Episode 127 – Paul Etchison, D.D.S. on Expanding Your Practice

Paul Etchison, D.D.S. is the author of two books on dental practice management, a dental coach, the owner of a $6 million group practice in the south suburbs of Chicago, and the host of the Dental Practice Heroes Podcast.

This week, the Dental Amigos host Dr.  Etchison and  they discuss strategies for growing and expanding your practice. Through creative planning and scheduling, a practice owner can increase  new patient flow and spend less time doing practical dentistry and more time running the business. Dr. Etchison offers strategies for building a team that an owner can trust to run his/her practice in the same way that the owner would run the practice.  From bringing on the first associate dentist to delegating responsibilities to empower owners to focus on elements of practice ownership that they enjoy, Dr. Etchison coaches his clients to grow professionally, financially, and personally.

Listeners who are interested in Dr. Etchison’s coaching can schedule a call with his team at dentalpracticeheroes.com. Stream the Dental Practice Heroes Podcast on Apple Podcasts or Spotify. Check out his books, Dental Practice Hero: From Ordinary Practice to Extraordinary Experience and Dental Practice Hero II: The Sequel: How a 3 Day Work Week Can Give You the Life You Want. You can connect with Dr. Etchison on Instagram at @dr.pauletchison, Facebook, or LinkedIn.

Listeners who want to reach out to Paul can do so at Paul@DentalNachos.com and those who want to reach out to Rob can do so at Rob@RMontgomery-Law.com. ‍

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Full Episode Transcript

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Bumper  00:00

Welcome to the Dental Amigos podcast with Dr. Paul Goodman and attorney Rob Montgomery, taking you behind the scenes of the dental business world. All the things you didn't learn in dental school, but wish you had. Rob is not a dentist, and Paul is not a lawyer, but since Rob is a lawyer, we need to tell you that this podcast is for informational purposes only and shouldn't be considered legal advice. Listening to this podcast does not and will not create an attorney client relationship. As is always the case, you should formally consult with legal counsel before proceeding with any legal matter. Learn more about the Dental Amigos at www.thedentalamigos.com. And now, here are the Dental Amigos.

Rob Montgomery  00:39

Hello, everyone. I'm Rob Montgomery, and I'm joined, as always, by the Head Nacho himself, Dr. Paul Goodman.

Paul Goodman  00:45

Glad to be here, Rob.

Rob Montgomery  00:45

It's good to see you, Paul. And welcome everyone to another episode of the Dental Amigos podcast, where today we are joined by Dr. Paul Etchison, a practicing dentist who is also a podcaster with his Dental Practice Heroes podcast, which I think Paul you appeared on recently.

Paul Goodman  01:03

Yeah. Great podcast, yeah.

Rob Montgomery  01:04

And Paul is also the author of two books on dental practice management. He's a dental coach. He owns a $6 million group practice in the south suburbs of Chicago, and today he's going to be here to talk about, really what to do to build a better practice. And really we talk about this a lot, Paul, being purposeful with your practice and being mindful on what you do, instead of just kind of going through the motions, really putting in processes and being goal-oriented to  really build something that is a good business, not just a professional practice.

Paul Goodman  01:16 Totally agree. I mean, to kind of give a preview, Paul has done a good job of not doing the procedures that annoy him, and we'll talk about that in a minute.

Rob Montgomery: That sounds good. Now everyone, without further ado, here's Dr. Paul Etchinson, welcome amigo, and thanks for being on the show.

Dr. Paul Etchison: Hey guys, thanks for having me on and Yeah, ready to talk about this stuff. It's something I really like talking about, and it's something I love seeing other dentists discover is the beauty in dental practice ownership. So excited to talk about this.

Rob Montgomery: Yeah, and it's great to have you. I mean, we shared a panel at one of Dr. Nacho’s events in Philadelphia this past year, and it was, it was great to hear you speak. And you know the passion that you have for the subject really comes through. And you can tell why you are a successful entrepreneur. And you know, it's great that you're willing to share some tips and thoughts with with people for them to build a better practice too.

Dr. Paul Goodman: Yeah, for sure. And we will we serve our hard hitting question, Paul, if we were in the suburbs of Chicago, where would you go for nachos, and what is your favorite topping?

Dr. Paul Etchison: Gosh, I wish I knew more about Chicago, I'm about 40 miles south of it. And if you're ever in Frankfurt area, by me, there's a place called Taste of Mexico, and they got quesabria Tacos, which are fried and, like, just hardened cheese. And I would say my favorite topping, it's got to be jalapenos. I like it hot.

Dr. Paul Goodman: I like that. And before we get into the podcast, I want to share I feel outnumbered in this moment because Paul and I got a chance to speak at the All Star Dental Academy, and part of my speaking contract is they can't have a taller, funnier Paul speak before me, but he did. But then I came on stage and I revealed that Paul is messing up group chats because he is a green bubble person, and you're a green bubble person, Rob, so I'm outnumbered by the green bubble people. I'm disinterested that your phone takes better pictures. You're messing up group chats. But I do feel outnumbered by the non-iPhone users here on this podcast.

