Dental Entrepreneur - Fall 2022

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Fall 2022

Editor & Publisher

Anne M. Duffy, CEO, RDH

Assistant Editor Clare Yeo

Project Manager Tari Sixpence Website

Bhakti Kulmala

Director of Strategic Partnerships

Melissa DeLong

Editorial Board

Mary Fisher-Day

Travis Rodgers Barb Stackhouse Dr. Lucas Shapiro Dr. Dirk Fleischman Dr. Earl Douglas Dr. Tom Snyder

Derek Champange Dr. David Rice

Layout and Design Brian Rummel

Fall 2022 Contributors

Dr. Franklyn Aguebor William Barrett Dr. Laura Brenner

Thomas Farmer

Dr. Jeremy N. Krell

Dr. Victoria Peterson

Travis Rodgers Dr. David Rice Dr. Luke Shapiro

John Palmour’s obituary was a great read with my morning coffee and the Sunday WSJ. “Once you finally get those first couple of people, everybody else wakes up and starts to follow suit,”he said. “Getting those first early adopters is the hard part.” His Startup could keep going because “we were small, we were nimble, we were crazy.”

Does that resonate with you?

His words certainly hit a chord with me, being married to an entrepreneur and being one myself. Most people stop at the first few signs that entrepreneurship may not work. But it’s important to remember your “why” and to keep pushing through. And if you’re feeling burnt out or having difficulty staying on the path to your dreams, you’ll find some valuable takeaways in this edition.

Our cover Doctor, Dr. Jeremy N. Krell, shares his journey of pivoting from a practicing dentist to becoming a venture capitalist. Most importantly, he gives us a glimpse into his company, Revere, an innovative Venture Capital with a mission to help young founders learn and grow and become leaders, and how his background lends itself to providing successful financing from someone with intimate knowledge of the industry.

You’ll also hear from the inspiring Dr. A as he shares his “why,” how he strives for balance, and how he overcomes barriers. David Rice shares his wisdom on accomplishing the impossible in dentistry, and Dr. Laura Brenner discusses the importance of designing a dental career on your own terms.

From the importance of keeping communication an open and flowing two-way street, as shared by Dr. Victoria Peterson, to Thomas Farmer’s realization of the expensive side effects burn-out can bring – this edition of Dental Entrepreneur covers the gamut.

If there ever was a time when you needed a little inspiration, motivation, and encouragement to keep fighting for your “why,” this issue is it. Crack it open, take what you need, and keep on keeping on.

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My Story

Dr. Jeremy N. Krell, Managing Partner, Revere Partners

I’ve always been passionate about affecting change in dentistry—and helping startups bring innovation to the industry. As Co-founder and Managing Partner of Revere Partners, the first and only independent Venture Capital fund for the oral health space, I invest in and help startups showcase and bring innovation to market.

My involvement in the investing space came from both my experience in the startup operator and the practice of clinical dentistry. For the last decade, I’ve been a dentist, having practiced in different settings, from single practices to multi-specialty, multilocation practices in different states—buying and selling practices as well as scaling practices. I've been in startups for the last 18 years, starting in tech, followed by health tech, and now oral tech.

On the tech side, I started a web and graphic design company and spun two companies off and sold them. Then, a luxury goods and commodity service targeting college students, which we sold four years later after scaling it up. I then started a venture incubator in Boston, New York, Chicago, and San Francisco, and led that for five years. I stepped down to sit on the board after accepting a leadership role at Oscar health insurance, which IPO'd in 2021. Jeremy then became the dentist behind quip, a subscription

electric toothbrush, oral health product and professional services company, and I scaled up the professional services side of the business for about four and a half years.

Next, I moved over into my management consulting firm-meets family office, investing in startups. Currently, I have about 40 companies under management—about a dozen and a half of my own investments. Many of these businesses have raised capital from angel investors, venture capital investors, and corporate investors. Ultimately, raising money from investors, managing that money, and making money for them is a proven part of my track record. That has enabled me to pivot my career, along with the clinical background that I have, into this very specific role of being a dental Venture Capitalist.

My partner Dave Arena and I founded Revere and publicly announced the company in 2021, although we were operating for 18 months prior. We had worked closely together at a dental startup and came to the collective realization that there was a real need for a solution to a problem—there wasn’t a centralized ecosystem where investors or startups could seek venture capital opportunities in the dental industry. Diversified investment opportunities for investors and strong innovative companies were

fragmented.

Innovation was staunched; it wasn't moving forward. Why should a founder invent or innovate a new product or service, just to find out that a necessary step down the pipeline, which is funding to grow and scale, is non-existent? Why bother with the sweat, the tears, everything that goes into that, their own time, their own effort, if they can't reach a point, to grow and scale it? It simply doesn't make sense. Dave and I spent a year researching, and collecting data to understand the problem and the space. This is where Revere was born.

What I especially like is working with young and innovative products and services and teams. I like the element of helping the founders learn and grow and become leaders. I also like helping the product or service go through its product development plan, iteratively designing a solution to a real problem. I like the ability to identify an open market, to be able to help not only capture market opportunity within the existing market, but also discover ways to expand the market itself. It really comes down to those elements of really liking to drive innovation.

Of course, prior to Revere, there were other Venture Capital

Funds outside of dental that didn’t have the industry-level expertise and data to operate in this space. The corporates were really primarily built to deal with later-stage technologies and services, not early-stage. Beyond that, the dentists who invest—it takes a lot of them—and that's a messy process for both the dentists as well as the startup to gain true economies of scale and get enough investment for a real seed or growth round. There simply was no Venture Capital Fund inhabiting this space to help bring a number of different fragmented, decentralized funding resources, into a more cohesive investment thesis.

Revere’s first startups were BrickBuilt Therapeutics, Zuub, and Sleep Architects. BrickBuilt was acquired in 2021. Revere is a high performing fund, posting an Internal Rate of Return (IRR) 39.95% in Q3 2022. Currently, Revere is invested in 28 companies. to date, and might even add 600+ dental startups in our pipeline. On average, the firm invests in about three to five per quarter. Then, we expose them to our ecosystem of about 40+ support services focused on some of the areas that are most challenging for them to overcome, including executive coaching and executive recruitment, IP and regulatory support, DSO partnerships, and more. We have about eight dozen co-VC investors, about six dozen DSO partnerships, PMS integrations, and much more.

Our portfolio companies are doing really well.

Many of them have had additional fundraising rounds, strong channel partnerships, and have seen growth in their revenue and customer sets. Why would an oral tech startup seek out funding from the dental community? If you're thinking longterm and planning forward your ability to grow and scale, you really want active, smart strategic investors to be part of your cap table and your company. The dental industry is a historically self-regulated industry. It is truly the clinicians representing the industry, as well as the patients, that have driven a lot of the innovation, infrastructure, and various ways in which the industry works today.

The dental industry wants to remain a vested party, a true stakeholder in the process. They want to be helping to design the new innovations and inventions that come to light, which means helping to also identify the problems that exist today.

In scenarios where the dentist or the dental industry is not part of the narrative or not part of the conversation, innovations are created that don't necessarily take into account the necessary provider and patient considerations. As a result, they aren’t successful or deliver inappropriate health outcomes.

We’ve seen some of this in some direct-to-consumer companies and others where they’re missing some of the key ingredients, marketing claims and alignment with the industry when they’re actually misaligned with the industry. That can really slow down or even stop their success and reflect poorly on the industry. So it's important to have clinicians as part of the innovation process. That’s what we help to drive at Revere.

We look at companies anywhere from pre-seed to post-Series A—those that have an application to something within dental—from software to FinTech, to consumer products to devices and therapeutics and beyond. They need to be a private company, aligned with the dental industry, doing something good for providers and patients.

On the financial side, we like to see disciplined expense management, early growth trends, and founders thinking about unit economic profitability, even if they haven’t yet achieved any. We also take a look at their projections, as this is more telling than you think. At the end of the day, a financial projection at early-stage is inherently inaccurate, but it’s always impressive to see projections that are well thought out, aggressive, but reasonable. We also look for a plan with the capital. Founders who have strong answers to “What are you going to do with this money?” and “What KPIs will that move,” are really good indicators.

Our process of diligence first starts out with screening. The startup submits its information or is introduced through one of many different channels, from live events or paid and earned media, to organic search. They have a brief 20-30 minute introductory meeting with a member of our team. If there’s a mutual interest, they’re given a questionnaire and a request for some additional information, such as a deck.

Once that's completed, they’re assigned to a diligence team that includes a general partner, a venture partner, and a few associates. The team hears a pitch from the startup and serves up questions, thoughts, and recommendations.

