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.
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Helping Healthcare Scale
What Makes Your Dental Practice Undeniably Different?
If your dental practice blends in, you’re already losing. Patients overlook you. Talent walks past you. Investors hesitate.
In this episode, I talk with Alex Sharp, CEO of Shared Practices Group – a powerhouse that’s launched 36 de novo practices across 23 states. We unpack what it really takes to build a practice that stands out in a saturated market.
We cover:
→ How to use grocery anchor data and competition overlays to find winning locations
→ The systems that drive fast cash flow and predictable growth
→ How to build playbooks that remove guesswork and create consistency across every site
→ The internal habits and team culture that actually hold it all together
If you’re building a multisite group or planning your next de novo, this conversation will give you a sharper edge – and a clearer strategy for building something no one else can replicate.
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So, in a nutshell, it sounds very simple. But what we do and what we it sounds like what you guys do, something very simple or similar is find out where are our ideal patients already going? Right, so we use grocery store anchor studies because we find that has the best data. So then, yeah, so we just tier those one through four, like they're color coordinated, but then you plot those on the map of a trade area that you want to go to, and we're not talking like the entire Houston Metro, that's massive, right. We'd be talking like Northeast quadrant, like a certain particular neighborhood or area, right, but we plot those on the map and then you start to see, okay, there's more clusters of greens, which is tier one, here, and there's more clusters of reds, which is like tier four, down there. So let's start looking up here around the clusters of tier ones. And then you do a competition analysis, right, and so then that's just a map. We don't need to overcomplicate it. We use Google Maps. It's a free software, anybody can use it. Put all the competition on a map, overlay that on the demographics, the grocer, anchors, data, and then you just start to see, okay, here's the most ideal patients, here's the least amount of competition.
Speaker 1: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. Hello, welcome back to Helping Healthcare Scale. I'm Austin Hare and today I want to welcome our guest, alex Sharp. He's the CEO and co-founder of Shared Practices and if you've been following the show for a while, you'll know that we did an episode with George Harari a couple of years back, who's also a co-founder. They started in 2021 and they've got 36 locations across 23 states and get this. They've grown almost exclusively by DeNovo, which is no easy feat. So, alex, thanks for hopping on Austin.
Speaker 2:thank you so much. And yeah, you can tell we've done all DeNovos by how much gray hair I have. So that's just part and parcel with a DeNovo growth strategy, but happy to be here.
Speaker 1:Yeah, I heard a funny joke one time. Somebody said I didn't realize DeNovo was Spanish for no cash flow for two years.
Speaker 2:It's funny you say that, because I've been talking to a lot of folks in the industry about our specific growth path and our ability to ramp, and I do think that you cannot do a DeNovo growth strategy of any kind if you don't predictably have a good cash on cash return quickly, and so that has to be something that you iron out from the get-go. You have to iterate on in your first one or two locations and nail that before you hit copy paste too many times or else you're upside down. So that's one thing that I'm happy to say we have cracked the code of, but it was through a lot of doing things wrong initially let's double click on that.
Speaker 1:I heard a phrase recently nail it and scale it, which I which has a good ring to it and I really like it. Coming from a background of trying, I had fitness centers that I tried to scale too quickly and I learned the hard ways, like how hard the whole thing is. So how much can you talk about that? What are these processes that you guys learn and now you put into play to help you achieve cashflow quicker?
Speaker 2:Easy to say, hard to do, like it's a nice bumper sticker to say, nail it and then scale it. But the human instincts sometimes get in the way of I've got this close enough, good enough for government work. Let's keep moving. And it's hard when you have folks that want to partner with you, whether you're in like a central DSO, dental service organization or managed service organization model, and you have people beating down the door to want to work with you, or whether you're in a franchise model. It's tough when you have a glut of folks wanting to open with you and then it's hard to say no. And it's hard to have that discipline to say, hey, we're going to have a methodical one per month type approach or one per quarter, one per year. It's hard to say no.
Speaker 1:One per month is a lot, but you guys are at one per month now, right.
