By focusing on the customer, dental service organizations have an opportunity to make great gains in the marketplace – even amid a pandemic.
In today’s climate, it’s easy to get overwhelmed. Emmet Scott, CEO and co-founder of National Dental Partners™ and Smile Magic Dentistry, and the newly elected president of the American Dental Service Organizations (ADSO) said he’s tried simplifying things during challenging times with a guiding principle. He calls it his North Star, and it’s kept him on course, even amid the changing marketplace and a global pandemic.
Scott asks himself one question – What does the customer want?
“If I want to know what the future is going to hold, I look to my customers, namely their lives, needs, and wants,” Scott said.
Efficiency in Group Practice discussed a wide array of topics with Scott, including what it takes to build a successful group practice, where dental offices were with re-opening as of mid-summer, and his insights on how 2020 will shape the industry for years to come.
Efficiency in Group Practice: Can you give us an overview of National Dental Partners? How did it get started?
Scott: In many ways, everything begins and ends with friendship. My partner, Dr. Chad Evans, and I have been friends since we were 2 years old. As we grew up, we both pursued our passions, his being dentistry and mine, business.
Then about ten years ago he reached out to me. At the time, I had a consulting firm called Entrepreneur Advisors and a radio show called The Entrepreneur Life. The radio show centered around answering the question, “How do you move from entrepreneur to executive?” I found that that’s really the key issue challenging potentially successful entrepreneurs and clinicians – they don’t know how to scale to that next level.
At the time, Chad was in the Dallas area, and was going to start his first practice. He had been really successful as an associate but now things were different, so he called me for advice about setting up a good practice, and as a friend, I was eager to help.
After a visit, I looked at the marketplace and saw a really big opportunity – especially when it came to scaling his dental business. Again, like most business owners Chad’s response was, “Well, I know how to take care of patients and deliver excellent dental care, but I don’t know how to scale a business.” So, I agreed to help.
In many ways that moment was the planting of a seed that would later blossom into National Dental Partners (NDP). It was the combining of two friends, two partners, who each wanted to do the best that he could in the way that he serves, for the good of the practice and ultimately, to deliver the best service and experience to the patients.
Efficiency: Can you give us some concrete examples of some changes you made in Chad’s business that allowed him to grow his practice effectively and efficiently, truly making it a leader in the field? It’s a wonderful case-study of the success when dental expertise combines with business expertise.
Scott: Of course, here are some real-life examples of changes we made…
The first thing we had to get right was really designing his practice. Chad wanted to see and serve kids. He was a general dentist, he himself has seven kids, and he had been treating kids already – all of this meant he could handle what came along with the pediatric dental market (including behavioral management). At the same time, he had a passion for the Medicaid market and taking care of the underserved.
In Texas, a lot of the kids who need care are on Medicaid, and a lot of doctors don’t want to treat Medicaid. So, there was already this theme developing from day one, of, “We’re going to treat the underserved. We’re going to treat those who don’t get care.” We were finding his niche, his specific customers, and developing his brand. Eventually this focus allowed us to make choices that helped our patients choose Smile Magic over other practices.
For instance, as we looked at pediatric dental, there was nothing particularly exciting happening in the market. Nothing felt different, unique, or truly innovative. Dentistry’s hard to market in general, but pediatric dentistry in particular. So, we said, “Who has a really good model out there?” Well it comes to serving children and families, creating a positive experience they’ll want to come back to, we were inspired by companies like Disney & Chuck E. Cheese (in its glory years). There was a time when 10 years ago Chuck E Cheese was really the only space that you could take your family for quick easy fun. Disney remains the happiest and most desirable place on earth for families to visit. As crazy as it may sound, we wanted to create that type of experience in a dental practice. This led us to ask ourselves, “What if we combined outside industries into dentistry?”
It’s that’s kind of thinking that has led Smile Magic Dentistry’s growth – it’s been our theme from the beginning.
Efficiency: How does that kind of thinking play out in your dental practices? What does that look like?
Scott: We built a movie theater and a play gym right in our lobby, and we built the practice as if it was a storybook. That’s a lot of what Disney does, it makes the rides a story. So, when you go into the X-ray room, it says, “Once upon a time, there was a chipmunk named Charlie…” And so, the experience begins. And remember, we aren’t just creating an experience when we do this, we are creating a lifelong relationship between our pediatric patients and their dental health that feels far better and far different than their friends and counterparts are getting at other practices.
