Dental Practice Heroes

You Can Grow Without PPO's with Dr. Andrew Kokabi

Paul Etchison, Andrew Kokabi Season 3 Episode 72

Big growth isn’t reserved for in-network practices. Dr. Andrew Kokabi has built more than just a thriving fee-for-service practice — he’s built a reputation as a trusted business that gives back.

In this episode, he explains what it means to be a community-driven practice and how this approach has helped him grow without relying on insurance. He also shares his best community initiatives, including one that cost nothing to launch but continues to generate trust and referrals. Don't miss this one — he’s got some ideas on service and leadership that you’ll want to try!

Topics discussed in this episode:

  • Why Dr. Kokabi wanted a fee-for-service practice
  • Early challenges and hiring lessons
  • Growing from 3 to 11 operatories
  • How they became a community-driven practice
  • Strategies to build up your reputation
  • The mindset that will hold you back

Learn more in Dr. Andrew Kokabi’s book, The Community Focused Dentist!
https://drandrewkokabi.com/book

Connect with Dr. Andrew Kokabi:
https://drandrewkokabi.com/
http://brookhavenfamilydentistry.com/

Call (770) 451-0611 to book Dr. Andrew Kokabi for your event!


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Speaker 1:

On this podcast. We are very much about scaling associate-driven models and creating a lifestyle, and this often involves insurance participation. But can you grow a large associate-driven practice out of network? The answer is yes. Today we are joined by Dr Andrew Kokabi, who started as a solo dentist and grew to an 11-ob fee-for-service practice and continues to grow with high new patient numbers every single month. He's going to share how he overcame his doubts, stands out in his community and continues to attract new patients into his practice despite his lack of network participation. So if you've ever thought you're done with the insurance game and you still want to have a big practice, this is the episode for you. 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.

Speaker 1:

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 Now. Welcome back to the Dental Practice Heroes podcast. I'm your host, dr Paul Edgison. I'm very excited about my guest. We've got somebody with a big practice the owner of Brookhaven Family Dentistry. He is an author who just put out a book and he runs an awesome big fee-for-service practice that I can't wait to learn more about. Please welcome to the podcast, dr Andrew Kocabi.

Speaker 2:

What's up, Dr Etch?

Speaker 1:

I'm excited to be here, man Dude, excited to have you how you doing. I am very good man. Andrew is a longtime listener and he reached out to me. I'm like dude, I got to have this guy on. We had some email exchanges here and there and I remember you emailed me a really long time ago and you asked me about the song in my intro, which was that was my brother's band, and I've had a few people ask me, but not that many, so I remembered you when you said that.

Speaker 2:

Oh man, well, I can sleep well tonight, knowing that I've made a long-lasting memory for Paula Etchison, that I've made a long lasting memory for Paula Etchison and I've accomplished my life goal.

Speaker 1:

So I'm good, that's great, yeah, I love it, man. So, yeah, talk about you've got this big practice and you got two associates that are full-time, you got one part-time associate. You got a number of hygienists.

Speaker 2:

Let's go way back into the beginning of that practice and take us through that, when you purchased it and how it led to here. First of all, before I say anything, I just want to thank you from the bottom of my heart for everything you have done for our profession. It is without a doubt because of you and a handful of other dental podcasts that I had a change of mindset in my early 40s and changed my practice, my life around. So and I know you know you put a lot of time and effort into this stuff and I just want you to know it is very much appreciated. So thanks so much, man. Get that out of the way. Get that out of the way.

Speaker 2:

So I graduated dental school in 2005 and being an entrepreneur was kind of in my blood. I'm a child of immigrants and same way with many of your listeners who are perhaps of Persian or Indian or Asian descent, when you have immigrant parents, from birth you are told you gotta be a doctor, and many of them are also small business owners. So I didn't really wanna be an MD because I didn't wanna be around sick people all the time. So I had to convince my dad to have him be cool with me becoming a dentist, and after a while he realized, okay, that's fine, yes, dentistry is good. So I decided early on in my teenage years I want to be a dentist, went to Georgia Tech, went to dental school in Augusta, graduated in 2005. And my first three or four years out of dental school were a great learning experience for me. Because to a layman or to a dental student, they probably think most dental offices are about the same. You know how different can they be. They're drilling and filling and maybe as a dental student, you think, well, some offices they do molar endo and other offices they do dentures. So that's how they're different, but your mind is only thinking about the clinical differences.