Speaker 2:Yeah, One per month is what we feel like is our kind of steady state carrying capacity. But again, that came over time. You mentioned the 36 practices in 23 states that took the form of a couple of acquisitions that we did individually. We merged those together and then we did nine openings in 2022, 19 in 2023, and then six in 2024.
Speaker 2:And what we learned was you have to have playbooks. This sounds so right and overused, but you really have to have well-modified, step-by-step, laid out ways of doing everything from marketing to site selection, to how we negotiate leases, to the equipment that we buy, to the training that each person on the team gets, to the different categories of people that you hire, the expectations, the performance management it's all of the boring stuff that you know you should do that you just have to rip the bandaid off and do, and really upstream of that being possible is getting the people on the bus to be able to do all of the construction of the playbooks and the the, I guess, holding people accountable to make sure that the playbooks are followed. But really you're only as good as your habits. You don't always rise to the level of your capability. Sometimes you fall to the level of your habits In business to me.
Speaker 2:I would say you always fall to the level of your habits? Yeah, completely yeah. Especially on the hard days, especially when it's a rocky road or the wind is buffeting you about, you find out what your habits are real quick when things don't go to plan, and to me, the habits in business are synonymous with your playbooks, your systems, whatever word you want to use of our systems, which I think is so true, and I think that to your point, it's boring, but, like Alex Hamosi quote, who I referenced a lot in here, is, it's the boring work that makes you rich and so, yeah, you have to go in and do those types of things.
Speaker 1:So I guess, maybe to get granular, what does that look like? Is there like a spreadsheet? Is it trial and error, like when you're looking at these things? You mentioned a couple of marketing and several other things. So are you just tracking all of the different approaches, like maybe we can get super granular on this?
Speaker 2:Yeah, one that comes to mind for me that's really top of mind is performance, because, again, marketing is a spreadsheet Marketing. We have all of our different individual campaigns for all of the individual locations cracked centrally in a spreadsheet, all of the individual locations cracked centrally in a spreadsheet. But what's sometimes tougher is the fact that most of us and a lot of folks that you interview on your podcast, you're talking to folks that have multi-site veterinary or med spa operations, and dentistry is no different in that we're rendering services. So every dollar that gets collected symbolizes some type of service that's rendered with somebody's own two hands. And whenever you're doing a service business, rather than, hey, we're racking and stacking lines of computer code or we're shipping out books, it's tough when the fulfillment of the product requires someone's actual two hands. And so for me that's where the playbooks are magical, because you have scripts that you follow, you have task management boards, we use mondaycom and really to me that's emblematic of the playbook in action is how visible are people's activities centrally? That's what we had to learn the hard way because we're a remote company. We came about largely because of all the COVID stuff.
Speaker 2:I can safely say that shared practices group, the DSO would probably not exist without the COVID lockdowns, because it was a forcing function for us to put our heads together and get creative and introspect and say number one what do we want our careers to look like? Number two, what type of impact we'd be making in the broader dental marketplace that we currently aren't? Through our podcasts, our education, our seminars, our coaching, we could be doing even more than that, and so we built the DSO with that in mind and we realized that when you're too reliant on the individual performers at the practice and you give a little too much latitude for each person that's in each individual practice, then you're person dependent rather than systems dependent, and we wanted to have the systems be such that, if folks follow that playbook, for example, here's how we welcome a new patient and give them the SPG raving fan experience. It's a playbook from everything from the marketing impressions to how the phone's answered, to how the folks are welcomed when they walk into the practice, all the way through the case acceptance process. So again, it's boring. Hormozy would say it's the boring stuff that makes you successful, but it's the stuff that you have to do, and sometimes you just have to do the Hormozy thing and you have to put in your earphones and crank away on scripting for eight hours if that's the biggest fire to put out at the moment. Crank away on scripting for eight hours if that's the biggest fire to put out at the moment. But I think anything that and the easy heuristic, like the easy tactic that I would pull from that is treat every dropped ball in your business, especially if you're already of somewhat scaled multi-site business of any kind.