The next stage is deeper levels of diligence that cover specific areas such as science or technology, or manufacturing and distribution. Once that process is complete, the startup can be promoted internally for investment.

As Revere is a Venture Capital fund, Dave and I, as the general partners, make the investment decisions. Of course, we listen very closely to our team and investor base. Our investors range from accredited angel investors (doctors, dentists, professional types), to high-net-worth individuals, including those who have exited a number of dental practices or corporate leaders in dentistry and outside of dentistry, to family offices and public and private corporates, to other funds.

What makes Revere especially attractive to investors is that they can diversify over multiple startup investments via a subscription model and/or multiple flexible payment plans, which frees up cash flow for investors, and provides an alternative to the traditional, upfront lump sum.

Revere’s open nature also allows investors to join over time and continually raise funds, as we don’t have a formal closing for the fund. We even devised a strategy to support other angel groups and funds forming, given the efficiencies and insights we can offer.

One of the main reasons we love dental—especially in times like these—is its ability to be recession-proof. It’s one of the best-kept secrets in investing. We studied the data, looking at past recessions, including 2008, which was particularly severe. At a time when revenues across many industries were declining, dentalrelated revenues in aggregate were flat to up. In fact, as recession fears loom, dental revenues typically jump as there is a bit of a rush to the chair, as individuals prepare for potential coverage disruption due to job uncertainty. There’s great hope in the oral health space.

If I were to give advice to entrepreneurs, I’d say seek out funds (like Revere Partners in dentistry) that know your space rather than waste time on those that are not a fit. There’s a known source that's going to understand your business from an oral health per-

spective, a clear place for early-stage oral health innovations and growth-stage businesses to approach for funding.

Also, Revere will give feedback and always provide you with an answer. We're always happy to check in with you throughout the process; we’ll give you feedback on your pitch, on your materials, or wherever else is requested. This is not, perhaps, the same Venture Capital experience experienced in other bigger or smaller firms.

We also provide a variety of opportunities to startups even in our pipeline that we haven't invested in. For example, we have various access points for startups at some of the big events, from general practitioner events, state events to specialty shows like ortho shows and conferences. We’re frequently offering opportunities for startups to access events and speak, essentially to give these startups a voice, whether or not we’ve invested in the company.

As Managing Partner of Revere, I’m especially proud of our diverse team—a 50:50 men/women ratio—and our recent launch of our second fund, RISE Health. RISE is the only inclusiondriven venture fund focused on oral health with a mission of real Inclusion, strength, and empowerment for untapped talent and underserved businesses in the oral health space— including women-, LBGTQ+- and minority-owned businesses.

While Revere may not be able to invest in every dental startup, our team is passionate about moving oral health innovation—and the industry—forward to elevate best-in-category technologies that promote better health outcomes. We’re especially excited

the future of the oral health space!

Jeremy is a general dentist with a combined business background. He is the Managing Partner of Revere Partners, the first independent Venture Capital fund focused on oral health, and RISE Health, the only inclusion-driven Venture Capital fund focused on oral health. Jeremy previously built out the Barchester Bay Group, a portfolio consisting of over 35 ventures. He has held key operator roles at startups, including Head of Marketing and Chief Dental Officer at Simplifeye, based in NYC, and the Chief Marketing Officer of Verena Solutions, based in Chicago. He oversaw provider and clinical growth initiatives at quip, the oral health and subscription electric toothbrush company and strategic provider innovation and development at Oscar Health (which had an IPO in 2021).

Jeremy has practiced general dentistry part-time for nearly a decade following his DMD at Tufts, sits on the Boards of healthcare and dental startups, and is an angel investor in approximately 30 companies. Jeremy has a 18+ year proven track record with startups through several successful multi-million dollar fundraises and acquisitions.

about

If I were to give advice to entrepreneurs, I’d say there is a fund in the space. There’s a known source that’s going to understand your business from an oral health perspective, a clear place for earlystage oral health innovations and growth-stage businesses to approach for funding.

DE Spotlight: Meet Dr. A

Dr. Franklyn Aguebor

WHAT IS YOUR WHY?

WHY not strive for excellence? WHY not be great?

WHY not be an educator, mentor, and helper to the community? These are my reasons. I've always believed in myself, and self-motivation gives me the ability to always rise to the occasion. I'm happy to be able to utilize dentistry as a medium to fulfill my desire to help people. With my platform, I am able to educate the masses, drive awareness about oral health and the connection to the body, and provide mentorship opportunities for up-and-coming Doctors.

As healthcare providers, we are tasked to not only show compassion and empathy for all patients, but also provide care that positively impacts their overall health. Through my craft, whether it's treating a patient in pain or completing cosmetic work, the feeling of instant gratification constantly fuels my passion. I truly love serving the community and making a difference in my patients' lives.

HOW DID YOU BECOME A DENTAL ENTREPRENEUR?

Being a dental entrepreneur gives you the freedom to do things your way, as I call it, the "Dr. A Way." Before getting on the ownership journey, I worked at several dental offices for a couple of months. I was able to dissect the entrepreneurial world and separate things I would incorporate in my own office and things I would not. So, I took the necessary steps: Created a PLLC, company name, logo, and now we have Smile Design Dental Studio. I chose a prime location in Midtown Manhattan in New York City for my practice, and designed it with modern touches.

For the first 6 months, I worked at an office from 9 to 5 pm and

opened my office from 6 to 10 pm. Offering late hours was a method to obtain clientele and provide care to those that work a typical 9 to 5 day. By the 6 month mark, I felt myself burning out, so I shifted gears and fully dedicated myself to growing my practice. As a practice owner, I had to learn to be 50% Dentist and 50% businessman; that is the only way to be truly successful.

HOW DO YOU FIND BALANCE?

I create balance between work and personal life. The thing is, I love what I do, so it's not a task to go to work daily. What I do is not a J-O-B, but a passion. I enjoy service to the community and crafting healthy, beautiful smiles. I also make work fun by putting a twist to it. I spend time creating entertaining videos that are relevant to dentistry. In addition, I love volunteering and mission trips. Something about being a servant to the community is entirely fulfilling to me and gives me instant gratification. I treat myself often by traveling. I've visited a number of countries, learning the culture, and enjoying various delectable dishes.

HOW DID YOU MEET YOUR PARTNER IN WORK AND IN LIFE?

I would have to say my partner in work is my dental consultant, Larissa Pretoni. I met her 6 months into opening my practice during the toughest point in my practice ownership career. I was going through embezzlement at the time. She was my saving grace and essentially an angel in disguise. When a member of your staff cares just as much as you do about your dreams and future success, they are practically family. She's the rock of my baby, Smile Design Dental Studio.

And my life partner, I can't say much about that quite yet, except God has a plan. HE's creating the greatest gift/ phenomenal woman, so on that topic, we can say LOADING...

HOW DO YOU KNOW YOUR VALUE AND OVERCOME BARRIERS?

You absolutely have to learn your value and know your worth. My value is continuously increasing because I am constantly improving myself. This self-improvement in regard to dentistry means a plethora of practice, continuing education, and building confidence in your craft. Once you have established that, you're essentially invincible and can overcome any barrier.

WHAT IS YOUR CALLING?

If you asked most people, they would say my calling is being an actor, comedian, and rapper, all in one. I owe this to my ability to be able to combine dentistry with modern entertainment. I create videos that are relevant to dentistry and that people can relate

to. Not only do these videos appeal to people in an educational aspect, but they are also hilarious. I also take well-known songs, go to the studio, write lyrics, and create a dental remix using the instrumentals. Then, I'll shoot a music video with my staff and patients, which makes it interactive and fun. Album coming soon!

However, if you ask me, my calling is truly service to the community through my talents. Not solely through volunteer efforts, but also by driving awareness and promoting education in my field. I feel that the more you educate patients or the community as a whole, the more knowledgeable people are, therefore, promoting the act of being proactive rather than reactive regarding their oral health.

WHAT ARE YOUR STRENGTHS?

One of my strengths is my creativity. I take pride in that because I feel that I am truly gifted. When you walk into my practice, it's like a creative space, from the gorgeous decor to the energetic atmosphere. I designed it to build comfort for anyone that walks

in. There's a beautiful stone wall with a grandiose logo that reads Smile Design Dental Studio that greets you upon entry. We have a number of speakers installed in the ceiling so people can enjoy their favorite jam while in the office. The operatories are equipped with beats by Dre headphones and TVs in front of you and on the ceiling so you can tune in to your favorite Netflix show, while having dental work completed.

