Helping Healthcare Scale
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Helping Healthcare Scale
Beyond the Dental Darling Days
Keith Miller, president of Partnerships for Dental (P4D), returns to the podcast to share how his organization has grown from two to 40 locations since 2017 —now 41— while many competitors have faltered under challenging market conditions. With refreshing candor, Miller reveals the financial discipline that has kept P4D profitable despite rising interest rates and inflated practice valuations across the dental industry.
At the heart of P4D's success lies a disciplined approach to acquisitions and operations. While competitors chased growth by paying 8-9x multiples for practices, Miller's team maintained strict financial criteria, focusing on practices generating at least $1.5 million with multiple providers. More impressively, they consistently deliver 35-40% EBITDA increases within the first year post-acquisition through supply chain optimization and operational improvements without disrupting clinical staffing.
The conversation takes a fascinating turn when Miller describes how the dental acquisition landscape has fundamentally changed. What was once a robust arbitrage opportunity—buying practices at 3-4x multiples and selling consolidated groups at 10-15x—has compressed dramatically. Today's buyers pay 6-7x while consolidated entities might only command 9-10x, leaving razor-thin margins after corporate overhead. This shift has created significant challenges for highly leveraged groups, especially with interest rates soaring from 3-5% to 11%+.
Miller also shares innovative approaches to post-COVID staffing challenges, including technology partnerships that have cut insurance collection times from 30 to 15 days. The episode concludes with personal insights on wellness routines, including daily ice baths and sauna sessions, providing a glimpse into the discipline that carries through both his business and personal life.
For practice owners considering partnerships or entrepreneurs building dental groups, this episode delivers essential perspective on creating sustainable growth in today's challenging dental marketplace. Visit p4dentists.com to learn more about their partnership approach.
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So the biggest reason why dental was the darling is because the spread right. And then vet Mary went through the same thing and I think that it's tightened up there as well. But in the golden days we would buy things at a multiple of three to four and then people would sell their company from 10 to 15. And there was arbitrage.
Speaker 2:A lot of the guys who packaged didn't necessarily worry about the efficiencies because there's so much arbitrage already. It's just hey how quickly can we roll these up and sell them. But in your case it sounds like you were doing that in addition to increasing efficiencies.
Speaker 1:But if you fast forward, that's back in 2017, I would say when we started Fast forward today. I would guess that most people, the average multiple they're paying is six and a half or seven, the average company selling nine to 10,. If you have any type of corporate cost or management fee, if you got to take that out of there, there's not much left over. And that's saying that everything goes perfect, that you acquire this practice and everything goes just as planned, which we all know that in a perfect world that would happen every time, but it doesn't actually happen in the real world. So the problem is there's been a lot of people paying really high multiples, which has continually drive the price up of the practice, but nothing has happened on the corporate side.
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 2:Hello guys, welcome back to Helping Healthcare Scale. I'm Austin Hare, your host, and today we have a repeat guest. His name is Keith Miller. He is the president of P4D, which stands for Partnerships for Dental, and they've been around since 2017 and are up to 40 locations. So last time we were on the show a couple of years ago, they had about 20, so about half, and had been having really strong growth, which I think, given the times we're at the end of 2024, is really impressive, because we've seen a lot of groups that are struggling. A lot of groups are interest rates have hurt them, the overpriced, overpaying for assets has hurt them, but at P4D they've managed to survive the storm, so to speak, and they're doing really well. Keith, thanks for coming on the show.
Speaker 1:Hey, it was great to see you again and always great to talk to you.
Speaker 2:Good. So, yeah, let's just talk about maybe what did you guys do that helped you stay not only afloat but really thrive over the past several years when a lot of other groups were struggling a little bit.
Speaker 1:I think the biggest thing for me is we have a very talented team. We have a lot of years experience. Most of us have been in this industry for over 20 years. We've seen a lot that's happened in the industry. We've seen a lot of ups and downs and I think the way that we put the company together from day one was very disciplined and it really was, with 15 plus years of learning in the DSO industry and mistakes that we made and everyone else made. So when we put things in place we had a very strategic plan. We knew what we wanted to do. We knew how we wanted it set it up. We were very consistent with our doctor contracts, with our vendor relations, all of those things that we really had a good plan from day one.