Speaker 2:What are the problems? What are the issues that you run into? What's caused someone to quit before? What's caused a patient to leave a one-star review that you've run into? What's caused someone to quit before? What's caused a patient to leave a one-star review? What are some of the things that you feel like are recurrent issues across your individual locations? Guess what? That's an opportunity and that's where we're at now in 2025 as a company is. We've made so many mistakes over the years, we've had so many missteps and balls dropped that all of a sudden we realize, okay, we've just solved enough of those issues to where we have that corpus of knowledge that we can move forward into our next phase. But just having that wherewithal to not make the same mistake over and over, see the mistake, come up with a solution, institutionalize it and move forward.
Speaker 1:Yeah, that's well said. Maybe to pivot a little bit. You mentioned Alex Homozy. Sounds like you follow him. I got the privilege of working with him personally in 2017, back when he was just getting started. I see I see, thanks. I see in your bookshelf you got 10x is easier than 2x, which is a book that was very influential to me last year. It didn't that actually encouraged me to join strategic coach, which is awesome thing, so you're familiar with Coach.
Speaker 2:Oh yeah, I've followed Dan Sullivan for years and it's just and I followed Ben's stuff that he's written both with Dan and individually, and Ben has intermittently put out a bunch of YouTube content that I found really valuable. But, oh man, like their story, their approach, their way of assessing what is the most important thing, to be focused on perspective, zooming out, taking those focus days. That was transformational for me and my leadership. But the thing that I like so much about 10X is easier than 2X is I feel like that's an evergreen book. That's a book that I know in the back of my mind I should be reading at least once a year.
Speaker 2:It's going to hit you differently every year.
Speaker 1:I already read who, not how, twice, because that was the first one that I read. And then that kind of got me hooked on him. And then he was at a conference and he was actually funny. We went to a conference here in Orlando and he gave everybody a copy of that book and I was like great, another book, right. So I grabbed it off my seat, took it with me, let it. I literally thought to myself gosh, like I don't want to 10X anything Like that sounds like so much work. It's hard enough. I'm trying to work less, not more.
Speaker 1:And so I did a two week tech detox in July, like literally no phone, no internet, no computer, nothing like had to let my whole team take control of everything. And so I grabbed that book because I was like, whatever it was like the top one. I was like you know what? I should probably bring it like last minute. I should at least bring a book Right. And so I grabbed it and then ended up reading it. I was just like, oh my gosh, this is so good.
Speaker 1:And the thing that sold me on it was it's not about working more, because they have they really. They're really big on recovery days, which is like defined as a period from midnight to midnight where you don't work at all, no customer communication, no emails related to your work, even like business books are like up to the up to interpret. It's up to you to decide, and it's like you know what. I totally see how putting constraints on myself. Actually, if I have all day to do something, like I'm, if it takes an hour to do, I'm not going to start it until the hour before I have to stop working. It's just because there's not enough constraints. And so, like, the idea of putting recovery days on and giving yourself restraints forces yourself to work within those restraints. I think maybe one of the reasons Musk is so productive is because, like, he can only afford a couple hours a day to be hyper-focused on certain companies and then he's got to jump to the next one, so he has to use that time.
Speaker 1:There's a lot of different ways we could go, but I guess one of the things that I've personally been struggling with is the idea of buffer days and focus days. So I'm just curious for you, so for everybody listening. We just talked about recovery days. The other two types of days are buffer days and focus days, and you get this from modeling NFL, nba, professional athletes.
Speaker 1:Like recovery day for LeBron James would be hey, I'm gonna, I'm not gonna play basketball, I'm not going to play basketball, I'm not going to work out, I'm a post-game, I'm going to ice bath and sauna and massage and relax, because if I go hard every day I'm going to break my body, and so it's like if you're an entrepreneur, you can still overdo it, even though we're not quite as physically active, and so that's easy to define. That's recovery. But for him, focus day is game day, and then buffer day would be all the trainings, all the practices, all the working out, et cetera. So how do you define focus and buffer? Because I personally have a really hard time differentiating between those two things.