Dr. Paul Etchison: I've heard that in September, the iOS update is supposed to make all our colors the same. Oh, I like that. We did. I believe Apple is switching to RCS chat, but that's this rumor mill. Yeah, we did use a WhatsApp group recently as a go between, but I want to be in that group with all my friends, and they're like, Oh, now we can add you. And then I want it to say Paul Edison has left the group.

Rob Montgomery  03:52

That's what I'm looking for. Great stuff. Hey. So you know what we like to talk about, really, and it's a recurring theme on the podcast Paul, is that I think a lot of dentists, and really all professionals, for that matter, I mean anybody that is a professional practice owner, whether it's a lawyer, a dentist, a veterinarian, I think we all kind of fall into this trap of just putting our heads down and making the donuts and doing all the clinical work. And I think a lot of times we also think it's better just to work a lot work, more work, more take on more patients, see more clients. But you know, is that really the best strategy for growing a healthy business?

Dr. Paul Etchison: Yeah, it's good question, because we are also so tied up in this idea of that. I mean, we go through high school and we go through, we have these part time jobs while we're going through dental school and stuff like that, and we're working by the hour. So we have this vision that, hey, if I just put more hours, then I can make more money. And what I realized just happenstance, just like serendipitously, as I brought associates into my practice, I cut my days back, and when I cut my clinical days back and was able to focus on the efficiencies in the business, what I realized is that when I started focusing on the business and not just on clinical, everything started growing so much faster and and I had more income, and I could take more time off and the problems that would drive me crazy at the office, the chaos and just the disorganization, all that stuff went away, and it was like, my god, what was really killing my business was me being a dentist four days a week and not doing any of the business stuff. So I think it's something that we need to realize, that we've got to get ourselves out of that technician role, as they say in Michael Gerber's Emes, gotta get out of the technician role. You gotta step more into that management role, more into that entrepreneur role. That's where you're gonna start seeing some big results. And I think most people don't realize that our lives can be really amazing, and we can really build a practice around our lifestyle and what we want and just exactly the way we want it, if we just focus on the business, and, you know, working with our team. I mean, everything gets better when you focus on the business, you focus on the team, more people stick around, less turnover, less chaos, better systems. I mean, there's not a single downside to doing less clinical if you do it correctly, and you make sure that it's efficient, so that you don't lose out on production.

Dr. Paul Goodman: I love that, Paul. I always say that the journey, like the quote says, The journey to less owner stress begins with one step, and I think that step really is hiring an associate dentist. Take us back to because you kind of just glossed over it. What motivated you to hire your first associate dentist? What was your practice doing revenue wise? And you drove home one day and said, Paul, I cannot do this alone. And there are dentists listening to this in their car at the gym, eating nachos, saying, that is me. I can't keep doing this alone. Tell us about that moment. What motivated you? What numbers you need to know. I think that'd be really interesting to our listeners.

Dr. Paul Etchison: Yeah, absolutely. So I did a startup in 2012 and it was probably about 2015 maybe three years in, that I was starting to feel just the drain of being a four-day dentist. We were busy, we were seeing a lot of new patients, and our whole motto going into the startup was like, Hey, let's just take great care of people, and let's talk at the end of each day. And let's say, hey, what went well? What didn't go well, and we just improved every little thing. And eventually it got to the point where I just couldn't handle it anymore. I mean, I was burning out. I was running. I mean, this is 2015 by myself, doing, like, almost 2 million in collections, and just every day was, I mean, I want to say it was controlled chaos, but it was chaos, and it got to a point where it's like, Man, I really think I could get an associate and I could cut down to three days a week. Now, in 2015 I feel like that wasn't very normal. I mean, some people were doing it, but there weren’t many people doing it. And all of my friends are not dentists. So they're just like, dude, like, you're like, 30 whatever. How old was I then, I mean, 32 or something like that, you know, like, Dude, you're like, 32 years old. You can't cut down to three days a week. You're still young. And I'm like, I think I can. And I just kind of said, I'm doing this. And what was magical about it is, I'd love to say that I, you know, only worked three days a week, and I went golfing for us the time. I mean, I did a lot of golfing, but I did still come in on that fourth day, and I did still work with the team, and so that, that's how that transition happened for me. It was never intentional. I never went into practice ownership saying I was going to have a group practice. I just said I was going to go in do the best I can and really try to do something special, patient experience-wise, for the patient. And it just organically got me to that point where I didn't have any other options. I mean, my other option would have been to drop insurance, and at that time in my life, I was like, You know what? I don't really think I want to drop insurance right now. So we just kept growing. And then we added the first associate and the second one and the third one, and then we added a periodontist, and then an oral surgeon to do wisdom teeth, and then we added an endodontist, and it just kept growing and growing because of those systems we set in place in the way that we set it up. And I would say, to answer your question, as far as like numbers, I think most dental owners this day and age, 2024, about 1.2 to $1.6 million in collections, they're at a good point to bring on an associate. But there's a little caveat there is that you've got to have new patient flow. I mean, that is critical. If you don't have the new patient flow, you just can't do this. But if you can get yourself to get a good, high new patient flow, and I'm saying like bare minimum, 35 new patients per doctor. But I would love to see 48-50 that's what I want to see.