Speaker 1:So when the competition got high with buying practices, we didn't chase.
Speaker 1:We didn't go pay the eight times, nine times, 10 times.
Speaker 1:Sometimes we're seeing that people are paying for practices that we just stay disciplined and even though we wanted to grow, we had the money to grow, we weren't going to go chase that ball.
Speaker 1:And I think that's one of the things that have really challenged our industry is the fact that you have these interest rates go for people who are paying 3%, 4%, 5% and now they're paying 11 plus and they have significantly overpaid for assets and in some cases they haven't performed as well as they thought they would, which leaves them in a huge crunch that they just get leveraged. And then you don't have a lot of places to go when you're leveraged and the bank's breathing down your neck and you're busting covenants and so forth. So I think just the discipline of how we set up our company, the experience in our management team and then our ability to operate the organization through COVID and all the staffing and things that went on. So it's. I don't think there's one thing or two things or three things, there's probably 20, but I'm just proud that we have great people that were able to pull it off and keep us where we are today as a very profitable and strong organization.
Speaker 2:So can you maybe give any examples of like when you say financially disciplined, looking at doing an acquisition, what's something that like where's the over-under? Is that something that you can talk about when it becomes outside of your buy box versus within? Like? What kind of metrics do you look at? Have a?
Speaker 1:tendency to just be looking at bigger practices. So our range is a little bit. I guess we can go a little bit lower, a little bit higher, but typically we don't look at practices under 1.5 million. We like practices with multiple doctors versus one doctor. We really in our history, since the very beginning, since the very first practice we bought, we've able to deliver to the doctors 40% Actually it's in a range between 35% and 40% increase in their EBITDA in year one. That's the practices we're looking for, because typically bigger practices have less discipline. They make so much money, the doctors do so well that they don't have to be so good on expenses or so good on growing the business because of the fact that they're financially very secure and sound.
Speaker 1:When we look at these bigger practices that we know truly what our returns will be at a minimum and a maximum. And there are some risks obviously in any deal you do. But when we look at it we know for sure because of our track record on what the synergies will be to get a multi or I would have called it an EBITDA or a multiple lowering effect. So we're able to take the multiple we bought at and lower it because we've been able to grow profitability so much just in year one. So it's all of those things combined of sticking in that box. And then obviously we run the financial models and if it goes outside of the financial model we won't chase it. And that's just as much. As we may love a doctor, we love the practice. That we think is probably the best deal that we could ever do If the price gets to a point where it puts us and the doctor at risk Because you're going to remember, we're in a partnership model.
Speaker 1:So any decision we make.
Speaker 1:And this is what I explained to the doctors.
Speaker 1:If we're undisciplined and we go and pay them or overpay them and put the practice at risk for one reason or another, if interest rates go up or if all kinds of other things can happen, then we're both at risk and I'm just not going to put ourselves or them at risk.
Speaker 1:So it's all of those things combined as discipline that I think it takes a gritty professional, I think, to stay disciplined during times where maybe you have private equity really breathing down your neck to grow and that you're trying to hit certain numbers, or you promise somebody that you're going to open up 20 locations and you're more trying to check a box than stay disciplined. Luckily in our situation that we're allowed to make good business decisions and not chase anything but keep the business strong and sound. And then when you do get difficult times, like COVID or post COVID, with staffing and all the things that happen, then you come out really strong. And that's what I felt, even though it wasn't easy post COVID for sure I wouldn't, I would never say that but financially we came out very strong.
Speaker 2:So yeah, it sounds like doctors obviously are rolling equity. Like if you're continuing a partnership together, do you have a certain amount of equity that you'd like them to roll, and is it like store level or would it be parent company?
Speaker 1:Yeah, ours is all at the LLC level. I just like that better. We do distribution. Being in this industry, you get to see a lot and I've seen a lot of bad things happen, with not only doctors but executives that get their equity trapped in a parent and that at some point they have all this equity and then a couple of years later maybe they don't have any equity because of things that have happened. So in our model it's all at the LLC. We do quarterly distributions so our doctors don't have to wait for an equity event to get any type of return on their practice investment, that they're consistently getting returns on their investment because we distribute the excess cash after every quarter.
