Dental Practice Heroes

Scaling a $5 Million Dental Practice with Dr. Iraj Kasimi

• Dr. Paul Etchison, Dr. Iraj Kasimi • Season 3 • Episode 45

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Should you grow your practice or stick with a solo operation? How do you avoid burnout and create systems that actually work? What are the biggest challenges to scaling a practice? We answer all these questions and more in this episode with Dr. Iraj Kasimi, who scaled his $1.8 million practice into a $5 million group practice.

Dr. Kasimi shares how he overcame the growing pains of scaling, implemented effective systems, and evolved from a clinician to a business leader. Tune in for insights on transitioning to a larger practice and the rewards of scaling versus staying small!

Topics discussed in this episode:

  • Sustainability and burnout: scaling up vs. staying small
  • Systemization and training a strong team
  • Leadership structure in a growing practice 
  • What makes a good lead and your role as leader
  • When to scale and when to stay small

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Etch:

Should you stay small or scale up? This decision could mean the difference between burnout and balance. In today's episode, dr Iraj Qasimi joins me to discuss the challenges of scaling a solo dental practice to a group practice and the rewards that can come with it. He shares how he built a strong leadership team, implemented systems that support sustainable growth and evolved in his role as the leader, all while more than doubling his revenue and increasing his income on less clinical days in the process. You're not going to want to miss this one. You are listening to Dental Practice Heroes, where we help you create and scale your dental practice so that you are no longer tied to the chair.

Etch:

I'm Dr Paul Etcheson, author of two books on dental practice management, dental coach and owner of a $6 million group practice in the suburbs of Chicago. I wanna teach you how to grow and systematize your dental practice so you can spend less time practicing and more time enjoying a life that you love. Let's get started. Hey, what's up everybody? Welcome back to Dental Practice Heroes. Very excited for my guest today, I got a previous client and just an awesome dentist, awesome business owner. 2013 Oregon graduate, dr Iraj Kasimi, hillcrest Dental Vegas. What's happening, iraj? How you doing man?

Iraj:

I'm doing well. I'm doing well, excited to be on your podcast.

Etch:

Awesome dude. I'm so excited to do this because I work with a lot of people and Iraj is one of those people that came in as a strong leader, knew what his vision was for his practice and he's got a great big group practice in Vegas. Talk about how your practice is now.

Iraj:

So I bought the practice in 2018. It was already doing pretty well, like it was about a $1.8 million practice. It was like one and a half hygienists I would say one full time and one like two days a week. I had a strong office manager who's still with me, and the lead hygienist is also still with me.

Iraj:

But you know I was doing well. I bought the practice and kind of met some mentors that kind of showed me how I could take it to the next level, Because I didn't think there was any. I didn't think there was a next level. At that time I had no idea what the potential was in dentistry. And when I started listening to podcasts like yours and started hearing from other dentists and what they were able to do, I started getting motivated to try to grow the practice. So I ended up doing some courses and things like that and just taking different materials and ended up growing it to about 3.2, with just me in 2021. And then 2022 is when I first brought on my first associate.

Etch:

And now, how many associates do you have now?

Iraj:

So now we have three, three associates full time and myself.

Etch:

Nice. Okay, so three associates and clearing $5 million this year.

Iraj:

Yeah, I just checked yesterday. It's the first time ever we crossed that mark for what we're scheduled for.

Etch:

And did it feel accomplished. And you're like I've done it, I've done everything in the world. I have nothing else left to do. Hang up my hat and just call it a day.

Iraj:

I actually have loftier goals. I want to eventually take it to 12. This is my personal goal 12 mil yeah.

Iraj:

Yeah. But the cool thing is I know a lot of docs listen to this thinking like, oh my gosh, that's way, way more than I'd ever want to do. But the thing is, if you are somebody who enjoys doing dentistry and you feel like you can offer something to your community good quality, ethical care, ethical diagnosis I kind of feel like I'm doing a disservice by limiting myself, because there's so many more people around me that I could help and so many patients come like oh man, I didn't even know you guys were here, I'm so glad I found you. That's kind of how I view wanting to go and help more people.

Etch:

Now I love that you mentioned that you went into this about one and a half million when you acquired this practice and you didn't know there was a next level. Talk about that first transition and how you got to that first transition of bringing on an associate, because I mean as one dentist, I mean those are pretty amazing numbers just by yourself.

