[00:00:00] Welcome, you're listening to The GrowOrtho Podcast presented by HIP. This podcast is dedicated

[00:00:07] to orthodontist who want to stand strong in their market and be leaders in their community.

[00:00:13] Now onto today's show.

[00:00:16] Shannon thanks so much for being on the GrowOrtho Podcast today.

[00:00:20] Thank you I'm at some pleasure to be here.

[00:00:21] Definitely so tell listeners and viewers who you are maybe some hobbies personal life

[00:00:29] but then also about your business.

[00:00:31] My name is Shannon Patterson and I'm a partner at Benson Couple in Associates.

[00:00:37] We are about to go through a rebrand so it's going to be Benson Couple Patterson in Associates.

[00:00:44] We're going to be doing that in the next couple of months probably before the AEO.

[00:00:49] Traditionally we are evaluation and transition firm and also Dr. Recruiting and we are ortho-specific,

[00:00:57] ortho-only.

[00:00:58] So we do a lot of speaking, we collect a lot of data from a lot of different groups and

[00:01:05] really put a story around that.

[00:01:08] We're big educators in the residency programs and do a lot with the AEO.

[00:01:15] And we've just been around a long time and know ortho really well so what we really

[00:01:20] say is if you're going to have a transition whether it's in your practice or your career

[00:01:26] you should talk to somebody and hopefully it would be us but there's other firms out there.

[00:01:31] On a personal note, I have three amazing children they are grown now so an empty nester.

[00:01:37] I love to fly fish and camp and I have a dog that I adore named Marley.

[00:01:43] So within orthodontics right now what is the hot topic?

[00:01:47] What are most orthodontist talking about?

[00:01:51] Worried about what's keeping them up at night?

[00:01:53] Well I think the hot topic is definitely the economy.

[00:01:56] I think people are concerned, numbers were down slightly last year, this year probably anticipating

[00:02:06] much of the same thing.

[00:02:07] January was a big month just because of all those HSA and FSA accounts coming in.

[00:02:14] February was a good month but we had an extra day in February which really accounted for

[00:02:19] that bump in production that we saw.

[00:02:22] What we're hearing so far for March is it's not great, future exams are down, people

[00:02:26] are concerned about that.

[00:02:28] It's an election year, the economy is not great, we really anticipate hopefully first quarter

[00:02:35] next year that we really pull out of this and the one thing that we know from historical

[00:02:41] data is when times are down because of the economy we end up having a bump and kind

[00:02:49] of a pent up demand coming out of that.

[00:02:51] So we anticipate first quarter of 2025 being pretty big.

[00:02:57] It's interesting the way that orthodontists look at their business too because we find

[00:03:03] that a lot of orthodontists are being reactive each month or even in some cases sooner,

[00:03:10] like this week.

[00:03:13] And really ever since COVID is when we saw volatility meaning some practices which

[00:03:19] is blow it out of the water, others would be down.

[00:03:24] Random occurrences within months because typically you would have your seasons for ortho

[00:03:29] and some are always being the biggest.

[00:03:32] And sometimes that would change depending on the location or you guys seeing that to

[00:03:36] just maybe some atypical things going on within orthodontics.

[00:03:43] I think so.

[00:03:45] You talked about geography, I mean I think there are some areas that are definitely feeling

[00:03:50] more of an impact than other areas and I think that rule practices are probably doing

[00:03:57] a little bit better because I think that their patient basis is just a little bit different.

[00:04:04] They probably have always had a budget and stuck to it versus the bigger metropolitan areas.

[00:04:11] I mean you've also had some population loss in certain areas but I think that people

[00:04:16] are affected by the cost of living in different areas.

[00:04:20] It's just gotten so expensive in some areas but it's definitely geographically dependent.

[00:04:27] Yeah, for sure.

[00:04:28] There's definitely some markets doing much better than others like a lot of people have

[00:04:33] moved to Florida.

[00:04:34] That's where I'm at in Florida.

[00:04:36] As a whole is doing pretty well.

[00:04:38] It's interesting too because you mentioned financing and we also see that a lot of practices

[00:04:45] will have fairly high down payments especially if they're heavy with indirect bonding labs

[00:04:52] and vis-a-line what have you.

[00:04:55] And the practices that are able to be more flexible with just getting started, that is having

[00:05:02] a huge effect on conversion rate production as well.

[00:05:07] So that's kind of interesting and I'm not sure if you guys have dived into that or have

[00:05:12] seen that as well.

[00:05:13] We have, and talking to young doctors that are associates and not really even practice

[00:05:19] owners but doctors that are out in their associates and their conversions are being

[00:05:23] affected and they're just calling for advice like is this normal?

[00:05:27] Is this what's going on in the marketplace?

[00:05:29] What we find is a lot of associates that work for corporate models not necessarily specialty

[00:05:36] lead corporate models but like GP lead corporate models.