Speaker 1:So I prefer that. I know there's a lot of different ways to skin that cat, but I've just seen enough that I like to be able to go to my partners and show them what their equity has done since they left from being on their own to being with us and there are times that you know the doctor has sold 70% of their business to us and they'll come up to me and said hey, keith, you won't believe this, but I make more money today than I made owning 100% of it, and that's pretty darn cool If you think about that. If they can become a 30% owner and their take-home income is more than it was at 100%, I think that means that we've done our jobs well and we've solidified the relationship, that you made a really good decision joining our organization.
Speaker 2:Well, let's talk about that then. What are some of the strategies that you guys use when you come in to increase EBITDA so much? Because it sounds like in his situation, you increased it by at least 70%. So if he's making me take a 70% reduction in ownership, what's?
Speaker 1:I think that the thing is, it's all about the discipline in our industry and this has been since I started that sometimes people it's the chicken before the egg and some people grow organizations and then figure out they have to be disciplined. Right, let's go buy 30 practices and then figure out we need a formulary. Let's do all these things, let's go accumulate as many practices as we can, and then when we try to sell, somebody is going to come to you and say okay, what are your systems, what are your processes, what are your synergies? And then everyone looks and goes oh no, we've been busy growing and we haven't thought of the things Really from day one.
Speaker 1:We were very disciplined on the vendors. We use up and down the line that we have a very small formulary all excellent top quality products but very few skeUs, and we're using the things that Gordon Christensen recommends and we have all the data and the white papers behind it to make sure that we're having the top products available. We only have three composites on our formulary versus somebody else might have 20, but you can't negotiate if you have 20 composites on your formulary. We can go and negotiate hard and typically we save the doctor 40 to 50% just in supplies and labs.
Speaker 2:Just because the economy is of scale, like you're purchasing such large orders, wow.
Speaker 1:And then benefits that we can give them better benefits and, at less cost, insurance for the practice. There's a lot of things up and down the line, even down to softwares and those things, so it's not just one thing. But I would say in any dental practice your three biggest expenses are labor, labs and supplies. So we are able to tackle labs and supplies right away. We don't do anything with labor because we never want to mess with any staff or anything like that. But if we can do those things and those things are agreed upon before we ever do a deal and we're very open on how to do that. But those are where our doctors really see a huge upside and see the benefit to themselves in especially getting their distributions to go up because we've saved so much money.
Speaker 2:That's good. Yeah, I'd like to talk about really one or two of the biggest challenges that you've seen over the last two years. I know it was three years ago we I think it was at least two and if not three but we've seen a lot of shifts in the industry, like the interest really interest rates is what it comes down to. It just changed the dynamics so much, but I don't know if that affected you guys or not or if it was something totally different, but just curious to see, like your framework for working through those problems.
Speaker 1:I think everything post COVID changed. In my career. I've never seen such a shift in mentality with people. You probably see it on the news and everything. Everyone wants to work from home. You don't have a whole lot of loyalty, the type of loyalty you used to have. You have people that quit with no notice. You have people that start and they never show up day one. There's a lot of behaviors from people have changed significantly. That has been a challenge. It's been a challenge. I don't think it's just in dental, though. A lot of my friends that run companies have the same challenges. But when you have these small little offices and one person matters, it is challenging.
Speaker 1:A couple of years ago one of our initiatives was really to find technology that could help us not be so reliant on the people up front at least. Obviously you need assistants and hygienists to run the clinical side, but the people up front, because if we couldn't hire good people or retain good people or train and develop good people, then I had to have some other way to make sure the processes were done. So the confirmations, the insurance verifications, the postings of the insurance checks. Be able to collect the money as fast as possible. Be able to collect from patients the money that they owe. So I really went to work hard on those areas to use technology to really lessen our reliance on the front desk people and I would say it's significantly changed our organization. Our AR is by far the best that I've ever seen in the industry.
Speaker 2:So what did you do exactly to increase AR, was it?
Speaker 1:more automation.
Speaker 2:Reduce AR, so we Reduce.
Speaker 1:AR.
Speaker 2:Increase efficiency of the accounts receivable. Okay, yeah.