Another strength of mine is that I am highly driven and see no limit to being successful. Ambition fuels an individual to chase goals, and self-motivation is the characteristic trait you need to attain them.

BEST ADVICE?

The best advice I have ever received is that "practice makes permanent." Everyone typically says practice makes perfect. When you think about it, we are never perfect because we are capable of making mistakes. Even those given the title "the greatest of all time" can fail, but the best thing about that is that they eventually rise and are still victorious. With dentistry, I have to practice constantly to elevate my skills and make them permanent. Attaining high-level skills foster confidence and comfortability; so when I do practice, it is seamless, and I know exactly what I am doing. By no means am I perfect, but I do things to the best of my ability and at the highest quality. My craft and skill set is permanent!

WHO IS YOUR MENTOR IN YOUR CAREER AND IN LIFE?

In my career, I have a number of mentors that have been around since the beginning of dental school. Whether they were upperclassmen while I was in school or practicing dentists, they motivated me to push forward and make sure to know that any goal is attainable as long as you work very hard for it. Getting into dental school, attainable; graduating dental school, attainable; opening up a dental practice in the middle of New York City, attainable; being instrumental in providing access to care to those that need it the most, attainable; obtaining opportunities to speak nationwide, attainable. They all have one common factor. I had to work hard for it! This is the same for everything in life. My mentors in life are my family because they never stop believing in me. They fuel my passion and ability to continue to excel.

WHAT IS THE LATEST INSPIRING ARTICLE OR BOOK THAT YOU HAVE READ?

“Winning: The Unforgivable Race To Greatness” by Tim S. Grover, is a very dynamic book. One of the biggest takeaways I got from the book is to bet on yourself. It made me think, about what makes Dr. A special. Is it my compassion to help others and

see people happy, my work ethic, my positive demeanor, or my ambitious attitude toward life? It is actually all of that but, most importantly, my unshakable confidence in myself, my craft, and my skill. When people doubt you, they are betting against you. This book challenges you to see if you have the confidence to take the other side of that bet and bet on yourself. I am constantly betting on myself, and in turn, I am winning.

Dr. Franklyn Aguebor, also known as Dr. A, was born in Benin City, Nigeria, but raised primarily in Atlanta, Georgia, prior to moving to New York. He has dedicated the past few years in his career to dentistry; from his undergraduate studies in biological science at the University of Georgia, dental school at Dental College of Georgia in Augusta, formal training in GPR residency at Bronx Lebanon Hospital Center to practicing as a board-certified dentist in Atlanta, Georgia and now, New York City. He is the owner of Smile Design Dental Studio in Midtown Manhattan, his private practice dental office, where his focus is cosmetic and general dentistry.

Designing Your Dental Career on Your Terms

Dr. Laura Brenner

Do you remember when you chose a career in dentistry?

With the exciting possibilities life in dentistry could bring you, you were confident that this would be your dream career. You’d get to change lives by helping others improve and maintain their health. From creating a beautiful smile in order to build someone’s confidence, to relieving earthshattering pain for a patient in need; dentistry would give you the personal fulfillment we all seek. Not only that, but a career in dentistry was sure to provide you with security and safety. After all, everyone would forever need dental care, and as a profession, dentistry wasn’t going anywhere. That career security would provide the time freedom, and income that would help you design your life on your terms.

Others saw that potential too. When you shared your decision to pursue dentistry with friends and family, you probably received a lot of praise. Dentistry has always been a noble, respectable career. Those kudos from others felt good, confirming how great this career would be for you. Combining this approval and all the perks, it became easy to settle into being your profession. Many of us comfortably fit ourselves into a box and settled in. We ignored that we could be so much more than our work. It felt right to settle into this identity because dentistry would surely become the ultimate key to lifelong happiness and freedom.

For some people, it did provide all that and more. A career in dentistry became the perfect marriage filled with gives and takes and a genuine love of the craft. For others, however, this dream job turned out to be nothing like what they expected.

I was in the latter category. I had spent much of my life dreaming of becoming a dentist. Childhood visits to the dental office always felt so fascinating to me, even if I had to “endure” dental treatment. I was a good, kind patient, and I thought this was just how dentistry was for everyone. The experience always felt so positive.

I became even more enthralled with dentistry when I got my braces off. Seeing how white and straight my teeth were felt amazing! That excitement canceled out the physical pain I endured over the years. It erased the tears I shed from having to add the rubber bands they promised I’d never need. The embarrassment I felt as an awkward high school sophomore who still had braces vanished. All of that teen torment washed away as I felt the pride of seeing my brand-new smile.

That was when I knew I wanted to help others smile… literally.

Unfortunately, dentistry wasn’t a match for me. After three years in private practice, I became completely burnt out and disillusioned with clinical dentistry. I spent the next seven years of my career trying out other private practice “dream jobs.” I took the

best CE available and got involved in the local dental society community, all in hopes of saving my career. Eventually, I decided to let go of dentistry and pursue a total career change.

My decade in dentistry was very painful for me. Not only was I filled with constant worry, anxiety, and sadness, but I was ashamed of what I believed was failure. I failed to create my dream career, to be the leader I wanted to be. And I also failed at simply coping with the stress of being a dentist. So many others could do it, so why couldn’t I?

As the years have passed, and I have found a way to work nonclinically in dentistry, I see things differently now. I better understand the dynamics that kept me stuck and why others suffer when they don’t fit into this career either.

We believe we have no options because our definition of success in dentistry has been severely limited over the years.

The common perception has been that there is one trajectory for a career dentistry: delivering patient care in private practice. Dentistry has always been viewed as one singular track straight into clinical practice. Sure, there were a few other options in public health, military dentistry, and teaching; but by and large, many considered private practice as the pinnacle of success. If you didn’t like clinical practice or teaching, that was it. Period. This created a culture in which the only choice for creating success in dentistry was to fit into a mold.

A lot of this thinking continues today. It’s a great mold if it’s the right match for you. However, if it isn’t, that lack of alignment in your life can create a lot of mental and emotional distress. Unfortunately, this cultural belief that’s embedded in the dental community contributes to feelings of failure. It makes many feel paralyzed to change when they don’t fit in.

What do you do when you’ve invested so much of your life–time, money, your identity– to get here, and it doesn’t turn out the way you had hoped?

Let me be clear about something here. This question encompasses different scenarios– not just the super painful plight of people like me who discovered that patient care was not for us. Maybe you love your work, but even so, doing the same thing every day for 20 years can get boring– and you’d like some variety. Perhaps you liked dentistry in the beginning, but the stress of juggling patient care and the dynamics of running a business all at once has made you severely burnt out.

No matter what the scenario, it’s okay to yearn for more in your life. Life is about growing and evolving. When we merely accept that singular image of what success in dentistry looks like, we leave ourselves with no options. We struggle to find our own

unique solutions and merely follow what everyone else has done for decades. We get stuck thinking the only road to happiness is to invest in that new dental “toy,” take more CE, or finally buy that practice. However, this cookie-cutter approach doesn’t work for everyone. For some, these “solutions” make it worse as we invest more in the very thing that is burning us out.

Instead of investing more in the thing that’s burning us out, why not invest in your own diversity?

Luckily, the culture in dentistry is changing. People are looking for more opportunities and are beginning to get creative about what’s possible in dentistry. Thanks to the innovators and the creatives in this field, we’re starting to see that there is no one-size-fits-all approach to practicing dentistry. More dental professionals are inventing products, developing services, and creating business startups that help the entire profession. These pioneers are creating a cultural shift and demonstrating that we can create more options in dentistry.

What do you want out of your career? You might choose to work two or three days a week so that you can create extra time for yourself. With that flexibility, you could explore unique ways to diversify your income and create multiple income streams. Maybe you want to start a side gig simply to have more fun. Having this personal and professional variety helps us engage our minds differently, and it’s working. For many, this diversity of life is proving to create more satisfaction in clinical dentistry itself.

This is the beauty of a career in dentistry today. We have more possibilities than ever. Instead of allowing our past decisions to force us into a mold that keeps us stuck for life, we get to choose how we evolve in our careers. Whether you love what you do and simply want more, or you desperately need to change, know that you have options. Know that you can design your dental career on your terms.

Dr. Laura Brenner practiced for 10 years before leaving clinical dentistry to become a blogger, a speaker, and a certified professional coach. After her blog post, “10 Reasons Your Dentist Probably Hates You Too,” went viral, she began connecting with dental professionals around the world who wanted more from their careers. This inspired her to create Lolabees Career Coaching to help dental professionals design their careers on their terms so that they can live joyful, balanced lives.