[00:05:40] They do have a high aligner fee, lab fee so starting they want that $1800 down and their

[00:05:48] conversions are a wreck because of that.

[00:05:51] So we definitely see if anybody's charging more for aligners that their conversions are

[00:05:57] being affected.

[00:05:58] And that's probably why we see that dip in adult starts as most adults are going to want

[00:06:04] aligners.

[00:06:05] And if you're charging significantly more and the practice down the road isn't, that's

[00:06:10] going to be something that they look at.

[00:06:13] And then also people who are just definitely like you said more flexible on the financing.

[00:06:18] Some people are extending it.

[00:06:20] We never tell people what to do but it's something that you should definitely investigate.

[00:06:25] I think something that I've noticed that's really interesting this year is the conversions

[00:06:29] out of the pending bucket has gotten better.

[00:06:32] And probably what that is in the last two years practices were so busy that they really

[00:06:39] didn't worry about those pending patients, right?

[00:06:41] So we recommended treatment.

[00:06:43] You didn't start, really didn't worry about it.

[00:06:46] I think now that TC's probably have a little bit more time because the new patient exams

[00:06:51] are down.

[00:06:52] And then we're thinking that column a little bit more and reaching out to that patient

[00:06:55] and saying well, what would it take to get you started?

[00:06:59] Did you go to your second opinion and we're seeing that conversion in that bucket actually

[00:07:05] is higher than it traditionally has been.

[00:07:08] Sure.

[00:07:09] And that's a great tip because there's still a lot of practices who don't have a process

[00:07:14] for that.

[00:07:16] We work that segment whenever we have time.

[00:07:22] That's what I hear.

[00:07:23] And so having an actual process for that because yeah, it's the same thing here at HIP.

[00:07:30] Is it easier to go out and get new leads or is it easier to actually take the person

[00:07:35] to the next step who already knows about us?

[00:07:37] We've already had a conversation with maybe they've already been in the practice.

[00:07:42] In most cases, all these people you're talking about have been in the practice had a console.

[00:07:47] And so I think that's a really good tip for practices listening is have a process, re-evaluate

[00:07:54] your process for pending and make sure that you're just being diligent in trying to help

[00:07:59] those people.

[00:08:00] And it's not always about financing.

[00:08:02] A lot of people think well, a pending patient means we've told them to start but if they

[00:08:09] need to have another appointment, if they need to go out for hygiene, things like that.

[00:08:14] Those TCs, there needs to be a process for following up with all of those leads and what

[00:08:19] we found again is that bucket's increasing conversions.

[00:08:24] We could maybe chat about window scale.

[00:08:27] You guys obviously help add associate docs to practices.

[00:08:33] I'm curious your thoughts on when is the right time?

[00:08:37] I see a lot of orthodontist do this very early on.

[00:08:42] It seems like it's the way now.

[00:08:45] It's like the talk within ortho.

[00:08:48] You know, it's like all right, you need to buy more practices if you're not growing and

[00:08:52] then maybe also hire other doctors.

[00:08:56] It's scary to me as a business owner when practices do that in their revenues and productions

[00:09:02] is still really low.

[00:09:04] So I'm curious what you guys see.

[00:09:06] If you see that, if you advise on that and just best practices for window scale.

[00:09:12] We definitely have those phone calls all day, every day.

[00:09:16] When should I hire an associate?

[00:09:19] If I hire an associate, should I acquire another practice or start another practice?

[00:09:25] And I think that there's really no easy answer for that because I think it's really individual

[00:09:31] to that practice.

[00:09:33] I think that what we know very well is that younger doctor demographic and what we find

[00:09:39] is typically associates don't want to be associates forever.

[00:09:44] So if you become a two doctor practice, it's really, really important to make sure that

[00:09:49] you hone in with that associate, understand when their contract is ending, when to start

[00:09:56] that renegotiation process because that's always the scary part.

[00:10:00] You can run a $3 million practice and do pretty well.

[00:10:04] When it starts getting a little bit bigger, people start getting a little stressed and

[00:10:08] they think they need another doctor.

[00:10:10] Sometimes you don't really need another doctor.

[00:10:12] You might just need a CEO or a practice administrator that really understands how to run a practice

[00:10:19] and KPIs and all those things.

[00:10:22] So we do have a lot of those conversations but I think that if you are going to grow by

[00:10:29] acquisitions and adding an associate and having a two doctor schedule that you're really

[00:10:34] in tune with that doctor being there.

[00:10:38] And if they are going to let you know, hey, I'm going to be moving on.

[00:10:42] I found my dream practice in Idaho that you have enough time and run way to find a replacement.

[00:10:49] Yeah.

[00:10:50] I think too.

[00:10:51] And this is just my personal opinion based on some of the conversations I've had.

[00:10:55] I see younger practices do it.

[00:10:58] Let's say they're more so in the beginning phases, a million dollars in production or so

[00:11:03] and they've got a doctor.