Speaker 1:Yeah, so we partnered with a company called InsideDesk and that technology allowed us to see these claims essentially when they bounced back the next day, versus waiting to know, hey, maybe 15 days or whatever it is, to get it back. So we are able to. We have some centralized folks that are able to attack those things and clean them up and get them resent the next day. So essentially, we went from we were around 30 days on collecting our money from insurance companies and now we're at 15. And we've reduced our total AR, for our company is about 60% of one month's collection. Literally, we've got AR cleaned up to, I would say, high performance level.
Speaker 1:And then, obviously, when you have the industry going through tough times, you want to go collect as much money as you can, and that was one of the initiatives that we had, and so it really helped us keep things smooth during some of the ups and downs we had post COVID. But now I feel like we probably have one of the best ER systems and results in the industry, so that it's just those types of things. But we could have never done it without parting with a technology company, and that was really something that I opened my mind to and said, okay, I need to get out there, I need to see what the market has, I need to get my team to be looking to say what type of technology can we employ to not be so reliant on?
Speaker 2:people. Yeah, and it's crazy, even that 15 day difference can really add up, just having that cash that much sooner for your operations up just having that cash that much sooner for your operations.
Speaker 1:Let's think about it if you got your paycheck ever the same paycheck every 15 days versus every 30 days, what difference would that make in your world, right? It's complete total difference in cash flow yeah, what about?
Speaker 2:are there any beliefs in the industry like connelly hill, beliefs that you disagree with?
Speaker 1:I don't know it's like everyone, every man has an opinion right, and I think, from our industry perspective I think that I think this is my 23rd year in the business and this is probably the most difficult time that I've seen, just because the industry had always been like the healthcare darling and that's the best way that I can say it that out of all the healthcare sectors and obviously this is multi-unit healthcare that dental was always highly sought after and you had all these PE companies bidding and you had just a list of PE companies that wanted to get in dental and they couldn't because they couldn't win the bids and so forth.
Speaker 1:Post-covid, because of competition, because of interest rates, because of performance that now the industry is, it's one that the PE companies are afraid of. I think last year 50 companies went out and three got deals and the multiples were nothing that we'd seen in the past. They're very low multiples and one of the biggest fears that I have is what's going to happen? What's the next step? What's going to cause a change on reducing what people are paying for practices to a more legitimate amount so you can have an arbitrage between an equity event and what you're paying In today's world? A lot of the deals that we lose, I would lose money on it. I couldn't make money doing it.
Speaker 2:Just based on the fact that, like your buyers that you'd exit to have lowered their multiples, they're willing to pay by so much. That's what you mean, right? Like the people who you're, the private practices who are selling haven't necessarily lowered their multiple in the same I don't know percentile that the conglomerates are buying at, or am I misunderstanding that?
Speaker 1:So the biggest reason why dental was the darling is because the spread right. And then vet Mary went through the same thing and I think that it's tightened up there as well. But in the golden days we would buy things at a multiple of three to four and then people would sell their company from 10 to 15 and their arbitrage and you're also doing efficient.
Speaker 2:I guess a lot of the guys who package didn't necessarily worry about the efficiencies because there's so much arbitrage already. It's just hey, how quickly can we roll these up and sell them. But in your case it sounds like you were doing that in addition to increasing efficiencies.
Speaker 1:But if you fast forward, that's back in 2017, I would say when we started Fast forward today.
Speaker 1:I would guess that most people the average multiple they're paying is six and a half or seven, the average company selling nine to 10, if you have any type of corporate cost or management fee, if you got to take that out of there, there's not much left over.
Speaker 1:And that's saying that everything goes perfect, that you acquire this practice and everything goes just as planned, which we all know. That in a perfect world that would happen every time, but it doesn't actually happen in the real world. So the problem is there's been a lot of people paying really high multiples, which has continually drive the price up of the practice, but nothing has happened on the corporate side because the private equity is so afraid of the results over the last two or three years that people aren't paying and they're not even bidding. So that's for me I don't know if that goes against industry thoughts or not, but I would say for my biggest fear for the industry, that's probably it on how do we get out of that cycle. And I think we've all sat around for the last two years saying, oh, there's no way this continue, no way this can continue. But guess what? As of today, I'm still losing deals that people pay an eight and a half and a nine. So it has continued. I don't know how or why, but it's still happening.
