Dental Practice Heroes

Stop Trying to Be a Super GP: Why Niching Down Can Explode Your Income with Alex Sharp

• Episode 625

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Trying to be the super GP who does every procedure might be making your practice harder than it should be. In this episode, Dr. Alex Sharp explains how specializing not only helps you create a model that's easier to market and scale, but also lets you spend more of your time doing the dentistry you actually enjoy. Hear where the GP model still works, how to specialize in an existing practice, and what the future of dentistry looks like!

Topics discussed:

  • Alex's journey from associate to practice owner to CEO
  • The benefits of niching down for dentist and patient
  • Why your marketing isn’t working and what to do instead
  • 3 key factors for a successful denture/implant practice
  • Hiring for implants: doctor fit and the dentist’s role
  • What’s changed and where dentistry is going

Learn more about Shared Practices Group: https://sharedpracticesgroup.com/

Listen to The Full Arch Podcast: https://thefullarchpodcast.com/

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

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Paul Etchison:

Have you ever felt like you're busting your ass, trying to be that super GP that can do every single procedure? You're doing fillings, crowns, endos, implants, sleep, invisaline, ortho, all that stuff. And somehow your practice just feels so much harder than it should. The truth is, what worked 10 years ago in dentistry isn't always what works today. It's changing fast. The opportunities are changing. The business models are changing. And the dentists who win are the ones who are learning to adapt, focus, and build a career that actually fits who they are instead of trying to force themselves into a model that drains them. And that's exactly what we're diving into today. You are listening to the Dental Practice Heroes Podcast. I'm your host, Dr. Paul Etchison, a dentist, a coach, and author of two books on dental practice management, and the owner of a multi-doctor practice that collects nearly $6 million a year while I practice just two days per month. On this show, we talk about leadership systems and the mindset that helps you build profit, build freedom, and build a practice that runs smoothly without you personally being chained to it. Our guest today is Dr. Alex Sharp. He's a dentist, he's a multi-practice owner, he's a podcaster, he's actually a former client of mine a long time ago. And now he's the CEO of Shared Practices Group, which is about to open their 40th denture and implant center. 40. He's gone from associate to owner to niche clinical focus and now to non-clinical leadership. And he's got a powerful perspective on where dentistry is heading and how you can thrive in it. Let's get into it. Alex, so happy to have you on, man. Listeners know this. This is somebody that I've known for a very long time in the industry, somebody I very much respect. We spent a little bit of time before the college is catching up and doing a lot of things I didn't know you were doing, man. So welcome to the podcast.

Alex Sharp:

Paul, thanks for having me. And it's great to catch up because I've known you for a long time and I've learned a ton from you over the years. And I just want to say thanks for giving back so much to your listeners and to clients and everyone else, because you're a wealth of knowledge, wealth of experience, and thank you for sharing it so freely. Oh man, thanks.

Paul Etchison:

I appreciate that so much. So let's tell listeners about, I mean, let's go brief story. I mean, you were a practice owner, but like you're in a completely different role now. So let's talk about how that evolution happened.

Alex Sharp:

Yeah. So, I mean, like a lot of us, like out of dental school, not really knowing my butt from a hole in the ground, trying to figure out like which way was up and how to be successful in this wild world of dentistry that we find ourselves in. And so uh bounced around doing associateships, doing all different styles of dentistry, some higher-end stuff, some Medicaid, high volume stuff, bought a practice in 2018, and then learned how to be successful in that model where you're doing all types of procedures, being all things to all people, traditional like family dental office that's trying to layer in more specialty stuff to serve folks at a higher level. And I just learned firsthand that you could be successful that way, but it's far from a sure thing. And I think those of us that are dentists learn sometimes the hard way that a lot of us prefer to narrow our focus to what we find ourselves compelled to do, what feels like fun to us, what might look like work to others may not feel that way to us. And so that's where I think niching down. And for me, it was implants. For me, it was doing full arch and learning how to transform people's smiles in the highest and best way that we know how as dentists. What really cinched it for me one day was I realized that I was spending however long doing a quadrant of composites, and I realized success in this procedure means that the patient doesn't know I did anything. They're paying me all this money. And best case scenario, nothing snags when they floss, nothing's sensitive when they chew, the bite feels good. And so I'm a ninja. Best case scenario versus you're doing implants and people are counting on a change, counting on something to categorically shift from the money that they've paid you. And I think that as a dentist, that's a much more empowering way to practice is to take someone who doesn't have teeth or has a bombed-out dentition, and all of a sudden you can take them from zero to one in a way that's hard when you're doing restorative. So for me, it was finding meaning in that narrower subsection of dentistry. And the great thing about dentistry is that there's so many different options. But for me, I was chasing the impact.

