What No One Tells You About Growing a Dental Group

One successful practice is a huge accomplishment. And then one day, you decide to expand to a larger practice, let’s say from 4,500 sq. ft. to 7,000 sq. ft. or even 14,000 sq. ft., or own multiple practices.

Most people I’ve met are doing it based on some rough numbers, advice from the banker who loans them the money, and a gut feeling. I’m all for gut feeling, but growth at scale needs to be based on a few more things, and I want to discuss them.

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1. Personal Impact

If you are single, skip to point 2. If you are not, then you have more on your plate. Family, spouse, kids, ambitions of people around you, and most importantly, your own ambitions.

Growth at scale will consume you and involve people you love, whether you want it to or not. It’s not good or bad, it’s just going to happen. So before you ascend, talk to your loved ones and paint the picture as realistic as you can and understand that they don’t have to do it with you. So sell them on the vision! 

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2. Are you a good person?

There is no hiding when scaling. Occasionally, things will be said that are out of context. But more importantly, are you intentional about what you say?

Are you really going to pay yourself last? Are you going to honor what you said and not play, “Well, if you look at it from my perspective”?

It’s pretty black and white, and people feel it.

Are you going to provide health insurance before buying yourself the thing, whatever that is: the car, the purse, the crazy vacation?

There is time for everything, and your team needs to have a leader who is successful, but not at their expense. Take care of your people first, take care of your family, and then show how successful you are.

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3. It will test your leadership and soft skills

With one successful practice, the leadership required is very basic: morning huddles, hire and fire, get your team energized to reach collection goals.

I don’t want to come off as if I’m downplaying leadership at this level, but we can all agree that it will require a different level of leadership with multiple locations.

You will be tested on a philosophical level. Is your moral compass right? Even a simple joke like “you are still on the clock” can get you in hot water.

Can you be unfazed by the positives and negatives and not let that get in your head?

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4. The industry will play you

Dinners and schmoozing are still in full swing, and it’s still “how business is done.” Dentistry, just like any other industry, is a machine.

It will lift you up or tear you down in a second. It will try to tell you, “It’s been done this way,” or “Who are you to try to change things?”

And my experience is that it doesn’t matter.

What matters is what you believe in and whether you are ready to get tested. That’s all.

No emotions. No “poor me.” None of that.

This is why I think immigrants do much better, because we have no perception of how it should be. We just work at it as if none of it is promised to us.

Just be ready to get calls, accolades, awards, Facebook group trolls, negative reviews at scale, employee complaints, all of it at the same time. 

And most importantly, none of it is important and shouldn’t derail you if you have your “shoulds” in check.

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5. Ideas are gold, but only the good ones

People say ideas are worthless, and it’s all about execution. Well, I agree that bad or average ideas are worthless.

But boy, what does a good idea do to a business if it’s met with excellent execution?

Unstoppable.

So ideas are worth gold, but only the good ones.

In order to get a good idea, you will need to generate lots of bad ones. And occasionally, in the shower, while grilling, or while taking kids to an event, it hits you like a truck and you better have a pen and paper near you.

When does a good idea find you? When points 1–3 are in check and your mind is open.

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6. Do it for the money

Too many times, we hear people sound negative about money or the idea of wealth.

But the more comfortable you get with money, the subject of money, and the idea of making money, the more opportunities you get.

I also think that people who talk negatively about money don’t believe they can accomplish what they want.

So go for it.

But the framework is not that money is the end-all, be-all goal. Profit for the business and running a profitable enterprise is the goal. Money is not the mission, but profit is what keeps the mission alive.

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7. Have strong opinions

Be flexible on how you arrive at conclusions. Keep an open mind.

But have a backbone on 3–5 things you truly believe in.

Don’t bend.

People will judge whether you have a strong opinion or not, so at least let them judge who you truly are instead of an uncertain version of yourself.

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8. Know the difference between confidence and arrogance

American business culture, from an immigrant’s point of view, often rewards arrogance.

Confidence is knowing and believing you will become someone, and chipping at it every day in the dark.

Arrogance is letting the world know before you get there.