Iraj:

Yeah. So it was kind of a journey where I was still, you know, pretty new into my career you know, five, six years in seven years in and I started realizing that the way to achieve those numbers was very team driven. So having the entire team educated on what we're diagnosing, why we're diagnosing, taking intramural images and pictures and so on and so forth, and just having them help the process of communication was what allowed me to really scale to that level. But I started realizing that this is just not going to be sustainable and I'm only going to do this for a few years and burn out and want to get out. So I started looking into ways that I can continue to offer that same level of care and kind of duplicate myself and also grow the business, be more profitable as well. Kind of all goes hand in hand and really the only way to do that was to bring on associates.

Etch:

When you say like it wasn't sustainable, what did you mean by like what wasn't sustainable about it? Were you starting to feel some burnout, or like what was happening?

Iraj:

Well, I feel like I could operate at that for several years, but I knew that beyond that I'd probably just burn out.

Iraj:

Yeah, I mean there was days where I'd be working till seven, eight at night, you know, show up at the office at around eight in the morning just doing cases and starting same day dentistry and so on and so forth Still gave patients a phenomenal experience. But I could just feel that in my own self and somewhat in my team members too, that you know there was some fatigue kind of setting in and so on and so forth. So I realized that we can really take the great things that we were doing and kind of like reorganize and restructure the practice in a way that we can continue to offer that, but just make it where it's very, very sustainable. You know patients aren't waiting and we're really giving people a great experience. But you know I've talked to so many people who had so many negative experiences working with an associate and I've been very, very fortunate and being able to find some fantastic doctors that are on our team currently.

Etch:

Yeah. So talk about the sustainability. Like you were cool doing it and I could totally relate because I was there and man, it was like just like totally what you said. Like I saw it in my team. I saw the fatigue. I knew I was I don't want to say I was driving them into the ground, but I just knew at some level like and we were working really hard and there was a point where I just didn't feel like working that hard anymore and then you kind of tamed down your schedule and then you realize, well, I don't want to really work this slow because this is boring now. But how is your life different now with a larger practice? I know your team's roughly around 30 people. Now you have to manage. You have multiple doctors, you're doing mentorship. How does this translate into, like your personal life and just how you feel about just your overall fulfillment now that you're running a bigger practice versus bigger practice versus just like when you were solo doc doing it all yourself?

Iraj:

I think I just feel like I feel like I'm being a lot more impactful. I mean, there's only so much you can do with your own two hands. There's always going to be a limit to what you can do. But having a system which we're still working on, we're definitely still in our building phase. I'm not like okay, we're done, like we've peaked. You know, we're very early in the evolution of where we want to be and I think that having like right now I'm working on things I never really did before, because with seven or eight people, I mean, or even 10 people like you can kind of just say how you want things done and people eventually catch on and it'll just work. But now I'm working on videos, processes, things that in your coaching program you do so beautifully and it's really picked up a lot on the importance of recording videos, of having an organized platform where people can watch that, and we're still definitely building that and that's one of the things I do work on on my off time currently.

Iraj:

But I just feel more impactful. I feel like there's so many more people that I can really help. I'm kind of taking on more of a role of the leader. I've always had to take that role, but now it's more so, more of a leader, rather than like an actual doer in the practice. So it feels great Like I never imagined going beyond you know around 2 million a year, and to be over double that over five this year and looking to grow, having great momentum to go well beyond that next year. It's just very exciting, right now.

Etch:

Yeah, it's so cool, man. It's like one of those things that when I think about, like my long-term team members that have gotten to watch like the whole transition, and sometimes they would say things like oh, I miss how it used to be. You know, it used to be different, we used to be smaller, it used to feel different. But I've always told them over and over again like there was nothing we could do, like we were just so good and it sounds like I'm tooting my horn, but I mean I tell this to my team we were providing such good service to our patients. There was no way this could have stayed small and what an amazing thing to be able to scale it.

Etch:

So I want to go back to you making a transition, to realizing that you need to have a little bit more systems, and I think this is something that comes from usually. We realize that about first associate. I think when our teams get over 10 people, we say whoa, okay, what's going on? Like the wheels are starting to come off a little bit. Talk about systemization in your practice and what you've learned and what you've experienced, and just you mentioned like you're recording the videos. Talk about why you felt like you needed that and what it's done for your practice.

