Dental Practice Heroes
Where dentists learn how to cut clinical days while increasing profits - without sacrificing patient care, cutting corners, or cranking volume. We teach you how to grow a scalable practice through communication, leadership, and effective management.
Hosted by Dr. Paul Etchison, author of two books on dental practice management, dental coach, and owner of a $6M collections group practice in the south suburbs of Chicago, we provide actionable advice for practice owners who want to intentionally create more time to enjoy their families, wealth, and deep personal fulfillment.
If you want to build a scalable practice framework that no longer stresses, drains, or relies on you for every little thing, we will teach you how and share stories of other dentists who have done it!
Dental Practice Heroes
How Cutting Clinical Days Can Help You Grow Faster & Lead Better w/ Dr. Ryan Bradley
How can you keep your team, grow your practice, AND reclaim your time? Discover how Dr. Ryan Bradley did all three without burnout, spending big on marketing, or micromanaging his team. We talk about what worked to reduce turnover through a merger, create work-life balance, and scale while cutting back clinical days. Tune in to learn how working less can actually help you grow your practice faster!
Topics discussed in this episode:
- How to successfully take over a practice
- Building a culture that reduces turnover
- Challenges expanding from 4 to 8 ops
- Maintaining low turnover through a merger
- Strategies to achieve work-life balance
- Avoid these common growth mistakes
- What it takes to be a good leader and practice owner
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Take Control of Your Practice and Your Life
We help dentists take more time off while making more money through systematization, team empowerment, and creating leadership teams.
Ready to build a practice that works for you? Visit www.DentalPracticeHeroes.com to learn more.
Is low turnover, fast growth and work-life balance really possible. Today, dr Ryan Bradley is on the show to share how he made it happen as a new practice owner, even through stressful transitions, mergers and cutting clinical days. This is a quick episode that will give you ideas on how to have better relationships with your team, get more patients without relying too much on marketing, and avoid making common growth mistakes of Chicago. I want to 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, welcome back to the Dental Practice Heroes podcast. Very excited for my guest today, I got a current DPH client and somebody that I had just really enjoyed working with. Really cool guy, 2019 graduate of OHSU. He's the owner of Pacific Northwest Dental. That's in Beaverton, oregon. It's a big practice, got associates and he's just somebody who I've got to watch grow the practice and choose and intentionally choose the life that he wants to live. So please, welcome to the podcast, dr Ryan Bradley. What's happening, man?
Speaker 2:Hey, paul, thanks for having me Appreciate it.
Speaker 1:Tell the listeners about what led you to practice ownership. Because you ended up doing an acquisition and I want to get into that. Yeah, but why this practice? Why any practice? Why did you want to be an owner and how did you find this practice?
Speaker 2:At the very start, if you go way back. I always wanted to be in healthcare. I thought I wanted to go into medicine. You know didn't love the way medicine was going. I liked the idea of four years and done with dental school. Always loved practice ownership. You know we have small business owners in the family. I just love the idea of autonomy, you know, just being able to run an practice for about a year. At that time owner wanted me to partner. Covid hit.
Speaker 2:It was a weird time in the world. I didn't love the structure of the office. I wanted to go off and do my own thing. I realized that pretty quick into associating at that other office that I wanted to run the ship and so I looked for offices right in the peak of COVID, which was crazy. There's a lot of people looking to retire, which was nice, so I had my pickup offices. The place that I landed. It's kind of near where I grew up. I understand the demographics in the area. It's a really solid patient base. I can tell that they have the financial means to get the dentistry done but also care about their oral health. And that wasn't really where I was at previous. It was sort of an emergency-based dental office. Not a lot of re-care going on and so landed on this office 4-op office. They're doing around 800,000 a year pretty solid patient base. They've been there for a long, long time.
Speaker 1:What was the one thing about that office? I mean, I imagine you were looking at different places where you're like this is the one. I just know it, this is the one.