Dr. Paul Goodman: I have a question, Paul and Rob. Maybe Rob, because, you know, he has an attorney’s work as associates. I have my answer. But why is that new? And there's might be more there, but why is that new patient flow so key? Someone's doing 1.6 million, they only have 10 new patients because they're fee for service. It's different than someone who's doing 1.5 million with insurance and getting 40 new patients a month. I have my answer. Why is that new patient float so key to you?

Dr. Paul Etchison: Yeah, because that's what causes the growth. And I know there's people who say I don't need that many new patients to be busy, and I agree with you. I don't need that many new patients to be busy either, but most associate dentists, in my experience, I've been through seven of them, need about no less than 35 new patients per month, and that's going to be different in every demographic and level of income, depending on where your practice is. But there's a number to shoot for, and I believe it's 35 but I want it to be 48 and this is all kind of mathematical for me, like I really preach that we hold space in our hygiene schedule for new patients, we are going to prioritize new patients. Most practices, they don't hold any space, so nothing gets priority. But the thing is, is like, when does a new patient call? A new patient will typically call maybe two, three weeks before their appointment. When does a recall gets scheduled? Six months ahead of time, so recall then takes the priority, and then we don't have space to see a high new patient flow, but if we block out a certain number of new patients, essentially we guarantee that within three recall cycles, we're going to be at complete capacity with our hygienist, and then the only way to fit more patients into our practice is to add another hygienist who, because of that capacity, in one more additional recall cycle, two years after starting this will be a completely busy hygienist. So it's all math, and it's hard to explain without diagrams saying all those numbers, but the point being is that you can easily get yourself to a capacity point where you can expand if you have the new patient flow, as opposed to somebody who doesn't give any priority to new patients. They've got a hygienist that's going to see seven recalls a day, and they're saying, Man, I really would love to bring on an associate, but I just don't see enough new patients. And we're like, Well, why don't you see enough new patients? Well, it's okay. I don't really have anywhere to put them anyway. Well, that's a problem. You need to have somewhere to put them. So if you this is where we see owners get stuck. They plateau and they don't know what to do. I'm just stuck at like, 1.2 million. I'm stuck at 1 million. My hygienists are busy, but I can't get a third one to be busy.

Rob Montgomery: You build it and they will come right?

Dr. Paul Goodman: As someone who was the son of a dentist who joined them. You gave a lot of good facts there, Paul, but whether Rob, it's you being busy as the owner. Guess what? All those new patients, they don't know me as their dentist, right? They know your associate as their dentist. And that is magical for the feelings of your associate, because when you constantly have to be like, Would you please see my associates? See me? It's you have you can grow that way too. But I just found that I would just love to see a new patient when I was an associate, because they don't have any other dentists in this office they've seen before. And that opens up, to me, magic in the associate the same thing, whether your attorney, if you're saying you're going to see the client for the first time, they're not going to know me. It just creates an opportunity for that associate dentist to feel like they're growing their base inside of your base.

Dr. Paul Etchison: Yeah, it is so true, because it's almost like a protocol that we have at my practice, when a hygienist is going to do scaling and root planing, if they do one half of the mouth, they do the other half of the mouth. We never, ever want to have one hygienist do one half and the other hygienist do the other half, because when you set it up like that, there's always going to be one that's too rough or one that was too light. And when you have your previous patient seeing the associate, sometimes they love them, and it's great, but sometimes they're just like, No, never again. That's not who I want to see. So when you have these new patients coming in, like you mentioned, Paul, they can establish care at your office with that new associate, and they don't even know who the hell you are. And that's great. I mean, that's what you want as an owner. That's my favorite place to be, the who dis that's what I want to be. You come in there and people don't even know who the hell you are. It's great. I mean, and then you can set up your practice in a manner that you can see patients as much as you want. And I'm not trying to make it sound like I hate seeing patients. I don't. I still see patients myself, not very often, but I still do see them. But I mean, you'll get that flexibility and all the freedom that comes with having associate doctors. Take off time, make more money. The Office stays open when you're not there. It's just everything opens up for you. And the hardest transition to make is that solo doc to the first associate. It's like, when people have even have your first kid, that first kid's a little tough. When you have the second one, it's a lot easier. By time you get to three, it's like, okay, this is, this is no problem.