Paul Etchison:

Yeah. So you've moved from a practice owner doing everything and now to some more specialization. But now, even from there, you've moved into a role where you're non-clinical. Talk about that.

Alex Sharp:

Yeah. And so right now, I'm the CEO of Share Practices Group. And so my partners and I merged our practices together. We united under that flag of knowing that in dentistry, sometimes you have to carve out your niche and say, what do we stand for? What do we want to do? Because if you try to have too big of an impact by having a nebulous set of deliverables, it's hard to be overly successful. So for us, that was what gets us out of bed in the morning is to create those opportunities for dentists that didn't exist when we were out of school. Like what is the ideal opportunity? So for me and for people that are wired the same way, it's surgery, implants, smile transformations, and doing that all day, every day. And so we predicated our company and our approach to being able to set dentists up to succeed in that vein. Practice number 40 opens on Monday. So when we're recording this, you know, we're about to open in Albuquerque. So it's been a cool journey and to go into your question about non-clinical. I think non-clinical has an allure to it. I think a lot of people put it on a pedestal to say, like, oh, if only I were non-clinical. And I'll say this this is going to be a little controversial. It's hard to deliver enough value as a non-clinical person to warrant a dentist income. I think it's it's important to realize that dentistry is very valuable. It's a service. And the further away you get from the provision of that service, the harder it is to justify the income that you're accustomed to making as a dentist. So I think that's the dirty underbelly of being non-clinical, is that you have to provide value, commensurate with what you're accustomed to doing care side.

Paul Etchison:

Well, it's true. And I think a lot of us, like we have this idea that we'll get one associate and allows us to be a lot more non-clinical. It does give us a little bit of freedom to some extent. But I mean, you can't go completely non-clinical with just one associate. There's just no scale. There's no and I think what it is is that you're right. We only can provide so much value. And then as like in your situation, lots of practices, lots of providers. Now you can provide enough value to warrant that, but you need to have some scalability to it. I love what you said about the composites that we have to go in there and make it like we never came, like we never changed anything. And that's so true. And it makes me think of like sometimes that I always tell everybody when you finish a patient, tell your patient to rub their tongue up there and how does everything feel? And like I did this once with the patient. I realized that bond kind of gets everywhere. You've got to polish it everywhere. Like I you polish that composite, but like if the rest of the field tooth feels rough and it feels rough on the gums, they're like, man, something's kind of wrong. And I never actually thought about it that way. It's like you're a ninja trying just to sneak in there.

Alex Sharp:

That's it. That's the job description. And what I think is challenging for dentists is that patients only have a very narrow way of assessing quality. It's a subjective way that patients understand how good are you. So they they equate quality with how we make them feel, how we communicate with them. Do they get the warm fuzzies from talking to us? All that stuff matters, but they don't know if we followed the bonding protocol. They don't know if the marginal ridge has secondary anatomy. They just know does it feel rough to my tongue? Did the shot hurt? Was the guy an a-hole when he was, you know, explaining treatment to me? So they only have so many touch points to assess our quality. And you just pointed out one of them.

Paul Etchison:

Yeah, it's so true. So you're noticing now more this change in the industry. When you and I knew each other like 10 years ago, everyone was being super GPs. You know, that's what we wanted to be. Everyone wanted to do everything for everybody. I mean, what are you seeing in the industry changing?