The Pros and Cons of Selling or Partnering With a DSO

William S. Barrett

Dental Service Organizations (“DSOs”) are management companies that provide non-clinical services to dental practices such as human resources, accounting, billing, finance, leasing, marketing, payroll, IT, regulatory compliance, and legal. A DSO is a separate legal entity from a dental practice. In all but a few states, only a licensed dentist can own the practice entity. By comparison, a DSO can be owned by anyone, including, dentists, non-licensed persons, and/or business entities. Such flexibility in ownership allows non-dentist investors the ability to indirectly invest in profitable dental practices.

DSOs have numerous operational advantages, including economies of scale, maximization of fixed and centralized overhead, greater efficiency, and the availability of a higher level of services. These advantages are realized through the DSO’s provision of services for any number of practices, which gives them an enhanced negotiating position with third parties such as insurance companies, and increased purchasing power for reduced pricing by vendors and service providers.

As with anything, there are both pros and cons to selling or partnering with a DSO. However, to understand these various

considerations, one must first understand how transactions are structured. Whenever a DSO “buys a practice,” there are actually two transactions that happen concurrently. One is the purchase of the non-clinical assets of the practice by the DSO entity (e.g., physical assets, intellectual property, certain contracts, and goodwill). The other is the purchase of the clinical assets by a professional entity, such as patient records, “contract privity” with the insurance carriers, and employment of the licensed clinicians.

After the sale, the DSO is responsible for all aspects of running the dental practice other than the actual treatment of patients and related clinical decisions. The professional entity, on the other hand, is responsible for providing the dental services. The practice collects money from the patients and their insurance providers and pays a management fee to the DSO in exchange for its management services.

Although DSOs can achieve lower overhead costs and increased profitability and efficiency, the decision of whether you should partner with a DSO should be made only after careful consideration of the following benefits and drawbacks, which are discussed in further detail below. The benefits of selling to a DSO include negotiating a higher purchase price; freeing up a selling doctor’s

time so they can focus on clinical practice rather than administration; and receiving equity ownership in the DSO, which means receiving distributions, and having an opportunity to sell that equity at a higher multiple in the future.

On the other hand, the drawbacks of selling to a DSO include the inability to sell or transfer rollover equity in the DSO unless certain limited circumstances exist; and a minority owner’s lack of decision-making authority in how the DSO is run. Further, the transition from practice ownership to employee, while beneficial in terms of freeing the dentist from management responsibilities, will also impact the dentist’s income dramatically once he/she is no longer directly receiving the practice’s profit, and writing off expenses.

MAXIMIZING PURCHASE PRICE

As previously noted, the first potential benefit to selling to a DSO is that they almost always offer a higher purchase price than an individual buyer. Traditionally, buyers determined the dental practice value by multiplying the practice’s annual gross collection by 60% to 80%, depending on the quality of the practice.

On the other hand, DSOs are financed by sophisticated investors who analyze investments with greater efficiency and determine the practice value using an EBITDA (“Earnings Before Interest, Taxes, Depreciation, and Amortization”) metric, which can often equate to anywhere from 100% to 200% of gross collections.

The benefit of relying on an EBITDA metric is that it purely measures a business’s profitability. Therefore, DSOs generally base their purchase price offer on a multiple of EBITDA. For instance, a DSO may have a model that offers a five-times multiple for a dental practice. If the DSO targets a practice producing $2 million annually and the EBITDA is $500,000, the DSO will offer the

seller a purchase price of $2.5 million.

PURCHASE PRICE STRUCTURE

It is important to note, however, that the purchase price in a dental practice acquisition by a DSO can contain a combination of cash payments, rollover equity, indemnification escrow, holdback, and earn-out. Each of these purchase price structures is briefly detailed below.

• Cash Payment: The DSO will often pay 60%-80% of the purchase price to the seller in cash, and then provide the remaining consideration in the form of rollover equity.

• Rollover Equity: Ownership interest in the DSO or a related parent company which is offered to the selling dentist.

• Indemnification Escrow: A fixed dollar amount (usually 5%-10% of the purchase price) that is held in escrow for a period of time (usually 12-24 months) to cover any indemnification claims that may arise during that period. Any money remaining in escrow at the end of the holding period is released to the seller.

• Holdback: A fixed dollar amount that is held in reserve to ensure that the practice generates a certain amount of revenue during a particular period after the closing date. Once the holding period expires, the money will be released to the seller or the DSO, depending on whether the practice exceeds the target revenue threshold.

• Earn-out: A portion of the sale price that is directly dependent upon the future success of the practice. For example, a DSO may want to incentivize the seller to continue growing the practice after the closing but may not want to offer additional

rollover equity. In that case, the DSO may offer to pay the seller an “earn-out bonus” based on future earnings.

• DSOs mix and match these elements based on their own corporate approach and philosophy. Because rollover equity is a type of investment in the DSO, and thus a more uncertain form of purchase price consideration, we will delve into this topic further below.

ROLLOVER EQUITY: THE ADVANTAGES AND DISADVANTAGES

There are benefits and limitations when a seller obtains rollover equity in a DSO. Normally, the seller will only acquire a minority ownership in the DSO. As such, the seller should not expect to have significant voting rights or decision-making authority. Additional risks and restrictions involved in receiving equity include the seller’s inability to transfer the equity in the future. In most cases, a dentist will not have the ability to sell or transfer their equity until a triggering event occurs. Examples of triggering events include a subsequent sale, recapitalization, or the dentist’s retirement. Additionally, if the majority owners decide to sell the company, the dentist will be “dragged along” in such a sale and may have to adhere to the terms imposed by the majority. Dilution is another potential risk a seller may encounter because the DSO’s issuance of additional equity will dilute the seller’s original ownership interest in the company. Dentists with equity in a DSO can also expect to be restricted from obtaining a put option, which is a term that is used to describe an owner’s request that the company buys equity back from the dentist.

Notwithstanding the disadvantages previously discussed, there are also many benefits to obtaining equity in a DSO. For example, dentists continually benefit from equity ownership because they may receive distributions from the DSO. Additionally, in most cases, the dentist is not required to pay taxes on the value of the equity unless it is sold. Another benefit of owning equity is that the dentist will have an opportunity to sell that equity at a higher multiple in the future. When the DSO investors are ready to cash out, the dentist will get a second payday for the equity they are holding. There are clearly both risks and rewards to owning equity in a DSO. Each dentist will have to balance these pros and cons and determine what aligns best with their goals.

FREEDOM FROM MANAGEMENT RESPONSIBILITIES

Another benefit to selling to a DSO is that the seller can focus on practicing dentistry and enjoy their freedom from the burdens of the day-to-day management of a practice and its employees. On the flip side, the drawback of selling to a DSO is the sudden loss of operational control. Some dentists become overwhelmed with

the fact that the DSO takes over every aspect of the practice except for clinical and treatment decisions.

DECREASE IN INCOME

Another important consideration when selling a practice to a DSO is the impact it has on a dentist’s future income. First, the dentist will encounter a decrease in income because he/she is no longer taking all the practice’s profit. Second, the dentist no longer owns a business and cannot continue to write off certain expenses through his/her practice. However, these new limitations should be identified prior to closing and should not come as a surprise to the seller.

LONG-TERM EMPLOYMENT COMMITMENT

Finally, some dentists are shocked to learn that a sale to a DSO also involves a significant post-closing employment commitment that is usually not present in private sales. In almost every case, a DSO buyer will require that the seller agree to work at the practice for a minimum of three to five years after the transaction has closed. Doctors looking to retire at, or shortly after closing, must be mindful of this. On the other hand, a younger dentist may view the long-term employment relationship as a benefit and incentive to further grow the practice.

A DSO transaction is a serious decision, and there are many factors that need to be weighed. Further, the path to partnering with a DSO is not a one-size-fits-all approach; the circumstances of each sale will be different. However, the primary takeaway is that prior to entering into a transaction with a DSO, sellers should understand how the transaction will be structured, and what their rights and responsibilities will be pursuant to the transaction documents. Moreover, if doctors have a clear sense of all the pros and cons of a DSO transaction at the outset, they will be better equipped to tackle the new issues and priorities that will inevitably arise as a transaction progresses to closing.

William S. Barrett, Esq. is CEO, Partner and Co-Chair of the National Dental Law Group at Mandelbaum Barrett PC, a full-service law firm in Roseland, New Jersey. He has over 20 years of experience representing a wide range of businesses with a unique specialty in mergers and acquisitions. He is the co-author of “The DSO Decision: Winning Answers from Every Angle” (Redwood Publishing, 2021) and “Pain Free Dental Deals” (Ethos Collective, 2021.) Contact him at wbarrett@ mblawfirm.com. For more information, visit https://www.mblawfirm. com/practice-areas/dental/.

