How to Know Your Practice Is Ready for the Next Level

Growing your practice can be incredibly exciting, but incredibly intimidating. Kiera tells listeners how they can scale with confidence by giving specific questions to ask yourself. These include:

1. Are your systems running smoothly?

2. Are your teams aligned and accountable?

3. Do you have a clear data back-growth plan?

4. And more!

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Transcript:

Kiera Dent (00:00)

Hello, Dental A Team listeners, this is Kiera. And today I'm super jazzed because I feel like this is such a great question that so many offices ask me of like, okay, Kiera, how do I know that my practice is ready for the next level? How do know I'm ready to add in more team members? How do I know I'm ready to add an associate? How do know if I'm ready to add another location? And I feel like so many of these things sit in our brains and we're always wondering like, how do you know? It's like, how do you know when you're ready for the next baby?

 

but instead of like babies, which like really, how do you really know? There are certain things to know or how do you know if you're ready to get married? Well, there are certain things actually. So let's take some of that guesswork out, make this a little bit more fun and have a great time on today's podcast. I'm excited and I hope you're excited. The Dental A Team was built for doctors. It's built for team members. That's why it's called Dental A Team. It's consulting for dentists and teams. I hate as a business owner where people just teach me and I have go try and take it back to my team.

 

but I love being taught, I love being focused and I love having high level and then I love having implementable things for my team, but from someone who's been there, done that and done that successfully. So that's what we've created. We have a space for doctors and CEOs and entrepreneurs to come and get together like-minded where we're talking high level. This is where I come into play. We have fun, we have business freaking tactics. We call it Think Tank Tuesday and we literally get all together and have a great time. And then we have our in-person mastermind where we're doing the same thing as business and life on purpose.

 

And then we have our consultants, including myself, our consultants then work with your team. We're going to be teaching your team members how to make your vision a reality, how to scale, how to have the conversations. I say we're like little fairy godmothers for your team members, where we literally are hanging out with them to help them know the resources and the easiest path to get the results they're looking for. That's what we're obsessed about. That's what we do for offices. And I hope that we're a part of your office. And if not, I hope we're apart really, really soon. All right, you guys, let's dig into how do we scale with confidence?

 

Because growth is super freaking exciting. Like, oh my gosh, we're growing. But back to me, when I first started, we were 500,000 to 2.4 million in nine months in my first location. We bought our second location and you better believe it was fire. And fire is exciting, but it burns hot. And it got hotter and hotter and hotter. And it was because I didn't have a plan. We just were like, sweet, we're at this amount. So let's buy our second location. And it became mayhem and it became crazy. And so it's one of those things of like fires can be beautiful and we can sit there and roast s'mores.

 

But fires can also be very, very volatile. They can destroy, they can burn fast and they can burn hot. And so this is a zone where if we have a plan, we're going to do really well. If not, we get burnout, we get turnover, we get stalled progress. We actually get sloppy. We actually could fall into really scary things. Like for us, it was full blown burnout. I was on burnout or my owner was on burnout. We were working from 2 a.m. till 10 p.m. every single day. ⁓ Our marriages were falling apart. Like everything was bad. Everything. It was not good.

 

and we would show up to work just to feel like we were like barely, like nose barely above water, but you better believe there's water getting into that. And so this is something where I really wanted to come on today of how do you know and how can we scale with strategy? How can we scale and know that we're ready for the next level? Because if I would have known this, I would not have bought my second practice. I would have optimized my first practice. I would have put a few more things into place and then bought the second location. But you know, I was young, dumb, I was reckless. We were just like.

 

We can do this. did the first one, but the first one wasn't like barely hanging on. We had two pending lawsuits on us. Like there were wild things going on, but yet shoot. I think that sometimes it's good to have a little bit of naive, ⁓ but I think it's more important to have a good plan and a good process. So this is the goal. It's not about adding ops and team members. It's truly about making sure our foundation's awesome, making sure that we know what we're doing, making sure we've got a good plan and then executing it. And that does not mean it needs to take a long time. You can scale very quickly, just making sure you have a few key places.

 

And I like to tell people our goal is to get flagship practice number one solid. We stamp it out and then we just stamp it out, map it out. We have a few nuances that we change based on location and demographics, but generally speaking, it's about the same thing. ⁓ $1 million, one practices versus multi millions, multi practices, multi ops, two very different models of business. So on that, this is what we love to do today. This episode is really for owners and offices asking the question of what's next, but scaling smart.

 

not fast and also looking at like the DSO landscape of where we headed. Do I DSO? Do I grow? I have a practice and what they were thinking about doing is they're thinking of selling out to a DSO. And I said, cool, but like, what's your plan? I'm like, I still want to keep doing dentistry. And I said, all right, let's look at the numbers. And what was wild is a DSO is going to pay this practice 5 million. And right now you might be like, dude, that's so much. Like I'd sell in a second, like one more bad day and like give me the DSO's number. calling them.