Alex Sharp:

I think being a super GP still has a place. And I think it's of the rare person, and I know a few of them, that really thrive in that environment, that truly do wake up and enjoy the breadth of procedures that they do from fillings and crowns to root canals to implants to sleep apnea devices to invisalign, they really do enjoy what they view as the departure from the monotony of doing one thing all day, every day. But what I've found is that for most of us, for the personality types that are attracted to dentistry, we're very analytical. We like predictability, and we like being really good at what we do. So from that standpoint, I think the narrowing of the focus to say, let's be honest with ourselves. What do I enjoy doing? What brings me joy? What delights my patients to no end? How can I create the boundary conditions for me to create exceptional outcomes for my patients all day, every day? Because if my patients are getting great outcomes, then my team is infused with that energy from rendering service at a very high level. And then the world goes round nicely, predictably every single day because we're delivering at a high level. And I think if we narrow our focus, then we're getting really, really good. We're approaching mastery more readily, the fewer types of procedures that we provide. And so that's the logic behind in our model, focusing on dentures and implants. And you see other types of sub-specialty, pseudo-specialties popping up where it's crown-only practices, it's invisalign-only practices, hygiene-only practices. And I think there's freedom in that discipline that you're able to architect for yourself. Because if you're playing the insurance game, you have to have volume. If you're doing like the traditional large practice, multiple providers in network with all these PPOs, then you have to beat those stalling out reimbursements through scale, through economies of scale, through better ways of negotiating fees, of negotiating your lab costs, of your equipment costs, because there's going to be an increase in hard costs, like the team costs are expensive now. And so how do you outcompete those? And to me, I've found that narrowing the focus does that. There's always going to be a market for the super GP, but there's almost like a bifurcation of the business model that we've seen over the last few years.

Paul Etchison:

It's interesting that you mentioned that, but like what I see is that if we're going to specialize in a practice such as you mentioned, most of the time I see it happening in a large group practice. So like you mentioned like these other things, like a crown-only practice, like an Invisalign-only practice. So there is a way to specialize in some dentistry without essentially having a large practice, which sometimes can be a challenge to grow. Like other than surgery, Invisalign, crown-only practices, have you seen any other like subspecialties?

Alex Sharp:

Yeah, I mean, there's folks that do like emergency only practices, like the 24-hour a day type of approach where the value proposition and the distinction is we're always open. There's always someone there that can do an extraction or extraction bone graft or extraction bone graft medium implant or molarendo. And I think it depends on population density, because if you look at your tertiary, quaternary markets that don't have a ton of dental saturation, you're going to probably see more Jackson Jills of all trades doing a wide breadth of procedures, probably not as much insurance participation. And something that you and I know from way back, and this continues to hold true at a degree that kind of boggles my mind, is that it's so easy to go where other people aren't, hang a shingle and crush. There's still so much of that out there. So for anyone listening that's in dental school or is a couple of years out and just trying to figure out their path, if you want to have a great living and a great meaning behind the work that you do and work with people that are grateful, go to a rural area where you have a radius of people, seven or nine thousand people that don't have a dentist in that area. And you'll be, you'll be the hero or the heroine of the entire area because no one else is there. And you're not going to have to do this whole game of competition that so many people find themselves playing, because that's a function of it, is you're narrowing your niche because that's where the opportunity is. Because if you open an undistinguished practice, I have a friend that just did this, or he opened up a practice and it's on like murderer's row of this busy area where there's all these other dentists, and he's wondering why aren't I getting any phone calls? Why aren't I getting any traction on my online marketing campaigns? And it's just because, pure and simple, the math of the saturation, the dentist to population ratio. So if you want to be the super GP, go rural because you can just go out there and annihilate.

Paul Etchison:

So, what would you say to the doctors that are like, I like doing surgery? I know I love doing on four. I wish I just had more cases. I tried marketing for it. It didn't work. Why can't somebody just build that out of their existing practice and then divide it? Or are you more saying, like, hey, if that's what you want to do, like if you build it, they will come figure it out. What do you think?

