that and less thoughtful planning about how are we going to generate more income from these collections as well. You don’t always have to generate more income. I mean if your goal is to sell the practice and you are just trying to get it to be larger, I don’t want to say that’s not a worthwhile goal. Most people are trying to get it bigger to take more home? Is that a fair criticism?
Pat Rosenzweig: Oh, absolutely, and you have hit on a very good point. Something that we are pretty adamant about is that part of good consulting is teaching. It is teaching you what to do when we have left. It is teaching you what to do when we are not there. It is teaching you what you should be looking for before you add another room. It is teaching you what you should be looking for before you add another associate. You have to teach the doctor what to do when he moves forward, or you are not doing a good job as a consultant. When you leave that immediate problem may be fixed, for instance, collections. Well, we might have gotten you there and got the ladies to start collecting like crazy and like you said for six months it is great. But if we haven’t taught them the skills to make sure we don’t get into this predicament again, where collections keep going up, then we haven’t done our job. We have to teach the skills to make sure that this doesn’t happen again.
Reese Harper: You have nailed it on the head, Pat. I think that is a really good way to summarize this whole conversation. Dave Ramsey, I think, ya know, he does a good job about talking about personal finance to a lot of people.
Pat Rosenzweig: Awesome, awesome.
Reese Harper: I respect a lot of the work he has done, a lot of the advice he gives I don’t agree with but I do believe his intentions are good. He frequently says, “when getting help with money, real estate, investments, (and I would put consulting, or your practice, or anything in there) you should always look for a person with the heart of a teacher, not the heart of a salesperson.” I really agree with that, and that is probably the biggest difference between whether your consulting dollars paid off or not. Is if at the end of that process if you feel like it has been more like tuition for school that left you smarter than you were when that person arrived, then you’ve got your money’s worth. Even if your practice didn’t necessarily see massive gains, if you really did walk away with more education, and not just your staff, but you yourself, I do believe that is a really important component in knowing if that was helpful. I do think that having the heart of a teacher is something that is interesting especially concerning that was your background. I think that just translates into your success, that is probably something I think is worth wrapping up with that! Any final thoughts you’d like to leave?
Pat Rosenzweig: First of all, thank you. Do your homework. Do your homework. If you are getting anybody, don’t just go on he or she is a nice guy or lady. Yes, here I go, I am a teacher again. Do your homework. We started there and we wound up there but that is our use for our liberal arts degrees after all.
Reese Harper: Well, I am excited to do this again. Next time we will have a different theme. But it’s been great. Thank you, a lot of really useful insight.
Pat Rosenzweig: I enjoyed this, I would love to come back, thank you.Practice Management