Anybody who’s been on a Disney ride kind of knows how the excitement of visiting different parts of the theme park is, and our patients feel the same things when they visit us. Along the way, each operatory is a different page in our storybook, and the kids get gold coins as they complete each piece. At the end, after their treatment, patients sit on a throne and we crown them to celebrate them while saluting them with, “For your bravery in dentistry, we now crown you king or queen of Smile Magic.” Everybody claps, and they leave with a balloon and sticker that says, “Amazing Child of Smile Magic.”
That is how you create families that want to come to the dentist – that choose to come to the dentist. At a time when so many are opting out of visiting dental practices (the statistics are staggering) it is our job to find ways to make patient acquisition and retention part of the work we do, and again the friendship that evolved into a business relationship, the joining forces of two talented professionals in their fields, is how we managed to do it.
Efficiency: Can you tell us about how you celebrated the moms of your patients who also quickly came on board the practice and brand you created?
Scott: Of course! Moms are a big part of the treatment and experience, so we created new stickers that read, “Amazing Mom of Smile Magic” which they receive in the process as well. Now everyone wins when they come through our doors, and these kids are walking out our door and immediately saying to their parents, “When do I get to go back to the dentist?” We achieved it. Oral health is now fun. Smile Magic is accomplishing its mission, and my friend is doing what he loves (and leaving the rest to me and my team).
Efficiency: How did you grow the business from there?
Scott: At a good dental practice, if you can get 100 new patients in, that’s great. If you can have 400 patient visits, that’s even better. We had 1,000 first visits in the first three weeks. So, we scaled and built multiple Smile Magic locations, and we were off to the races trying to just manage all of this.
As we grew I was able to use my business acumen on the back end to make the rest of the practice flow more smoothly and successfully, which meant the dentists could do what they do best while I made
sure they were supported by the best possible practice.
Some examples of systems that we saw needed an overhaul, that allowed us to grow (and continue to grow today):
Our billing systems needed a serious upgrade to handle growth and multiple locations. This was upgraded and changed – today we have a fully centralized billing team.
As you grow you are managing more humans and more patients and lots of regulations, which led to me immediately hiring a compliance officer on the first practice – something that many now consider commonplace which at the time was a very new idea.
Other additions as we grew included a software development team and call center. We really just tried to build things right so the practices could do their best and their teams could feel their best and most supported. And they do.
Efficiency: Using these systems and changes, what else led to your scaling from a pediatric dental partnership to National Dental Partners?
Scott: I think what really made us National Dental Partners, beyond just pediatric dental partners, was our awareness that there was a group of practices that were struggling in rural towns and dentists that needed help. These were practices that served communities that needed them, and they needed us, or they wouldn’t survive. The ripple effect of that is huge, and the fact that these practices could stay afloat simply by getting our support, while they carried on serving as they know how to serve really called to us.
Dr. Evans ended up buying those locations and we started supporting them. With that we expanded our work for the underserved beyond pediatric Medicaid underserved, to rural towns with all types of underserved populations.
The kids need care there, but the adults need care there too, and we decided to provide that to them sealed our vision for National Dental Partners. We’re going to support dentists who are serving the underserved, whatever their age or location.
By doing this, we allow dentists to retain autonomy in terms of how they practice, because they know their patients and communities, and we’re able to bring in what we know works on the back end to support their business while they support their community’s dental health, without stressing about practice survival.
Efficiency: Can you talk about your new offering with National Dental Partners and how that works? I’ve heard it called “Open Source” and I’d love to hear more about what that means.
Scott: That’s correct, we are the first truly Open Source DSO™. We always want the practices and dentists we support to feel like they have the time to do what they do best and enjoy the most, while we handle the rest, so the first thing about Open Source is that they, the dental practice members, choose what and how much support they need. Is it accounting? Call center support? Scaling advice? What are the blocks and issues holding you back? You tell us so we can take care of them with you. We don’t charge any markup for our services either. Everything we do is at cost. If you imagine a practice was stuck in the dark while trying to get to the light at the end of the tunnel, think of us as the bridge that gets going to get you to that light faster than you can imagine.
Participating practices can customize their support needs and we will serve them in the ways they need, as determined by them. Dental practice work isn’t one-size-fits-all and neither is the way we support our partner businesses.