Alex Sharp:

Depends on demographics. There are plenty of cases where people have carved out that niche within an existing practice where they just have a sheer number of people coming in that a sufficient volume of candidates for that treatment come through the door and that works. But again, it's really challenging to get to that level of scale, that level of new patient flow. Because in my experience, yeah, you can get people just naturally, organically coming in that need the procedure. But let's analyze the target audience here. Let's analyze the type of patient that's going to need that procedure. They're usually dentally avoidant. They don't normally willingly come into the general dental office for routine care, or else they wouldn't be in the predicament of needing the all on four in the first place. You have to market to those people differently. You have to strike a different chord with those folks because either they've all of a sudden had this type of emergent situation that's been their own little internal call to action to cause them to move forward and start doing research. Or you have to find a way to get in front of them, TV, radio, social media, to where all of a sudden that's the epiphany for them, where they see your stuff and they say, you know what? I'm going to do some introspection and I'm going to say, now's the time. I've been putting this off for too long. I'm seeking to get either this aesthetic transformation or the restoration of my full ability to function, whatever that button is, you've created your marketing apparatus to push that button for those people that are chronically dentally avoidant, that are oftentimes very scared and a lot of times very distrustful of the dentist. Because we get that all day, every day. Nothing personal, Doc. I hate the dentist. And so they make a joke of it. But a lot of people make a life out of it where they just avoid the dentist. And so only until the chips are on the table and they realize I got to do something, then they take action. And the marketing, that's that's one big source of learning for me, is learning the back-end machinations of how to create the marketing apparatus to be able to appeal to that cohort of people that aren't the types that have Delta Dental. They look and see who's in the network and they come habitually every six months. Like we're talking to a different patient base. So you have to become a student of whatever vertical you want to serve. And so to answer your question, yes, you can do that in a large enough practice with enough new patient flow because law of averages, you're going to get people that need any type of procedure in a large enough cohort. But the marketing for whatever cohort it is has its own nuance to it.

Paul Etchison:

Now, you guys at share practices, you're just adding your 40th practice, and you guys are more focused in de novos now, correct me if I'm wrong, but you're you've obviously figured out something. These are denture and implant centers. Would that be an accurate representation? Yeah. Yeah. So you've figured out to some extent some secret sauce that's working, that's replicable, that you're now putting in different locations and redoing your model and scaling. What do you think has been that that's worked for you guys? So you could say, I can just open a location where only doing dentures and implants, and it's going to be massively profitable and successful.

Alex Sharp:

Just like everything else in life, you learn by making mistakes. So like you you look back at prior decisions and prior sacredly held beliefs, and you poke holes and you say, okay, that worked 75% well, 90% well. Where was our knowledge base incomplete? Where did we make decisions based upon incomplete data? And so really it's just figuring out the demographics, it's figuring out where the optimal place is within those demographics to put the practice. And then who's the dentist that's going to be the right one to partner with and deliver the care? So it's really that that three-legged stool that you have to solve for in every situation. And so we know in just general dentistry, opening a practice is risky. It's risky to just hang a shingle without understanding how many people might I be able to reach under optimal circumstances. How do I stand up above the crowd so that people choose me above anyone else? And it's all about distinction. It's all about clarifying what you do differently or what you're poised to be able to offer that other practices can't. And usually it just means speaking to that patient in a more clear and desirable way so that you're actually speaking their language and understanding what their pain points are and how you're positioned to solve for those pain points. And so that's again, another reason why I was attracted to this model is because those are the patients that have the most acute pain points, which means that we have the ability to solve more wide-ranging problems than you can in someone who just needs a couple of occlusal fillings.

Paul Etchison:

True, true. So if you would say comparing your practice model with like GPs, like I'm thinking about the fact that there's so much that goes into the associate dentist in the associate-driven model. Like they've got to be clinically good. I mean, it's got to be clinically good. That's like bare minimum, but it requires a certain personality. And I wonder in your model, how hard does that get to find people? I mean, you got to find someone that's at a high skill level, but also it does it require as much on personality and charisma as the general practice, or is it less because you can rely on a treatment coordinator to handle that stuff?