Speaker 2:Dude, it has taken me years to get even within shouting distance of what they talk about in the Dan Sullivan books, and the excuse I always have is that for those of us that are what I would call technical founders. So in my case, I'm a dentist, so it took me from getting away and deprogramming from the dentist mindset and getting into the CEO mindset. And it's no different than a software engineer who turns CEO. You have to disambiguate what made you a successful engineer and say that does not serve me any longer in my pursuit of being a successful CEO. So I had to learn that the hard way, because, if you think about what's rewarded as a dentist, the actions that were rewarded as a dentist were to say yes to everything. Can you fit this patient in? Yes. Can you work through lunch? Yes. Can you add this procedure onto the appointment? Yes. Can you come do this extra hygiene exam? Yes. Everything had to be yes in order for you to maximize your bottom line and top line for that given day as a CEO or as a business leader. No has to be your default in most categories. And what you're talking about between the different types of days, the buffer days and the focus days in particular is you have to shut out the noise and Formosi talks about the Paul Graham notion of maker versus manager time and I like that.
Speaker 2:I like that framework too. But the focus time really, I think is the key. Buffer time's easy because you can just cram all of your emails, your meetings, your administrative stuff, the minutiae of the maintenance of the business you cram into your buffer time. And the focus days to me are way more high leverage than people usually think. But it only works if you take the time to think and have those light bulb moments to let you realize okay, this is the best utilization of my focus time. Like for today, I've done less focused days and more focused chunks of time.
Speaker 1:You know what that resonates with me a little bit more.
Speaker 2:We're at right now Three hours Because I'm like, how am I?
Speaker 1:going to go a whole day without checking my email. It's great in that moment, but then the next day it takes I feel like I'm spending all day getting caught up in that and then I'm not really actually productive. So what do you personally do in your focused three hours?
Speaker 2:Yeah, focused three hours to me is I'm recording internal propaganda for our company, where I'm recording a podcast that goes out to the ether.
Speaker 2:It's called the SPG pod, but it's intended primarily for our doctors, our central team members and our practice level team members. But then there's also people in our ethos, that's in our network, that like listening to it, because it's looking under the kimono of how the business operates and what we talk about, what we update on and interviewing doctors, celebrating wins, that kind of stuff we make it public. That's focus time. Also writing notes of recognition, like I try to write out several of these notes every day to high performers in the company, having one-on-one talks with doctors, talking to my business partners, talking to people in the space, networking with other CEOs, looking at the high-level performance, seeing the trends, answering questions, because really, if you're a business leader of any scale, you should be teaching, you should be empowering, you should be solving problems that others can't solve, removing roadblocks, imprinting, being the standard bearer of the culture that you want to make. And to me I can't remember where I ran across this definition but a true company culture, if done well, is not a shared set of beliefs, it's a shared set of options, which I guess you can argue come from shared beliefs. But it's really if in each of our 36 locations, you have this type of challenge in the cross. What's our consistency of handling that challenge?
Speaker 2:The SPG way, like that, would be the way to test how aligned are we culturally. Until you're 100% across the board consistent, then there's still work to do. That's how I look at it. I want to be a cultural standard bearer to help teach and show and demonstrate how we do what we do, how we win, how we dust ourselves off when things don't go well. And then what roadblocks are people running into? That's my favorite question to get when I have solicit feedback is what do you feel like in your lid right now? Is that lid imposed by the market, your operational processes, anything else? What's causing you to top out at where you are? What can I remove to get that out of the way so that you can continue to proceed forward?
Speaker 1:Yeah, that's good. So, kind of looking at it, to summarize, it's a three-hour block of time. You've got those five or six categories that are your specific role as the CEO, as the entrepreneur, as the leader, whatever, and focusing on anything that will move those levers in those categories.
Speaker 2:Okay, and also understanding that your company at any given time has a lot of different fires burning. So you have to understand what is the highest magnitude fire and then putting it in that quadrant of what's important and urgent right now. And then, if there's nothing super urgent and important, sometimes you have to let the other urgent, unimportant stuff be handled elsewhere. And then you have to again come back to discipline, focus on the important but not all that urgent stuff and to me that's the playbooks that we talked about like the important stuff that doesn't feel urgent. No one's running around with their head on fire yelling we gotta get this playbook done and sent out, but your company needs it, yeah, okay, I think that's a good moment to pivot.