Rob Montgomery

And what are some tips that you would give to the dental practice owner who's looking to go from no associates to one?

Dr. Paul Etchison: Yeah, I would say that the first piece of the puzzle is solving the new patient problem. And I'm not I'm saying problem, and maybe it is not a problem for you. If it's not a problem, fantastic. But is figuring out how to attract new patients. And when I think of how do new patients come into the office, they got to get through three gates, and the first one being, is when they're looking for a dentist on the internet, they have to see our practice. So that's going to be having Search Engine Optimization. That's going to be using your marketing like pay per click. I need the prospective new patient to go on the internet and at least get a chance to see my office. Then the second hurdle they have to get through is they have to pick up the phone and call me. So now I need a nice looking website. I need an attractive looking practice and up to date practice that has some nice pictures on it, a nice slow motion video, just it's put together nicely. And it's not just having somebody that knows how to do website design. You've got to give them good content to put on there. So you've got to give a good video. You got to give them quality pictures, and you've got to have a I don't care how good of a photographer you are, if your practice hasn't been updated in 30 years, it's not going to look updated. You can't make it look updated. So you might have to do some updates. But I want the user, the prospective new patient, to see that and say, Why would I go look for anybody else? This place looks fantastic. And I also want to have the reviews to back it up, because that's how they're going to see me on Google and click on me before anyone else. And then they're picking up the phone and calling, which gets to our third hurdle, which is, can we train our front end to convert a person on the phone to coming in for an appointment? So those are the three hurdles. And what's nice about it is the first two I mentioned don't involve any interpersonal contact. There's nobody on your team that's going to blow this at the first two. It's just creating a website and creating a nice-looking practice and photographing it nicely and just putting a nice visual product out there. The only place you can screw it up is on the phone skills. And I would say for most of us, it's for an in-network dentist. It's pretty hard to screw that up on the phone, but if you train on it, how much better does it that patient journey begin for the patient experience when they start in your office? So I would say the first thing to do for somebody who's thinking about adding an associate, you got to solve the new patient problem. You've got to get enough new patients. So you got to look at those things, and when you start seeing enough new patients, then you've got to get yourself to capacity, where you essentially don't have anywhere else to put anybody. And this is what I preach with my holding space in the schedule. What we're doing is, if we look six months ahead, we're going to see there's a lot of open time in my schedule, but it's blocked off for new patients. And we do have open time because we know it's going to fill later on, like five, six months from now, it will fill with those new patients. But we're forcing capacity by holding space for new patients so that we are forced to expand our capacity so that we can see our recall patients, and that's all predicated on having those new patients. So start there.

Dr. Paul Goodman: Paul, I want to just ask before the next thing, because you ou really, I admire you for this, not your choice in cell phone carrier, but I admire you for this. You know, you've started practice, Rob does a lot with startups. I've never done a startup. I've done acquisitions. But you know, you started your own practice in 2012 right? And you know dentists they're quite control freaks in the Krebs cycle streets, right? They are. So you're doing $2 million a year, and I just would love for you to share, how did you trust an associate to see your patients and do your culture and your care? I mean, it's great to have new patients, but how did you say, Okay, I'm doing $2 million a year. I started this up. You truly are an all star. What was your mindset? Where, like, Hey, this is gonna work. I’m gonna delegate it. I'm going to be patient with them. Because there's so many of these owners saying, hey, I want to hire an associate. But do they have experience? Do they know what they're doing, what you understand? So just talk to us about that clinical trust or training, or how did you make that work?

Dr. Paul Etchison: Yeah, and that's the tough part, because I think being a dentist is like, how we think of our driving, everybody thinks they're a good driver, and everybody thinks they're the best dentist ever. And I'm guilty of that as well, you know, and I have been humbled many times. I mean, just recently, one of my assistants worked with another associate, and then she came back and we did, I did a crown on my cousin, and she goes, Dr. Steve's margins are like, way smoother than yours. I'm like, are they? Well, let's see this. And I couldn't believe it.

Dr. Paul Goodman: Hold on Paul, margins are like, if another attorney had a fancier legal pad than Rob. Okay, so I wanted to bring Rob back into the conversation. But, yes, yeah.