Alex Sharp:

That's such a good question, Paul. So I'll start with the first part of your question. The people part of this business is always going to be the hardest part. Whether you have one practice or 40, the people part is the challenging part because we are people working on people with other people. So it's like that challenging no matter how you slice it. Yeah. And so we have a multi-pronged hiring approach where we're measuring all these different aptitudes, we're looking at the resume, we're doing these different types of interviews and assessments. And is it perfect? No, but it's it's way better than it used to be. And I think it comes down to understanding that people have to just love the craft. In dentistry, you you and I have met so many dentists over the years where some people are just amazing. They have hands of gold. They could make a little wad of composite look like anything. And those are the people that are really motivated to be great at what they do. And implants, it's a little easier to measure on like a post-op comb beam or in like post-op patient interviews. How was the experience? How was the delivery? So it's a little more easy to quantify effectiveness in this model. And I would also say that when you're understanding what makes a successful doctor tick, yes, you want to have great front office team members to be able to get cases across the finish line, but there's no substitute for the dentist being the one to look the patient in the eye and say, look, if you were my mom, here's what I would recommend. Or to actually talk about clinical urgency, to talk about here's what could potentially happen if that periodontal infection lasts for another year or five, the bone can continue to erode away. Here's the links between heart disease and diabetes and other autoimmune issues and the current oral health condition that you have. So you can have the best front office team in the world to help patients overcome their financial obstacles, but there's never gonna be a substitute for a dentist that can confidently walk in the room, build value for what they're what they're recommending, and help get the case across the finish line because the dentist having the thumb on the scale is the best thing ever.

Paul Etchison:

Yeah, totally. And I've noticed that in my career. There's no level of front desk that's gonna carry that over the finish line. I mean, the dentist has got to sell it first. You got to create the need, you got to create the desire. So, I mean, where do you see dentistry going? What's in the future? What in your opinion are we looking forward to?

Alex Sharp:

I think it depends on who you ask because you have these two simultaneous truths that you see all the time on Facebook groups, where some people are saying, I'm more successful than ever, I'm busier than ever, I'm more fulfilled than ever. And then by the same token, you have plenty of people that are complaining about student loan debt. They're complaining about them not making any more money than they ever have before, they're working harder for less money. And both things are true at the same time. Dentistry is what you make of it. And it comes down to those early decisions that you that you think about early in your career, like what CE did you take? Where did you set up shop? How much did you paint yourself into a corner in terms of your current practice model, size-wise or location-wise? And I just want to point out that there's always a way to hit the restart button. Like you're you're never just stuck. Even if you think you're you're stuck, you're not stuck. And we're more interconnected than ever before. Find a community, find a group of like-minded people that you can use to volley ideas back and forth with, whether that's a mastermind group or something, because you don't have to be by yourself. It's too great of a of an industry, too great of a profession to have to settle. And there's so many unhappy people. Maybe it's just the squeaky wheels on Facebook that make it seem like there's a ton of unhappy people. But go take CE, get reinvigorated, learn what you want to do, what lights you up. And that's what that's one of my favorite things about the company that we've built is that all day, every day on our Discord channel, people are sharing wins. People are talking about, like, hey, I had this complication happen. How would you guys handle this? And when you're doing something as a team, it doesn't seem as daunting. So, whatever style of dentistry you do, don't make it a single player game. It's way more fun as a team.

Paul Etchison:

Yeah, it is so true. I mean, we just came back from our mastermind weekend. We had 15 dentists in Destin, Florida. We all rented a house together. Awesome. And it was just so reinvigorating. And I think this is, I mean, maybe you could speak to this too. I'd love to hear your opinion on it. Like when you have a podcast, you draw a certain demographic, like you draw a certain type of person. And these 15 people that I hung out with this weekend, not a single one. I don't think I could go one-on-one on I could go with anywhere. We could go hang out. Like it was such a great group of people. We had so much fun. But what was so cool is that everybody was so into making the best practice possible, like running a practice like a business. And it's so nice to have that community. And a few of the members said that to me before. Now, I've been part of Masterminds before, but they're like, wow, I just can't believe it's so good to be part of this group. It's amazing. Like, do you hear the same thing with your shared practices group?