Anytime we’re partnering on a DSO entity with another doc, we always like to be 50/50 at the DSO level and the doctor owns 100% of the practice. Maybe that 50/50 comes from that community feel of two friends, which again, is how this all began, through friendship. We feel like that equal partnership is an authentic and strategic way to say “Hey, let’s bring our value together and be partners. We’re in this together.”
It’s also important to note that only dental clinicians can own practices, so there aren’t “businessmen with money” in the background running the show secretly. We are very strict on corporate practice of medicine laws and have been from the beginning. I, not being a clinician, can never own a practice. Dr. Evans can. Our other member doctors and associate doctors can. What we own is an entity that supports them, and we provide them services. So, I’m a shareholder in a business that works to support the success of a dental practice that is run by a dentist, a member of the dental community.
Efficiency: You mentioned that you as a non-dentist cannot own a practice, but really quickly I’d like to highlight that for a non-dentist you love the dental industry and are highly involved in it and respected by its community, tell me about that.
Scott: You could say I’m a bit of a dental industry super fan. I’ve recently taken on the role of president of the ADSO (American Dental Support Organizations), an honor for which I’m excited and humbled to take on and lead.
Outside of running National Dental Partners with my friend and partner Dr. Chad Evans, I’m also the host of the DSO Secrets podcast and community, and a senior faculty member and partner of DEO, the Dental Entrepreneur Organization.
Efficiency: From your observations, where are dental practices in the re-opening process as of mid-summer?
Scott: It’s been really interesting because as a member of ADSO I’m able to talk with some of the biggest DSOs. That coupled with my work with the DEO (Dental Entrepreneur Organization) and on our DSO Secrets FB group, gives me a flavor of the industry – in real-time.
What’s happening is, frankly, different than anything anyone predicted. People predicted customers and patients were going to be very concerned about coming into the dental office. That really hasn’t happened for many practice owners. I mean, not on a bulk scale.
What has happened, and I’m sure many people can relate to this, is that people are just wondering what your rules are. They’re asking, “So do I have to wear a mask here?” “Do I not?” “What’s going on?” There is an expectation that you’re a clinical office and you know how to handle this thing. Patients probably have had more respect for us than we’ve given to ourselves.
The reality is, dental offices are some of the safest places in the healthcare industry. Remember, we were the ones in the ‘80s who had to deal with the AIDS epidemic and since then a lot of the protocols have already been put in place.
We’re noticing patients want to come back and need to come back. So, the patient flow component is there and that’s happening across the industry.
The other interesting thing that’s happened is, we’re noticing a kind of the great exit. Instead of exiting over the next five years and however that would have segmented out, it just all happened in June. Dentists are just closing the doors. The way many are thinking is, if you were going to retire in the next three years and you’re 65-70-years-old, why ramp back up your workload in this chaos?
Another scenario? Maybe you’re a dentist with five locations. Two were doing well, but three weren’t. With those three an owner says, “I’m out.” It’s just too much to manage. Because the other side of this is yes, the patient flow and demand are there, but the staffing piece is super complex. The dentists who are willing and have patients coming in don’t always have the support around them that they need. I think that’s been a struggle.
Where these challenges may have been easier to manage before, life is more complex these days for everyone, from patients to practices and managing that can be more difficult than ever.
It’s been very clear through all of this that those with the biggest support teams are able to handle the most chaos. Members of DEO have leaned on each other and supported each other. Members of ADSO have done the same. This has been the great accelerator and humbler for all of us that we need teams of support to handle this level of workload and information.
What does this mean for dental practices? We encourage our practices to help make their patient’s lives easier and safer while taking the necessary steps to ensure their own business can survive and thrive.
Efficiency: Have you seen any forecasts on when we’ll be back to pre-COVID-19 levels?
Scott: We actually have the data from China and Europe that’s come out because they were ahead of us on a lot of it. They came out of the gates at like 50% the next month after re-opening, and then they were at 75%, and then they trickled back to 100%.
America has responded a lot faster than that. Across the board, at minimum, dental offices were at 50% as soon as their states reopened. Many are now anywhere from 75-100%, or even above 100%. It’s because the supply has shrunk. The demand stayed the same. So, all those reoccurring visits that didn’t happen in April, those needed to get in.
I would say the other interesting component is the limitation on distractions we’ve had as Americans. Typically dental gets moved down the stack of “most important things to do today.” We have to do a better job marketing the value of oral health and the oral systemic link. Right now we are getting an artificial boost but soon others industries will be marketing more aggressively and taking the hearts and minds of our patients to other products and services.
