Helping Healthcare Scale
Imagine you're friends with multiple CEO's of billion dollar organizations. You can call them anytime you like and ask them all that they've learned about real estate and investing, including some of their biggest mistakes.
That's the mission of this podcast, to teach the insider strategies used by the big guys to everyday healthcare operators in order to get access to the best strategies and real estate at the best prices.
If you need help finding the perfect location or you're ready to invest in commercial real estate, email us at podcast@leadersre.com.
Helping Healthcare Scale
When Less Is More: How Consolidating Practices Boosted This Dental Group's Bottom Line
The path to scaling a successful dental group isn't always smooth, as Dr. Bradley Dykstra candidly reveals in our raw conversation about overcoming critical staffing challenges. When unexpected provider departures left his practices struggling, he turned to temporary dentists—a decision that spiraled into financial strain and team burnout.
"They just want to come and collect their paycheck," Dr. Dykstra shares about the locum tenens experience that cost his practice dearly. Through this painful journey, he learned crucial lessons about vetting providers, setting clear expectations, and maintaining accountability. His honest reflection offers invaluable guidance for any healthcare organization facing similar staffing dilemmas.
Beyond staffing solutions, we explore the counterintuitive strategy of consolidation. By reducing from seven locations to six, MI Smile Dental Group strengthened their bottom line and optimized resources. "It's not number of locations, it's the bottom line that really counts," emphasizes Dr. Dykstra, challenging the growth-at-all-costs mentality common in healthcare.
Looking ahead to 2025, Dr. Dykstra reveals his innovative approach to hygienist compensation—treating them as true providers with production incentives rather than fixed salaries. This forward-thinking strategy aims to attract motivated clinicians while controlling labor costs in an environment where insurance reimbursements remain stagnant despite rising expenses.
Whether you're managing temporary staffing challenges, considering practice consolidation, or reimagining compensation structures, this episode delivers actionable insights from someone who's navigated these waters. Visit www.mismilesdentalgroup.com to learn more about their approach to dental practice management.
If you need help finding the perfect location or your ready to invest in commercial real estate, email us at admin@leadersre.com
Sign up for a FREE vulnerability analysis and lease renewal services
View our library on apple podcasts or REUniversity.org.
Connect on Facebook.
Commercial Real Estate Secrets is ranked in the top 50 podcasts on real estate
You hire one person and then you hire another, and you hire another and you can spend a lot of time with them and it's not really there's a feedback loop there intrinsically. But as you start to grow like you have to be really intentional about the systems that you put in place, or like it starts to take on a mind of its own and it's not going to necessarily be a good direction. So I think the important takeaway is just the process. Whatever it is, everybody's going to come up with their own anyways.
Speaker 1:But the important thing is you do a review right, at least annual. We actually started doing quarterly reviews as well, but yeah, that's the important part.
Speaker 3:The goal of this show is to help healthcare organizations scale by leveraging real estate strategies and interviewing high-level healthcare executives in order to pull out lessons learned along the way. If you'd like a free site selection analysis from our team, visit us at wwwreuniversityorg and drop us a line.
Speaker 1:Hello, welcome to Helping Healthcare Scale. I'm Austin Hare, your host, and we have a repeat guest today. His name is Dr Bradley Dykstra. He's the CEO and founder of my Smiles Dental Group. They got six locations across Greater Grand Rapids, michigan, and today we're going to talk about some of the struggles that he faced over the last couple of years, particularly involving temporary dentists, locum tenants, and how he overcame that so that he's poised for growth in 2025. So, bradley, thanks for coming on. My pleasure, austin. Yeah, I think that obviously, it's not all roses all the time. Right, like, business is full of struggles and a lot of times there's things we might not want to talk about while we're going through them, but when you come out on the other side, you learn a lot. Yeah, let's you know since our last recording, which I believe was probably at least two years ago. Maybe catch us up to speed. Tell us what you've been going through, some of the struggles and how you overcame them. All right, going through some of the struggles and how you overcame them All right.