[00:11:05] I mean, I've seen people within a location producing two million, three doctors total.

[00:11:10] So you got the owner to associates.

[00:11:14] Heavy and vis-a-line.

[00:11:15] So there's a lot of lab fees.

[00:11:17] And you mentioned something.

[00:11:20] CEO, maybe a COO, some type of ops or leadership team.

[00:11:25] In most cases that is overlooked and the focus is I need to get more doctors in to help me.

[00:11:33] And if you look at a practice producing that if there's efficiencies within the clinic

[00:11:39] on the business side, administrative side as well.

[00:11:41] And there's a leadership team to manage the team and adapt, change, grow the processes

[00:11:50] within the business.

[00:11:51] I think that's a better route and I think it's something that isn't talked about enough

[00:11:56] within orthodontics.

[00:11:59] Doctors are very clinical, obviously they're brilliant.

[00:12:02] And so that's where their mind goes is the clinical side, doctor side.

[00:12:08] But I always encourage people let's put on our business hat.

[00:12:12] And a lot of times that means getting educated around the business of orthodontics which

[00:12:16] really applies to any small business just about, maybe not something like e-commerce.

[00:12:22] But a lot of the levers are the same.

[00:12:27] So that's what I see and just looking at profitability.

[00:12:32] Like what is a good margin?

[00:12:34] What should I be aiming for within a net profitability as a healthy business?

[00:12:42] And I guess my last bit, I'm going on a rant.

[00:12:45] But I always tell people do you want to try and duplicate a D or C business or an A or B

[00:12:52] business?

[00:12:55] And you can definitely get your single location to where you want to be this practice I'm

[00:12:59] mentioning the two million three docs heavy and vis-aligned.

[00:13:03] I told them man, you can easily double.

[00:13:06] And he just couldn't even believe it like he couldn't conceive it.

[00:13:10] Like how would I get to four million?

[00:13:11] I'm like, well you're in a great area.

[00:13:14] The markets here.

[00:13:16] You know yeah, you have some competitors but that's not always a bad thing.

[00:13:19] That's a good thing that's showing you there's a demand.

[00:13:22] This is a great area for ortho.

[00:13:25] I think we just need to focus on the business, efficiencies, the team.

[00:13:31] Within this practice there's very little leadership.

[00:13:35] And I'm referencing it because that's kind of the stereotype that I see a lot.

[00:13:40] We know the average practice, you would know better than me but it's somewhere between

[00:13:43] 1.2 and 1.7 million ish.

[00:13:48] But ortho is very scalable.

[00:13:51] Once you have the right processes in team in place, it can scale fast.

[00:13:58] So it's just so interesting because I with all these young docs and again, I'd love to

[00:14:04] know where all these conversations start.

[00:14:06] Like yeah, get more locations, get more doctors.

[00:14:10] But we have started, HIP has started to speak at residencies and this is part of what

[00:14:17] we're telling them is here's the things that you know just the little bit I know, I mean

[00:14:22] I've only been doing this for 10 years but really try to think like a business owner

[00:14:29] if you're going to be in private practice.

[00:14:31] Oh absolutely.

[00:14:32] It really is when you think about this model compared to other businesses, there's very

[00:14:38] few businesses out there that are $3 million business and the owner does everything.

[00:14:44] Right?

[00:14:45] And so you know when I first started in this industry 14 years ago, I came out of medical

[00:14:50] and I came out of the clinical side and burnout was a real thing.

[00:14:54] And it was really refreshing to be in this industry and we just didn't have burnout.

[00:14:59] I mean every client I talked to seemed to be really happy and the young doctors were

[00:15:07] even more happy.

[00:15:08] They were just starting their career, they were excited and I definitely get more of those

[00:15:12] burnout calls but practices have gotten bigger.

[00:15:16] I mean, I think we think the average practice is about 1.8 to 2.1 and that's big and if

[00:15:22] you know, you went to school to be a clinician.

[00:15:25] Sometimes I get a phone call where people say well, I want to hire a doctor because

[00:15:29] I really want to be more management and run the practice.

[00:15:33] And I kind of jokingly say, well you should have gone to school and gotten an MBA but you

[00:15:37] went to school to become an orthodontist so you really shouldn't give up being an orthodontist.

[00:15:42] There are people that are much better at running and managing your practice than you are.

[00:15:48] And I think they just get so overwhelmed.

[00:15:51] They think if they do that part that they'll be happier.

[00:15:54] But the reality is if you're a really good orthodontist, you don't want to step away from

[00:15:59] that.

[00:16:00] It's kind of like making the best salesperson, the sales manager.

[00:16:03] It never works, right?

[00:16:05] So if you're, you know, it's a disaster, right?

[00:16:09] It's like well, I was really good at sales but I'm terrible at managing people and I think

[00:16:13] that ortho, again, it's just one of the few businesses that it's a $3 million business

[00:16:17] and you don't have a COO or at least a practice administrator and certainly not to knock

[00:16:27] people that are out there that are office managers.