Speaker 1:So the other things that we were talking about, let's go real estate. So DeNovo requires a lot of real estate strategy, a little bit more so than acquisitions. What's your real estate strategy? What are some of the mistakes you made? Maybe you can walk us through some stories early on of mistakes you made and how that helped to hammer down your strategy.
Speaker 2:As they say, garbage in, garbage out, and so a lot of our initial strategy was going off of freely available population demographic data and doing our own cursory demographic studies of places that we wanted to go into, and so our initial thought was okay, our specific business model. It doesn't require recurring revenue, it doesn't have a dental hygiene base. We're all direct to consumer, which means that if our marketing apparatus is strong, then folks are going to be relatively location agnostic because they're going to be driving for our services because of the nature of the services, versus if you're going to a regular general dentist. They're going to be a lot more location sensitive. I don't want to cross this river, I don't want to go over the bridge, I don't want to go to the other side.
Speaker 2:I don't want to turn left at the stoplight, yeah exactly Like those weird barriers that people impose upon themselves, and, yeah, we're immune to those, but then not. So our first version of the company, we found some issues, but then we've continued to iterate and we worked with Buxton to get some studies done and we were able to get some more up-to-date data on our own historical performance, knowing the types of patients that wanted to see us superimposed over the geography, and so we've used that to tailor upcoming location strategy in a much more targeted and quantitative way. So really, the tricky part that I would recommend for listeners is, once you have data, once you have past performance, once you know who your ideal patients or clients are, use that data to then overlay on top of the population distribution of the area that you want to go to, and then you're going to be able to say, okay, this is the pocket of opportunity, informed by my specific past performance, rather than it being a patchwork of guesswork.
Speaker 1:Yeah, like you said a moment ago I'm going to butcher your words, but like easier said than done or something right, we use a very similar approach. You and I were talking off camera about how I got started in this whole business was when my partner ran a demographic analysis, competition analysis for my fitness centers. And, yeah, same thing, right. So, in a nutshell, it sounds very simple, but what we do and what we it sounds like what you guys do, something very simple or similar is find out where are our ideal patients already going, right, so we use grocery store anchor studies because we find that has the best data. So then, yeah, so we just tier those one through four, like they're color coordinated. But then you plot those on the map of a trade area that you want to go to and we're not talking like the entire Houston Metro. That's massive. Right, we'd be talking like Northeast quadrant, like a certain particular neighborhood or area, right, we'd be talking like northeast quadrant, like a certain particular neighborhood or area, right. But we plot those on the map and then you start to see, okay, there's more clusters of greens, which is tier one here, and there's more clusters of reds, which is like tier four down there. So let's start looking up.
Speaker 1:Here we're on the clusters of tier ones, and then you do a competition analysis, right, and so then that's just a map. We don't need to overcomplicate it. We use Google Maps. It's a free software, anybody can use it. Put all the competition on a map, Overlay that on the demographics, the grocer anchor's data, and then you just start to see okay, here's the most ideal patients, here's the least amount of competition. Again, it sounds simple, but it's a little bit more complex than that. But, in a nutshell, that's just the simplest form of stacking the deck in your favor.
Speaker 2:You have to understand and see what you described. You have to have experienced V1, v2, v3 of what you're doing before you can realize. Okay, there's a correlation here. There's a correlation to working alongside these anchors, these anchors demonstrating roughly, apples to apples, performance across different market segments. And then here's the opportunity, like you have to have made those mistakes early on and then learn from them and then apply those lessons into that future looking strategy.
Speaker 2:And so I think that's the part where a lot of people get hung up is they make those initial mistakes and the magnitude of those mistakes feels so vast and so great early on when you're just getting your sea legs under you, and then you somehow get deterred from pushing through those because you don't have access to capital or you run afoul of your business partners or whatever the case may be. So you have to have that inborn resiliency, and sometimes it just comes from setting expectations realistically, because I think we all enter into the multi-site game bright-eyed and bushy-tailed and it's about how well can you stand up after getting knocked down. How resilient can you be? Because there's very rarely just a straight path up like a straight, nice, fun, linear path up to where you want to go. You have to be able to stomach the twists and turns.