I fully believe supported practices with large teams are in the best position and I know so many in this industry who are feeling that as well, partly because the amount of information, data and complexity that this has put on the system is so high. For instance, now you’ve got PPP loans coming in, EIDL loans, etc. You’re navigating new compliance components and PPE. How do I procure all of this and ensure high level of compliance?
If you don’t have a division of labor capability, if you’re like the single doc trying to do it with staff who have their own life complexities, you just can’t ramp up fast enough into this game. But if you’re able to divide out and you have an infrastructure in place, you’re more ready to serve the customer, the patient.
Efficiency: Speaking on behalf of DSOs across the nation, has the pandemic made DSO offerings more valuable to the independent dental office?
Scott: Yes. I think this was already starting to happen. Even dentists who were kind of wary on DSOs are seeing that these DSOs are willing to provide more capital to them if they want to exit or if they’re looking for a partnership. That’s interesting to them.
They have teams that can help them navigate all this complexity. All great athletes, even if they look like they’re alone, have huge teams.
This complexity, having a team, network, and support system, I think everyone’s saying, “Yes, at this level you do need a team. You do need support.”
That leads me into how we evolved and became what we are today, National Dental Partners, which happened before we knew there was going to be a global pandemic. That said, the state of our country has shown us and participating (and interested) members that there has never been a better time for partnerships and collaboration like this in our industry.
National Dental Partners (NDP) is taking groups who have built some infrastructure or have a vision on how they could really support patients, but don’t have the finances for things like a call center and a full executive team. CFOs are expensive. You’re not just competing against dental offices for CFOs. You’re competing against a lot of industries. And they need CTOs to get the technology, to feed them the data. All of these needs quickly become expensive and a struggle if the infrastructure is not there.
We created National Dental Partners to provide our infrastructure to emerging DSOs, so that they can skip over that dark tunnel many are in and skip that place of having to build everything out. They simply must stay focused on just taking care of patients.
Efficiency: As you said earlier, doctors are retiring earlier, but many of the consequences due to the change in practice have been well-documented, such as the struggle for procuring and using PPE, staffing issues, and patient confidence returning. What are some of the unintended consequences of the change in practice you are seeing?
Scott: I call COVID-19 “The Great Accelerator”. People were using Zoom before COVID-19, so it wasn’t like Zoom got created during COVID-19. People were using telemedicine before COVID-19. There were regulations. There were roadblocks. There were mindsets. There were my own mindsets of where I needed to be to have a meeting with somebody.
There were things already in motion, and frankly, DSOs were in motion long before COVID-19, because of the complexity of dentistry and our desire to streamline our member’s work and organizations. We have been here watching and planning as regulation continues to increase and the patient’s demand for standardization, more availability and time open and all of that continues to increase as well.
Thank you, iPhone, Walmart and Amazon and every other customer centric company. They’ve made us entitled customers. What COVID-19 has done is move us five years into the future where we have needed to move.
I talked to someone the other day who set a goal at the beginning of the year to have a 20% of his meetings this year be virtual. He’s a forward thinker – this was before COVID-19. He said COVID-19 helped him crush his goal. He’s had 100% of his meetings virtual. That’s what I think has happened for anyone who was forward-thinking. Whether they saw it was a train coming or the future coming, it came fast and furious within 90 days instead.
If you were already running that way, then it just felt like you sped up. If you were resisting, it felt like you got shoved. Or if you were going in the wrong direction, you kind of got shoved into this direction.
I think that’s going to be the consequence of this. There will be some level of normalization. For example, that guy I mentioned above won’t be 100% next year with virtual meetings, he’ll drop down, but maybe he’ll drop down to 50%. So, he’ll be way ahead of where he thought he was going, but not so much being forced, like this is.
I think the DSO consolidation will go faster. I think anything that was technology driven will go faster. We’re all moving faster on that piece. Let’s call it unintended consequences of this or byproducts.
Efficiency: Looking into your crystal ball, what do you see for the next 12-18 months for the industry?
Scott: With so many things going on, it’s easy to get overwhelmed. It’s easy to see so many data points. My North Star in business and maybe for life has always been the same thing. What does the customer want? If I want to know what the future is going to hold, I’d look to the customer. What does the customer want? The good news is, all of us are customers. So, it’s easy to diagnose too, because we can say, “What do I want as a customer?”