[00:16:30] But I think that when you get to a certain level, if you're not re-skilling or upskilling

[00:16:35] that person to understand what they need to be doing or having somebody that kind of has

[00:16:43] a history to understand that, it can be challenging because you don't just need a people person

[00:16:49] that all the team likes, right?

[00:16:51] Oh, everybody loves her.

[00:16:52] She's a great office manager.

[00:16:54] That's not really what you need when you get to a certain level.

[00:16:58] And if I was a young doctor today and like you, you know, speaking with young doctors regularly,

[00:17:02] I tell them all the time.

[00:17:03] And when I hit that million dollar mark, I'm looking for a high-end practice administrator

[00:17:08] that really can handle that piece so that I can focus, you know, meet with them, understand

[00:17:15] the growth of where you want to be and looking at all those metrics because that's where

[00:17:20] the burnout comes from.

[00:17:21] You're an orthodontist all day long and then at night, you're going home and, you know,

[00:17:26] you're looking over all the reports, you're trying to pull the data, you're trying to

[00:17:29] think about marketing.

[00:17:30] It's a lot.

[00:17:32] So having somebody that really understands that can be hugely beneficial.

[00:17:36] And a lot of practices at that two million dollar mark, you don't really need another

[00:17:39] doctor as much as you need somebody to kind of take that management piece off your plate.

[00:17:44] 100%.

[00:17:45] Have you ever read the book The Emeth?

[00:17:47] No.

[00:17:48] I've read this book.

[00:17:49] I'm curious what you would think about it.

[00:17:52] It's one of the best small business books.

[00:17:56] I think it's in maybe like, I don't know, a lot of different languages.

[00:18:02] Maybe I want to say 50 million copy sold.

[00:18:07] It's a very popular book and the author is Michael Gerber.

[00:18:13] So in the book, he talks about for a business owner, there's really three roles you can

[00:18:20] play.

[00:18:21] And typically it's a linear journey through each three as you grow.

[00:18:27] So the first is Technician and the second is Manager and the third is Visionary.

[00:18:34] And I don't want to tick off any dentist or orthodontist.

[00:18:36] I don't mean dental tech.

[00:18:38] I mean, as an orthodontist, you're doing the work.

[00:18:43] You're actually seeing the patient putting on braces, etc.

[00:18:48] That is a technical role.

[00:18:51] The manager, that's pretty easy.

[00:18:55] You're managing people.

[00:18:56] You're giving them feedback, telling them what to do, traffic control.

[00:18:59] And then the visionary, obviously you're creating the goals, the mission, the vision

[00:19:04] and you're casting that vision to the team.

[00:19:07] So the best businesses I have seen within ortho, typically the owner orthodontist is they

[00:19:15] float between two roles.

[00:19:17] It's the Technician and the visionary because eight to five or whenever they're open seeing

[00:19:22] patients, you're right.

[00:19:25] 100% they never need to move out of being the orthodontist unless they create this big

[00:19:31] practice or DSO or something.

[00:19:33] And obviously that's different.

[00:19:34] But let's just talk about your average two to five million dollar practice, they should

[00:19:42] always be a orthodontist because that's going to be the best thing for the business in terms

[00:19:47] of producing.

[00:19:48] Absolutely.

[00:19:49] A orthodontist can produce $5,000, $10,000 an hour.

[00:19:54] Maybe more, I don't know.

[00:19:57] But then if there's nobody setting the mission, vision and casting that, then the team is

[00:20:03] kind of lost.

[00:20:04] It's like, okay, why am I showing up?

[00:20:07] Is this just another job?

[00:20:09] There's no uniqueness to the brand or the culture.

[00:20:13] And so I think of Ernie McDowell, you may know him all smiles in St. Pete.

[00:20:19] He said, which I think I quoted him in one of these books.

[00:20:24] He said to me, Luke, when I show up at the practice, I'm going to say, I'm going to say,

[00:20:26] I'm going to do a called at the D personal training, and I'm going to do a small part of

[00:20:33] pastoral training.

[00:20:34] My doctor will tell me that my therapist is going to go out on the basis and do that.

[00:20:39] She's going to be turning a topic for me.

[00:20:42] And I'm also going to talk about it as an example when I said I was going to do a research

[00:20:51] service in the field of arts, and then I went to the department.

[00:20:55] the list goes on and on is typically they have that vision.

[00:21:01] They have that mission,

[00:21:02] the team can help them refine it,

[00:21:04] especially like a COO or integrator,

[00:21:06] practice administrator,

[00:21:08] but then they're showing up

[00:21:09] and there's still a high performer

[00:21:11] within the orthodontic technical role.