Speaker 1:Yeah, and that's another good point too about knowing your ideal avatar. It's a little bit hard to do this for your first location. How do you know your ideal avatar? So how many locations do you think it takes before you really start to get a good sense of these? Are the demographics to look for.
Speaker 2:Oh man, yeah, there's an actual answer and then there's a pie in the sky ideal answer. I think it depends on how constrained you are in your geography. From the get-go, like for us, our whole ethos was we wanted to sprint to build the best remote support structure that we could for our company. So we we made a lot of home run swings. We also had some issues across the board.
Speaker 2:But I feel like if you're getting, if you're in a more constrained area and you have the discipline to say, hey, I only want to be in texas, or I only want to be in florida, or I only want to be in tennessee, then it may be easier to find those trends after about five or 10. For us the number was probably higher before we hit our ideal avatar, because things vary based on the state, the metro, the size of the metro is it primary, secondary, tertiary, quaternary metro? What's the size of it? How do we get apples? Have we done enough repetitions of a tertiary metro to compare apples to apples from Spokane, washington to Sarasota, florida? You have to slice and dice the data a lot of different ways, but it's simpler and it requires fewer reps to me if you are more constrained in one state or one region, rather than going national from the get-go.
Speaker 1:Yeah, that makes sense. So, staying along the same veins of real estate, do you guys typically buy lease or opportunistic? How do you look at that?
Speaker 2:We started out pretty opportunistic and we evolved to be far more in the camp of leasing. And the reason is that if you're just looking at raw cash, on cash return, it's way better for us, with our business model, to just lease and spend the money on launching another practice rather than spending to buy the real estate. And that's just in this version of our model. That's what works. And then as we diversify and as we get more obsessed to capital in the future, I think we'll go back to being more opportunistic and less focused on just leasing. But yeah, the leasing approach definitely has pros and cons. You have to be sure that what you're leasing is going to serve your needs now and for the duration of the lease, rather than, oh shit, we grew out of it and now we have to pivot. And now we're stuck with this lease and we don't have a way to vacate or sublease or whatever.
Speaker 2:The key is with leasing just begin with the end in mind and try to negotiate. And we've had some luck with being a national tenant, because obviously that plays better than being a one-off solo person with no track record. So, again, the sprinting to scale helped us in that regard to have a bit more negotiating power with these landlords. But no, I just think that being opportunistic at first is great. But I also like the fact that when you start out you're so scrappy, you just find ways to make it work and later on folks get fat and happy and sometimes the fat and happy people don't always have their eye on the ball as much and that allows room for those young upstarts to be competitive and find these opportunities that maybe the big boys don't see after they filled their bellies a little too much.
Speaker 1:Yeah, and also it just bigger ships become harder to navigate. It's like turning around the Titanic. But okay, so many, so many different things I want to say. But, yeah, I think that it's good. First of all, you guys realize you put it down in the spreadsheet hey, I'm going to make more money on my operations and investing in real estate, because we work with a lot of groups who want to own the real estate, which is like that's great. But the problem is they don't understand the trade-off.
Speaker 1:Because I think that there's been a lot of gurus who have said real estate's passive income has been ingrained in your head that, oh, might as well just buy the real estate. But really it's an entirely different business. Like, our business is real estate and we've had to. We've had a little bit of friction sometimes when groups are like, hey, we'll just, we'll just, we'll just buy. Well, we'll just buy. Well, we want to do it, we want to buy everything. It causes them to slow their growth. So there's been in some of those same groups as they realize you need a different management company, right, like you need a different, you need different capital to go into this. You need a different operational company. Like we've worked with them where it's just, hey, just okay, just take it over, like, just handle our real estate, because you guys, 36 locations, you're in that hard spot. I think your first couple you can afford to buy the real estate. And if you only ever want to do one location, yeah sure, buying it is a great investment, but between kind of like 10 and really 70, 80 locations, it's hard to manage both those things. After you get maybe above 80, then you can start to bring in your own in-house real estate team and you can have economies of scale there. They even have people to manage that sort of fund on the side. But yeah, there's definitely a hard spot there where I think people really take for granted how difficult it is to manage, especially if you're trying to buy it right, like to manage all of the different processes that go on to it and then sometimes make it even more complicated.