Speaker 2:Yeah, so I did a lot of research. You don't learn anything about practice management when you're in dental school, so I read a lot of books. Read your book, read some practice transition books, just how to look at numbers. I think the numbers were super important. In hindsight, having a big patient base is super important. Growing an office is probably the most difficult thing in practice ownership that I've learned. Outside of that, they had a really strong re-care percentage, really good collection rate. I could just tell that the office was really solid from their overhead numbers and it had all the infrastructure. I didn't have to scan a million paper charts. They had a CT. They had digital records. It was pretty up-to-date, so I didn't have to do a lot on that front, which was nice.
Speaker 1:Now, when you showed up at this acquisition, you're like hey, I'm new boss, Dr Bradley, what was the vision for the office going in? Or did you even have a vision?
Speaker 2:I'm sure a lot of people can relate to this. Ask the previous owner hey, can I meet the team? I think that's super important. You know, I've always kind of had, and this is why we ended up working together because you're big into culture in the office and that was kind of my vision too is have a really solid place for the employees to work and the patients to come, and I think that all flows and accelerates that growth. And so the dentist let the team know on a Friday. I met them Friday afternoon and then I started working on Monday and that was the most stressful situation I've ever been through all week. I didn't sleep at all. The weekend before I was like no patients are going to show up, the team's not going to show up. The team looked kind of pissed. They were upset that I was. He was a younger guy, he's like his mid-40s. So he just up and left, moved to California. Here I'm this new grad, say hey guys, how's it going? Brought some cookies like I'm your new boss, and they were just shock. Since then it's been a really solid transition.
Speaker 2:I was talking to you before the previous owner. He was a real micromanager. He would do everything. The hygienists were not supposed to talk to the patients about treatment. He was the dentist. He did all his temps for crowns. The assistants they were spit suckers, that was about it. Front office team they didn't really know what their role was because he dictated everything in the office, and so when I came in, I wanted that solid culture Let people be in the role that they're supposed to be in, give them a framework to work in and then let them off to the races. I don't want to be everything. I want to be the dentist and the owner and the visionary. I don't want to have to be doing treatment plans and making temporaries and doing all those things that other people can do.
Speaker 1:How did you win the team over? Do you remember a time where you're going into a conversation with a team member and you're slightly worried that, oh, I'm doing this wrong?
Speaker 2:Yeah, I think just from the start I've just been super open and honest with the team as far as like hey, here's my vision for the office. I want to grow in this direction. I hope you guys are on board with me. I think previous they didn't really have a structure in the office. It was just kind of like we did dentistry and it was just chaos every day and implementing systems doing that kind of structure. They kind of eventually sort of just saw through example that I showed up early, I left late. I really met them where they were at. I didn't give them the hey, I'm dentist, you are below me sort of feel. It's like hey, we're all colleagues together. I just happened to be the leader of the team and I think, just through example, I think they bought into sort of what my vision was Was there any employees that just weren't having it like that were out of here?
Speaker 2:Honestly. No, I have had kind of similar to yourself, really low turnover in the office. I think everyone's been really solid. The only turnover we had was a couple assistants that we tried out, but I think very quickly they realized that this was not the office for them and I think the team kind of weeded them out. What I did to empower the team is if we brought someone else on, I would send them out to lunch and I have my lead assistant give me a text message, thumbs up or thumbs down, as far as can we bring this person on, and I was just like, hey, you guys tell me. So that's kind of how I empowered them as well.
Speaker 1:What do you think your secret is to low turnover?
Speaker 2:I think like I said, just having a good place to work. We've all been employees before at various offices through our life or even before dental school, working at a job, and I don't think the pay is super important. Obviously you have to hit relative where your area is at, but I think just having a solid place to work that has structure, where there's not a lot of team drama, everyone's very mature and is rowing in the same direction, knows what the office goals are, and a lot of my front office team has worked as dental assistants before, which is really nice because there's a lot of well, I don't want their job, you don't want my job and they understand the frustrations of both, and so I think that helps a lot.
Speaker 1:Yeah, it's so true. It's like any front desk that has assisted, or any. Vice versa there is a different level of compassion for the other person. Now, you mentioned when you came into the practice you had this vision of just making it a great place for employees and a great place for the patients to come to. Has that vision changed over the years?