I look to the future, that’s what I think is going to keep driving this industry. “Can you make it more convenient for me?” What’s more convenient? So, if convenience means more technology, then it’s going to drive more technology.
Here is another piece of advice as you plan for the future of dentistry, and your success in it: You can’t think of dental just from a clinician perspective of procedure types. You have to now start thinking about customer avatars within dental and think of bringing them exactly what they specifically need.
For example, I think how the 60-years-and-older demographic is going to have a very specific desire. Maybe there’s more desire around PPE and cleanliness and convenience, but maybe you’re not feeling as much pressure around time slots. Maybe they have more flexibility.
Those in the pediatric market, on the other hand, may be less concerned about PPE. Whether it’s subconsciously or consciously they are saying, “This hasn’t really affected kids as much, and I just need convenience. I need you to open at these times and I need you to not have too many demands on what I have to do to get an appointment.”
What else do I see when I look at providing convenience? I see two-way texting and communication becoming the demand. That’s something that we’ve now implemented. People want to communicate more than just yes or no on the confirm text. They want to be able to say, “I can’t do it right now, but can we move it to this time without having to call in?” We want to be able to get on when we get in bed at 10 o’clock at night and reschedule things. So, whether we like that or not from a business perspective, as a customer, we love that idea.
Efficiency: Any last tips for practices trying to take care of these patient avatars in the best possible way?
Scott: Really look at your practice and ask yourself: What do you hate? I’ll do what I call a feelings audit on a dental practice. I’ll drive up. “How do I feel right now?” I’ll look around at the space and notice things such as, “Okay, that tree bugs me,” or whatever it might be. The signage isn’t right, etc.
When I walk in, how do I feel as a customer? Because that’s the only thing customers are actually experts on, how they feel. They don’t know the margins. They don’t know any of that. They’re concerned with: “How do I feel? Does this feel safe? Is this good? Well, one of the things that I always hate is, I have to fill out that paperwork again.” So that goes on the list to solve.
Customers are going to keep demanding those kinds of things. And when I say demand, it means they’ll actually switch service providers over those type of things or simply stop coming and do something else with their day. I hear it all the time. “I left whatever relationship because they had an app and it was easier. I left this because they have this way that this worked, and it was just easier.” So, I would just say that if you’re preparing for the future, do that feelings audit and look for where convenience could be better driven in your business and in your practice.
What is the biggest misconception when it comes to DSOs?
The power that the clinician has, Scott said. The fear among dentists is a DSO will come in and tell the clinician what clinical care needs to be provided. Any investor or DSO wants the dentist to keep doing what he or she is doing and providing the care they know their community needs. “We will do all the admin and business things to keep their practice growing and thriving that they likely don’t love in the first place!”
Scott has his own term for that type of organization, a DCO – a Dental Control Organization. “And I don’t think those should be around,” he said. “I think the misconception is, they say DSO, but they don’t really think about what the name is. Dental Support Organization. As a clinician, you’re in control. You’re where revenue happens. So, when I hear stories of, ‘They came in, they told me what I needed to do,’ I want to say, ‘Well, tell them no or quit. You have power.’”
The Dental Support Organization’s goal is to relieve the clinician in such a way that they can provide better clinical care, Scott said.
“I want you to imagine two dentists. One is on his own. He feels independent. This means he or she is also responsible for payroll that week, for how many patients are coming in, and the tiff that’s happening between the front desk team members. The dentist is responsible for the computers going down and responsible for all of the admin and business chaos.”
How is that dentist providing better clinical judgment and care than a second kind of dentist who’s not responsible for any of that back-office stuff, who’s not responsible for patient flow and scheduling, HR human resources, and technology upgrades?
“I believe the second dentist actually has more autonomy to focus on the clinical care at hand and serve the patient. All he or she is responsible for is to show up and take the best possible care of that patient, and choosing what supplies they need for that,” Scott said. “I mean, just think about brain power and mental focus. You can see that a DSO done right, the clinical piece outperforms an individual dentist just because of human bandwidth realities.”
And finally, Scott adds, “This entire DSO world of National Dental Partners really began as the friendship between two people: a dentist and a businessman, Chad and Emmet. I like to think that in some way that is how a DSO done right can act for its member practices – as a true “friend” in the dental industry that is there for support, encouragement, helping you improve the places in your life that you need improvement, all from a place of trust and care, all with the benefit of all involved – both friends – in mind.”