Speaker 2:

Once I got onto the real world, I worked probably at about four or five different offices over a three-year stretch and I learned a lot about what I like and what I hate about dentistry in the real world. And I worked at like a kid's heavy Medicaid office. I worked at a PPO office, fee-for-service office, corporate, hmo-driven office and after these first three or four years I said, okay, a I know I want to be a practice owner because being an entrepreneur is in my blood, and B I really, I think, want to have a fee-for-service office and I know it's harder to grow that, but let me do it. I looked around for a while. I'm from Atlanta so I knew I wanted to settle my roots here, so I found this practice that was in a good part of town. It was an old office, though only three operatories, and this was 2009,.

Speaker 2:

But this office did not even have computers, so, no joke, they were using like an old book to make appointments in. Oh God, they were using a typewriter to send off like insurance claims, so that was unappealing. However, what was exciting about it was that it had like 700 solid fee-for-service patients that were coming to this doctor because they knew him and trusted him, and that's definitely the environment I wanted to go into. I bought the office. The old doctor only stuck around for about two weeks and he was gone, so it was pretty much on me. I didn't take home a paycheck my first year and we went from three operatories in 2009. We moved across the street to five operatories in 2015. And in 2020, we took over the adjacent space and we currently sit at 11 operatories with about three full-time doctors and about five or six hygienists a day.

Speaker 1:

Wow, you know, when I had my associateship, we had paper charts but we still had, like, they had a computer chart and a paper chart. I think they were like in between they weren't fully transitioned, oh man. But like the idea of like putting a claim paper through there and lining it up with where it would hit and you can't make a mistake, I mean you can cause, then you can white it out, but you, there's no backspace. Yeah, like you got to nail it. You know, and the amount of time you know. Right now, we just highlight the procedures and say send claim oh, really, so easy. And this is that was probably a 10 minute thing just to send a single claim. Talk about. You said 2009,. You got it. 2015,. You moved across. Yeah, what happened in those six years? Like, I mean, you're working on three ops for quite a long time. Yeah, talk about that. That moment when you decided like we're doing something different.

Speaker 2:

So I was never the guy in dental school that had the incredible drilling skills. You know my buddies. They would finish a crown prep and it would look phenomenal in like 10 minutes. And I'm there waxing up a denture for two hours and at the end it just looks like it has buck teeth and stuff. So I knew what I brought to the table was my heart and my ability to truly care for my patients and not that most dentists don't, because most dentists are good humans and they all want to take good care of their patients but I knew that was my special trait that I had. I can get people comfortable, I can let them know that I care for them, and I trusted myself that that's what's going to help me grow my office.

Speaker 2:

So yeah, man, those first couple of years were lean. We had maybe like two or three days of hygiene with one hygienist and I learned so much in those first years because I had the time to learn all this stuff. I'm not even talking about clinical skills, because most assistants to hygienists you can teach them clinical stuff. They are going to be able to get all the plaque off the teeth. However, are they going to be able to get all the plaque off the teeth. However, are they going to be able to connect with a patient, are they going to be able to carry a conversation with a patient, and so that's the stuff we focused on those first four or five years.

Speaker 2:

And at one moment you know you start just running out of operatories and you realize okay, if we keep going down the path that we're doing, we're doing things the correct way. Obviously, because we're getting a good number of new patients per month. If we keep heading down this path, I'm going to be limited in number of operatories. So, about a year or two before we reached that, a new shopping center was being built across the street, and so I realized, okay, let's go from three to five. And at that point I just had the mindset that's it five operatories, I'm done.

Speaker 1:

So fast forwarding like you're working as a solo doc. You've got five ops now instead of three, so now you can run more hygiene you can. You've got more capacity, still solo doc. When did you reach that point where it was time to?