1. Determine your goals, objectives, and priorities (e.g., What are your financial needs? Do you want a practice ownership opportunity?)

2. Start early (i.e., Start 6 months to 1 year prior to availability.) 3. Prepare a professional curriculum vitae and cover letter (Check spelling and grammar) 4. Reach out to potential references (i.e., Ask their permission, confirm contact information) 5. Before an interview, research the practice and owners/principals (e.g., Social media, website) 6. Prepare questions for the interview (i.e., You are interviewing them too, you want to show interest) 7. Make sure the practice is ready for an associate (e.g., Do they have the space, equipment, support staff, and a sufficient number of patients?) 8. Ask for next steps and timing at the end of the interview 9. Send a “Thank You” after the interview! (Mailing a personal note is best.)

10. Align your resources. Be ready for an opportunity. (i.e., Find an attorney for employment agreement review) To find the best dental opportunities, contact: HENRY SCHEIN DENTAL RECRUITMENT SERVICES 866-409-3001 or RecruitmentServices@HenrySchein.com Dental Recruitment Services is 100% FREE to candidates (job seekers)!

Top 10 Reasons Why Dental Software Start-Up Companies Fail

Travis Rodgers

As I crossed the finish line, cut through the ribbon, and fell to the ground with exhaustion, my dad’s words rang through my head, “Travis, luck is what happens when preparation meets opportunity.”

Over the past 20 years of working with over 750 dental software start-up companies, I have seen hundreds of them fail. The one thing that differentiates those that are successful and those that fail is “planning their course” and developing a winning strategy prior to starting their “race.”

At 10 years old, I decided to enter the Turkey Trot race. This was the first competition of my life, and I was competing against my neighborhood bully, Jimmy. It was November 23rd, 1983, and Los Gatos was in the heart of Silicon Valley with a lot of competitive families. I wasn’t much of an athlete, but on this day, my dad and I got there early. We walked and planned the course down to the point on the course when I would sprint to the finish line. I was prepared.

When the race started, I quickly fell to the end of the pack. But as the race went on, I continued to surge towards the front. The course was not well marked, but I had a plan, and I knew where to turn. With a quarter of the race to go, I was in third place behind

Jimmy and my friend Johnny. At the quarter-mile mark, there were two directions to go, and I saw Jimmy and Johnny take the wrong turn in the wrong direction, but I stuck to the plan my dad and I had set out. As I cut through the winning ribbon, I gasped for air and collapsed. My dad ran over, picked me up, and held me over his head. I had won the race, not because of my talent but because I had planned better than my competitors. Many dental software startups I’ve seen fail had superior talent and products, but they lacked a solid plan.

In this article, I am going to share my research of 100 failed companies and outline the top 10 reasons why dental software companies fail, and give you some tips on how to avoid them.

#1 - NO MARKET NEED

On a daily basis, dentists come to me with ideas for software products, and most of the time, I tell them not to do it. The #1 reason is that their target market is not large enough. That doesn’t mean they shouldn’t do it to solve their own problem but building a commercially viable product is a much larger undertaking than a one-off custom project.

Tackling problems that are interesting to solve rather than those that serve a market need was cited as the number one reason for failure in a notable 42% of cases I studied. As Patient Communicator wrote, “I realized, essentially, that we had no customers because no one was really interested in the model we were pitching. Doctors want more patients, not an efficient office.”

Startups fail when they are not solving a large enough problem with a scalable solution. They can have great technology, a great reputation as a thought leader, great expertise, great advisors, and great investors. But if they don’t have the technology or a business model that solves a large enough pain point in a scalable way, they will surely fail.

On a daily basis, I coach Entrepreneurs on how to follow the “Customer Discovery Process,” and I suggest they interview 50-150 potential users to make sure their product hypothesis is more than just what they think is a big enough problem but is, in fact, something that solves a big market need.

#2 - RAN OUT OF CASH

Investors are more likely to back companies that have followed a solid product research process to determine market fit. Money and time are finite and need to be allocated judiciously. The question

of how you should spend your money was a frequent conundrum and reason for failure cited by failed startups (29%). As the former team at Ajeva Dental Financing exemplified, running out of cash was what eventually killed their company. Make sure you are following a solid budget, and don’t spend time and money on anything that doesn’t have a measurable ROI.

#3 - NOT THE RIGHT TEAM

Dr. Jeremy Krell, who runs the Revere Partners oral health venture fund, cites that according to their data, “people problems, from backgrounds that don’t mesh well with the startup’s goal, to founder disputes, to a marked lack of the industry relationships needed to scale” is the leading reason most dental startups fail.

Failed startups I’ve worked with often lament that they wished that their dentist founder CEO had more business startup experience. Often saying, “we should have brought on additional co-founders, who would have been compensated primarily with equity versus cash, but we didn’t.” I have a template for equity compensation for dental startups we like to use as a starting point. Early on, several of my products failed because I didn’t have a technical or clinical co-founder to round out my team. Industry and business experience are rarely found in the same person.

#4 - GET OUTCOMPETED

The old idea of “build it and they will come” has proven to be incorrect over and over. We saw this ten years ago in the patient reminder space, and we are seeing it again in the dental AI category.

Despite the platitudes that startups shouldn’t pay attention to the competition, the reality is that once an idea gets hot or gets market validation, there may be many entrants in a space. Obsessing over the competition is not healthy; ignoring them was also a recipe for failure of many startup failures.

In 2011 I was the first to build online scheduling for dental practices. Shortly after, LocalMed developed what at the time was an inferior product, but they had the funding to grow a larger sales and marketing team, and they forged ahead and outcompeted me and eventually sold to Dental Intel for a nice exit.

Weave is an example of a company that had a product that wasn’t as good as many competitors, but they raised significant funding and grew a large sales team, and for many years they dominated the dental practice phone category. Don’t forget the purpose of running a business is to make money, and without money, you can’t innovate.

#5 - PRICING & COST ISSUES

Pricing is a dark art when it comes to startup success. More and more dental software companies are including analytics and ROI tracking in their products to demonstrate the value of their offering. Most dentists will tell you they are trying to eliminate their $297 a month subscriptions, so creative value-based pricing models are beginning to replace the older monthly subscription pricing models.

Several failed startups I interviewed stated that they underpriced their product and, in fact, the “low perceived value” of their product caused their demise. Several also mentioned that the high integration costs passed through by the practice management systems were the root cause of their downfall.

Dr. Jeremy Krell of Revere also pointed out that high prices and rising inflation will become more of a factor in the upcoming years. While dentistry may have proven itself to be recessionresistant, Dr. Krell warns that this may not apply in the same way to the impact and aftermath of inflation.

#6 - POOR PRODUCT

Bad things happen when you ignore a target user’s wants and needs, whether done consciously or accidentally. Bad things also happen when you only listen to one customer’s feedback which was the downfall of my original RecordLinc product, which was the first doctor-to-doctor referral product in the industry that was originally the idea of my Orthodontist brother-in-law. With no competitors, we had nothing to compare to. We proceeded to build it around the feedback from one Periodontist in Long Island. We ended up overbuilding it and made it too complex.

The lessons learned from that is to build products that solve one big problem at a time and make sure they are integrated and easy to use. This experience gave me a deep understanding that the most important part of building a product is to get the product to market as quickly as possible and with the minimum viable features and then cautiously add more features as needed based on feedback from many customers and advisors.

#7 - NEEDS OR LACKS A BUSINESS MODEL

Failed founders agree that a solid business model and plan are important but sticking to a single channel or failing to find ways to make money at scale is also a root cause of many failed startups.

As my dad stated in the opening story, “luck is what happens when preparation meets opportunity.” Make sure you have a plan, and that you constantly revisit and adjust the plan. For most innovative Entrepreneurs I coach, I suggest implementing the “Entrepreneur Operating System (EOS)” outlined by Gino Wickman in the book Traction.

#8 - POOR MARKETING

Knowing your target audience and knowing how to get their attention and convert them to leads and, ultimately, customers is one of the most important skills of a successful business.

Dentists and practices are bombarded daily by marketing and sales teams. Getting through the gatekeeping is difficult.

Dental legends Jim and Naomi Rhode grew SmartPractice to be one of the largest suppliers in the industry by implementing their “three pillar” approach of speaking at conferences, putting on small seminars, and selling great products.