Speaker 2:So we've had a couple struggles, but the main one was having enough providers, both hygienists and assistants actually all positions and we found ourselves in 20, actually end of 2023,. We lost our pediatric dentist and we couldn't really find a replacement. So, out of desperation, after a while, we went to the temporary dentist route, or they're called locum tenens, and that one it didn't go too badly. But we had another office, our most remote office, where we just lost a great dentist and we actually the dentist that was there we moved to one of our other locations because it was near where he lived, and so we just couldn't find anybody for that office. So again, we resorted to temporary dentists and it went from one bad one to another and none of them ever actually produced enough to pay for themselves, because they come at a very high price. That was something we learned. Also, they come highly recommended and they say they'll do anything that comes in Pretty soon. They won't do A, they won't do B, they just want to come and collect their paycheck. And so you go back to the ones who placed them and they talk to them, but if it doesn't get better, then they try and replace them. But it just got to be a merry-go-round in that office, and what happened then?
Speaker 2:The rest of the team turned over by in the fall. We had two great hygienists and they got so sick of it they both walked out. So all we had there was a bad locum that didn't want to do too much and no hygiene. So the last half of 2024, we poured a lot of money into that office. We didn't really want to close it because in the past it has done very well, and so we started making a plan to move one of our long-term partner dentists down there and he finally decided that was best for the organization. So he started one day a week in November, december. Now he's down there Three days. We have another good doctor down there the other day, so it's open four days. We've hired one hygienist and interviewing another one today, so it's definitely turning around, yeah. So maybe.
Speaker 1:Yeah, go ahead. What'd you learn from this?
Speaker 2:what I learned is you can't believe what people tell you. You really need to do your own research and you need to set really high expectations. When they do come in, Make sure they're supported, but set high expectations and for a while, inspect daily, I think and have a senior administrative person down there. We also had a core office manager that had some health issues, so that complicated things. So we hope never to have to do it again, but if we did, we would bet the person very well a lot more reference checks of where they've worked. We'd make sure there's a senior administrative staff there, or office manager always, and really take care of the team too. So they know it's a temporary solution.
Speaker 1:Okay, maybe let's start high level. The issue was that you lost a doctor in the practice and then you just thought to yourself, or somebody told you, hey, we'll do well, you don't need to hire right away. I think that traditional thinking is you got to have a full-time guy, like you got to have, you always need an associate. And somebody, I guess, told you, hey, get a locum tenens, which is like a temporary dentist, and this is going to come in, they'll solve your problems in the meantime, is that?
Speaker 2:Yeah, it was not that we weren't trying to hire a full-time. We just had a real difficulty for several months finding someone who really wanted to come to Western Michigan, which I'm not sure why because it's a really great place to live, to practice dentistry, to raise a family, to have fun.
Speaker 1:Actually, yeah on that note I know that we were talking off camera. Grand Rapids specifically, I like because I just have fond memories of it. When I was wakeboarding professionally, we were probably there, like every year. Millennial Park was where we had boat contests. I think they even had the finals, I think it was the grand finale of the Pro Tour stop would end up there, and so that was always a fun time. And then before that we had rail jams. Before the Pro Tour went to Grand Rapids, we had rail jams at the Bob, and this is probably gosh gosh 15 years ago now, a long time ago, but yeah, when we were there. It's a beautiful place in the summer and we could go hiking like how far are you guys from the great lakes?
Speaker 2:20, 25 miles and actually where mothership is in hudsonville, we're like 15 miles from lake michigan. So great beaches, grand haven, hollandkegon, saugatuck, lots of great areas, the city itself. Grand Rapids is a vibrant, growing, friendly city.
Speaker 1:Yeah, I had really fond memories of Grand Rapids in particular. I was always there in the summer, but still, I thought it was always a really cool spot and then you could go right out to the lake. It wasn't that far of a drive, I think. We went hiking to the lake and then jumped in and that sort of thing. Anyways, side note, but yeah, I think it's a cool city. Back to the issue. Yeah, you're looking for a doctor. You can't find one. Eventually it gets so painful that you just tried this locum tenens, but it was more of a bandaid than a fix and it turns out the Band-Aid didn't really even stop the bleeding.
Speaker 2:The Band-Aid actually caused more bleeding and so I guess would we do it again. I don't know what's going on with my computer, but okay, would we do it again. We would do it differently, but we always are trying. That was going to be my question.