Speaker 2:

well, maybe I should bring another person in here and that was the hard part that was me coming to terms with. I need to let go of my belief that I'm the only one that can do this, I'm the only one that uses these words in this way and can help make a patient feel comfortable. And also, you know, life happens. You start having kids and it's not like when you're single and you have just bought the practice and you can devote all hours of the day to it. I need to have some time outside of the office to do stuff. So I was at some points, I think in my 30s. I worked five or six days a week every week for, like you know, five to seven years. I did that. So I just kind of dipped my toes in it.

Speaker 2:

At first I hired a person to just come work, maybe Fridays and one Saturday a month, and slowly that became one or two Saturdays a month. But with five laboratories you are limited. I do not believe you can have a two doctor office with five ops. I think six is the minimum you really need for a two doctor office. So once I realized, okay, this isn't going to work, I'm getting burnt out, I'm too tired and we've got this incredible practice and I don't want to let all these patients go to waste. I don't want to stop seeing new patients.

Speaker 2:

That's when I decided we're going to need more than five ops, and it was a little scary going from a one doctor operation to a three, four doctor operation, but by then I'd been doing it for a good number of years and I believed in myself. And just half of it is just believing in yourself and not having those self-limiting thoughts that I had early on in my career that told me nope, it's just you, you can't have anyone else, you can't grow this practice. Once I got those thoughts out of the way, I could realize all right, now I can grow this practice and we need more than five ops to do so.

Speaker 1:

Now, when you went from this five to 11 ops. Now you're bringing other dentists in. What was the biggest challenge during that part of your career?

Speaker 2:

Oh man, yes, I had had part-time doctors before, but it was always just one doctor working in the practice. It was never both of us working there. When you have another doctor who you are hanging out with all day long. A personality-wise you got to get along, and B this is the hardest thing I think to master and I always say it to whenever I'm looking to hire an associate dentist. I say to them I do not expect us to be 100% on the same page when it comes to treatment planning or diagnosis. However, I do expect us to be 90% on the same page, because nothing looks worse than when one doctor at a practice says you need a filling and then the other doctor comes and says no, you don't need it.

Speaker 2:

So I made a huge mistake early on when I was hiring associate doctors, where I thought you know what, let me just talk with them and see how it goes when they come on board. After one hire my first hire I was like okay, I told her we don't really like to do things this way, but she's still doing it this way. I realized it's not fair for me to just say something to someone at an interview and then expect them to remember that forever. It's not fair for me to say to them okay, well, we don't really do fillings on abfraction lesions unless they're X number of millimeters deep. And then she comes in on her first day she's training planning fillings on every single abfraction lesion.

Speaker 2:

So after that I realized, okay, when I am interviewing from the first time I meet a doctor and I interview them I have a nice packet that goes into great detail about A what our practice stands for and who we are. B examples of my treatment planning philosophy how I tell a patient that I think they would benefit from a night guard. How do I recommend a crown on a patient with asymptomatic crack that the patient doesn't even know the tooth has any problems? So on the front end, I go over all these different philosophies, our treatment planning philosophies, our communication philosophies with the potential associate doctor, and usually you get a good feel for who is down with this and is on board and says this sounds awesome, yes, I want to do this. And who's like, no, thanks, I'd rather just you know work at a regular office instead of one that's with a owner doctor who is so hyper-focused on how we communicate with patients or how we present treatment plans.

Speaker 1:

Yeah, I love that you do that and I've had the same experience Like you. You want to hire an associate and you want them to come in and just man, I hope this one just works out and I don't have to do much with it and yeah, it's rare. Yeah, we can't expect the results from our team and we can't expect them to do things a certain way if we don't ever tell them how we expect them to do it. Now tell me about you. Guys do a lot with community and it's a big focus of your practice. Talk about that.

Speaker 2:

So you know, one way we brand our dental office is that we are a community-focused dental practice. And what does it mean to be a community-focused dental practice? Well, it's a lot of stuff that many different dental practices are doing, such as sponsoring a local little league team or having a table at a school carnival or buying advertising in a church bulletin. But taking these things and doubling down on it, putting it on steroids Jose Canseco style and I guess you're in Chicago, so Sammy Sosa style, hopefully, oh, white Sox guy.