 

But we looked at and I said, all right, let's expand out a couple more ops, which you've already been thinking about doing. And realistically in the next one to two years, like that's what the DSO is going to do. They're going to come in, they're going to expand this out. So either you can sell to them and live here and do it with them, or you can do it before that. And literally we did that. And this practice in two years is making 5 million net profit. And I think about that because it seems so tempting to sell to the DSO and how it's like, but you're giving up all of this. And if we just had a quick plan.

 

This doctor now is working about two days a week. They have associate doctors in place. They have this beautiful building and they're looking for the next expansion piece. Beyond Happy, this is their plan. And they're literally making more than they would have with the DSO. And so just be careful, because I think sometimes DSOs can seem so sexy and alluring when we're having bad days. You better believe it. There have been days when I'm like, someone walks by and offers me a buck for Dental A Team. They get it, right? We all have those days as business owners. That's not a joke. It's real life. But I think this is where we can like,

 

not make reactive decisions, but actually figure out how we wanna scale. And what I will always say is when we scale and what's next, I want you to always ask the question of what do I want in my life and what do I want my life to look like? Because we can scale. You can have 10 practices and say, only wanna work one day a week. That's totally allowed. It's just a different strategy. Or you can say, wanna be a clinician. I love doing the dentistry. Again, different strategy. I was on an on-call yesterday with a potential client and they were like, Garrett, we need systems. We need to have help with our finances.

 

our financials and we also need help training our team. And I was like, rock on, that's right up our alley. And at the very end of the call, I said, Hey, is there anything else you feel like I should, I need to know? they're like, well, yeah, we're considering selling in a year. And I was like, wow, that changes the entire plan of what I would do because I would not be building all the systems if we're planning to sell in a year. I'm going to be cranking your EBITDA. We're going to be working on case acceptance, adding production to this practice to make sure we're getting top dollar for the sale while also making it easy and enjoyable to live there at the same time. So one of those things of

 

where you want to go and what your North Star is, radically changes your question of what's next. It's what's next based on what you want to do. So when we look at this, I really want you to think about and look at these pieces of what's next. And again, some of these things might change depending upon what your next is. If we're selling to a DSO, it looks very different than if we're building a legacy practice. So just know a lot of these pieces might be dependent upon where you want to go.

 

So number one, I think this is a great thing. If you want to grow, you want to add another practice, you want to add more ops, you want to add more team members, you want to grow to the next level financially, is make sure your systems are truly running without you. So you don't need to be there in every single decision. Doctor, you don't have to be answering, signing off on what are we ordering? We don't want to be signing off on payroll. We literally have built this delegation ladder. We have team leads in place. The systems are running where the team can execute daily. We have end of day checklists. We're not having to look over every single thing.

 

We have checklists of what people need to be doing. It's very clean. People are in the right seats. They know what they're doing. We have clear operations manual built out for scheduling, billing, case acceptance, hygiene, all these different areas of our practice. It's clear. We have it mapped. We have documented systems that are followed by all. So not just documented, but truly followed by all. ⁓ And honestly, it's something where doctors, would recommend, a fun thing. You're welcome. I'm giving you a vacation. You leave for two weeks.

 

I want you to leave the practice for two weeks. And when you're gone, I want you to see that practice thrive while you were gone. Did it barely survive? Was the team able to make decisions without you? What systems fell apart and let's fix that. This is something where doctors are always a little nervous to take time off for production. Yes. But I say it is absolutely essential and crucial doctors that you take time, you leave the practice so you can actually find out what's breaking down. Same thing with office managers and leads. We need them to leave. We need you out. And what's wild is when offices, I see them. So for example, I have a doctor.

 

They usually take about two to three weeks up in the summer. They usually take two to three weeks off in the early spring. And it's awesome. And what happens is on those months, production doesn't The practice doesn't fall apart. The office manager is able to execute the way the doctor would execute. Team culture runs the exact same, whether the doctor's there or not. And that to me is a sign of your systems are not dependent upon you. So if you want to do a stress test, rock on. Prep your team. don't just like spring it on them. That doesn't usually go well.

 

but stress test and go for two weeks and see what happens to your practice. And then also look to see when you go around and you're doing your CEO time, let's rate every single department in our practice on a one to 10 of how are they doing? Could they run this without you? Do they know what they need to do? Are we hitting the KPIs that we need to hit? And if not, do we need to put some systems into place that can run independent of you? So that would really be a good stress test of go on vacation and also rate your departments and see where maybe our system is lacking. Now.