People feel the difference. At first, they might confuse the sound of confidence with arrogance, but over time, actions speak louder than words.

Confident actions will take you much further into the future than arrogant words.

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9. Who is your number one hire?

It depends and will require you to look in the mirror.

If you are a clinical genius, then an ops person should be first on your list.

If you love ops, then you need someone to oversee clinical work.

If you have that covered, I would hire an HR person first who helps you build the org and has a pipeline of candidates: associates, ops people, finance, etc.

This person translates your values, culture, and DNA to the organization.

It’s extremely important to get this person right. And again, make sure you resonate good values, not just on paper, but actually.

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10. Build systems

A one-page Google Doc “this is how we greet new patients” is an SOP, standard operating procedure, and is a system, even as small as it looks. 

Your values written down is a system.

Whether you pick Gmail or Office 365 is a system.

Just try to document your decisions so you can come back and fine-tune them.

People who succeed the most are the ones who always change. But you can’t change if you don’t document decisions and processes. 

You tried one practice management software and it didn’t work? Well, cancel and move on to the next. It’s hard. Your people will be mad. But own it, pay for extra time to learn the new software, and move on.

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11. Waste time early and a lot

In the early days of scaling, you have a lot more time and the decisions are less impactful.

So let yourself waste time a lot.

Go to a conference that has nothing to do with dentistry, but is about HR and systems.

Talk to the local bankers.

Go hang out with nonprofits in your area.

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12. Don’t delegate or outsource critical parts of the business

We all agree that hiring associates is a critical part of any scaling group. So you wouldn’t outsource that, and it should be a core competency of your business.

But let’s take something like a call center.

Most will tell you to outsource it, but what if you are building in an area where people love to chat on the phone, and you know that most dental practices don’t answer calls at all or don’t know how to schedule appointments?

So why not make that part of your core competency?

Build a training process. Hire based on human traits. Monitor. Sit next to each person. Listen to the calls.

This is just an example, but as you are building your org, decide what your core competency will be early on, then keep it in-house.

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13. We are not rich enough to buy cheap stuff

One of my good friends used to say that, and I think it’s extremely valuable in business.

Time is your (and your employees) most valuable asset. And if you are spending your breath trying to get $2/box gloves, you may not build the organization you are dreaming of.

Build partnerships that allow you to have a shared vision with suppliers, vendors, and anyone you are buying from.

At some point, it becomes a liability to buy cheap stuff. That could become an emotional or legal challenge later.

Remember point 11 about wasting time? Early on, waste your time learning different products and vendors. Go visit them. Buy cheap stuff, try it yourself, and at some point, you need to become the most expensive buyer in the room, as long as what you are buying gives you time back.

Focus on core competencies.

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14. Simple vs. Easy

Don’t chase easy. Make things simple.

Businesses are meant to take complex problems and make them simple.

You are building a practice in rural Wisconsin and half of your patient base can’t get to you. You hire a bus once a week and help people get to you. Or you have a mobile clinic.

This is taking something complex and making it simple.

Chasing easy doesn’t serve you in the long run, and most importantly, it doesn’t help you build the business muscle.

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15. Private Equity changes everything

You will scale, find your success, build a great org, and then, drum roll, people in Patagonia vests with fancy titles will start calling you, offering blue sky, telling you how great you are, and taking you to sporting events in private jets.

Everything I described in point 4 will seem to happen all over again, except private jet flights will feel special.

They will present PowerPoints of all possible ways to engineer a successful exit.

And at the end, it’s your call.

Only you, depending on how the legal docs are structured, can decide whether to sell or not.

More importantly, it’s who you sell to.

That’s where I hope you will feel responsibility to the industry to find the right partner who can carry it forward if or when you decide to sell. 

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16 Bonus Point: Keep a good circle of friends

You will make good professional relationships and work closely with amazing employees, but don’t look for these people to replace your circle of friends.

Your friends, your core group, be intentional. Call them. Share what you are going through. Let them judge you and poke fun at you. This is the place where you don’t have to carry a serious face or be someone.

Be yourself.