Speaker 1:

No, Canseco was on the White Sox for a little bit.

Speaker 2:

Oh man, I don't remember so doubling down on these things that you're doing to establish your practice as a service. But they want to come and spend money at a business that they know cares about their community and putting money back into the world. And as a result of doing these things, you build a reputation as the go-to practice in your community and this entails results in being able to stay out of network, getting a hundred plus new patients a month.

Speaker 1:

But give me an example of one or two things that you do. Yeah.

Speaker 2:

Okay, so while we do many community engagement activities, our two most prominent ones are A. We have one that's called our Brighten your Smile Better the World campaign, and the way this works is you know, seven, eight years ago, we never really did much whitening on people. I never had the mindset that I should try to sell whitening to patients because someone's teeth are yellow. I don't want to say to them hey, you ever thought about whitening your teeth? And they're like why, doc, nothing's wrong with my teeth. So I was always hesitant to bring whitening up and, as a result, we never did much. But during the shutdown pandemic back in 2020, just like you, I had two or three months where I was just sitting around thinking about stuff and my wife and I always enjoyed doing the community engaging activities at our practice, and we came up with the idea and we calling it the Brighten your Smile Better the World campaign. Each month we or at least most months we partner with a different local school or nonprofit and instead of people spending $400 to whiten their teeth, if they make a donation of at least $150 to that month's chosen partner, they get the whitening trays for free, and this has turned out to be a very successful program. It's a win-win-win A your patients are getting whiter teeth, not having to pay $400, just paying $150 for it. B you're bringing a lot of attention and money to the nonprofits.

Speaker 2:

At the beginning of each month we send out an email to our patients saying we are excited to announce that last month we were able to raise over $1,000 for XYZ School and we're happy to announce that our Brighten your Smile Better the World campaign partner for this month is XYZ Nonprofit and here's a little bit about their mission statement and what they're up to.

Speaker 2:

So, number one your patient are getting their teeth whitened at a discounted price. Number two the nonprofit or the school is getting money and is getting notoriety. And number three it's a huge win for us because we are getting our name out there in places that previously it wasn't. And once you have this many people talking about you and sending positive thoughts about you around the world, this turns into a one of the flywheel effect More and more people talk about you and I'm a big believer of someone once said they won't remember what you said or what you did, but they will remember how you feel. And if I can get enough people to have positive feelings associated with our brand, then I know good things will come our way.

Speaker 1:

Yeah, you know it. We've always done these things with the charity, where they do the auctions and stuff, and we'll donate whitening. And sometimes I feel bad because the people are thank you so much for donating that. Oh, you're so kind. But I know that if whoever wins this when they come to my office and let me know if this is your experience Is they walk in and they go. Oh my gosh, I had no idea dental office could ever be this nice. This is amazing. You guys are also nice. I'm switching my whole family, yeah, yeah, and it's, it's almost like kind of self-serving.

Speaker 2:

Sometimes I feel like you know, yeah, I know, I feel guilty, yeah, yeah, but you've got to have the same experience. Yeah, and one of the things I have in my waiting room, we have this once again self-serving. I kind of feel guilty having it, but nonetheless I do want people to be aware of it. We have this big shelf full of pictures of how we partner with XYZ High School and we partner with this nonprofit and people are often like commenting us on oh wow, I didn't realize you guys were so involved in the community. So, yes, this definitely helps you get a good number of new patients who are coming to you, not because you're on some insurance list, but because they have a good reason to come to you.

Speaker 1:

Now is someone listening saying like, yeah, I want to do something like this at my office. Like what are the steps? Like what do they go for? Do they reach out to people? How did you do it?

Speaker 2:

The best way to do it is knowing your patients. So we have a huge emphasis on our office that I want my hygienist to know who our patients are and carry conversations with them. So then once you do start a program like this, you ask your hygienist hey, who do we know that is very involved in the school that's a mile down the road from us and you can just go on the school's website and kind of read the names of who is on their PTO board and I am sure you'll recognize one or two names of individuals who are patients at your office and then when they come in you say, hey, you know we've been thinking about starting this program up and I know you're involved with the elementary school down the street. How can we get this going? And many times I've also just, you know, cold called or cold emailed the vice president or president of the PTA and they will tell them what we're up to and like 99% of the time people are on board to partner up with your school.