[00:21:14] Yes, 100% and the team needs that

[00:21:17] in what really surprises me sometimes

[00:21:19] is doctors who maybe want to bring on an associate

[00:21:24] that they really do kind of want to back away

[00:21:27] from that clinical role,

[00:21:29] or a lot of times they'll want to hire an associate

[00:21:31] because I have two locations.

[00:21:33] And if I could just get this other location off the ground,

[00:21:35] I could be so big

[00:21:37] and post-residency is just an extension of your education.

[00:21:44] The one thing you have not learned how to do is sell a case.

[00:21:47] And I know that that's probably overused but it's true.

[00:21:50] They really don't know how to be a leader in clinic.

[00:21:53] They really don't understand the kinds of questions

[00:21:56] they're gonna get asked by moms.

[00:21:59] They just have not been in that environment yet.

[00:22:01] They have been students and they have studied

[00:22:04] the clinical aspect.

[00:22:06] And so being in that practice

[00:22:09] with that younger doctor for a long onboarding process

[00:22:13] and really making sure that whether you're there

[00:22:16] or not there,

[00:22:17] they're doing things the same way that you would do them

[00:22:19] is pivotal.

[00:22:20] But I always tell doctors,

[00:22:22] I would not run two locations simultaneously.

[00:22:25] I would say work at least one or two days

[00:22:29] a week in the same office

[00:22:30] because you are gonna absolutely kill it on those days.

[00:22:33] The energy that you bring to the team

[00:22:35] and to the patients,

[00:22:37] sharing new patient exams and running the clinic.

[00:22:41] We see those practices get much bigger than doctors

[00:22:44] who are in separate locations

[00:22:46] because that separate location is a younger doctor

[00:22:50] that really doesn't understand what you've done

[00:22:57] and how many years it's taken you to get there.

[00:22:58] And that's what people need to remember.

[00:23:00] Whether you're 10 years out or 20 years out,

[00:23:03] it took you all that time to build what you have

[00:23:06] and to bring someone into that

[00:23:08] and push them out on their own.

[00:23:10] Sometimes can be a struggle

[00:23:11] and not just on the doctor but the team.

[00:23:13] So working together is a huge benefit

[00:23:17] for not only the young doctor,

[00:23:19] but the practice.

[00:23:20] And I think it re-energizes the senior doctor

[00:23:23] but you're giving a lot of leadership

[00:23:25] and a lot of goodwill to that younger doctor

[00:23:27] when patients see you together

[00:23:29] and that you believe in them

[00:23:31] because that's the biggest thing

[00:23:32] that young doctor struggle with

[00:23:34] is that goodwill still not transferred over,

[00:23:37] you know, they still when somebody calls,

[00:23:40] well, I don't wanna see that doctor.

[00:23:41] I wanna see this doctor

[00:23:43] and the more patients and referrals

[00:23:45] and the team sees you together

[00:23:47] and believe in that doctor,

[00:23:48] they're gonna follow suit.

[00:23:49] Yeah, for sure.

[00:23:50] And we could talk about ego too

[00:23:52] because I think to go back

[00:23:54] even to team building or I can do everything,

[00:23:58] I can be the manager just as good

[00:24:01] or better than anybody.

[00:24:03] It's letting go of the ego

[00:24:05] and like you said,

[00:24:06] there are people who have been trained on the business.

[00:24:09] Maybe there's people who have done this

[00:24:11] for 10, 20, 30 years that you could hire

[00:24:13] into the practice already.

[00:24:16] So ego's a big thing

[00:24:20] and that's with any doctor, you know,

[00:24:23] we used to work with surgeons

[00:24:25] and the ego was crazy.

[00:24:27] You know, they say it's surgeons,

[00:24:29] it's God complex.

[00:24:33] And the same thing applies here

[00:24:36] if you let go of the ego

[00:24:39] and especially with these doctors,

[00:24:41] younger associates really being their mentor

[00:24:45] and wanting to not be the face

[00:24:50] or all over the posters in the office

[00:24:53] and you know, I had somebody say,

[00:24:55] yeah, I really need to promote my associates.

[00:24:58] And as he's talking, I'm looking around.

[00:25:01] I see like three graphics on the wall about him.

[00:25:03] Top dentist, this award that award

[00:25:06] and he's like, yeah, everybody asked for me

[00:25:07] and I'm like, yeah, I would ask for you too.

[00:25:10] There's nothing in here about the other doctors.

[00:25:13] So leading from the back

[00:25:15] and I had to realize this, you know Harrison,

[00:25:19] how do I promote him?

[00:25:20] How do I get him speaking at all the events?

[00:25:23] Not me because I can't be everywhere.

[00:25:27] You know, you can't be everywhere.

[00:25:29] So how do I build up my team to where they can do it?

[00:25:34] And I love what you said about the doctor

[00:25:36] working in the location

[00:25:38] because you can really prove

[00:25:40] to the associate what is possible.

[00:25:42] Maybe they think I can only see 30 patients a day

[00:25:45] and I'm like swamped.