Dr. Paul Etchison: So, so I got humbled a little bit. But you know what, having an associate come in, you're gonna have somebody seeing your patients, interacting with your patients, interacting with your team. It is pretty scary, because nobody is going to do it like you. And I think the mindset shift that needs to happen is one, you got to realize that from the get go, you're going to be coaching and checking in with this associate, helping them, mentoring them, and you're doing it from the start that is so important, because it is so easy to mentor somebody and coach them. When you start it off like that, it's not so easy three months in when you're like, hey, let's start doing coaching. And they're like, Oh, really. Why? And you're like oh, because everybody complains. And I look at your work and it really sucks, like it's hard to react, have a reactive conversation like that. So you got to do coaching at the beginning. You got to be checking in with them, listening to their exams, let them shadow you. And then the second thing is, you've just got to step back and accept good enough is good enough. You know, they are going to not diagnose some things that you would have diagnosed. They may not have as good of case acceptance as you. They might talk to somebody about a big case, and you feel like you would have closed that case up, and you'd be doing those eight to 10 veneers, and that person walked out the door. That's going to happen, and it's totally okay. You got it. If you're looking at all the opportunities lost, you're going to drive yourself mad because they are not the same person as you. So it is that mindset shift that we have to have in order to bring somebody else into our practice. But at the same time, I tell every associate that starts, hey, number one thing here is you've got to stay on the good side of the team. You've got to treat people, the team and the patients, with respect. If you get on the bad side of this team, you will not last. And I tell them, because I've seen it happen with associates. If they come in with a chip on their shoulder and they're not as nice as they should be to the team, they're above them. They're a doctor, that team is going to reject that person, and they're going to get, hypothetically, voted off the island because the team is not going to want to work with that person, so they got to be nice to everybody. But I think it's sometimes you get a good one, sometimes you get a bad one. And my experience has been, pretty soon, you usually know, within four weeks what you got, and you can do some coaching, clinical stuff, I found it is very easy to coach people on the personality stuff, the communication stuff, the just the character sort of things. I have not found in my experience, that I can coach people on that. I think that's kind of set. And if you get somebody that's a bad apple in that regard, I think it's time just to have that conversation and move on.

Rob Montgomery: They’re not coachable, right? So, but as you talk about the team, right? You know that's a whole other dimension here. And you know, if you're looking to really build a healthy, successful practice that keeps you sane, you know you're talking about the clinical partner there, the dentist, the associate dentist, but for every associate dentist, there's 10 more team members that are not dentists, right? And what role do they play in in building a better practice?

Dr. Paul Etchison: Yeah, I mean, since we're talking about associates, they play a big role in endorsing the associate to your patients. That's why that respect is so important. They have to feel in their heart that they can have anyone in their family come to your practice still and they're still confident they're going to get a good experience and get taken care of. But I think the team is everything, and if you can retain a solid team, you can go so much further. Because, I mean, think about this, we're going to really try amping up our new patients, right? We're going to grow our practice. We're going to have to bring people onto our team just to grow if we have to bring people onto our team just to combat and net zero out that turnover that we're having. It's going to be hard to continue to grow, to have systems in place and train people. It's just going to get more chaotic. So you want to keep the team, but I would say in like my practice experience, I've been I own my practice for about 12 years. Now I'm down to one day a week, just three weeks a month. So I don't practice all that often. And Paul, I like to joke about I just do ortho. I'd never do dentistry. Just fake dentistry.

Dr. Paul Goodman: Just fake dentistry. Yeah, dentistry, Rob, because you don't make people numb. That's the injection that you get for fillings. They don't have to do that. So it's all at a jealousy. Ortho is fake dentistry. Next time you have a new client who calls up and says, Hi, I'm an orthodontist, like, Oh, you do fake dentistry and everyone's jealous of you. I actually talked to orthodontist yesterday, and he actually took it in stride. I think they all are glad that they do fake dentistry because they don't want to be drilling on teeth. And one of the things I'll add in, Paul, because we just did Boost Camp, can't wait to have you next year. And someone said, you know, your team pays so much attention to detail at these CE conferences, no one pays this much attention to detail. And guess what? I'm going to take a lot of credit for that, because I led them, and then when we don't do something well and there's a problem, I'm also going to take the blame from that, because I led them, and I think you got to give your team the tools to make good decisions when you're not there. And I think too many dental practice owners don't take that time to train them. You know, how are you going to make decisions when I'm not there, whether it's seeing an extra emergency patient, whether it's what to do if someone doesn't have their patient portion, whether it's what to do with your associates or anything. So I'm constantly training my team Dental Nachos, Dentist Job Connect, and my dental office team. How do you make good decisions when I'm not there? Because otherwise I got to be there all the time.