Speaker 1:So now looking back in hindsight hindsight is always 20-20. Would you go through just the painful periods of no doctor while you recruit, or would you still do this process with a local not local temporary, but do it like just completely differently, I think we would try doing it differently, but we'd also take a real hard look on.
Speaker 2:Do we want to keep that practice long-term? But if you don't have a doctor pretty soon, you don't have a team, you don't have patients, then you have nothing. But also, which makes it basically unsaleable even if you wanted to, and so by keeping it alive to a degree, even if it's costly, I think that still may be the better route if it's not going to go on too long. It's the longevity of this one that was the killer. If it was a month or two, you can survive that, but this went on for a whole year and so we had to solve it internally. But we were able to find other dentists for our Grand Rapids area offices, so that allowed us to move somebody else down there.
Speaker 1:Yeah. So what was like? I guess, even though you've got this locum tenens, you're still recruiting for a full-time doctor right In the process.
Speaker 2:Oh, absolutely Every way we can With Headhunters, with Indeed, with I don't know. I have my people do that, but they were trying everything. And finally, the last four or five, six months we've had some good luck. We actually have, I'll say, a dentist and a half, starting next week again. So that will bring us to where we need to be. So that's week again. So that will bring us to where we need to be. So that's yeah.
Speaker 1:So maybe let's walk through that process. Why do you think it took so long to find one? And like how would you recruit differently if you were put in that situation again?
Speaker 2:Austin. If I had the answer to that, I would share it. I think we would do it more aggressively maybe, but there was just a lot of people looking at that point in time and not many dentists coming to the area and, like I said, if I knew the answer, austin, I would tell you. But I think the more you do it, the better you get at it. We've had more practice now.
Speaker 1:Yeah, maybe specifically then with the temporary dentist, like if you're going to do that route again. You said that you learned a lot during that. What specifically would you do differently in hiring locum tenants?
Speaker 2:Okay, I would really look at what they're asking prices per day, per hour, whatever and then figure backwards Okay, this is how much you have to produce a day just to pay for yourself and then to support your share of the office. So I would set very much production expectations on them, knowing that if they don't make it, they're done okay.
Speaker 1:I think that's number one, and also you have those for your part, like your full-time doctors, right? Yeah, we really check a lot more so for some reason, when you're hiring a temporary doctor, maybe you feel like you might not need to have that come. You feel like you don't need to invest that much time in the because they're there for so short, is that?
Speaker 2:the thing. That's part of it. And again, never having done it before you, I learned not to trust what the agent, the agency, tells you about them. They say, oh, they do this and this. So we didn't always, especially at first, follow up with anybody. The last one we did, but still, even the people you're able to talk to, nobody's willing to really tell you the truth if they weren't good.
Speaker 1:Yeah, If they're not good. Do you have any advice for how to sniff that out ahead of time?
Speaker 2:I think really talk to the last three places they've worked and talk to a couple people there. I would go to the office manager and assistant and a hygienist if you could. Okay, I don't know. I think the bigger thing is setting clear expectations and following through every day and having somebody there watching them basically watching them. Ie making sure they're doing what they should be, keeping them on track on task.
Speaker 1:I want to double click on that because I know that sometimes with doctors and dentists they feel like they need to be the highest of the totem pole. So it's hard to put somebody who holds them accountable right. Like, even though they have the title of manager, sometimes they might feel like a doctor or dentist. Somebody with that kind of title might feel like they don't need to report to anybody. How would you go about holding them accountable, like, who? What person gets put in that role Eventually?
Speaker 2:me, but a good office manager manager could, or my director of ops got better at it, but again, because this was a more remote location, it was hard to have someone there every day yeah, I guess, if you said yeah, just one second.
Speaker 2:The other thing we learned is, if there's any issue at all, call their placement person and tell them, make it very clear, and so they have actually their placement. People have more influence on them than you would think they do, so that's the other thing we learned. Towards the end, I was on the phone daily for a while with a couple of them and all of a sudden they responded quickly, so that was good.
