Struggling with Team Buy-In? Here's What to Do

When team members push back on production or growth, it’s rarely about the numbers or your systems... it’s about clarity. True buy-in comes from showing your team why growth matters and how it benefits everyone, not just the practice. In this episode, learn how to create true alignment with your team, track the right metrics, and talk about money and growth without sounding like a greedy owner!

Topics discussed:

• Why teams are resistance to change
• How to align your team around a shared vision
• Leading vs. lagging indicators of success
• Setting boundaries and non-negotiables
• Tips for talking about money without sounding greedy
• How transparency drives team buy-in

This episode was produced by Podcast Boutique https://www.podcastboutique.com

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Chapters

• 0:00 When Work Steals Your Life
• 1:58 Show Intro And Host Creds
• 2:37 Meet The Coaches And Topic
• 3:26 The Hygienist Hiring Wake-Up Call
• 5:36 Painting A 12-Month Vision
• 6:32 Capacity Ceilings And Next Steps
• 7:31 Goal Alignment And EOS In Practice
• 8:41 Leading Vs Lagging Metrics
• 10:22 Clarity That Attracts And Repels
• 11:49 Split Shifts And Bringing People Along
• 13:24 Owner Planning: Up And To The Right
• 15:24 Sharing Revenue Goals Without Greed
• 17:27 Transparency, Ethics, And Production
• 19:00 Team Incentives And Shared Wins
• 20:32 Financial Health And Thinking Like Owners
• 22:29 Invitation To Work With The Coaches

Transcript

Paul Etchison: 1:24

If you've ever felt like your practice is running you instead of the other way around, well, you are not alone. You might feel like you're working harder, seeing more patients, chasing higher numbers, but it's not creating more freedom, more income, or more peace in your life. And the crazy thing is, is that it may not be a systems problem. It might be a direction problem. Now, in today's episode, we're going to be talking about what happens when your team doesn't know where the practice is going and how getting clarity around that can change everything. You are listening to the Dental Practice Heroes podcast, where we teach dentists how to step back from the chair, empower their team, and build a practice that gives them their life back. I'm your host, Dr. Paul Etchison, dental coach, author of two books on dental practice management, and owner of a large four-doctor practice that runs with ease while I work just one clinical day a week. If you're ready for a practice that supports your life instead of consuming it, you're in the right place. My team of legendary dental coaches and I are here to guide you on your path from overwhelmed owner to dental practice hero. Let's get started. Hey, welcome back to the Dental Practice Heroes Podcast. I'm your host, Dr. Paul Edgeson, and I am joined today by my DPH coaches. I got Dr. Steve Markovitz, owner of six practices on the East Coast, and Dr. Henry Ernst, owner of a large 18-op practice in the Carolinas. So welcome guys. Glad to have you back. And we're talking today about something that I think every owner can benefit from. We're saying, where is your practice going? Where are you taking your practice? And I think a lot of people, when we work with them as clients, this is something we always get to the bottom of early because if you don't have somewhere that you're going, where are you really doing? You're kind of idling. You're just, you're, you're going randomly around the world and there's no goals. And it's really hard to wrap the team around and get them excited about zero goals. So I'm going to pass it to you, Steve. Where do you see this being beneficial for practice owners?

Steve Markowitz: 3:30

I just saw it this week. We have an office that is a nine-off practice. It's multi-doctors. And I thought by saying to the office, guys, we want to get $250,000 more dentistry this year, that would be enough for them to understand what we need to do. I'm sitting there being like, guys, we found a hygienist. Let's find a way to pencil this hygienist in. And they're like, whoa, whoa, whoa. I don't want a hygienist. Like, we don't need that right now. That hit me like a ton of bricks. I'm like, how is it possible that we've had an ad-out for hygienist for 18 months? We haven't got a response. I finally get one, and then I present it to the office, and the office is like, that doesn't make sense. That's not what we want. So it just made me think, oh my goodness, they don't know where we're going. And if they don't know where we're going, of course they're going to try and solve the issues for what they're seeing and how what they're seeing impacts their days. So what I did was instead of like, I just said, you know what, we're going to let this hygienist, we're not going to accept meeting her. I we're not going to offer her a job. That might be the wrong decision. But before we do that, I need to get clear with where the office is going. So I sat down with the leadership team of that office at lunch. And we I put together a PowerPoint. I kind of masked my ideas and some rambling thoughts. And I just sat and I said, hey guys, all right, we're going to start from scratch. I was under the impression that if we had a hygienist, we added a hygienist to our team, that would be a great thing. You guys clearly saw it differently. Let's try to look at where we're going. And I clearly laid out what the next 12 months would look like. If I could paint the picture of what this office looked like in 12 months, this is what it is. And we need to add a doctor, we need to add a hygienist for us to get there. So I thought that if I'm having those same struggles, and I think I'd be in clear, I can imagine that every office, every dental office, as the visionary, as the owner, as the person who's supposed to be directing the ship, they're probably also not being super clear on what the next 12 months or 18 months or three months is going to look like. And everyone's going to be solving their own problems. So I thought it'd be a good idea to unpack that.