Speaker 2:Yeah, that's crazy, and you made a good point. It's like on paper. You think oh, like, if I'm a private practice selling to a group, it's buying me at a 6x, you're going to sell at a 9x or 10x. You're making all this money off my back. But yeah, there's a lot of corporate expenses that go down there. So actually the EBITDA might go down a little bit initially, because now you've got to spread out all these corporate costs. That's just something that I haven't really thought about. Do you guys allocate a percentage to that? I guess the corporate infrastructure that's required to run a group versus a private practice.
Speaker 1:Yeah. I think probably all groups do it a little different. At the end of the day, you have to pay for your overhead. If you sell a company, it's simply your EBITDA minus your costs, right, and so whatever's left over is what you're going to get a multiple of. I always for all of our investors. In the practice, everyone pays a management fee, and so it's my job to ensure that the corporate costs don't exceed the management fee, that those things should really equal, that, whatever costs that we have.
Speaker 2:So it's like a fund in that sense and it's really something I have to balance.
Speaker 1:Like I am typically right on, Like we, it's not, it's definitely not a profit center. Like we don't try to make money off of a management fee. We try to. It's like a balancing the budget that we try to keep all of our costs within that and that's every cost. If you have to redo your bank deal and it costs you a million and a half dollars to redo your bank deal, that's part of that's a cost to the business that has to go in your management costs. So it's not just some people think it's management fee is just something that is people or travel, or corporate office, those things, but it's all the costs that the corporation has to absorb that go into that management fee.
Speaker 2:I like that. What's your advice for people maybe biggest piece of advice who are looking. Maybe they got a private practice they want to sell to a group, or maybe they're looking to start a group of a couple handful of locations. What do you know now that you wish you would have known when you were getting started?
Speaker 1:I would just tell everyone anyone that will listen. I will always tell before you start buying, have a plan, have a really good plan and consult people that have done it. I always share everything I can because I want. This is a very cool environment because we are all competitors and we all are working to get practices and run the best businesses. But if we don't all do well, it hurts us all. Right, because if our industry doesn't do well, people are not going to want to invest in it. So I always share everything I can and I just for anyone that's starting a DSO, I just say, hey, make sure you talk to a lot of people. If you need consultants, friends, industry peers, go to the meetings, the DICOMAs and ADSOs and DEOs, those type of things. Just learn as much as you can so you can be disciplined day one. You don't want to try to turn the ship when it's too big, it's just, it's very hard. And if you go tell doctors, okay, join us and nothing's going to change and that was a buzzword for several years that, oh, join our DSO and nothing's going to change, and then guess what, no one will buy your business because you haven't changed anything. You'll tell your doctors three years later, oh, we have to do this and we have to do this and we have to do that. And then your doctors feel like it's a bait and a switch. Just have a really good plan from day one and do that, and I would say that Anyone that's looking to join a DSO it's like getting married, and part of the tough part of today's environment with dental brokers is it's really like speed dating, like in the old days, like we used to spend time with the families.
Speaker 1:We used to go and sit at the dinner table with the doctor and the wife and sometimes the kids and talk about our company and talk about the relationships and talk about this is long-term investment together.
Speaker 1:Today you get an hour with a doctor and you get an hour on Zoom and you say turn in an LOI. And so it's become this huge speed dating thing and where people are being driven primarily to make decisions on whatever the highest bid is and not particularly what the best fit is or what the strongest organization financially is. That has changed significantly and I think that's something that a doctor who is, you know, trying to join a DSO needs to really understand that process there, that they're new to it. They don't know anything about it and they're trusting the broker 100%, but they should really rely on hey, I'm getting married and I don't ever want to get divorced, so let me make a really good decision on who I'm marrying. And sometimes in today's world you just don't get that opportunity unless you win the bid, and that's when you're allowed to spend time with the doctor. So you know, that whole process is changed dramatically and I think it's something that's made it more difficult for doctors, because they're just yeah.
Speaker 2:So how do you overcome that? Are you putting in more LOIs so that you can kind of court more people and get to know them more, or what exactly?