Speaker 1:

I'm going to ask a question for all the dentists listening. Yeah, because I know there's people wondering what kind of whitening are you giving away? Okay, I guarantee it's someone's still wondering that right now.

Speaker 2:

We are old school, just regular old school whitening trays. My assistant takes an I don't know, maybe people use the 3D printer now, but we still take the alginate and then my assistant goes there and does a little suck down matrix and cuts it out. So you know it doesn't cost that much money. I think there's four carpeoles of carbamide peroxide gel that we give them, which I think has somewhere between $15 to $20, and the suck down costs nothing. So it's really the time of the alginates and your assistant devoting time to it, which I don't know what that adds up to, but in my opinion it is priceless. The positivity goes into our community and comes back to our office through this program.

Speaker 1:

Is this something that you think is strictly for fee-for-service offices or any office?

Speaker 2:

I think any office. Now that's the thing. When you're a fee-for-service office, you have more ability and time to do these things. For example, I make sure our hygienists have an hour blocked off for their cleanings, not because they need an hour, but because I want them to talk to our patients and know who they are. I know a lot of times with non-fee-for-service, out-of-network offices you have to make those prophy appointments faster. You have to have assisted hygiene, where perhaps the time that the hygienist spends with the patient is limited and they really need to be cleaning the teeth during that time. This prevents them from being able to build a relationship with the patient. This prevents them from knowing that they have two or three kids to go to this elementary school or that they're involved with the PTA of the school. So I would think it is possible, but I do think it's harder if you don't have that hour-long profi appointment booked.

Speaker 1:

Now, other than doing this like brighten your smile, change the world initiative, are you also going to? Are you sponsoring like a lot of events and local things Like how does that look in your office?

Speaker 2:

So, with all these community programs, there's two types of them. One kind is the one that's going to cost you money sponsoring stuff and you have to put a limit on that because otherwise people are just going to keep coming to you over and over again and you're going to run out of funds pretty quickly. So, yes, there's one category that is the sponsoring stuff, but then there's another category that all it takes is time and effort, and one of the main community initiatives we have at our practice is called our Small Business Initiative, and the way this came about was about seven, eight years ago. I was sick and I went to the primary care doctor and I'm sitting in the operatory coughing, waiting for the doctor to come in, and they have TVs on the screen in their operatories. These TVs were on a loop playing commercials for products that they are now selling. I think it was like some lip injectable or some cream to get rid of wrinkles on your face. So I'm sitting there coughing and I'm looking at these advertisements and, for better or worse, the effect that had on me was oh great, here I am, another place trying to sell me stuff, but when I'm at a healthcare provider's office I don't ever want to get that vibe that I'm being sold to. So I left that and I thought to myself okay, we have TVs in every one of our operatories and usually sure, we show the patient's x-rays on it, but 99% of the time these TVs are just blank and just has the Microsoft background on it. I thought to myself what could we do which has the exact opposite effect on people of what the primary care office had on me? What can I do with these TVs? That's going to build trust. And so that's how I came up with the spotlight on small business initiative.

Speaker 2:

I said earlier my dad was a small business owner growing up. I worked at his clothing store when I was a teenager. So small business has always been important to me, and the way this program works is for our patients that are small business owners or perhaps provide some kind of service, like a real estate agent or an insurance broker or something. We essentially advertise them for free on our TV screens and we have a slideshow that plays on a loop over and over again. The first slide says is about the individual. Hey, my name is Jane Doe. I'm from Atlanta originally. I have two kids, we go to this school, blah, blah, blah. Then the second slide talks about their small business. I'm also the owner of XYZ Dog Grooming Company. We have five-star rating on Google, we are open seven days a week and here's our website.