Paul Etchison: 5:41

I'm curious, just in your situation, what was the team's argument for not wanting the hygienist to join the team? Where did they think they were going?

Steve Markowitz: 5:48

Yeah. So it was more like, how is it going to impact my schedule? I can I do that many exams and what days and times is this person going to work in? All of it, everyone's intentions were good. They just didn't have enough of take step taking a step back to understand what problem they were trying to solve. And it was really like what I was seeing was doctors wanting to work through lunch to add production or to see more patients. And my thought was like that, you're going to kill your team or you're going to burn people out. You could work less and the office can still do better. And maybe that's too high view of a view of the of a dental office, but we can take that down even to the single doctor practice and uh sharing direction with their team.

Paul Etchison: 6:32

Well, it reminds me of this client I was working with on the West Coast, and he came in at about 600K in production. And we put the systems in, we got new patients up. We started like working on case acceptance and systems with the front desk and closing treatment. And we got them to about 1.7. And after 1.7, he said to me, he's like, gosh, like, how do I get more? How do I get more of this? Like I'm going as fast as I can. And I remember I had to say, hey, this is normal. This is where we're at. You're at capacity. There is no, he's, but you said, but there's still room. I still have openings in my schedule every now and then. And I'm like, but how far is that going to take you? If you want to continue going, the next step is setting up your office for an associate, for bringing on scale. So knowing what the next step is in your office evolution, I think is critical. But also, if we're not sharing this with the team, it gets really hard. And you get, you have so many people going different directions. Is how do you even get alignment? What's coming in your mind for all this, Henry?

Henry Ernst: 7:31

Uh, I thought that thing that came in my mind was alignment of the goals. The team has to be aligned with the goals. And you were touching on this, Steve. But I mean, kind of in the infancy of our practice, we implemented EOS and we had a five-year plan and a one-year plan. And part of our five-year plan was we want to get to, I think it was 18,000 active patients. Well, how do you do that? Right. You don't just snap your fingers. There's a lot of steps that have to go along that process where you're mapping out what does each quarter look like? What does each year look like? And the most important part is the team has to be on board. So I'll take a really simple dental example. If we're in yearly meetings and let's say we're just starting in visaline, which we actually did this years ago, and we said we want to get to 100 case starts every year. That's two a week. How do we do that? Doesn't happen right away. You gotta A, do we all agree that this is a good idea? Yeah, this is great. We can help more people, blah, blah, blah. Well, let's do the next quarter. Let's get training, let's get everybody trained so they understand the verbiage. Let's make sure we've got the IT rows. Let's make sure we've got it set up in our system. Okay, who's gonna be the person in charge of that? Boom. Now, second quarter, we've got that in place. Let's have a goal for two consults every day from each hygiene team, from each doctor team, just the consults. Now you know what I mean? So that the point that I'm getting to is everybody's got to be aligned with this goal. Everybody's got to have accountability for this goal. So we're all rowing in the same direction.