Speaker 1:No, I don't think it's. We bid on everything that's in our wheelhouse. We bid on it. It's not that, but it's a lot of times you just don't make the cut right. There might be 10 people bidding and they only take two LOIs and then go from there, and a lot of times you just don't make the cut and because we're disciplined in what we do, we're not going to go and make offers that don't make sense for us and the doctor I don't. Unless something changes in the broker network and how that's handled, I really don't think there's much that can be done, except try to educate doctors that there's a lot more to it than just price.
Speaker 1:Like this is a big deal for you. And even though you're getting paid something up front, if you're going into like a JV model where you're going to be an equity holder, that's probably your most upside is what your equity is going to be worth down the road. And that's hard sometimes because doctors don't understand that. They just see, hey, what am I selling my practice for. They don't understand that. They just see, hey, what am I selling my practice for. They don't understand the big picture of what the equity value could be worth in five or 10 years, which could be worth way more than it was when they got paid the money up front.
Speaker 2:Okay, let's pivot a little bit into maybe a little more personal side. What are you listening to or reading right now in terms of books or podcasts?
Speaker 1:I am actually nothing, actually business-wise. I'm into a lot of health stuff right now. It's funny that I've gotten crazy I don't know if you do this, but doing ice baths.
Speaker 2:Oh yeah, yeah, I just did one yesterday. I do them like every other day. Yeah, sauna, sauna to ice bath. Do you do a sauna too?
Speaker 2:Yes, I have both in my garage, which this morning I think it was like 36 degrees here, so it was awful. Our ice bath is 36 degrees, so it was. It was yeah, I'm at like 46. I did a 36 twice and I my, I had this head rush Like I felt like I was high or something, Like it was so intense and then when I got out it was like the craziest feeling. But my, my hat's off to you, because that that 10 degrees makes a big difference.
Speaker 1:Oh, I've been doing it now. I do seven minutes at 36 degrees and I do the sauna at 150 for 20 minutes and sauna into ice bath. And then today it was really cool. I went back to sauna because it was so cold, but it's funny.
Speaker 2:My son Every day, every other day. How often do you do it? Every day, every day, wow.
Speaker 1:So we I learned about it. My son plays college football and he you play. It's a very violent sport and so you spend a lot of time in ice baths. And so he started because he had injuries and things and he was in the ice bath every day and he started reading and really educating himself on the benefits of these ice baths and it's the endorphins that release, it's the brown fat that it burns, and the mentality changed, like getting coming out of the positive mentality. And he came home and he's telling me you got to do it, you got to. I'm like no way, like I'm not a person I like to go on vacation on the beach, I don't like to go skiing. And I just started it and he forced me to do it and at first my feet were so cold I couldn't like walk coming out of it. And then I bought the little neoprene booties that you bought After my feet weren't so freaking cold every day.
Speaker 2:Yeah feet is brutal. Do you keep your hands in or out?
Speaker 1:I keep every up to my neck. But I'm usually reading my phone, so my hands are up, so that keeps me entertained, so I don't think about the cold.
Speaker 2:Man, that's cool. Yeah, I've been doing it, but I read somewhere the benefits. You got maximum benefits at like 12 minutes a week or something like that. So I just do three and a half minutes every other day, but I don't know. I'm wondering. I do see the benefit in the mental capacity, like when you do it, you're like yeah, I was talking to you.
Speaker 1:I think I'm motivated to just try and do it every day, or at least days a week, and it's not even that. I think it gives you better. I don't know there's a lot of science behind this right, but it's like the the whole thing of the survival in our, in the human history it's a survival.
Speaker 1:So your body is surviving and it's fighting all these things and burning these calories. But I I do think it gives you mental clarity, like I think it. It helps you think clear and help you think positive. And you know it's so funny. My son was so into it. He started building on it, so he he bought freezers chest freezers and I guess he learned online how to seal them with all this weld stuff and put them on shield, and he does, and they started selling them and that's cool. People are buying them and it's like crazy. And then I get all these stories that a guy I play basketball with he bought one and he said he just loves it and he goes. You wouldn't believe my wife. She's had chronic back pain for 10 years and it's gone. She tells everything. He like he's coming home from school because he's just finishing up school but he has a list of people that want to buy these things just because of the people that he sold to that have loved it so much.