Alex Sharp:

Completely. And at its core, my favorite definition of a community is a group of people that come together around something that they care about. So for your community that you're talking about, they care about maximizing what they're capable of in their practices, getting the most out of dentistry as a profession and also helping their comrades in arms do the same thing because they have their own practices, but they're not playing a single player game. And that's what we've built is we've aligned our efforts around creating the best group of full-arch dentists in the country that want to over-deliver for their patients, which then puts us in a position to over-deliver for our teams because it's it's infectious when you see these transformations of someone going from a dentalist to brand new teeth or bombed-out meth-mouth dentitian to all of a sudden bright, shining teeth with whole new job prospects and new life prospects. Our teams love that too. And so there's just a lot of incalculable ripple effects from mastering your craft and being around other people that are going to push you to continue to master your craft. So it's it's an exciting time in dentistry. And back to the prior point, there's really no excuse to not put yourself in a position to enjoy what you do because there's lots of shades of gray in terms of how you practice.

Paul Etchison:

So if there's a dentist listening that's hearing like what you guys are doing with Shared Practices Group, your denture and implant centers that you're opening, you're that all that stuff, is there somewhere where they can learn more about this? If someone's thinking about like doing this, is there opportunities for that with you guys?

Alex Sharp:

Yeah, definitely. The the best way to get in touch with us is uh sharedpracticesgroup.com. And we also have a full arch podcast called the Full Arch Podcast that we release every week and we go into a nerdy amount of depth pertaining to how to do this type of procedure at scale, best practices, CE courses. We're actually hosting our own CE course called Intro to All on X, and that's going to be February 20th and 21st. And uh go to the Full Arch Podcast website for details. And I think we have an early bird special going on, but try it. And we have plenty of like mid-career dentists that come to our courses and have a new lease on their practice, and they they add this stuff into their practice, and it gets them a few more years of excitement and purpose in their careers. So I think you got to keep the keep the saw sharp and coming to one of these courses is a good way to do it.

Paul Etchison:

Yeah, I love that and tying that in with the fact that there's no reason to be miserable in dentistry. I've been there. I'm guilty of it. You know, I have been miserable. I know a lot of people that have been miserable. And just recently, Share Practices we had Richard Lowe came on the show and told his story, a very interesting uh story of just burnout and stuff. So it's like we've for us to be in a place of power, we've got to take our reality into our own hands. And I love that you said there's nothing wrong with hit and reset. I think we think that we get so trapped. So if you're looking for something other in dentistry, you're looking for something other than what you're doing, looking for some more excitement, go find it. Go find that community, go register for a course, go check out shared practices materials and all the stuff that they provide. Alex, dude, always good to catch up, man. Thank you so much for coming on the show. And uh I'll let you leave our listeners with just one piece of advice for dental practice owners.

Alex Sharp:

Okay, my best piece of advice for dental practice owners is to trust but verify. And what I mean by that is people want to be doing proportionately more. If you're hiring a team worth at salt, they don't want to be doing the same thing year after year after year. Help them to grow, interview them as to what a successful growth path for them within your business looks like for the next one, three, or five years. And then keep a heavy hand on their as you manage them, as they gain skills and gain aptitudes and gain responsibilities so that it can be a win-win of them doing stuff that doesn't require a dental license, you getting stuff off of your plate. But then it also teaches you to be more effective with your time so that you're not the one doing it, but you are providing oversight so that big mistakes don't get made, people don't embezzle from you, et cetera. But I think that's the rising tide lifting all boats kind of philosophy that dentists aren't, in my experience, all that naturally adept at. Because a lot of us just want to muscle things over the finish line ourselves. We're reticent to delegate, we're reticent to develop people because we tell ourselves stories of people are just always going to be leaving. There's gonna be a revolving door of people. Every unit of energy that I put in someone is gonna be a waste because they're gonna leave me anyway. But maybe that's the answer. Maybe by pouring into people is how you retain people. So it's an abundance mindset that I I still struggle some days to be able to fully live out, but that would be my advice.

Paul Etchison:

Yeah, I couldn't agree more, man. I think it's the solution. It's it's the solution of people leaving is to pour into them. So, Alex, thanks so much for coming on. It's been a pleasure.

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Dr. Paul Etchison

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