Dr. Paul Etchison: Yeah, it's so true. And if you ask any dental practice owners that if you had one highly paid employee that made sure that you never had to do any more admin work, that you never had to deal with any of the interpersonal conflicts, that this person's not being nice, or this person's not turning their rooms, or they're not doing sterile if you could pay somebody a lot of money, and you never had to deal with that ever again. Would you do it? And they all say yes. And then we say, well, why don't you just do that? Because you already have that team member on your team. You just have to pour the training into them. And I have my main assistant. Her name is Jacqueline. She's been with me for 10 plus years. I call her my clinical manager. She is my insulator. She is the person that has made my life amazing, because when it during my practice career, what burnt me out so much was just I'm trying to focus on growing the business. I'm trying to focus on everybody being happy. I'm trying to make sure that the patients are taken care of. And then I'm dealing with this BS between these two assistants that can't get along. And then I got the front desk person that keeps calling off. And I just get tired of dealing with that stuff. I eventually hired her she was my lead assistant. She took on a lot of responsibility. I started giving her more. She started doing all the hiring, does all the firing, you know, deals with all the interpersonal conflict. And I can go, I mean, in the summertime, Now we're in August, but this summer, I mean, seven of the past weeks, I haven't been there for five of them, and I haven't got more than maybe one or two texts about something that I needed to attend to that's great. And I know there's things happening, and I know. And she tells me that. She says, yeah, things are always going on. Do you want to know about them? And I said, not really. And she says, Well, yeah, I'll bring you in if I feel like I need you, but it's all under control. And I pay her well, because that is a lifestyle decision. And man, is it amazing to have her. And it's, I've got four other people on my leadership team that are really amazing too. So it's about pouring into your team and telling them what to do, because if you're not going to do it, it's just they're not going to do it on their own. It has to be intentional, and they want your blessing. And people want autonomy in their work, and they want to have that. They want to be creative. Just you have to give it to them and let them run with it. And it has to be a certain type of person, of course, but I don't think they are super hard to find. I think every single dentist listening to this right now has two people on their team right now that could easily do this.

Dr. Paul Goodman: I totally agree that it's the dentist that is holding back. The one thing you had made some notes on Paul, which I wanted to bring up, was some of these dentists may be listening and saying, look at these two, Paul and Rob, they're doing great. This is great content. But what about the money part? Because you had shared that you one year only produced 800,000 but made 1.6 million. You have a $6 million group. This is not to brag, but just to give you context to our listeners. So for the dentist, who's saying, Oh, this all sounds great, but I'm gonna make so much less money if I hire associates and do this. How did you make that magic happen? Where you decrease the procedures you did, did less dentistry, but actually increased your income?

Dr. Paul Etchison: Yeah, that's interesting is, because a lot of the everything I know and everything I learned, I feel like for the most part, I'd say 80% of it I learned the hard way. And this is one of those things I would have done different looking back, is I would have pulled myself out clinically earlier, or I would have focused myself clinically earlier. I mean, there was a certain point during the practice cycle where I said, Okay, I'm not doing any more fillings. No fillings, I'm only doing everything else. And then I said, Okay, I'm not doing any more crowns. I'm just doing implants, veneers and ortho but that didn't happen until, I mean, fairly recently, maybe three, four years ago. And what spawned that was that I was really getting overwhelmed. I've noticed that a lot of my overwhelm has to do with their stuff going on with the practice, or there's things I need to get to, and I can't get to them because I have to see patients. I want to sit in my office. I want to work on these things. I want to clear my desk, but I have to see more patients. And then a patient calls on my admin day, and a patient calls and they want to see me, and I got to go see that patient. So when I started looking at what I took home that year on my tax return, I said, Okay, well, I produced 800k so if I paid myself that 30, 33% of my production, that would have been, you know, 240 to $300,000 What did I take home that year? And what I realized was that, you know, 80 something percent of my income was from EBITDA. It was from owner profit, and only that little piece like 15% was for me doing the dentistry. So if I could just find another associate to produce that level of dentistry, I could still make that whole other 85% but yet, here I am spending 90% of my time at the practice doing dentistry. So why am I spending so much time when I'm there's so much more value as a dental practice owner, to lead, to inspire, to train your team, to manage people, just to be there and be enthusiastic and set an example. It's like, that's the beauty of growing a group practice as an owner, is that you can really step back and just do the amount of dentistry that you're comfortable with, and then do the amount of management you're comfortable with, and you can still make a ton of money and have a ton of freedom and take a ton of time off. So that's where that 1.6 came from. Is the 1.3 came from EBITDA, and the other 300 came from what I would have paid myself as an associate. And like you mentioned too Paul, I never want to say that to like, brag or humble brag. I just want people to see that you can really, you can do really well as a practice owner running a group practice, if you get, if you spend the time on the business and get your head out of the chair a little bit

Rob Montgomery: Yeah, I feel like over the years, I've observed that really good group practice owners realize that you can't do both of those things at the same time. You can't be the dentist and the manager and the entrepreneur and the person growing the business if you're also trying to do the clinical stuff at the same time. It's just impossible to do all those things well. And the people that I've seen succeed are the ones that, like you Paul, have realized that they need to get associates to help, to free themselves up to do those other business things, or they continue to practice dentistry, chairside dentistry, full time, and bring on business people to do that, but like there needs to be somebody doing each of those roles. And you can't try to wear both of those hats at the same time. You just can't be successful at that.