Paul Etchison: 8:58

Well, what I'm hearing is leading and lagging indicators. You got these lagging indicators, which for most dentists is going to be production. That's the lagging metric that is going to lag all these other things. But then what are the leading indicators that will lead to more production? So, like, you know, for your Invisalign thing, taking more scans, getting buy-in from the team. Right now in my office, we're really our payroll is getting a little high. We are trying to increase our revenue, but our bottleneck is lack of new patients. And it's not lack. I mean, we're seeing like 90, but we need probably 15, 20 more for my doctors to truly be busy. But so our leading indicator right now is we're going for new patients and we're trying to reduce cancellations, keep those schedules like full. Because if our schedules are full, everything else will fall in line, the revenue will fall in line, but we can't just grind harder and work through lunch, like you mentioned, Steve. That's not the solution.

Steve Markowitz: 9:53

Do you know what I this was a couple of years ago, maybe even maybe even longer at this point. I had a hygienist that came up to me just like by the water cooler. And she goes, I quit. And I was just like that. She's like, I'm I'm putting my notice and it was like a nonchalant. And she was with me at the time for like 10 years. I was like, Why? And she said, I know where you're going. You're pretty clear about where you're going, and I don't want to go there. I know where you're taking this. I want to hear where you're taking this. Well, at that point we were like two offices, and and I I was sharing, like, guys, we're gonna we're gonna try and see if we can expand this and build more locations and all the things that where we are now. And I thought that was really cool. It was upsetting because she was a really good hygienist, but I was clear enough with where we were going that it got people who wanted to do it super excited, and people who didn't didn't want to be part of it anymore. And that's not that they weren't great at their job. She was. But she wasn't great at her job for where we were going. And that I think was the biggest win of the whole thing. The clearer that you can you can be, the more excited you're gonna have, the more people you're gonna get to buy in and you're gonna be able to delegate very effectively because the people that you're delegating to want it just as much as you do.

Paul Etchison: 11:07

Yeah, I give you props. I feel like if somebody said it to me, I would get very defensive. Like, where am I taking this? And what does that mean? Well, it makes me think about a lot of offices where you're five, six ops. In this podcast, we're talking about creating a practice that allows you to have associates and allows you to take time off and scale more of a business, you know, rather than being the producer all the time. If you got five or six ops, it's hard to have two doctors there at the same time. So split shifting. And I work with a number of doctors, and they say, Well, I just don't think it's the right time to bring on split shifting with my team. Like we got so much, I don't want to introduce more complexity. And I always say the same thing. I say, you got seven, eight people on your team right now. Try doing it with 15 people. Do it with 15 people that are resisting that, and it's so much worse. If you know that's where you're going, go and bring the people who are ready to go with you. Don't get there and then pull the rug out from underneath them and be upset that they didn't want to go there all along. And that's what I think is awesome about what you did, Steve. You're very clear about your intentions to go to multiple practices and accept the fact that maybe somebody doesn't want to go with you. And I think that's one of the big lessons here. We don't have to bring everybody with us. Not everybody has to come. But if we have clarity in where we're going, that's a good thing. Yeah, this reminds me of Henry. I'd love you for you to share that when you partnered up with the DSO, I believe um you were clear about where you were going and how you weren't going to be the person, the fill-in doctor for everybody.

Henry Ernst: 12:37

Yeah. So fortunately, I learned my lesson from great mentors ahead of time. And I got really smart and I went from four or five days a week to two. This was about a year or two before I sold. And that's what really made the business great. And I don't know, we've talked about that before, but yeah, when when I first joined, I remember saying, I said, listen, this is great. I just want to make one thing perfectly clear is if and when doctors leave or something happens, because you get nervous in that transition. That's a whole other podcast we could talk about. But if somebody leaves, I'm not gonna be the person that jumps in and goes five, six days. I'm just not gonna do it. That's my line in the sand. I'm gonna work my butt off when I'm here. I love being here. I'm gonna do my two days, but that's my line in the sand, right? And it's the same thing. It's like the hygienist, right? They know who I am. They know that I'm I'm gonna run this place great and I love it. I love the business aspect, but I'm making sure they know who I am ahead of time. And a couple of other things that were in my mind is I'm at that point now, I think it's just years of experience where something like that with the hygienist would not bother me too much. I want the right people in the right seats, all going in the same direction. And if you're not, handshake, I wish you well. And you know you have a good office, by the way, when you have people leave and they come back. I've had over the 10 years I've been here, at least five or six. They leave, and when they come back, it's a little gratifying. You almost want to say, like, I told you so, but you don't. Yeah. You say, Oh, welcome back. And it's I love like parading them around with the around the team, like in the office. Look who came back, right? Guess it's not so great out there.