Speaker 2:

So we make sure that our patients know that we are not charging these people to put these advertisements on there. And, believe it or not, it works. I have one lady who has a housekeeping company and she is always talking about how many customers she gets from her slide on our slideshow. And one time it was a chamber of commerce event and she stood up and was like Dr Kokabi is the greatest supporter of small businesses and I've been going to him forever so I can vouch for him.

Speaker 2:

So, number one, it makes your patients or small business owners happy and appreciative and then they start talking about you and referring patients to you. And number two, it's a benefit to our patients because I'm recommending to them trustworthy businesses. I only put a business on there if I know the person and I can vouch for them, and so they're getting trustworthy services done. Number three, same concept as before it's spreading a lot of positive thoughts about our dental practice around our community. Hey, dr Kocabi, they're a good officer, a good steward of the community. They help out small business owners and, once again, in my opinion that kind of advertising is priceless compared to regular old school paid advertising.

Speaker 2:

And the fourth one, which I didn't even think about, but it happened as the program got going, is often I will have a patient sitting in the operatory and I walk in and they're like, hey, I just saw my neighbor on your slideshow or I saw my friend on your slideshow and yes, it makes that patient happy. But what it does on a subconscious levels, it reaffirms in their mind that they are in the correct dental practice. If this is where their neighbor is going, if this is where their friend is going, yes, this is the dental office to go to in our community. So it costs almost nothing other than time and effort you put into making it happen.

Speaker 1:

So where are these screens that are playing this? Is this just in the waiting room, or is this also in the operatory?

Speaker 2:

Waiting room and operatory. We have a probably a 42-inch TV in every operatory and I learned a long time ago if I need to show people their teeth on x-rays, I need to have it blown up so they can see it, otherwise they're never going to be able to see this interproximal decay. So luckily we started out having 42-inch screen TVs in every laboratory and now it plays the slideshow most of the time.

Speaker 1:

That's awesome, man. I think it's a great idea. Last question is you talked about how you were never the dentist that had the super fast crown preps, but you could take great care of people and make them feel good. What would you say to a dentist that might be a little bit self-doubting and I know there's a lot of new graduates coming out that say, man, I don't know if I picked the right profession, this doesn't seem like I'm made for this, this doesn't seem like there's a place for me here. What would you say to that dentist?

Speaker 2:

Well, take it from a guy who's been practicing for almost 20 years now who, when he first started in dental school, his wax ups looked terrible. First started in dental school, his wax ups looked terrible. You're going to get those skills. Do not be worried that right now you have a hard time looking at that mirror trying to do a filling on number five DO and you just can't figure out which way the burr is going to go. Those skills are going to come.

Speaker 2:

The much bigger thing is one of my favorite quotes is whether you believe you can or you can't. You are right. So if you keep telling yourself, no, I don't think I can do this, I don't think I can be a good dentist, I don't think I can be a practice owner, then it will become a self-fulfilling prophecy. But if you tell yourself, you know what, right now it's just my second year doing this and I have no doubt that I'm gonna be able to get better and I care going to give it my 100% effort, then there's nothing that's going to be able to stop you.

Speaker 1:

Awesome. If the listeners want to reach out to you or learn more about you, where can?

Speaker 2:

they find you. Yeah, definitely, I would love to have people reach out to me. My website for myself is drandrewkokabicom and the website for my dental practice is brookhavenfamilydentistrycom. There's a link under my bio to my speaking website. I've got a book. Well, I mean, you know you have a book, dr Etch. I have like a glorified pamphlet. It's, like you know, 70 pages. It's called the Community-Focused Dentist. It has like 20 or 30 great ideas what you can do in your office to get it to be more community-focused and enjoy all the awesome things that come as a result of that, and I love speaking at dental meetings and to dental clubs. So feel free to reach out, or you can just also call my office at 770-451-0611 and leave a message for Abigail, who schedules my speaking engagements.

Speaker 1:

All right. Thank you so much, man. I love your vibe. I love just what you're doing for the community and I think it's something that you can do it in any dental environment. More or less, it's just setting aside the time and making it part of your culture at your office. I think it's really cool, man. But, dude, thanks so much for coming on. The podcast Really appreciate it, dr Andrew Kokabi. Thanks sir.

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