Speaker 1:Cool, let's pivot for a minute and let's talk about the consolidation you did. So I know that we all talk in terms of like numbers of locations and like how many are you growing to, but you guys went from seven to six and you consolidated one of your practices. And so again I want to talk about that theme of let. Sometimes less is more and it's specifically like when you go, if you're not that you guys are looking to sell, but if you are looking to sell and you have a, just because you have 10 locations, if one of them is not profitable, it's actually going to drag down the price that you're selling for. So sometimes it makes sense to cut the one that is negative cashflow or the problem child, if you will, or consolidate them or whatever. So I'm just curious, like what was the strategy and the motivation behind you guys consolidating two of your practices into one?
Speaker 2:It goes back a few years. But one of the practices we bought was in between two of our others, one a mile and a half from one, three and a half miles from the other, so right in between. But it came with. The selling dentist came with it for a couple days a week where it was going to be one or two years. That ended up being three. But we knew that he was a good dentist. He really wanted to stay, but once he was like, yeah, I'm not so sure I want to be here too much longer. Our lease was about up. It's okay, this is our chance. So in the beginning that was the long-term plan. We just had to wait for the right situation so we always planned to merge yeah, yeah, that was always the goal.
Speaker 2:But as long as it was doing well, and we do, that dentist wouldn't work anywhere else because he had been there his full career. But it's an off off street area and a big building, no signage, anything. Our other two are very good locations. We own those locations, so it made sense to merge that one into the other two, which now is making the other two busier because neither were working at their capacity and as far as staffing, it's much, much easier. So staffing, supplies, rental expense, everything. So again, it really helps the bottom line.
Speaker 2:Like you said, austin, it's not number of locations, it's the bottom line that really counts, and so we made the decision this would be better for our bottom line and it actually went well. The majority of the patients are transferring to one of our other offices, mainly the two, and so we're just three weeks into it because we closed there December 31. So we're still moving stuff out. And the other thing we got there was quite a bit of good bigger equipment like x-ray machines, chairs that we were able to move to replace some that were iffy in some of the other offices. Oh cool, yeah, that was as an unexpected benefit, I think.
Speaker 1:Yeah, that makes sense. You had it, you had that plan all along and, yeah, like we talked, like we said, it boosted the bottom line. Okay, I want to talk about plans for 2025. But before we move into that, just curious is there any other thing that maybe mistakes you made or any other lessons that you learned, that you were unexpected or that caused you to pivot in 2024 or since we recorded last?
Speaker 2:I would say, what we did do, though, also is, we really got our annual review process in order, because otherwise it was haphazard, so we have that much more down, so that's good.
Speaker 1:Is everybody a part of that annual review Admins, front desk, all the way down to associates?
Speaker 2:Yeah, we haven't really gotten to the associates yet. That's on my agenda in the next couple of months, but we did everybody else last year.
Speaker 1:And what does that look like for you? Are you using any sort of there's EOS and there's other programs like? What does your annual review process look like?
Speaker 2:We've so I'm not the one who does it, other than so. The admin team set it up and I do, just the admin team. But it really revolves around adherence to core values and we have set definite KPIs for everyone. So with kind of on a point system now, so if they are at this level or at different levels, so when it comes time for the review, it's core values and it's performance.
Speaker 1:Core values and performance? Yeah, and do you have KPIs that you can talk about with those? I?
Speaker 2:do we do. I can't necessarily like for the office managers. It's you know what, austin, I don't have that all in front of me because I'm not the one who does that. That's good. Yeah, I have that.
Speaker 1:Yeah, I think the takeaway is like the importance of doing them, because when you've got, I don't know, I don't know how to explain it, but it feels like it happens quickly before you really know what's going on. I know when I had my gyms, I had about 20 employees, maybe 22. I can't remember. You hire one person and then you hire another, and you hire another, and it's like you can spend a lot of time with them and it's not really. There's a lot of feed. There's a feedback loop there intrinsically, but as you start to grow, like you have to be really intentional about the systems that you put in place, or like it starts to take on a mind of its own and it's not gonna necessarily be a good direction. So, yeah, I think the important takeaway is just the process. Whatever it is, everybody's gonna come up with their own anyways. But the important thing is you do a review right, at least annual. We actually started doing quarterly reviews as well. But yeah, that's the important part. Yeah, absolutely.