 

I will also put a word of caution because a lot of times doctors, are very meticulous. That's why you're dentists. That's why you're working on that little box on the MO and you do so well with your very, very, very, very fine skills because that's what you do day in and day out. A lot of offices are actually ready to scale with their systems. Being systematized where it runs without you does not mean perfect. And I really want you to hear me loud and clear. It is not about being perfect. It's about being scalable and that this can run without you and that you're really able to move things forward. So.

 

A lot of people get stuck and they don't grow because like, don't have every system in place. No, we're talking that like the bulk of your KPIs are able to be hit. The bulk of our systems are able to follow. The culture doesn't dip when you're gone. Production doesn't dip when you're gone. ⁓ But you might be more ready than you think you are. So be careful. There's a second side to it. Make sure that we're good on that rather than just being like, ⁓ my systems will never be perfect. Cause honestly, systems will never be done. Your practice will never, ever, ever, ever, ever be done. But that doesn't mean it's not time to scale. So that's your system's text. Number two.

 

Teams aligned and super accountable. So this is different than the top one because it's about systems running. But when the teams align, this is us hitting our KPIs. So we have leads in place. They own their area. They own their numbers. They hit their metrics consistently. We literally have a weekly leadership meeting. Even if that's just your whole team, we're hitting our metrics. We're reviewing our wins and we're all staying accountable to it. So this is what we're looking for is team high level accountability. If we say we're going to do it, we follow through. If we say we're going to get this KPI, we do it. If we say we set this goal, we hit this goal.

 

And honestly, a big piece of that is we're not having a ton of turnover. So that's helping me know that your practice is stable. Your team is stable. We're hitting these KPIs. So if you're not tracking your data, you're not tracking your numbers, you have no clue. I would strongly advise not growing and adding more ops because all it does is it just makes the chaos even bigger. Trust me, I did it. I had no numbers. I had no KPIs. I had no accountability. I had no team members reporting up. And then all of sudden my problems doubled because now I had a second location and none of this was in place. I will tell you, it is a train wreck. You can get through it.

 

but it is not fun and I almost didn't get through it. So for this is just make sure that we have our leads, make sure that they're reporting. And I have a practice who started doing this and they were around like 3 million ish and they grew to 5 million, but just been putting their numbers in every single week, their leadership teams looking at their numbers, they're making adjustments every quarter. We're setting goals for them and we follow and that's just happening in one year. So exponential growth can happen and be careful because you can actually squeeze more juice out of your lemon.

 

in your current practice by even following these steps. So this can be growth internally. It's kind of like a house, right? Like we can go buy a new house or we can just make our house even more awesome. There was an office that I knew and they literally were like, we can go buy another house, but why don't we just invest the money here? And they've made their house this incredible oasis, made it even better. They have even more fun. That's something that you can do in your practice too. So don't, don't worry. It doesn't mean have to sell. doesn't mean you have to scale. It doesn't mean you have to have multi-practices. It doesn't mean you have to expand.

 

It means you could even do this within your practice, looking at these pieces will exponentially help you grow to the next level with ease. Number three that you're ready for is you have a clear data back growth plan. So we're looking at this and we're making sure that like, our KPIs are tracking and that we are profitable and we have the right patient flow to be able to grow. We have the right team members. We have a pipeline in place to bring on another doctor. We have a pipeline in place to have more hygienists coming in. Like we are not going to get stuck in that area.

 

We have an office manager or regional manager that has the bandwidth to be able to go. Our billing team is very consistent. Our collections sit at 98%. ⁓ And then what we have from here is we're going to have a scaling growth plan. So when I work with offices, we had a doctor reach out. They were at a four ops practice and they're going to an eight, they thought, and we pushed them to a 10. I asked them, are you so glad we went to a 10? And they said, Kiera, the answer is yes. I thought you were crazy. And I was like, nope, you will never regret having more ops. But they started with us. So we're talking four ops to 10 ops. And what we did before is we literally started with this practice.

 

about 12 months before they expand and we started putting together the plan of, all right, we're gonna start saving money. This is how much it's gonna cost. This is how many team members we're going to need. So let's start building the pipeline for it. We're going to need a doctor at this point in time. So you're gonna need to start working on that. We're gonna be meeting with the contractors. We're going to be expanding this out. And honestly, this doctor is so happy because they have the cash. So when they built it out, they weren't cashflow stressed. They had a new patient plan to grow. They had a plan for a new doctor. We had associate onboarding documents in place for them. We had a hygiene pipeline.

 

We had the new patient plan. We had the doctor's plan of what procedures this doctor was going to do. And literally this doctor was like, well, another building just came up. Do you think that I'm ready for it? They had just opened the 10 ops. And I said, well, the answer is I actually think you are pretty well ready for it because we had the KPIs. We were tracking the pieces. We had a plan and we did this for almost 12 months. There's another office that was bringing in a partner. And for 12 months, we figured out how much is their true pay of true compensation.