[00:25:47] Well, maybe that was residency

[00:25:49] but we do things a lot different.

[00:25:52] You could maybe see 80 patients, you know, here's how I do it.

[00:25:56] Show them it's possible, mentor them

[00:25:59] and then maybe down the road,

[00:26:01] you know as they grow and have that wisdom

[00:26:04] and that training,

[00:26:06] then they can just operate that location,

[00:26:09] you know if they're the right person for that.

[00:26:11] I think that's 100% right?

[00:26:13] I think something that we tell our doctors all the time

[00:26:15] is as an employer you have to do three things.

[00:26:18] You have to be, well you don't have to do them

[00:26:20] but a young doctor needs these three things.

[00:26:23] They need a coach, they need a mentor

[00:26:26] and they need a promoter

[00:26:28] and coaching and mentoring are two very different things.

[00:26:33] A coach talks to you, you know,

[00:26:35] it's not like if you're out there playing basketball,

[00:26:38] coach K say and you know, Luke how do you feel out there?

[00:26:41] What do you want to do?

[00:26:42] I mean he's telling you this is what you're gonna do

[00:26:45] and I think that young doctors need that

[00:26:48] in a positive way but a mentor sometimes is someone

[00:26:53] it's not necessarily you like working for you,

[00:26:55] it's hard for you to be my mentor.

[00:26:57] A mentor might be someone, you know outside the practice.

[00:27:02] Sometimes a great coach can be a TC of hey

[00:27:04] this is what I would do, this is what I think you should say

[00:27:08] but promoting and sponsoring is a huge part

[00:27:12] of a younger doctor's success that joins a practice

[00:27:15] and for anybody that wants to bring an associate on

[00:27:19] I think the things that we hear is

[00:27:20] well I don't want to promote somebody that isn't gonna stay

[00:27:23] but again if you're not promoting them

[00:27:27] and you're, I hear this a lot.

[00:27:30] Oh this associate's lazy, they don't take any dentists

[00:27:33] out to lunch.

[00:27:34] Well I can assure you that that dentist

[00:27:36] doesn't want to go out with that associate.

[00:27:38] They want to go out to lunch with you

[00:27:40] and the best thing to do is you to continue

[00:27:43] to go do those lunches either while the associate

[00:27:46] runs the clinic or bring the associate with you

[00:27:49] and introduce them, let them see you interact

[00:27:52] and how much faith that you have in this person

[00:27:55] but just expecting an associate to plug in

[00:27:57] and do those kind of things is a challenge

[00:28:00] because again this is not something

[00:28:02] they had to learn how to do so

[00:28:04] a lot of times what adding an associate will allow you

[00:28:07] to do is to grow by giving you some more time

[00:28:11] to work on those things but expecting them to go out

[00:28:14] and do the promotion themselves, it's a fail

[00:28:18] it's just not gonna work.

[00:28:19] Yeah so have the right expectations going into it?

[00:28:22] Yeah you're a promoter and a sponsor

[00:28:24] you're bringing in this person on

[00:28:25] and transferring that goodwill to them

[00:28:28] of your reputation as pivotal.

[00:28:30] I love that coach, mentor, promoter.

[00:28:34] Did I get it right?

[00:28:35] Perfect.

[00:28:36] Yeah you did.

[00:28:37] When is it time to transition and how do you plan for that?

[00:28:41] There's again and I'm sure you see this way more than we do

[00:28:46] but a lot of the older docs more so in the autumn of their years

[00:28:52] they think maybe I can keep going till I'm 80

[00:28:55] or 75 and then you have these younger docs who are like

[00:28:59] well I really wanna have a transition plan in place

[00:29:03] and how do I do that?

[00:29:05] And I'm sure that's when a lot of people come to you guys

[00:29:08] for guidance and help but what is best

[00:29:14] and I'm sure it's individual based on the person's goals

[00:29:17] and setup but how does somebody know

[00:29:21] it might be the right time to start that process?

[00:29:23] That is a great question.

[00:29:26] And I kinda have a two part answer.

[00:29:29] Transitions have changed tremendously

[00:29:33] and it's just kind of evolved into

[00:29:37] it's not what it was 10 years ago.

[00:29:39] 10 years ago a doctor would think,

[00:29:41] okay I'm ready to transition,

[00:29:43] I'm gonna get my practice valued

[00:29:44] and I'm gonna find the buyer

[00:29:46] and I'm gonna sail off in the sunset.

[00:29:49] That is just not how it works anymore.

[00:29:52] For one factor is school debt

[00:29:56] has impacted younger doctors tremendously

[00:29:59] and then you've kinda had the last five years

[00:30:03] has just been a lot, right?

[00:30:05] You had COVID, you have the staffing shortage,

[00:30:09] money's expensive and I have a tremendous school debt.