Dr. Paul Goodman: Your points are so good. But also, people can take these points home in whatever it looks like to their life, whether it's their first associate, their fifth associate, or hundreds, is the more people you have doing dentistry in your organization, the more flexibility you have, right? The more vacation you can take the more things you can do, and you can't get anywhere if you don't. I give Rob a lot of credit. Early on in all this, my journeys he was like you got to replace yourself. And I could find someone to do dentistry, Paul Etchison, but I couldn't find someone to run a Facebook group. That was just me. So I had to say, I will do the refereeing of people fighting on Facebook, and I guess someone else will have to do the class twos. And maybe, Paul, I've never brought this up, but I think you'd be a good person to ask about it. And I felt this way to some degree, not like there's this weird guilt if we don't do the dentistry, but it's just not, it's just a feeling right, like, like, whether you're Mark Costas, Paul Etchison, Summer Casmill, Paul Goodman, and whatever you do, it's like, but I'm supposed to be doing this dentistry. But at a certain point it's kind of annoying and stressful to be half in and half out of clinical dentistry.

Dr. Paul Etchison: Well, and that's like I said, my overwhelm came from when I had things to do and I had to do dentistry. And some people might have a different experience with dentistry. I mean, I was a CE junkie. I took a bunch of stuff. I do implants, I can do, like, all the specialist procedures. I'm like, a super generalist, and I do enjoy doing that. But when it comes to predictability, I find that managing my team and managing my business is way more predictable than dealing with dentistry. I mean, we've got somebody that's calling our practice right now saying that we said, we hope Santa buys you a new toothbrush, and we would never say that to anybody. And why would we be talking about Santa? It's August. She won't stop calling. Like, she keeps calling us. And I finally said, Okay, when she calls the next time, just put me on the phone because, she won't call me back. Yeah, I'm like, Why does she keep calling? She said she wanted to make an appointment so that she could come in and we could tell her to her face that we didn't say that. It's just, like, It's wild. But you know, that's the kind of stuff you did get with dealing with patients. Yeah, I don't get that dealing with my team. And if I do get that, it's like, see you later, and it's over and we don't ever see them again. Yeah, it's, it's finding what you love doing. And I think if we all sat back and we said, what part of running like you mentioned, Rob, somebody needs to wear these hats. Which ones do you enjoy doing? Because the ones that you enjoy doing, you're going to do them with so much more passion and intensity, and you're going to do them well. The ones that you don't like doing, you're not going to put as much into it. So find somebody who does find that passionate. Because all the stuff you hate at your practice, there is some member of your team, or someone that you can hire that would walk in and be like, I freaking love this. I gotta, I gotta do an expense report at the end of the month. I hate doing this. I finally delegated that off to my assistant. It's like one of her favorite things to do. She thinks it's fun. I don't know how she thinks it's fun, but she thinks it's fun. So that's just a perfect example of something I just dreaded, and I got to delegate to somebody, and they're just happy to have a new responsibility to do something new.

Rob Montgomery: Well, as you say, that delegating so really, and that's one of your themes, and this is what Paul mentioned a few minutes ago, Paul, which is, you know, building this practice or this business that can run without you. You know, when everybody else can do their thing and free you up to do everything else that helps with the growth and the creative aspect of the business and the entrepreneurship. That's really when you've got something that's firing on all cylinders.

Dr. Paul Goodman: And also, I mean, Paul, this podcast is about being real, and I feel like I'm a champion of dentistry, but I'm also someone who talks about the concerns in dentistry. You know, whether you're $2 million a year like Paul Etchison, whether you're doing 800,000 a year, if you're a solo GP, you can feel trapped in all of it, right, no matter how much money you're making, because if you don't, like Rob says you don't show up. You don't show up to make those donuts every day, the whole thing collapses. And I just can see how that can be just so much pressure on somebody. And you know how you can tell if something's a good decision, Paul? Rob, when you would talk someone who's hired an associate dentist, know what they say, I'll never go back to practicing alone. I should have done this sooner. So maybe people can learn from this and accelerate their enjoyment of whatever they're doing sooner by hearing you tell the story. And it's the same thing with if you get efficient and you get yourself from five to four to three days a week, nobody goes back to four days a week. So dentistry is dose dependent, but I always like to quote Paula Dean, it was on at the practice one day, and she was making a upside down cake, and she said, You know what the only thing better than a chocolate Upside Down Cake is? And we said, what? It's a double chocolate upside down cake.

Rob Montgomery: You know, though, as we talk about building the team and the importance of retaining people, you know when you talk about adding additional locations, when you're talking about a group practice, Paul, that really makes those issues with your team and kind of the health of your business even more crucial, right? I mean, if it's like trying to build multiple stories on a house with a bad foundation, the people that I see that try to go from one to two to three practices that don't have a good organization, where they are still trying to wear multiple hats, that's really a recipe for problems.