 

We worked through all those different pieces for them. So that way when the partner bought in, it wasn't this chaos for them. And I think this data-backed growth plan of knowing what the reality is of how much your expenses will be, having things in place, having your reserves, your financial reserves, that's going to make it to where you are not stressed out of your mind when you take this on. Because cashflow, resources, not having enough money.

 

That's going to cause chaos. That's going to cause frustration. This is going to cause like, oh my gosh, I don't think I can do this. Then on top of it, you have systems. Then on top of that, you have team members that aren't accountable. And you're like, oh my gosh, I now have like 25 team members and it's so stressful. And like, I wish I never would have bought the second practice or I wish I never would have expanded. And I'm like, it's not that you wish you would never would have expanded. You wish you would have just done it differently. That's what it is. You wish you would have just done it differently. You wish you would have had a plan in place. You wish you would have had the cashflow for it.

 

Because it does take, like when we expand out, I told this doctor, said, I want you to plan three to six months of reserve of cash of covering all these expenses. So we're building up, building up, building up. They were very profitable at the beginning, like very profitable on this for-off practice. They just were expanding it they were too stuck. Like they had no more space. Same thing with my other practice. They were eight and they went to 15 ops. They were just stuck. But if you don't plan for these pieces, I said, I want you to have three to six months worth of cashflow.

 

when you go into whether we're getting that as a loan or working capital or you're building this up over the next couple of months while we build this out, these doctors are so secure. And then what we do is once we expand it, know that we know the metrics that we need to hit to be able to pay for all these expenses that we just put into place, still give a great patient experience, still give great case acceptance, still give great exams, still give great hygiene, so we're not sitting here stressed out of our minds, we're having to do all these pieces.

 

because my gosh, we just bought this so now like sell as much as we possibly can because I'm stressed out of my mind. It takes all that stress out for these doctors and it really makes it to where they reverse engineer and we figure out staffing, space, systems, finances, protocols, when do we do this, how do we build this out? And it's wild because when you have someone who can coach and guide you through that, it's insane how much better prepared you are. Also with these doctors.

 

We squoze the juice out before they expand it. So how can we maximize and optimize? I another doctor who had four ops. Like, here there's no space. I'm building this building across the street. It was a beautiful building. And I'm like, but you actually have space for one more op in this practice. And they're like, what? Why didn't you come four months earlier? And I was like, well, hi. So we added another op, even in the time they were building the practice, we spent the money on it. And it's crazy because that one op produced about $400,000 $500,000 in just one year in that one extra op.

 

We were then able to take that money and obviously apply it to the next building and they were able to maximize that space that they were in. So looking at that reverse engineering is really going to give you clarity. And so when we look at these three strong signs of you're ready to grow with strong systems in place, team accountability, and then a clear plan forward that you're planning for, you're preparing for, you're executing on, and this is going to truly help you have confidence. Confidence comes from being prepared. Confidence comes not from being perfect.

 

Confidence comes from, know where I'm headed, we've got these pieces. And I tell every single doctor we work with, I'm like, listen, we're gonna do our absolute best to plan and repair. We're gonna do our absolute best to get the numbers in place. There will be things we forget every single time, because we're not perfect. But the antidote to fear is action. The antidote to fear is having a plan. The antidote to knowing if you're ready to go is to be prepared in these areas. And so I really think when you look at this, like, don't have to guess if I should go.

 

Don't guess and be like, Kara, where it's like, we've got the first one, let's just add on a second one. You're welcome to, it's just a thrill of a lifetime that I think adds more burnout, more stress, more chaos than necessary. And I'm like, you can have the same growth, you can have the same scalability, just with more strategy, more fun and more predictability. So if you're interested in about it, don't guess, like just DM us. We have ideas to how to scale, we have different pieces you can DM us scale, you can say like, hey, I'm thinking about this, how do I know? We'll get on a complimentary practice assessment with you.

 

give you like complimentary advice, truly, we're gonna help you build a plan and see how we can fit, how we can help you. But really, if you're thinking about it before you sell to a DSO, even this practice I was talking to, I was like, listen, there's other options because we work with hundreds of practices, we see different scenarios, this is why we get our doctors together, is because the more we learn and the more we educate each other, the better decisions you're able to make. Do not be paralyzed by fear and not make a decision, because what's worse than making a wrong decision is not making a decision. So make the decision.

 

Execute and truly let us be your guide get a guide guide through it. It makes it so much easier You're able to scale faster not be stressed out and really this is what we excel at This is what we're great at so reach out [email protected] comm click on our link on TheDentalATeam.com podcast Make sure you're following along for more tips and tricks because our goal is to make your life less stressful More fun and more predictable and as always thanks for listening. I'll catch you next time on the Dental A Team podcast