Speaker 1:The best thing that's available for DeNovo is a ground up development, which I know you said you guys like to do empty path, sorry, second generation spaces. We love that too for our clients. That's, hands down, the cheapest way. The problem in 2025 and that we've been seeing for the last year and a half is really the shortage of retail space that happened as a result of underdeveloping. When COVID hit, covid came around, people thought developers in particular oh wow, retail's dead. Nobody's going to go here. You can't get your hair cut virtually. You can't get your tooth pulled virtually. You know what I'm saying? There's just a restaurant, so there's been a huge lack of retail. They've all been filled. And then dentistry, healthcare it's been a strong asset class. They're not going dark.
Speaker 1:And so a lot of times you have to do a new construction, development and the costs are just really high. But what I would say to that is let's look at it the other way around. Assume costs are what they were in 2019. Okay, for real estate. What does that mean? Okay, yeah, real estate is way cheaper. What does that do to competition? There's gonna be a ton of de novo competition coming online. So I think that really, the price that you pay to have a barrier or a moat around your business is, in terms of real estate. It's the cost of the new. Like, if you have to go, maybe you don't go into construction, maybe you can find second generation, but if you do have to like labor's up, capital's up, supplies are up, goods are up, interest rates are up, everything's up, but it is having some effect on the competition. And yeah, do you guys? I know you said initially you tried doing second generation space. Have you ever have you been able to successfully pull that off? Or have you been able to, or have you had to, pivot?
Speaker 2:We've only had, we've only quote unquote had to do one gray shell development in an existing shopping center where it was already built out. We just had to outfit it for dental. Every other one has been second gen dental.
Speaker 1:So we've done over 30 second gen dental. How do you guys that's such a good strategy? How do you locate those buildings?
Speaker 2:We have one all-star broker that just canvases the different markets for us and he kills it. And then we got lucky to find him and he just goes to bat for us and negotiates for us and just handles it.
Speaker 2:So we I think we just got really lucky with connection that one of us had to this fella and he's just been amazing. I don't want to say his name or people steal him, but he's, he's great and no, it's. That's the key is just having your finger on the pulse of what comes available, because some of those spaces, the competition is right for them, and some of these landlords they go on market. They don't really know what they have. They realize, oh, I hope I find another dentist as a tenant and then before they know it, if you're sleeping, then they have tons of offers. Then you're negotiating against other potential tenants and it gets annoying. But if you have someone who's just rolling the different websites all the time, then, yeah, you can get lucky and find what you want.
Speaker 2:But to your point, I love what you said about the strategy evolving relative to the number of spaces that you have, because on our podcast we get questions all the time from dentists generally dentists that are buying their first practice and they're trying to figure out the age old question I'm buying the practice, how hard should I push to buy the real estate too? If it's a standalone building and I think you said it perfectly which is in a vacuum. It tends to be a good thing to buy the real estate If it's a single site. You don't have any intentions of using that capital that you're sinking into the real estate to launch location number two.
Speaker 1:Or even anything else you can do with the investment right, Like the question is always compared to what? Yeah, it is a good investment. But what if you could invest in Apple in 1986, but instead you bought your real estate? Is it still a good investment? I would have chosen Apple all day long. So you always got to be thinking compared to what?