Be strategic with your marketing. Become not only a product expert but also a content and industry expert, and you will dominate your category. Get on stage and spread the word in a strategic way that builds trust.

#9 - IGNORE CUSTOMERS

Ignoring users is a tried and true way to fail. Tunnel vision and not gathering user feedback are fatal flaws for most startups. Many failed startups I spoke with said, “We spent way too much time building it for ourselves and not getting feedback from prospects.” It’s easy to get tunnel vision. I’d recommend not going more than two or three months from the initial start to getting in the hands of prospects that are truly objective. Another founder said, “We didn’t spend enough time talking with customers and were rolling out features that I thought were great, but we didn’t gather enough input from clients. We didn’t realize it until it was too late. It’s easy to get tricked into thinking your thing is cool. You have to pay attention to your customers and adapt to their needs.”

#10 - PRODUCT MIS-TIMED

If you release your product too early, users may write it off as not good enough, and getting them back may be difficult if their first impression of you was negative. And if you release your product too late, you may have missed your window of opportunity in the market. Set proper expectations with customers and get them involved with the product roadmap early. There is a large group of dentists who love to be a part of building the products they use.

Jinesh Patel, the founder of Uptime Health, has grown his product to be a category leader. Jinesh states, “products being mistimed is a big factor for dental startups. When everyone is consumed with labor shortages, and there is a general reluctance to move into the 21st century for many of these orgs, you will find it hard to introduce new technology without having something super special. Even with great tech or products, the market might not be ready for you. However, as the younger generations begin to take over and the PE funds begin to provide structure and are willing to spend on efficiency, we will see the market timing element go away. But right now, many new companies may be on the cusp of being too early for the market unless they can financially weather the length of time it may take to see a significant change in the mindset of buyers or market conditions.”

As we close out 2022, more and more dental software startups will enter the market as low-code, no-code, and API hosting companies expand. If you have always dreamed of starting a dental software company, there is no better time than now to do it. Make sure you have great advisors, a well-rounded team, create a plan, raise more funding than you think you will need, and put your own personal interests and ego aside and make sure you have done enough research with enough people to help you build the right product. Best of luck, and I will see you on stage.

Travis Rodgers specializes in technology, strategy, fundraising, and go-to-market strategies and tools for dental software companies. He is VP of Business Development for Revere Partners Venture Capital. His company, DrDDS Innovations is best known for building many practice management integrations, custom software solutions, whitelabeled software, dental databases, and marketing systems used by dental vendors and dental practices. He has developed 27 different dental software programs and helped launch hundreds of dental products since 2003. He was the first to develop the electronic referral, online scheduling, and a patient file-sharing app in the dental industry. Travis is a speaker and consultant on technology and implementing change in dental practices. You can find Travis on LinkedIn or subscribe to his Dental Venture Capital newsletter.

Investment Grade Communication: The Key to Building an Investment Grade Practice™

Dr. Victoria Peterson

When it comes to communication, you innately know two things: 1. What you want to communicate, and 2. Who you want to communicate it to. The biggest variable in communication is simply how? How to best communicate your message so that the other party understands your message. As a leader, I struggled with communication for years. I’m an extrovert, and extroverts like to talk… and talk. Meetings began with gusto, with me in the lead, of course. They ended with bravado as I patted myself on the back for a meeting well done. Days later, when I checked in with team members on progress, I was shocked at their confusion. Wasn’t I clear in the meeting?

Communication is a two-way street involving both the sender and the receiver. Investing time and effort into your communication skills is one of the most important pillars in building an Investment Grade Practice™. The past 25 years of consulting and business ownership have taught me that great conversations don’t just happen; they are designed through an understanding of how to navigate complex emotions, differing opinions, and mindsets.

With that in mind, I present to you an excerpt from Chapter Six

of my new book, Building an Investment Grade Practice, to help you confidently navigate two of the most awkward conversation dilemmas in dentistry. I’ve termed these the Employee Ambush, and Accosted at a Trade Show.

EMPLOYEE AMBUSH

One of the most common - and most uncomfortable - positions owners find themselves in is spontaneous negotiations for salary increases, time off, or change of roles. You feel the tap on your shoulder while walking down the hall, “Doctor, can we meet at the end of the day?” Chills run down your spine as you imagine all the bad things this could mean. Employees never ask to meet with you unless it’s something uncomfortable, right?

NAVIGATION SKILL #1: STOP, DROP, AND ROLL

That’s right; stop in your tracks, turn around and make eye contact. Take a deep breath, drop your voice and say, “I’m always available to meet; let’s make sure today is the best time. I have

about three minutes available now. Can you share the topic with me now?” Then roll into active listening. Stay present in the moment. Even if every cell in your body is screaming that you do not have time for this, plant your feet, smile, connect, and listen. This shows respect and increases endorphins and dopamine for both the speaker and listener. Stick to the three-minute rule - you can even ask the other person to time it. “We have three minutes. Will you be the timekeeper?” When time is up, wrap up the conversation, even if in mid-thought. “I see we will have much to explore. I can (or cannot) meet today. I do, however, set aside administrative time on Thursdays for these types of conversations. Can we get you on my calendar?” Always end with the next action step. No one likes to be left hanging in suspense.

My experience is that spontaneous requests are never as dreadful as you imagine. Taking the time to listen in the moment, you can often diffuse a potentially larger situation. By mastering stop, drop, and roll, you’ll be prepared for these spontaneous questions.

We can break this navigational technique down into the following negotiation skills:

1. Control the process: You cannot control people, but you can control the process, such as timing, and your ability to prepare.

2. Get on the same side: It takes courage for your team to confront an issue. As a leader, be sensitive to this. By sharing that you are always available to meet, you decrease anxiety and open communication pathways.

3. Control the time and place: By virtue of ownership, you hold a position of power. The proper use of power includes setting up the ideal conditions for conversations to take place; the right time, in the right place, with each person prepared in advance. In the sample script outlined above, you’ve exercised proper use of power with two statements, “I have three minutes now” and “let’s make sure today is the best time to meet.”

4. Set expectations: By taking three minutes to establish the topic, you’ve relieved both sides of needless anxiety, wondering what to expect later in the day. You can go about your day, relieved to know that you’ll be prepared when you do meet.

ACCOSTED AT A TRADE SHOW

Resisting sales professionals at trade shows is almost pointless. You know you want the latest technology, and the conference environment is intentionally designed to put you in a buyer’s frame of mind. So what’s a doc to do? Arm yourself with deeper negotiation skills.

NAVIGATION SKILL #2: I KNOW YOU ARE . . . BUT WHAT AM I?

Sales professionals will throw everything in the book at you, using time-tested techniques, tugging on your ego, shaming you with comparisons to others, enticing you with statistics, etc. They will

make you an offer you just can’t refuse. “You are going to do this for me? Wow!” is the reaction they look for as a buyer’s signal. Sales professionals are literally paid to do this! When you find yourself tempted to say yes to the first offer, pause and reframe the deal through the lens of: I know you are! But what am I? This harkens to childhood insults and will break-up the super-chargedendorphin buying state for just a moment.

PART 1: I KNOW YOU ARE…

Just as surfers look for big waves to ride, you should expect great sales pitches to come your way. You are not dazzled by bells and whistles (OK, we are, but put that aside), and you will not be intimidated by offer expiration dates. Impulse purchases often leave you with the same hangover experienced after a great night out with friends. Part two of this navigational skill is to flip the script by knowing what is truly in it for you.

PART 2: BUT WHAT AM I?

Preparation is the key to every great negotiation. Prepare yourself long before you enter a sales conversation or trade show by reviewing not only the speaker line-up but by the list of exhibitors and their products. Read the pre-event e-mail promotions, and get your team involved in the research. Every new procedure you learn, and every new piece of technology you purchase requires your team to adapt to change. Leverage this fact when negotiating.

As the sales representative shares all the wonderful things they are willing to do for you, say, “Wow, I love that you are willing to do this for me. I have to take this back to my partners for review. In addition to what you are offering, I know they will ask me for these considerations. . .” Be prepared to list considerations. This may include:

• Additional team training

• Support hours

• Special hotline or dedicated representative

• Extended warranties

• Upgrades to the product should new releases come out within 12 months

• Movie tickets, lunch, and any outrageous things you can think of (Seriously, add a little levity to the moment)

This is also another great time to use Stop, Drop, and Roll. If the sales pressure is too high, and you’ve not reviewed the product with your team or bookkeeper, use the technique above to regain

control. Be prepared to walk away and come back to the conversation later.