[00:30:12] So what we're seeing is the younger doctors

[00:30:14] still very much want to have equity in a practice

[00:30:17] but they're a little standoffish of coming out of school

[00:30:21] and executing on a 100% asset sale

[00:30:24] in the senior doctor going away after 12 months.

[00:30:27] The second part of that is we have

[00:30:30] a new generation of doctors

[00:30:32] and it's not as much as millennials

[00:30:35] as it's gonna be the Gen Zs coming in

[00:30:39] and they're a very collaborative group of young people.

[00:30:43] We also are almost at 60% females

[00:30:48] in residency and graduating.

[00:30:50] They tend to be drawn to more partnerships

[00:30:53] and small group practices.

[00:30:56] So what I'm advising people to do

[00:30:59] is depending on the practice size

[00:31:01] and where you at are in your career life cycle

[00:31:04] is thinking about bringing someone on

[00:31:06] because I think that what younger doctors are very drawn to

[00:31:10] is being able to come into a practice work

[00:31:14] and have the opportunity to buy in and become a partner.

[00:31:18] And then in seven or eight, 10 years

[00:31:22] when you're ready to leave,

[00:31:24] you have somebody to buy the remaining 50%

[00:31:27] and they can bring someone else in.

[00:31:29] So we see a lot more people going that route

[00:31:33] just because the buyer base has changed

[00:31:36] and the other part of that is there's a lot of acquisitions

[00:31:39] out there being made like to your point earlier

[00:31:42] of people who are already established

[00:31:44] and looking to grow their footprint

[00:31:46] and acquiring practices in the area as they come up.

[00:31:51] So it's changed a little bit, but I think that

[00:31:55] if you're looking for a buyer

[00:31:57] and you're selling your practice,

[00:31:59] we tell doctors all the time,

[00:32:01] it's a one-to-three process.

[00:32:03] If you're in a hard area,

[00:32:04] it could be three to five-year process

[00:32:07] because it's just sometimes more challenging

[00:32:10] geographically dependent.

[00:32:14] Something else that's really changed in the resident base

[00:32:16] is five years ago, I would say 70% of them were married

[00:32:21] and now 70% are not.

[00:32:23] So where they want to go has changed.

[00:32:27] When you're married and you have a family,

[00:32:29] it's pretty easy to go to a rural area.

[00:32:32] If you're single, maybe not so much.

[00:32:35] So we watch a lot of the trends in the younger doctor base

[00:32:39] because we know potentially they're gonna be the buyer.

[00:32:41] So that's something that we watch

[00:32:43] and those trends affect the transitions tremendously.

[00:32:47] Yeah, for sure.

[00:32:49] And we recently saw you guys

[00:32:52] what was it in St. Thomas?

[00:32:54] Yes.

[00:32:55] And you guys had talked about legacy

[00:32:59] and thinking about what that looks like.

[00:33:03] A lot of times as business owners,

[00:33:05] we are just in habits.

[00:33:07] Well, I mean we're all creatures of habit.

[00:33:09] But you know, you're showing up, you're doing the same thing.

[00:33:12] And if you're older listening to this

[00:33:15] and maybe you've been thinking about this,

[00:33:18] I would encourage you to zoom out, take some time

[00:33:20] and look at what your legacy looks like,

[00:33:22] not just as a orthodontist,

[00:33:24] maybe as a dad or a mom

[00:33:26] or maybe you're a grandparent.

[00:33:29] And what's the best move for everybody?

[00:33:31] Because you just, you get in a habit

[00:33:35] and it's like, oh, I can go till I'm 70 or 80

[00:33:38] and I mean that's great.

[00:33:39] If that's what's best for everybody

[00:33:42] but I was really drawn to what you guys were saying

[00:33:48] around that because too few people really zoom out

[00:33:51] and think about it.

[00:33:52] And time is life is just so fleeting.

[00:33:56] You know, it can be gone like that.

[00:33:58] So I think that is a really important aspect too.

[00:34:01] Absolutely.

[00:34:02] And when I came in this industry, it was about 2010,

[00:34:06] 11, 12 is the years I started working on this component.

[00:34:10] And it was coming out of a recession.

[00:34:13] There were not a lot of jobs

[00:34:14] and there were not a lot of practices for sale.

[00:34:17] People had, you know, we're building up their retirement

[00:34:20] savings again and so doctors were working longer.

[00:34:24] And the saying was, or those don't retire, they die.

[00:34:29] And I used to just think, what in the world are they talking about?

[00:34:33] But they would just work until the very end

[00:34:35] and they would, you know, the practice would just get smaller

[00:34:38] and smaller and smaller because, you know, if you're 75 years old

[00:34:42] everybody referring patients in town knows

[00:34:44] that you're 75 years old.

[00:34:46] And is this guy even going to be able to finish

[00:34:48] this patient if I send them over there?

[00:34:50] So, you know, as you age, it really does impact your practice.