Iraj:

Yeah, no, it's like sometimes when you start to feel really comfortable your practice is doing well, you know, you've, you've grown and so forth, you kind of get on autopilot a little bit. That's kind of where we were at. I felt like we were on autopilot, like my core team. They knew our systems, they knew how we run, you know, and those systems came about through shadowing. Some of the top dental offices had great mentors and worked with you know various other docs to kind of learn their ways and so forth, and also getting materials online et cetera.

Iraj:

But I would never really put it into writing or put it into a recorded video or anything like that.

Iraj:

And I think, realizing that when you are in that autopilot mode, you kind of just you don't realize how much you actually have learned and you kind of think that this is just standard protocol and everyone should know that.

Iraj:

And when you start to see people missing things that to you and your team seem really obvious, but to them it's not, because they've never learned it that way and you kind of forgot that you know that process of where you came from and how you learned all that, I started realizing like, wow, these are some things that to me seem obvious, but to a whole new person.

Iraj:

I can't expect them to know how we do things in every way. So once I started realizing that, and then I started seeing, like, started remembering with some of my prior employers, like how they you know, they had protocols, they had operation manuals and they had some training videos and so on and so forth, I started realizing that, man, if I just spent the time and it does kind of suck I mean, you're a full-time dentist, you're like seeing patients and now you got to go home and make some training videos that investment in time is just so. It's like an endless ROI because you can really scale almost limitlessly at that point, because you can have a team that can just watch the materials, learn the materials.

Iraj:

And there's still plenty of hands-on training that's required. But and once you get into this world there's great platforms available and today it's pretty easy with the softwares that are available the video editing and all that stuff. I mean, it's still not easy. It's still a lot of work, but compared to what it was probably 15 years ago. Now I use Loom a lot and I just record a video and it and not have to go and talk to every team member. When you have 30 team members, it's very, very difficult to spend that one-on-one time with everyone to provide that mentorship and training. So it's just really necessary if you want to grow and scale.

Etch:

Talk about the structure at your practice of leadership, because you mentioned that you are the leader. You're still the leader and as you grow a team and I know this from experience 30 people it becomes more difficult and communication breakdowns happen. Oh yeah, put these protocols out there, because there's a lot of I didn't know. We did things that way and I love that you brought up. There's so much that we think is just like common knowledge and we totally forget that. We learned that somewhere. You know and our teams need to learn that. But what is the leadership structure? Look like at your practice, like how do you manage that many people?

Iraj:

Well, you know, I do have to give you a lot of credit because working with you has kind of shaped that. So we have a lead dental hygienist, now we have a lead dental assistant. We have an office manager, but now we also have a front office lead. I always kind of viewed the office manager as the front office lead, but she's actually really overseeing the whole office, not just the front. So you know, office manager, slash operations officer, all the leads report to her and then they'll report to me. So yeah, so we have leads in various departments.

Iraj:

What I'm learning right now and the kind of the growing pains we're going through, is knowing who would make a good lead is something that, like I have wonderful leads. But I'm starting to realize that there are certain characteristics that you want to look for for somebody that's going to be a lead of the department. But just to kind of back up in terms of speaking to it in general, if you're a leader, even if you have smaller than 30 team members, even if you have 15, I mean even at 15, it's still hard for you or one office manager to really effectively manage that many people. So you have to kind of break it down into organizations, into subgroups within your organization, I meant to say. And so having departments in your office and then having a lead that oversees each department, giving each lead key metrics or stats that they need to track and report to you and then meeting with them regularly. So I meet with my leads, you know, every month and kind of go over the progress that we've made. But that's basically the leadership structure.

Iraj:

Currently I also have someone who's our implant coordinator. So we're kind of having a she kind of runs our full arch practice side of the practice. So we kind of have two divisions. We have our general side and then our full arch focus side. But there's overlaps. There's patients that come in for an implant consult and end up just needing a cleaning and a crown and then vice versa, we have people come in for a cleaning and end up needing all the next implants. That come over to the implant side. So we do have an implant coordinator. We have a COO, slash office manager, front office lead, dental assistant lead and dental hygiene lead.