Paul Etchison: 14:08

I would love to look somebody in the eye when they're putting their two weeks in and tell them, you'll be back. You, yes, you will. I don't believe you. I don't believe this is the end of us.

Henry Ernst: 14:16

I say that in my head, and I I've literally had it about five times happen.

Paul Etchison: 14:20

You belong to me. That is the best. It totally is. So let's talk tactical, because I think it's important for we've got to, as owners, we've got to stop, we've got to slow down, we've got to put our thinking hats on. And so, Steve, you know, you've got six different practices where you're probably you've got this core alignment between all of them, but you've got the individual goals for each individual practice. How should an owner look at their practice and decide this if they're saying, you know what, I don't really know where we're going. I just want more revenue.

Steve Markowitz: 14:48

I want more money. Yeah, that's typically where everyone starts. But even before that, you have to be able to have the freedom and time to think about what you actually want. Something made you dive in to want to be a practice owner. And that probably wasn't a just uh, it's a Tuesday and I'm just gonna make this decision. It was a thoughtful decision for you to be a practice owner. And then you went out and you either built out your space or you found a practice to acquire. That same thing you should do at least once a year as you prepare for the following year. This time of year, I'm thinking about 2026 and what needs to change so that we can continue to grow. I share with my teams every year we need to grow. It's not a want to grow, it's a need to grow. And the business needs to grow alongside our team. We can only fulfill our purpose if we're growing. So the first thing I do is I need to look at our revenue because that's the fuel that allows us to do everything we do. And that will be the first number that I look at to see, all right, we're here, we need to get here. And that doesn't mean it's 10 or 20%. It could just be three or four percent. I don't know. It depends on what that, where that office is in its maturity, but it needs to grow. And then if I can determine that number, then I can start to peel it away. All right, these are the parts that I know are there now. If we're gonna increase about $400,000 next year, what do we need to do? We probably need to add X amount of hours or X amount of days of hygiene. Maybe we need to add a specialist in that office, maybe we need to add one or two doctor days a week. Once I can determine where I want us to go, as long as it's up and to the right, then we can start to put in the tactical granular decisions that we need to make to get there.

Paul Etchison: 16:37

We're always scared of presenting these goals because they're usually revenue-based. How do we present this to a team so it doesn't sound like greed? I was just having this conversation with someone this morning.

Steve Markowitz: 16:48

Healthcare is it is weird. And because it's direct to consumer health care. And every spot, every single time we help somebody, the value that we create, there's a dollar associated to that. And the reason why I feel so comfortable sharing that is I feel so great about what we're selling. And I'm putting that in quotes, what we're sharing with our patients, the more that we can help them, the greater our the value is that we're creating, the higher our production is. I don't know of a better metric of determining how well a dental office functions than production. If there is, I would love someone to tell it to me. I just have never found a greater metric that measures how the entire team is working together, how much value we're creating for our patients than production. So if I truly believe that and I want us to help more people and serve our patients better, the only way that I know to measure everything is production. So let's share that with our team. Guys, we were able to quantitate exactly how much value we were able to create. Next year, I want to be able to do more. I want to help more patients. I want to help our current patients better. And that's what this number indicates. Who is not going to get behind helping our patients better?

Paul Etchison: 18:01

Well, I think what's important too is I totally agree with you, but also throwing in with the team, asking them, does anyone feel like we ripped anybody off this year? Does anyone feel like we did anything unethical here to get to that dollar amount? Because if you can truly say we were operated within the boundary of ethics, then that is 100%. Look at how many more people we helped by increasing our revenue. It wasn't, we didn't have to do anything bad to do it.

Steve Markowitz: 18:28

Yeah, I don't even ask. It's a non-negotiable. I am so proud. I have this conversation. Clearly, I've had this rehearsed. I had this conversation a ton. I am so proud at the value that we create for our patients. I'm so proud that knowing that it's a non-negotiable, that we're not going to do dentistry that isn't necessary for our patients' health. If that's where we start, and everyone knows anything above that, we're helping our patients get healthier.