Dr. Paul Etchison: When I look at my leadership structure, I have my office manager, and I have my three leads, and I also have an insurance coordinator too, but pretty much four people that I'm a leadership team and I'm the fifth. But you know, when I look at them, they run everything, but they're also like an assistant some days, and they're just assisting patients, and they're also the hygienist, and they're seeing their own patients. And there's part of me that is like, Hey, I've got this great thing going. Why don't we take them out of patient care, and they want to do this as well, and we'll go get a few more practices, and I would love to give them some ownership in it, and I think it would just be fun to do, but that's the whole thing. Is, like, I have now multiplied myself into these four people who are now really good at running my practice, but there's still, there's a lot of patient time that they could get out of, and somebody else could fill in that patient time so that they could run more practices. So I think it's great to have the systems in the first practice before you go to number two. And I'm not pooping on the multi practice, people, that's awesome. It's not my jam. I haven't done it. I have a feeling I’m going that way every pretty soon, but I think you can do a lot out of one practice, and at a certain point it's just like, what's enough? Is enough? You know? Is it enough? I'm doing pretty well. I don't think I need any more. It's more of a fulfillment thing and something fun to do with my leadership team, who I really enjoy spending time with, more or less.

Rob Montgomery: Yeah. I mean, more is not always better, right?

Dr. Paul Goodman: As we kind of wrap up, well, I wanted to ask you this, what do you do with your coaching, exactly? You know, you're someone who's grown this practice. You do a podcast, and coaching is a popular thing. We just talked about this with a recent guest, and I love coaching, and you can get coaches for all different types of things. Who are the people coming to you, saying, Paul, coach me to do this. What is the this?

Dr. Paul Etchison: Yeah, I would say most of my clients are people that are near at capacity, and they're bringing on associate, that just seems to be who I draw. I don't get a lot of the Oh my gosh. I hate my job. I hate my practice, but I do have those too and I do work with those people as well. But I'm saying what people are coming to me. They want to grow a larger group practice, and they want to cut themselves out clinically, and not to an extent where, like, they hate doing the dentistry, but just have the freedom to do as much dentistry as they like. So those are the people I typically work with, dental practice owners who wants to grow their practice and have more time off. And I always say, it is never about the money. It's never about the profit. I am going to help somebody systemize their practice. I'm gonna help them put in the systems. I'm gonna help them handle the issues and troubleshoot what's going on as we're systematizing this practice, and we're gonna make it a great place for everybody that works there, and we're making a great place for all the patients. And guess what else is gonna happen? You're gonna make more money too, but we're not gonna give two craps about the money, because we don't even have to worry about it if we do all the other stuff that just takes care of itself. All you have to focus on is taking great care of your team and great care of your patients, and the money just follows. So it's not about cutting costs. It is about being more efficient, but it's not about seeing more patients and doing things faster and cutting corners. It's about doing solid really, five-star dentistry, and giving people a five star patient experience, and being clear with your team on how we do things, so that your team knows how we do things when you're not there, and just essentially removing you as the bottleneck that so many of us practice owners become. Where you're the person that they come to, and they have a question, hey, what do we do now? What do we do now? Well, eventually you get to the point you say, Well, what do you think we should do? And then they turn around, they say, well, that's why I'm asking you, and that's the problem. They need to stop asking you. But the reason they don't know is because you've never given them that autonomy, and you've never put those systems in place. So that's what I'm about. And if anyone's interested in checking out my stuff, it's dentalpracticeheroes.com. There’s a free webinar on there that talks about the foundations of what to do to take your practice to the next level, to get to that associate level. So that's free on there if anyone wants to check it out. But yeah, that's my stuff in a nutshell.

Rob Montgomery: Awesome. And any social media platforms that people can follow you or check you out on?

Dr. Paul Etchison: Yeah, I'm on Facebook and Instagram as well. I think I have a LinkedIn. I have somebody managing that, but yeah, that's cool. Check me out there, shoot me a message on Messenger, or just shoot me a message on my website, dentalpracticeheroes.com. Heroes is plural, and heroes is spelled H, E, R, O, E, S, because a lot of people seem to make that mistake, but that's okay. Not you listener, you wouldn't make that. I'm just going to share it anyway for the people, just in case.

Rob Montgomery: Great, awesome. Well, Paul, it's great having you. Thanks for taking the time.

Dr. Paul Etchison: Yeah, thanks so much for having me on. It was fun.

Bumper: Thanks for listening to another great podcast with the Dental Amigos. And don't forget to tune in next time to have the dental business demystified. If you're looking for more information about today's podcast, you can find it on thedentalamigos.com. If you're looking for Paul, you can find Paul at drpaulgoodman.com and if you're looking for Rob, you can find him at yourdentallawyer.com. This podcast has been sponsored by Orange Line Media Group, helping dentists and other professionals create content people love. Find out how we can help you take your business to the next level At www.orangelinemg.com, till next time.

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