Etch:

And I think if any listener is, if you're listening to this and you're just like whoa, this is way too complex for my practice. This is not something that happens overnight. This is something you see a need for and you add a position or somebody steps into this role and you see that value. Talk about the characteristics that you've realized that it makes a good lead as you got more experience in this.

Iraj:

The characteristics that you really want to look out for is someone who's willing to confront others. I mean, that's kind of been the main thing is have people that dentistry generally very nice people usually come into this field for the most part, you know, very, very friendly, very, very nice. But sometimes it can be hard for us to confront someone if there's something there that needs to be done differently. It can be very difficult because you don't want to hurt people's feelings, you don't want to cause animosities, you just kind of sometimes avoid that conversation. But that one conversation that needs to be held can make such a big difference in how things are run or even having to let people go. I mean I had one of my dental assistants. I was extremely close with her. She's been in dentistry a lot longer than me, very, very strong clinically Probably the strongest assistant I mean almost like a dentist, and I had worked with her for years.

Iraj:

You know this is someone I wanted to be the lead of my dental assistant department but I started realizing as we started adding assistants I just noticed this strong pushback and resistance. She did not want to work with more than two or three other people. She did not really think that training was important or part of what she wanted to do. She just didn't enjoy training, she didn't like change and so on and so forth. And it became pretty kind of negative in terms of the work environment, pretty toxic in terms of like sometimes you had a strong person coming in and she kind of like almost I don't want to say sabotage them, but kind of like not really help them in a way and not set them up for success, and it kind of became. You know, I started getting all this feedback and complaints from the team members. I'm just like what are you just talking about? She's amazing, you know, but then you don't see their side of it, how they interact with others.

Iraj:

You know John Maxwell. I've been reading his books for years and kind of learning more about leadership. It kind of taught me that it's just a different mindset. So you may have someone who's not necessarily the most clinically strong devil assistant in the world, but they're really good at talking to people, really good at communicating and leading. That person's the one you want to put in charge of leading that department. And then that person is also going to be tasked with finding other people within that department, because even as a lead.

Iraj:

Oftentimes they still need help, depending on how large your team is to train et cetera. So they need to be able to identify other people that can help them in that leadership role. So, finding people people can relate with people, connect with someone who cares about others. Really, people don't care how much you know until they know how much you care. It's kind of cliche but it's just so true. And then also it was like connecting before you correct et cetera. You have to have that rapport and that affinity with people before you're able to really critique them. And that was something that you know. In dental school, you know, I had very little and there had management training or anything, and I worked at a couple jobs that I went straight through college and in dental school. And in dental school the feedback is very blunt, like it like wow, this prep is horrible.

Iraj:

You know undercuts, you got whatever, and there's no like that's why we're so traumatized, right and uh, and you just kind of get used to that and you just kind of think, okay, when I'm out in the real world, that's kind of how you, subconsciously, you start talking very you know, start giving feedback. Like that you start realizing whoa, like this doesn't really work in the real world, like people have options to work other places. If you don't connect with them, they're just going to quit or be frustrated and so on. So learning all those skills and finding people that some people just naturally have that and I think for me I had a lot of struggles with that early in my career and a lot of things I had to learn to be able to give feedback in a way that people respond to, which is really critical. So kind of mentoring people to be able to give that feedback.

Iraj:

It's a much bigger thing and I think that's what limits so many of us as dentists, so many of us that want to scale and grow, but we run into all the headaches and stress of just running a smaller team of five or 10. And we just end up selling our practices or just giving up. If you can kind of get that part put in place, it makes your life so much easier. But I don't want to sound like there's no stress. I mean there's definitely with this size of team. There's definitely fires we have to put out still and so on and so forth, but having a strong leadership team makes your life so much easier. Well, again, I'm kind of preaching the choir here on that, because you're the one that kind of helps me see that a lot.

Etch:

Thanks. Well, yeah, and it's been life-changing in my practice and my life. I mean life. I mean I don't think I'd still be at my practice without my leadership team. I would have fulfilled my contract when I partnered up with the DSO and I'd be doing other things right now. They are the reason I am still able to be there and enjoy it. Because I think it comes back to what you said, man. What I was doing was unsustainable. I was handling every little fire in the practice and it was draining me on a level that you couldn't believe. And when I was at the practice I was drained. And when I was home I was still at the practice mentally and it was. It just never went away. All right, so you went through. I mean, you got this leadership team that helps you a lot, but you had somebody that was the wrong lead in the wrong position. So how did this play out with that dental assistant? What did you do with that dental assistant lead?