Humor is a great diffuser, and there are times to take communication seriously. For me, the most important line of communication within a business is the feedback process between employees and management. Open, honest communication is at the heart of business and personal relationships. It takes practice and feedback from others to master this level of connection. Great communicators invest time in developing these often unfamiliar skills within themselves. Think of it much like football teams and coaches watching the replay of their last game. Peak performers analyze each player’s position, timing, and adherence to the play call. They note where players observe the call and deviate from the plan. Each player looks for where they contributed to success and where their actions distracted from the outcome.

The invitation is to apply that same sense of curiosity whenever you receive feedback on your communication style. As a leader, there have been many times when I did not want to hear the feedback of my team. It is hard to hear disappointment, frustration, or anger regarding unmet expectations. Calling up the courage to ask questions, and actively listen in spite of my internal emotions, created growth opportunities within me.

IGP Insight: Creating a safe space for your team to tell you the truth is the greatest gift a leader can give their team. Using these conversational navigation skills will set the proper parameters for healthy, honest communication in traditionally stressful arenas. When you take the reins and control these situations in the way you want the communication to be directed, everyone - especially you - gets what they want in the end.

Dr. Victoria Peterson, co-founder and CEO of Productive Dentist Academy, combines her lifetime of entrepreneurship with a doctorate in spirituality. Her latest book, “Building an Investment Grade Practice,” will be released in Spring 2023. To take the IGP business assessment, visit www.ProductiveDentist.com/ igp-assessment. For more information, go to www.productivedentist.com.

Launchpad

Weighing in with Dr. Sergio Valverde

Luke Shapiro, DDS

HOW LONG HAVE YOU BEEN PRACTICING FOR?  WHERE DID YOU GO TO SCHOOL?

I worked for 4 years as a general dentist / orthodontic resident and 11 years as an orthodontist.  I went to Cayetano Heredia (Perú) for both dental school and residency.

You have an amazing clinic! Are you mostly focused on the business of dentistry or just dentistry?

Mostly orthodontics (clinic work and academic).  I do a lot of interdisciplinary dentistry.  I treat mostly adult patients for orthodontics combined with other specialties.  I don’t know a specific reason, but maybe because the clinic is advertised as concerned about esthetics and smiles, so adult patients come over seeking that. My wife is also a good cosmetic dentist, so maybe that too?

HOW DO YOU MANAGE ALL OF THESE INTERDISCIPLINARY CASES?

I don’t have a choice! As most patients are adults, I have to do orthodontics with missing teeth, missing molars, gingival recessions, implants, and extruded teeth.  So, for treating these kinds of patients, the records are super important for us. Photography allows me to communicate with the other dentists in my clinic.  To have all the specialists in one building is a big advantage.  We

do short meetings for planning or, when we’re busy we send a lot of pictures and voice messages between each other.  No secret, just good communication.  I once read in a book that said, “The difference between multidisciplinary dentistry and interdisciplinary dentistry is that in multi, multiple specialists treat a patient while in inter, the specialists interact between each other before treating the patient.” This will become a high-quality treatment, and that is what we want for our patients.

SPEAKING OF YOUR PHOTOS, HOW DID YOU GET SO GOOD AND DEVELOP THIS? HOW DID YOU GET INTO IT?

I had my first course in residency, but it was photography for orthodontics – very simple.  I wanted more, so I then learned from a guy that teaches aesthetic dentists how to do photography (he was a Brazilian photographer, not a dentist).  And then after that, I learned a lot on YouTube, and I kept practicing.  Having better pictures helped me a lot to watch details and communicate with other dentists.  It is also good for me because it helps me critically evaluate my work.

WHAT’S YOUR CAMERA SETUP?

Nowadays, I’m shooting with twin flashes and diffusers.  Nikon D7100 with a Nikkor 105 mm.  Sometimes I use a soft box, but

I’m trying not to now because the softbox room is one floor over my office, and walking there with the patient is a waste of time.

ARE YOU TEACHING ANY COURSES IN PERU?

I’m an adjunct faculty member at Universidad Científica del Sur, but I only do special topics.  I’m also an occasional lecturer at Seton Hill in Pennsylvania, and I am the new editor of Pearls section of the Journal of Clinical Orthodontics (JCO). I have done some publications too, but what I love the most is lecturing for orthodontic and non-orthodontic Congress.

WHAT WOULD YOU SAY ARE THE DIFFERENCES/ SIMILARITIES BETWEEN PERU AND OTHER COUNTRIES LIKE THE US?

In Peru, you have to do a lot by yourself.  There is no school for assistants.  Maximum, I have 1 assistant in another chair, but that’s it.  Less delegating for orthodontists compared to the US.

WHAT ARE SOME PRODUCTS YOU’RE USING?

As for brackets, I don’t have a favorite brand.  I think that with clear objectives and a treatment plan you can solve anything with any bracket, as long as you choose the prescription you need. For bonding, I love Reliance products and Transbond (UNITEK) for bonding. Reliance or SS White burs for removing composite and for fixed retainer Orthoflex. American Orthodontics or Rocky Mountain plier are very nice too. I’m using Invisalign for clear aligners.  There aren’t many options here in Peru yet.

WHAT ARE YOUR THOUGHTS ON SOCIAL MEDIA?

I’m very active in Facebook groups, especially orthodontic pearls. I like to share cases or pearls there; that’s how I got involved in the JCO.  I also use my IG page (@drsergiovalverde) to connect with dentists around the world.  This also helps me in recruiting patients, but mostly for sharing with dentists.  To complement, we have an Instagram for the clinic (@infinityclinicadental), which is more for patients.  In the past, patients used to ask for CVs (which is important), but nowadays, they like to see what their doctor can do for them!  They like to see us solving cases, especially the ones similar to what they have in their mouth. So social media can help to build a connection with our patients, which is the beginning of a relationship of trust.

Dr. Lucas Shapiro is a graduate of Washington University in St. Louis and Stony Brook University School of Dental Medicine, where he received his Doctor of Dental Surgery. He completed his post-doctoral orthodontic training at Tufts University School of Dental Medicine. He currently practices orthodontics at Lemchen Salzer Ortho in NYC. He started the Instagram page @futuredentists, works with the educational organization @ignitedds, and has an orthodontic tiktok page @drshap.

Impact

The Hidden (Financial) Cost of Burnout

Thomas Farmer

Irecently spoke with the HR Director at a large national DSO and was not surprised to hear that her major concern is burnout amongst her team. It is well-documented that people are more stressed than ever following the onset of the COVID-19 pandemic. Things have gotten so bad that on May 23rd, 2022, the Office of Surgeon General issued an advisory “highlighting the urgent need to address the health worker burnout crisis across the country”. Even before the pandemic hit, the World Health Organization (WHO) included “Burn-out” in its 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon and updated its definition to read as follows:

“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

• Feelings of energy depletion or exhaustion;

• Increased mental distance from one’s job, or feelings of negativity or cynicism related to one’s job; and

• Reduced professional efficacy”.

In addition to the health-related issues resulting from burnout,

which are considerable, there are important financial considerations Dentists need to be aware of, both personally and as an employer.

PRODUCTIVITY

As the WHO points out, productivity tends to suffer when someone is experiencing burn-out. There is ample evidence explaining how burn-out impairs focus, attention, motivation, problem-solving skills, and leads to severe emotional and physical exhaustion, all of which drain productivity. In addition, burn-out leads to health-related issues, and businesses see an increase in absenteeism and employee turnover. Consequently, a practice fraught with burn-out will likely experience a negative self-perpetuating cycle similar to the following:

• revenue drops as team members are out sick more frequently, leading to fewer patient visits

• team members are less engaged and motivated at work, leading to lower case acceptance rates and new patients

• team members must take on others’ work while they are out, leading to increased cynicism and resentment amongst the team

• patients pick up on the tension between team members and have a poor experience

• the practice reputation suffers as the quality of care declines, limiting the number of new patient consultations

As entrepreneurs and leaders, dental practice owners need to be mindful of their own wellbeing, as well as their team’s, to ensure they are running a productive practice. Just like when the airlines encourage you to put your own oxygen mask on first, you need to take care of yourself properly so you can be the leader your team needs and provide the clinical care your patients deserve. Below are a few suggestions that can help you become reenergized and productive in the office:

1. Remember your why -- a byproduct of burn-out is detachment and experiencing a loss of meaning in work. Most dentists did not go to dental school to learn how to run a business; rather, they went to school to learn the skills to care for patients. It can be easy to lose sight of your why when having to keep up with the day-to-day demands of being a business owner and a health care provider. By intentionally contemplating your why, you can reignite your passion for practicing dentistry and/or being a leader, which will lead to a more productive and enjoyable day.