Speaker 2:So, yeah, we do have KPIs, and the other thing that we haven't always been good at, which we resolved to do this year, is holding people accountable for what's expected of them, which, a couple of years ago, austin, was hard, because if you'd hold people very accountable, they would just leave. So, that's starting to change too. That's on a good front.
Speaker 1:I remember that was a big topic of discussion on this podcast was the labor force. So it was so hard to just get people to show up. Nobody wanted to come and work in person and then there was a bunch of groups that were all recruiting and inflation was crazy. So wages were going way up and yeah, it was hard recruiting for every across the board. Every single role was hard. But are you guys seeing that's becoming coming back down to earth a little bit?
Speaker 2:It's coming much more down to earth, it's still. It's still not nearly like it was in 2019, but it's a lot better than it was in 22 and 23. 24, it started to change and, like I said, now we are starting to hold people more accountable and, on the rare ones that don't want to be, we're better off without them. And we do have a full-time HR person and we have a full-time onboarder trainer. Just because we want to give everybody a good start. Before we throw them into their role, we want them to understand who we are, why we do what we do. These are our systems, this is our software. This is all of this Pretty much. They all go through two weeks of orientation before they really get to their role.
Speaker 1:All right, let's talk about what's on the horizon. What are you focused on for 2025? What metrics? What are you looking at? What are your goals? That sort of thing 2025?
Speaker 2:What metrics? What are you looking at? What are your goals? That sort of thing. Our number one goal is to increase production in each office, to get our percentages for the different categories in a good stead. Actually, our lab and supplies we have those well under control. Our labor costs are still higher than we would like. We are changing, in the process of changing our hygiene comp to the hygienist much more like a dentist, so that they'll have a full but anything over the floor. They'll start getting a certain percentage of that, which then will allow us to say, to attract hygienists who really want to work and to make more. We don't want to just stick to a set salary, a livable salary, and then incentive if they go above and beyond.
Speaker 1:Yeah, no, I love that. It's interesting that for it's such a common model for associates, they have a percentage of the revenue, collect our collections and it's really not that common in hygienists, but there's no reason not to do it.
Speaker 2:Because really they are providers. And so why don't we treat them and respect them as providers and give them the opportunity to do better?
Speaker 1:Yeah, I love it, great yeah. Look, we want to get right into the meat and potatoes of these things, and so I think that you've shared some really good insights in terms of deciding when to consolidate, how to view a locum tenens like a temporary dentist, and then structures for your hygienist. So, before we wrap, is there anything else that you want to talk about we didn't get a chance to talk about?
Speaker 2:No, unless you can fix the insurance reimbursement issue.
Speaker 1:I know, yeah, that makes the whole industry hard. When you're capped, your costs are going up, but you're capped by what you get reimbursed at. You just get squeezed, and my wife's a PA in dermatology and Medicaid Medicare. They actually cut their reimbursements for Derm specifically and so they're getting less reimbursed less than they were back in 2018, 2019. It's crazy.
Speaker 2:Yeah, I haven't seen ours come down, but they're definitely not going up, so that means you just have to pay more attention to every cost in the organization.
Speaker 1:Yeah. Are you thinking about automating a lot more to lower your labor costs?
Speaker 2:Yeah, we're automating pretty much as much as we can. We do want to make sure all the Clinically we have things as automated as they can be. I think we have basically all the clinical technology that there is and we use it well. We're really working on automating stuff in the call center, patient relations kind of stuff, and we're really starting to dig into the RCM process.
Speaker 2:Yeah, I love it Because a lot of that stuff it's there, but it's not quite where we want it to be. But I think this year we'll see a lot of changes coming down on that. That will be good.
Speaker 1:Great. So if people want to reach out and learn more about what you guys got going on, what's a good resource for that?
Speaker 2:The best way to find out about our organization is just go to wwwmysmilesdentalgroupcom. So mismilesdentalgroupcom. That will bring you to our organization landing page. There you can learn all about us.
Speaker 1:Great. Hey, it's been a pleasure and thanks for coming on the show.
Speaker 2:Thank you, austin, my pleasure.
Speaker 3:If you need help finding the perfect location for your practice or you're ready to invest in commercial real estate, email us podcast at leadersreecom R-E, as in realestatecom, or go to leadersreecom and fill out our form. See you next time.