Iraj:

So, yeah, I had, you know, I started getting, like I said, complaints from other team members and I started realizing that we're really going to limit our growth if there's someone like this on the team that's really pushing others away. It's not going to be a very attractive person. That one negative person can really change the environment in your office. And after a lot of I mean people were pushing me to let her go for about a year and I kept pushing back because I'm like, what are we going to do without her? She's so strong and you sometimes start thinking that one strong team member is irreplaceable.

Iraj:

I finally worked up the courage to go ahead and let her go, and it was a very, very difficult decision because I had grown close with a friend as well, but that was really the best decision that we made for the office, because now you come into the office, you hear people laughing, joking. You know, even after a busy day, the environment in the office is still so upbeat and positive, and that was not the case when she was there. So you know, just having that willingness to make changes in your team, even someone who's you've been with for years, who seems so critical to your, we've actually grown a lot since she's been gone, which I didn't really. I wasn't sure if that would happen.

Etch:

It was a very, very scary thing and it's one of those things it's. We're looking at it from our perspective only and in our perspective this person's great and we know what they do for us. You know, we know, like, how they're a strong performer and I've had. This is reminding me of a story with a front desk employee that we had and it was like she was great, you know, and everybody knew she was great at her job Like everybody would nobody would deny that she was great at her job but she just couldn't get along with everybody. But she was so good with the patients and she was so good with, like, if you gave her something she was reliable.

Etch:

But I just kept getting complaints after complaint and then one day we just said you know what? It's time I'm tired of hearing about it. And this is what I saw. I think if my team talks to me enough about any employee, they could literally vote them off the island If they don't want anyone on the team. They will eventually get them out if they complain enough about it. But it kind of sent like a shockwave through the practice when we let her go, because nobody could believe we did it, because everybody knew how strong she was, but everybody was so happy she was gone.

Iraj:

Yeah, exactly what you said is literally the exact same situation that we experienced and we actually had a really strong dental assistant who actually quit because of that dental assistant.

Iraj:

When she heard that she's no longer with us, she actually came back, and I usually don't bring back employees that have left, but now she's one of our strongest assistants and is playing a leadership role within our assistant team. So, yeah, we're growing. Now we're probably going to be up to about a total of nine dental assistants here, about to bring on one more. In one of your training videos in the Proke and the DPH program, you talk about how your leads have actually let people go or hired people without you being involved, and to me that just seemed so.

Iraj:

It seemed like such a foreign concept. I never even thought that I didn't have to be involved hiring someone or letting them go, because I've always been really involved in that. But now we're almost to that point as well. Like, my office manager brings people on, sometimes I haven't even met them or made decisions to let someone go without me being involved at all. You know, sometimes we think like, oh my gosh, letting someone go is the end of the world. But sometimes it's doing them a. They're on the wrong bus and they'll find another office that's a better fit for them, and they'll probably be happier too. Yeah.

Etch:

I think those I hated firing I mean I hate firing people.

Iraj:

Yeah.

Etch:

You're rejecting somebody. You know it never feels good, but the most easiest firing that I've ever done are the ones that my team does. And I have I'm not in that room, you know, so that's not something I'm willing to take back from my leads. But and I have, I'm not in that room, you know, so that's not something I'm willing to take back from my leads, but this is how it is. I'm just like you have the competence. You trust in their competence, you trust in their judgment.

Etch:

But I love that you say it's like a foreign concept, because it is foreign to a lot of people and I think a lot of people, like when they start in my programs, we want to have a leadership structure and that's something my leads do in the. But that's like high level, you know, like you don't. You don't just say, hey, I'm going to get four leads in my practice Now I'm never, never have to hire and fire again. Like you build to that. You know. I want to go rewind a little bit and talk about if you're, if there's a listener listening and saying you know what. I think I'm so torn between this staying small, being the only dentist here, versus having something like E-Rise where he's got, like this, multiple people to manage large practice. What would you say to that dentist who's wondering what is the difference between being smaller by yourself versus where you are now, if they're thinking like I don't know if this type of practice is right for me or if I should just try to stay small and this is okay?