2. Delegation -- by constantly revisiting your why, you will become more aware of the areas in your life and daily responsibilities that detract from your happiness and productivity. Remember, as a business owner, you have the power to structure your business however you want. If items drain your energy, find someone who enjoys doing that type of work and empower them to do it well.

3. Take control of your day by owning your calendar -- If you don’t take control of your own schedule, someone else will. One major cause of burn-out is feeling a loss of control, so be mindful of how you structure your day and do not compromise. Furthermore, consider timing certain events to occur at specific times of the day to optimize the results. For example, a growing body of research supports making key decisions early in the day while you have the brain power to make good decisions; decision fatigue is a real thing! In addition, timing your exercise and meals can give you the energy needed to power through your day. Finally, you must prioritize getting proper sleep to stay healthy and function at a high level.

Don’t forget about your team; they also need to prioritize self-care and are looking to you as the leader to empower them to do so. Remember that what works for you may not work for others, so

be empathetic to the needs of your team members and be patient as you work together as a team to strike the right balance as a group.

As a CERTIFIED FINANCIAL PLANNER™ working with dentists, I understand the positive impact running a profitable practice can have on the well-being of dentists, their families, and team members. As your practice becomes more profitable and cash flow improves, you will have opportunities to reinvest in your team’s well-being, reverse the self-perpetuating cycle of burn-out, and increase the overall value of your business. As burn-out declines, morale amongst the team improves, patient care improves, and the virtuous cycle fuels itself forward.

DISCRETIONARY INCOME AND SPENDING

Another hidden cost of burn-out relates to personal disposable income and expenses. Specifically, individuals coping with burnout will likely see their income drop over time. As health declines, people will be out sick more frequently and need to see the doctor more often, resulting in higher medical bills. For both dentists and team members, less time in the chair means less money. Furthermore, those participating in an incentive compensation plan may receive lower bonuses because they have grown disconnected from their work, resulting in a lackluster performance.

In addition to making less money and spending more on medical bills, burn-out can also impair judgment leading to poor spending decisions. When someone is overworked, feels underappreciated, and is exhausted, they can justify spending more money on themselves. Whether it is out of convenience, like paying more for food delivery services, or large splurges to treat oneself for their hard work, burn-out impacts the part of the brain that modulates impulse control and willpower. When exhausted after a long day, people don’t have the energy to monitor their finances diligently and are prone to impulsive purchases.

BAD INVESTMENT DECISIONS

When people are stressed, activity in the pre-frontal cortex slows, which is where more complex cognitive behavior occurs in the brain. In response to a stressor, the nervous system triggers a “fight or flight” reaction in the body, which prompts people to eliminate the threat and seek safety at all costs. The “fight or flight” response is hard-wired in our brains as a survival mechanism and happens automatically. In the event of life or death, there is no time to think through all aspects of the situation or to contemplate various possible outcomes.

Though what we perceive as a “threat” has evolved, our brains still behave the same way today when we feel threatened. When someone is experiencing burn-out, the “persistent overhang of stress results in chronic exposure to elevated levels of cortisoland permanently higher levels of cortisol in our bloodstream is

a very bad thing. Similar to acute cortisol exposure, it reduces the quality of our judgment and our ability to assess objective probabilities”.

From my experience working with investors during the 2008 Financial Crisis, the 2020 and 2022 bear markets, I have witnessed impulsive fear-driven reactions first-hand. Despite all the research that promotes staying the course and discouraging “panic-selling,” investors give in to their emotions when things are uncertain in the financial markets and economy.

An effective method to prevent “panic-selling” is to implement a rules-based, disciplined approach to managing a portfolio. For example, automate your savings so you continue investing during both good and bad times. Counterintuitively, investing during a bear market is a good thing for long-term investors because assets are acquired at discounted prices. Furthermore, consider rebalancing your portfolio using pre-defined thresholds or at periodic intervals. The key is to stick with whatever game plan you develop and to remain disciplined.

Lastly, consider hiring an objective third-party fiduciary to oversee your investment strategy on your behalf.

Fortunately, people can recover from burn-out and regain their motivation, focus, productivity, and health. Much of the research relating to burn-out focuses on health and well-being, as it should; however, the financial ramifications can be devastating as well. If you or anyone on your team experience symptoms of burn-out, seek help from a professional or contact the ADA or state dental society to inquire about available programs in your area.

Thomas is passionate about helping clients question what “wealth” means to them personally, then redefining it in their own words. He enjoys partnering with clients to design a life that is in alignment with their beliefs, values, and aspirations. His ultimate role as a Wealth Advisor is to empower clients to focus on what matters most and to live a fulfilled life. Thomas is a Partner and Wealth Advisor at CI Brightworth. He graduated from The University of the South in Sewanee, TN, in 2006, obtained the CERTIFIED FINANCIAL PLANNER™ certification in 2011, and the Certified 401(k) Professional designation in 2014. He is originally from Atlanta, GA, and has lived in Charlotte since 2006. He and his wife, Erin, are proud parents to two amazing children- a daughter and a son.

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YOUR STORY IS WORTH IT.

How to Accomplish the Impossible in Dentistry

David Rice, DDS

In 1954 Roger Bannister did what the world believed to be a literal impossibility. He ran the first sub-4-minute mile. In itself, a cool story. The more important story, however, is this. Over the next twelve months, more than twenty runners did the same.

How did the impossible suddenly become possible?

What does it have to do with your pending new dentist success?

I. MINDSET

Like Roger’s success, your success begins with your beliefs. When you believe you can win, you will. When you believe you can’t, you won’t. That can be challenging when a considerable amount of people have a vested interest in constantly telling you how your student debt will limit you… how owning your own practice is next to impossible… and how if they had to do dentistry again, they wouldn’t.

Is that what you’re hearing in school? Have you noticed how several of today’s largest Facebook groups force-feed the same 3 messages over and over and over again?

Student debt is insurmountable.

Young dentists get paid less than seasoned dentists to do the same work.

Owner docs are taking advantage of young dentists all the time.

Why do you think they’re doing that? What’s their motivation? I’ll share two with you.

1. Ignorance

I don’t mean this crudely. In life, however, many simply don’t know what they don’t know. And that is dangerous food for thought for you.

2. Fear

Your fear drives their engagement. Your fear drives your need for a solution they present. Funny how that solution is a win for them, isn’t it?

MINDSET RESET

What I love about the Roger Bannister story is simple. YOU have the power to form your own beliefs and to do what the masses say cannot be done. You have the ability to seek out the dentists who already defy what the nay-sayers are saying. And guess what…

There are a lot of us! Want to meet them and ask how they do it?

CLICK HERE, DM, and ask away. We have thousands of dentist friends all over the country who want to help you!

II. TRAINING

If you want a taste of how thousands of dentists are doing what you’re hearing is impossible, read this next sentence. We are doing exactly what Roger Bannister did. We are training DIFFERENTLY than everyone else.

Before Roger B, runners were taught to train at slower paces in the beginning so they wouldn’t tire at the end. Think about that…

How could anyone break the 4-minute barrier if they were taught and trained at a slower pace? It makes sense no one broke the barrier.

Roger knew if he was going to run a faster mile, he had to run faster from the start. You and I need to train differently, too. We have to train very specifically for our goals.

TRAINING TRANSLATION

• Step one - know what your win looks like

• Step two - seek out dentist mentors who share your goal

• Step three - while keeping your eyes on the graduation prize and doing what you need to do… STOP letting anyone with negative vibes into your life.

• Step four - when you don’t know how to find exactly who you are looking for CLICK HERE. Twenty-eight years in dentistry means if I’m not the right mentor, I know them, and I can connect you to them.

Friends. Everything is possible. Your degree is your ticket to more opportunities than you know. You’ve worked too hard to be where you are to allow anyone to tell you otherwise. Stop hanging out with classmates who are doom and gloom. Stop hanging out in Facebook groups that limit you or try to sell you their dream. Stop believing you can’t break the 4-minute mile!

You can do this!

David Rice, DDS, is on a mission to improve our profession by leading the next generation of dentists to grow successful lives and practices. The founder of igniteDDS, Dr. Rice speaks to over 35 dental schools and residency programs a year on practice building, team building and wealth building. Dr. Rice is a private practitioner, educator, author, and mentor who connects students, young dentists, and professionals from diverse dentalrelated businesses, “fueling passion beyond the classroom.” https:// ignitedds.com/user/david_rice/ @igniteDD

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