Speaker 2:Not necessarily. I mean, I think the direction that we're going right now is kind of making it a one-stop shop for our patients to come in, not have to be referred, because they really do love our office. I've provided a lot of amenities to the office. We've done remodel in the office. So our office, as far as treatment goes, it's now a two-doc office. We've gone from four ops to eight ops and then now we have a couple of surgical ops which has been awesome to have an associate in there where they're doing a lot of the bread and butter.
Speaker 2:I'm doing a lot more of the surgical complex treatment and just investing super heavily into continuing education. I think that's huge. I've really come to realize I like the complex dentistry. I think if I do less days just doing that, I'm going to be really fulfilled in my career. And I've talked with you before there are kind of two camps of dentists. It's like, hey, I just want to be hands-off dentist and I want to go in and just maybe open up multiple offices and so on and so forth. Or like the hey, we just grow one big office and you just get to do the specialty procedures, and I think that is kind of where I'm at right now.
Speaker 1:Yeah, are you only doing specialty procedures at this point?
Speaker 2:No, and I need to slowly start to give the reins off. But I think there's just a lot of dentistry coming through right now. I really like where our office is at. Back to the cultural thing I check in with all my employees individually all the time, see how their lives are going, so on and so forth. I think that's really key. I think eventually, as we do more specialty procedures and just have a higher volume of patients, I'd like to bring on maybe one more associate to take on all the bread and butter that's coming through and then I just focus on the complex surgical stuff. Yeah, totally.
Speaker 1:Now you had four ops and you went to eight ops when you were just four ops. Like at that part of your practice growth, what was the biggest challenge? I?
Speaker 2:think just continuing to grow, getting new patients, and I think that was the biggest thing. And then the hygiene part of things. If we would template and block off new patient blocks, I didn't realize coming into how hard patient acquisition is. We're in an urban area, there's other dentists there and I think just really hammering online reviews, being a player in the space in the local area your name out there helps a lot. It has to be organic at some point. You can't just spend a bunch of money and expect a million new patients to come through. So growing on that end, everyone deals with the hygiene thing.
Speaker 2:We had two hygienists and finding month over month over month is like hey, we need another hygienist, but I can't find anyone. I can't find a hygienists. And finding month over month over month is like hey, we need another hygienist, but I can't find anyone. I can't find a hygienist. The dentistry I don't think the dentistry is too hard, it's the people thing. We have a really solid team. So I just think the growth part is really difficult. It's not as easy as everyone tries to make it to be.
Speaker 1:Yeah, I think a lot of people right now are really hung up on growth because their bottleneck is hygiene. And it's unfortunate because it's like for me, when I was growing, that was one of the easiest pieces of the puzzle. Like you know, I'm talking 10 years ago. There were so many hygienists it was almost like they were graduating too many and people were saying that there's too many hygienists, like it really stinks for you hygienists, and now it's just like what happened. It really stinks for you hygienist, and now it's just like what happened and it seems to be like that bottleneck for people and it's really unfortunate. Let's talk about you going from four to eight ops. Walk me through what happened there and what motivated you to do that.
Speaker 2:Yeah, I think I just saw that hey, I'm young, I wanted to continue to grow the office. We kind of had two directions to go, I guess three. It was hey, open up, maybe we're at capacity here, maybe we expand hours. And I just like my team too much. They all have young families. It's like hey, do we do extended hours, do we do split shifts? I just knew that that wasn't what my team necessarily was best for the team. I thought that was super important, or it's hey, do we go build another location? Well then we're kind of back to my original comment about culture and maintaining that culture.
Speaker 2:And your overhead doubles. It doesn't get smaller when you buy another office. You're just doing the same thing twice over. So we're in a medical complex. The guy next door, he was looking to retire, really small office, needed a lot of remodel work. But they had the infrastructure, they had a couple hygienists. So we ended up doing a merger, which is super non-traditional but we just had the ability to do that. We actually got a city grant, which is really amazing, yeah, and so we ended up doing a merger and so we ended up outfitting three ops. We ended up outfitting another one, remodeled the whole thing. So I think that was definitely a way to get to growth a lot quicker. It was just patient acquisition through a merger.