Speaker 3:And then they go tell it's just like me.
Speaker 1:I'm getting excited about it because I'm passionate. I think it really can help people. But it's like you don't even have to advertise because people that actually do it and they're like spend a couple thousand dollars like this is amazing, man, cool.
Speaker 2:People that actually do it and they're like spend a couple thousand dollars Like this is amazing, man Cool. So on that note then, what does your ideal day look like? Like work day.
Speaker 1:I start well. On Monday, wednesday and Friday I start really early. I get up at 4.30. I go play basketball for two hours, then I go lift and then I come home, do the sauna and the ice bath and then I'm at my computer by probably 8.15, 8 o'clock, and then on the Tuesdays and Thursdays it's usually get up at six and then do the ice bath and do the sauna and then I'm at the computer by seven.
Speaker 2:And then when I travel, I can't do any of it. So I miss it when I have to travel. What about once your workday starts? What does that look like?
Speaker 1:What's that. What about your workday when it starts? What is? What does that look like? Oh, it's. Every day is an adventure like it's. There'll be a day that I'll have one meeting and I'm like I'm gonna just get caught up on everything and I got all these things to do and all these projects and then, next thing, you know, I don't get anything done and I have 400 sitting there.
Speaker 2:The unexpected phone calls and fires. I know same thing happens to me. I got a couple calls, a lot of free time between. I think I'll knock all these things out, but it's like, yeah, I got to get. I think what I got to get better at is putting the things that I want to do on my calendar. So it's in my head is all I got to block the time I'm going to do that. But you allow, like I allow myself to get distracted because it's not physically on the calendar. So that's one thing that, like for years, I've been saying I need to do it. I just need to do it.
Speaker 1:Yeah, in our company in your calendar it's like everyone's plugging the holes. So I have definitely learned like I'll, if I need time to do something or catch up or whatever it is, I'll block it off, so no one can plug in appointments into those things.
Speaker 2:Cool. So yeah, anything that you want to talk about that we didn't get a chance to talk before we wrap.
Speaker 1:I don't think so. I appreciate the forum to be able to just talk to you and share some ideas and opinions of what's going on, and I think dental is definitely in another evolution. I think the AI and technology part of what we're doing is going to get stronger and stronger, which I think will help us, especially with backend support and staffing. But this industry is resilient.
Speaker 1:One of the reasons people love to invest in it is if you look at the graph, we never go down right. You never see, even during recessions. You never see crashes and you just see little blips. But we'll just continue to evolve and I do think that over time we got to get the insurance companies to catch up and reimburse better and if they want people to stay in the PPO networks and make it more fair, especially with all the costs that have gone through the roof and they're not willing to do much with that. So I think that's probably some way. Somehow the industry has to figure that one out is how to get the insurance companies to be more reasonable on their fees and being able to help us be able to run the businesses even though we've had a lot of outside inflationary things hurt us.
Speaker 2:Yeah, no, it's crazy that you can have reimbursement reductions in a really high inflationary environment and Medicaid. My wife's a dermatology PA and Derm got their Medicaid Medicare reimbursements cut like last year and again. But I don't think that's. I think that's unique to Derm. I don't know. Have you guys seen that?
Speaker 1:I haven't seen any reductions in Medicaid. We don't take a whole lot of Medicaid but we have a lot of Medicaid in one state, just in New Mexico, but it's actually in New Mexico. The reimbursements are pretty positive because they have such a lack of providers that they have to do well with that. I think 55% of the population in New Mexico is on Medicaid. So, it's a heavy part of the state's processes.
Speaker 2:Okay, what's a good resource for people to reach out and learn more about what you're doing or what you guys are doing?
Speaker 1:We happy to go to our website and that's p4dentistscom, and if anyone would ever want to reach out to me, my email is kmiller at p4dentistcom and I'd be happy. Anyone that wants to talk or chat about anything in the industry or they need help or just advice. I'll always have my door open to help people.
Speaker 2:Awesome thanks so much.
Speaker 1:Okay, thank you.
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.