Paul Etchison: 18:52

Henry, do you have this conversation with your team? I've had this conversation around money with my team and starting to think like I'm this is something that is necessary. It's something I've always done, but it's almost like a step in a checklist. You have to have these conversations. Is this something you've done?

Henry Ernst: 19:05

We've always done it. So with our leadership team, we have our weekly goals of production. We share the quarterly goals with the whole entire team. You know, like, hey, our goal for production this quarter is 1.5 million. We got 1.55, which is 102%. Great job. We try to make it fun. So we have all of our metrics. Like we let them grade it. I do something similar to what you were mentioning to where the team can get involved in the meeting. How do you grade this? And we do red, yellow, and green. So, hey, our new patient goal this quarter was 800 patients, and we got 700. So it was this percentage. What do you think? Oh, it's yellow, green, you know, something like that. So they're involved and we're not afraid to share. And I think just like you, Steve, we're proud of that because the more people we help, we're treating people in a great manner, ethically. Nobody gets quote unquote ripped off. So we're doing a great job and we're helping more people. And I'll take it one other turn here is looking at it from the employee point of view. When you're standing up there, Steve, talking about we want to do this, do this, what's in for it for the employee? Like, okay, I'm gonna buy Steve another mansion, I'm gonna buy Steve another yacht or whatever he's got over there in Boston. What's in it for the team member? Not from a selfish point of view, but we've done these kind of things over the years where we make a big broad goal and we say, hey, how about if we get to this number, we'll do a cruise next year? And we've done that. We've done that about six times. Or, hey, we're gonna hit a profit sharing model where if we do this, you're gonna get a certain percentage. I'm gonna share it with all of you. So look at it from the team's point of view, too. Because if you're standing up there talking about a six million dollar practice, you know, kind of like ours is pretty close to that. They don't care about that. They just look at I'm working for this dude that's making a lot of money. Let's share, let's do something together. And we've had it before where when we had the cruise things, they would have like a little thing in the break room that had like, you know, those things when they have um when they're collecting money and they have like a red thing that keeps going higher until the you see the goal. They had something like that that I didn't ask him to make. And I said, Well shit, they're trying to get this really hard too. Because in my head, I already figured it out. If I pay for this vacation and we're hitting that, I'm happy to do it. Yeah, I think that's called a thermometer. A thermometer. Hot damn. You got me on a clinical day where I'm actually working seeing patients. I did a couple sedations this morning, so don't use the thermometer, Henry. Gotcha.

Steve Markowitz: 21:20

To add to that, if you have a six million dollar practice, what most employees think is every single dollar goes directly into Henry's pocket.

Henry Ernst: 21:28

Yes.

Steve Markowitz: 21:29

Yeah. It is very okay to explain to the team how the dynamics of the business work. Paul, you mentioned before that your payroll was high. That can sound super icky. Yeah. When the employees, like, what do you mean the payroll? I'm a percentage point on uh some statement that you look at. But I think they the team also needs to understand why that's important. Why is financial health a something that is important to them? Because when the business is healthy, it's able to fulfill its purpose. And part of that purpose for us is to make sure we can take great care of our team. So if the business isn't healthy, guess who doesn't get more? Everyone that I'm talking to. And that needs to be okay to share because if they don't know, they're just gonna assume that every single dollar that comes in goes directly into your bank account. And we know the margins of dentistry aren't that at all.

Henry Ernst: 22:26

Yeah. And all they see is Steve's. You're making them think like owners, basically. And so many dentists are I don't know what it is, but so many dentists are so afraid to share with the team what the practice actually makes. Note to self, they can go on the practice software and see what's getting collected, guys.

Paul Etchison: 22:42

Yeah. All right. If you are listening to this and you're thinking that you want a practice more like this, I think this is where our expertise comes in. This is why we are not business consultants. We are dentists that have actually done it. Talking about how to deal with your team. That's the hardest part. Sometimes it's not the systems, it's the conversations around the system. So if you're looking for someone to take your practice next level so that you can have more time off and enjoy what you love doing, please reach out to us. Set up a strategy call with me at dentalpracticeherous.com. Thank you so much for listening and take care. We'll talk to you next time.