Speaker 1:So let's talk about work-life balance. I mean, because you're not at the practice five days a week, how often are you working? How often are you seeing patients?
Speaker 2:Yeah. So originally doing the traditional four days a week at the initial office when I started working with you, you were really pushing hey, go down to three days. Whatever. Your scheduling is making it super efficient. I think that's helped a lot, giving the autonomy to the assistants making temps, doing night guard deliveries, doing all those things that they can do. All of a sudden we're consolidating. I went from one assistant to two and, yes, my overhead went up, but the second assistant pays for themselves so fast. And then my four days got shrunk down to three. But looking at the numbers, everything was still where it needs to be. And just having those efficiencies in the office and trusting the team that they can Not micromanaging freed me up to do a lot more dentistry, and then that extra day I could spend working on the office and growing it that way. So I think honestly, if you can do three days a week, you're going to grow an office a lot faster, even though it sounds counterintuitive.
Speaker 1:Talk about what did you do on your non-clinical day. Yeah, because I think a lot of owners they say like I get it, I should be working on the business, but what does that really mean?
Speaker 2:Some weeks would be nothing. It's like I just go golf with friends or just hang out with my family and just coming back into the office and just being fresh and just being like, hey, let's hit the ground running, we're here to work, so just having that just fuel behind you when you come in with a shorter work week instead of coming in dragging your feet Monday morning, the team kind of feels it too and they're like, well, we're going to drag our feet too. I think that's huge. Yes, we work on the business on the off days and maybe doing marketing calls or looking at numbers or so on and so forth, but trying to slam that in on your lunch hour, trying to talk to your accountant noon and then popping back to a patient 1230, it's just chaos, yeah.
Speaker 1:How have you changed as a leader, I mean from going into this to where you're at now?
Speaker 2:Yeah, I think just confidence. Initially you came in, you kind of fake it till you make it. Same thing with taking on new treatment you're learning. I in, you kind of fake it till you make it, and that's the same thing with like taking on new treatment you're learning, you know. I think just having the confidence you know and really meeting my team where they're at, like taking more of an interest in them as people, I think that's kind of helped a lot and grown in my confidence leading I used to be very big on, like everybody on my team.
Speaker 1:Now, eventually my team got to a size where that just wasn't feasible. I couldn't know all of them on a deep personal level. I just didn't have the time. But I still have my leadership team, which is my four people on my leads man. I can't remember the last time I asked them about what's going on in their lives, because we've been so business and that's one of the things is like we can get so set on the business that we lose that relational component of knowing that these are people and these are our friends. And part of what makes that good culture is that, even though that doesn't seem like productive work, I mean, would you agree?
Speaker 2:Yeah, totally. I mean, I got to put myself in their shoes a lot of the time. It's like okay, they have families, they're trying to make an income. You know they're here more than you know they're at home, and so to provide a good place for them to work is super important.
Speaker 1:What is one of the biggest mistakes you've made in practice ownership that you look back on now and laugh?
Speaker 2:I would say bringing on new employees and thinking I can change people. I've always had that mindset of like hey, I'm the leader, if someone's not doing their job it's because of me, and a lot of times sometimes people just aren't in the right role. I tried to force somebody into a role that they just weren't great at. She was a dental assistant but also worked at the front. With the initial transition she was a floater back and forth. Really great person, terrible dental assistant, really solid front office team member. And I think just finding the right role for people is really important and trying to bring on assistants that, just like we had one assistant that I brought on, she'd been a temp for the last 15 years. I think that should have been a little bit of a red flag because I don't think she ever saw in hindsight like the terrible work she was doing and she just things at the end of the day just could not do her job and I just I kept her on too long.
Speaker 1:Yeah, it's funny when we look back in retrospect and we're like the red flags, they were so obvious. Yeah.
Speaker 2:I know they should have been so obvious.
Speaker 1:So as far as like work-life balance goes, man, do you feel like you've got enough at your three days or is there something? Are you pushing for less clinical dentistry? What?