Iraj:

Yeah, that's a great question and I've actually thought about this quite a bit because I get messages from people I went to school with who asked for advice and about similar type of questions. I think it does require a certain level of self-reflection of what your personal goals are, Because for a lot of people, what I have was not the right fit for them. I think you just have to look at what are your strengths and it all comes down to leadership. Can you be able to identify who strong leaders would be in your practice? And in order to have strong leaders in your practice, you have to be a strong leader first, Like you can't have people that are stronger leaders than you, because it just doesn't work. They're not going to stick around. The leader has to be the strong. You have to be the strongest in terms of your leadership skills, but the good news on that is it is a skill that can be learned.

Iraj:

But to go back to your original question, I think it does really depend on you. But if you are willing to learn those leadership skills and invest in the training, invest in programs like yours and others reading watching videos John Maxwell was a big one for me and amongst others that helped influence me in that area. If you're willing to do that and the rewards are, it's very rewarding because, like I said, you're able to help so many more patients Financially. I mean, there's days where I don't even, I'm not even in the state, like I'm out of state and the office did 40,000 that day or something like that, which I never thought that that was even possible without me there at least, Like I've done. I've had bigger days than that, but that's always when I've been there.

Iraj:

But to hear like my associates, after the mentorship and training, they're taking on bigger cases, they're feeling more confident, they're able to communicate and get that case acceptance and I hate to call it sales, but it really is like that skill of being able to communicate and really build the value in the patient's eyes versus them spending their money on a TV or a vacation or something else and really doing what's best for their health, taking care of their oral health. It's really rewarding and financially too, like being able to have a practice that's earning you profit while you're not there necessarily, or even if you are there, you're not having to run around and see all those patients yourself. It's extremely rewarding but it definitely does take certain investment and time in terms of building that up, setting up the systems, putting in all the infrastructure for that to be able to happen. If you do it, it's awesome.

Etch:

You know, what else I'm hearing too is that you mentioned like learning with the leads. What's a good lead, learning that you're kind of a D to work with for assistance. These are all learning moments. If we could just be a little introspective and think about what's working well, what do I want to? We're always improving, so I love that. You say that the leadership skills it's something it just continually learns, and I know this has been my experience, I'm sure yours as well. I look back three years and I was a completely different leader than I am today, and it's because of the experience, because there's only so much you can learn in a book and there's so many things that lessons that just come, and I think, as long as you're willing to think about it, reflect on it, you will always get the lesson that you needed to learn, no matter what.

Iraj:

Yeah, absolutely, and I think as dentists, a lot of us are very at least in my experience we already kind of think we know, we know we need to know and we're good, and that's fine. If you're content with your practice and you're perfectly happy with where you're at, that's totally fine. But for those of us who do want more, who do want to grow that willingness to take criticism, self-reflection, oftentimes without beating yourself up and getting down on yourself, and just learning that, hey, I could do better, this is something I can learn from. Since then, I've had a very, very solid team and the team members that we like, we've had extremely low turnover, so I have improved, just learning how I communicate better, I can connect better, and just also knowing who I work well with, who is a good fit for our office. Those are skills that can be learned. Having mentors and great podcasts like yourself to listen to and people you can talk to that have achieved what you want to achieve. It's pretty cool to know that pretty much anything is really possible Awesome man.

Etch:

Well, dude, it's been so much fun. I'm so happy that you came and share all that with the listeners. It has been a pleasure for me for working with you for about a year you know, like about a year we worked together and just to watch you grow into more of a CEO and take your practice to just an insane level. But I love hearing your story and I loved how you just able to reflect on the growth that you've had and just continuing learning and stepping into a new role and just the possibility you know that's of what is possible in one dental practice. So thanks so much for coming on the podcast, dude. It was awesome and, uh, really looking forward to see what you're doing in the future. So thanks so much.

Iraj:

Thank you so much for all your help. All your materials have been so helpful and our calls have been just wonderful and learning a lot from someone like you, I know it wouldn't be possible without your guidance, so I really appreciate it and I'm very, very thankful for everything.

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Dr. Paul Etchison

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