[00:34:55] But I think that bringing in a doctor, you know,

[00:34:58] depending on where you're at and if you're able to do that

[00:35:00] and want to do that, it can re-energize everything

[00:35:03] and then you kind of have an exit plan in the future.

[00:35:06] So, again, we're just seeing a significant rise in partnerships

[00:35:10] but, and you know, or those different

[00:35:12] the general dentistry, you can't just close your doors one day.

[00:35:16] I mean, you've taken on a contract so it is,

[00:35:19] you really do have to think about your exit plan

[00:35:22] because no matter what, you're probably going to be able

[00:35:24] to get your probably going to continue to work for 18 to 24 months,

[00:35:27] even if you stop taking new patients

[00:35:30] and stop starting treatment.

[00:35:32] So, it's not something that you can just walk away on.

[00:35:34] You really do have to plan and understand the timeline.

[00:35:38] Yeah, get a plan in place, be strategic.

[00:35:41] Yes.

[00:35:42] What is the next generation of ortho?

[00:35:45] So, the next generation of ortho is, you know,

[00:35:47] everyone's talking about it.

[00:35:48] We've had a huge gender shift

[00:35:50] and so we are definitely graduating more females than males.

[00:35:54] Much more diverse demographic than what it used to be.

[00:35:59] And all of that is really impacting the migration of patterns

[00:36:03] of where doctors go and where they practice.

[00:36:05] So, it's something that we pay attention to very closely

[00:36:09] but I think the young doctors are absolutely amazing.

[00:36:14] There's a lot of stigma around, they don't want to work.

[00:36:17] They only want to work three days a week.

[00:36:19] They don't want to own a practice

[00:36:20] and we find the exact opposite.

[00:36:23] They're very eager to get out there

[00:36:25] and start their careers.

[00:36:27] They very much want to still own a practice someday.

[00:36:30] They just, again, are a little gun shy

[00:36:32] of popping out a residency

[00:36:34] and buying something right away.

[00:36:36] But we think that partnerships

[00:36:38] are going to probably be,

[00:36:40] in corporate entities are probably going

[00:36:41] to be the predominant modality in the future

[00:36:45] just because we have had that gender shift

[00:36:48] and the females tend to be drawn more towards partnerships

[00:36:51] and small great practices.

[00:36:53] Are most young doctors coming out of residency

[00:36:56] and going corporate?

[00:36:57] What's that look like?

[00:36:59] Sure, we get that question a lot

[00:37:01] and the data shows, they're definitely not going all corporate.

[00:37:06] I would say that about 30% of residents

[00:37:09] are joining corporate practices.

[00:37:12] What we find young doctors are really looking for

[00:37:16] is really a practice with a great culture

[00:37:19] where they can really hone in on becoming

[00:37:22] a good orthodontist.

[00:37:24] They really want to, again, have that onboarding,

[00:37:30] that coaching and mentoring experience.

[00:37:33] They have heard good and bad stories out there

[00:37:38] about joining corporate groups.

[00:37:41] Most of the specialty lead groups are doing great.

[00:37:44] It's definitely some of the groups

[00:37:46] that are more dental service organizations where they struggle.

[00:37:50] But they're really looking at that first job

[00:37:53] as an extension of their education

[00:37:55] and really hoping to join a practice

[00:37:57] that has got a trained skilled clinical team

[00:38:02] to help them get the conversions.

[00:38:04] Good TCs, they're very leery of sometimes

[00:38:08] I'll get a phone call from someone and they'll say,

[00:38:10] well, gosh, the TC started the same day I did

[00:38:14] really putting a doctor in an environment

[00:38:16] that doesn't have the best team

[00:38:19] like if you had two locations.

[00:38:22] They're not gonna do as well as if you put them

[00:38:25] with the team that really knows how to run that clinic.

[00:38:28] So they're really looking, again, at that first job

[00:38:31] looking for a great culture,

[00:38:33] looking for a highly skilled team, somebody

[00:38:35] that's gonna take time and coach them and mentor them.

[00:38:39] And we always say, hey, if they have a great first

[00:38:43] experience, they might not ever leave.

[00:38:45] So it's really important.

[00:38:47] So if there's somebody listening watching

[00:38:49] and they wanna know more, they wanna connect with you,

[00:38:52] what's the best way to do that?

[00:38:54] We would love for them to give us a call

[00:38:56] or reach out via email

[00:38:58] and I believe you're gonna be sharing that information.

[00:39:00] Shannon, thanks so much for coming on

[00:39:02] the Grow Ortho podcast today.

[00:39:04] I really appreciate it.

[00:39:05] Absolutely, it was a pleasure being here.

[00:39:07] Thanks for listening.

[00:39:09] If you'd like to learn more about hip

[00:39:11] or any of the topics in this episode,

[00:39:14] send an email to helloathipcreativeink.com.

[00:39:18] That's helloathypcreativeinc.com

[00:39:23] or jump over to our website at hip.agency.

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