Speaker 2:are you?
Speaker 1:doing, going forward.
Speaker 2:I think you know me buying an office you know, only a year out of school, was great. We didn't have kids yet. I was recently married, I had a lot of free time and so just really pushing to grow the office to where I felt comfortable three days a week could step back, really just enjoy life. Since then we've had I got married, had a son he's six months right now. So now just being able to spend time with family and just enjoy was really great.
Speaker 2:I think the next step for me is bringing on one more associate to take on the bread and butter work and then just continue to grow our full arch side of the office. I really like surgery, implants, things like that, and so if I can do that a couple days a week for a very long time, I'll be very happy. And, like I said, I don't see our office growing exponentially bigger because I think the cultural piece kind of you know it's hard when, like you said, just to talk to everybody in the office and so you know that might change, but we have space in our office to grow.
Speaker 2:I just don't see us doing multi office.
Speaker 1:So you bought a practice pretty early out of school, and that's something that some people have some opinions about. What are your thoughts?
Speaker 2:I think straight out of school is really tough. I think my strong suit's always been able to relate to patients and talk to people. I've worked a lot of sales jobs in the past and so I think having that under my belt has been really nice. Not being that dentist technician that talks very analytical to patients to kind of meet them where they're at the dentistry side. I think finding an associateship on my front end that was very busy was nice. So I got to kind of practice within their practice. So I thought a year out I was very comfortable with the dentistry side of things. I think once you feel comfortable with the dentistry by an office, I think it's tough to learn both at the same time right out of school. So I thought a year was a pretty sweet spot.
Speaker 1:What's one thing that you wish more practice owners understood about practice ownership.
Speaker 2:I think, kind of like what I said before, the dentistry is not hard, it's the people thing. So if you get a really solid team behind you, turnover is the hardest thing to do. It looks bad for the office. It's hard to retrain people. The patients don't love it. So if you can have a really solid culture and I know you've talked about this over and over and over and people don't want to hear it I think just having that really solid team behind you is key and it's taken so much stress off my plate. I don't have to worry about team drama. It's hey, how can we grow the office? I think that part is super important Knowing your numbers, just self-educating on those things. Looking at the back end, you may have 100 new patients in, but if you have 150 out the back end every month, that's what everyone wants to brag about is their production and their new patient numbers. But if you do all that dentistry and you have a super high overhead and a lot of patient attrition, you're really going backwards. So I think that's super key.
Speaker 1:Was there one moment during your practice growth where you said we've made it, I am successful?
Speaker 2:Yeah, I think after my first solid year we saw really good growth and I saw that our overhead was obviously, when you do a practice transition, they're going to give you evaluations of where the office numbers are now. And then my CPA, they did it like, hey, if you have 10% attrition or 10% growth, this is kind of where you're going to be financially. And we had about 25% growth after the first year and I was like, okay, this is awesome. And then the second year was pretty consistent from there and so at that point it was like, okay, I think whatever I'm doing is working, let's continue down that road. But I didn't try to reinvent the wheel. I listened to you. I listened to other people who've done this successfully. I think that's where a lot of my successes come from is just really listening and being open to what other people have done and not trying to pretend like I know everything.
Speaker 1:Yeah, awesome, all right. Final question what is the best piece of practice management advice you've ever gotten?
Speaker 2:Know your numbers. If you can do as much dentistry as you want, but if your overhead is super high, that's not going to put you in a good spot.
Speaker 1:So really looking at your numbers month over month, knowing what good numbers are supposed to be, yeah, it's so true, and there's a lot of dentists that are still doing their own books and they don't get their numbers until the quarter, until they actually have to turn in something to the IRS, and it's hard to operate a practice that way. So, dude, right, it's been awesome having you on, man. It's been great to watch your journey. I appreciate it. Thank you so much for coming on to the podcast and sharing some knowledge with the listeners. Really appreciate it.
Speaker 2:Yeah, thanks, get a coach. They'll accelerate your growth exponentially. Any recommendations? This guy, paul Etcheson. He's a really solid guy. Thanks for that man.