Speaker 2:That's a great point. Like you, have to look at the counter argument and compared to what is the key question. And a lot of dentists that are going into practice ownership for the first time they're just broadening their horizons into entrepreneurship and so they don't really have that frame of reference to say compared to what? So we try to help them along the path of yeah, you could sink a couple of hundred thousand into a down payment for this big, expensive building, or is there something that you could do to expand the practice, to open up the door for performance and then generate net worth by growing the overall practice asset? Yeah, there's lots of different considerations, but I like what you said about not being married to just leasing. And then maybe there's an opportunity, there's a branch point down the road, to say, hey, we're going to absolutely pivot and go back into ground up construction or a different strategy that can be afforded to you by the economy of the scale that you achieve. I love that point.
Speaker 1:Yeah, thanks, man Gosh. Yeah, so much to talk about. I think that's a good fork in the road, a good way to put a pin in the real estate section and go on to what we were mentioning earlier, which is just differentiating your business. Maybe you want to talk about that for a little bit.
Speaker 2:Oh man, that's a two hour episode unto itself.
Speaker 1:We got less than 10 minutes, but Okay.
Speaker 2:I'll be succinct. So they say don't go into business unless there's an acute problem that you stand to solve that no one else is solving to the degree that you're about to. And I think that's another way of saying be differentiated, be different, be authentic, have a different angle of approach on whatever it is that you're doing, and you want to avoid overly commoditized businesses. You want to have a different spin on whatever it is that you're doing. And the way I look at it is if we're a dental company, like we are, or if you're a veterinary company or you're a med spa company, what makes you stand out, not only to your patients or your customers, but also to the dentists or the veterinarians or to the technicians that you employ? You have to stand out in the workforce before you can hope to stand out in everything patient-facing. And so, for us, one of my things that I try to focus on is I'm well aware that the patient experience that we provide our patients can never exceed the experience that the dentist has in our company, in our company. That just it didn't seem obvious at first, but that's something that we've learned over time is you just have to take care of your people so that they can take care of your patients. There's an order of operations. To think of it in math terms, you have to please excuse my dear Aunt Sally when you're solving an equation it's the same thing Like you have to solve for the dentist experience before you can solve for the patient experience. So anybody who does multi-site healthcare of any kind, think about that Like what about the experience that you're providing for those that provide to the patients? What about that is wanting? What about that is missing? What about that is incomplete? What about that is inconsistent? What's the value proposition? How are you going to asymmetrically over-deliver for those people that are supposed to asymmetrically over-deliver for their patients every day? And we had a wonderful roundtable discussion last night with all of our longstanding doctors that are on the equity path in our company and it was so cool just to hear their stories, their perspectives, what they're excited about going forward, how they're so bullish on our growth over the next five, 10 years.
Speaker 2:And I think it just starts. The differentiation starts with how you treat people. It sounds so overdone to say that, but you have to really plan out what's going to attract people to you and what's going to make people stick around, because people can vote with their feet, especially when you're employing what's going to make people stick around. Because people can vote with their feet, especially when you're employing highly educated people that have the ability to quit and go do something else. Quit and go get a job like that the next day, or go hang a shingle and do their own thing. What are they getting by virtue of affiliation with you that they could not get anywhere else? I think that's a great place to start when you're digging your moat.
Speaker 1:I love it.
Speaker 1:Yeah, if you become a differentiator and focus on things that are different than you, are no longer a commodity, like in your world, it would be you could view the DSOs as commodities not saying they are, but just for this example.
Speaker 1:So what are you going to be looking for is essentially the getting the highest pay right, or it'll strictly come down to nominal terms, like looking exclusively at the numbers. And what I'm referencing is again more Alex Ramosi stuff, where he says, yeah, if you're a commodity, that means you can't charge any more than everybody else does. But if you create something unique, like you have a very unique proposition where there is no competition because they can't do what you do, which we all have strengths that are different, so it's finding out what those are Then you can now charge whatever you want, because they can't price shop you. And so, by the same token, I think what you're saying is you got to make it about more than just the money. What are the other benefits that they're going to get that make you valuable that you cannot get anywhere else? Yeah, and you have to.
Speaker 2:You may not have the full answer before we get started, but you have to have an eye on what are they getting, what is the value add opportunity that the folks that are working with you are going to receive? And that, obviously, if we're talking about healthcare stuff, it's the providers of the healthcare have to feel that, but then also the support team. There has to be something compelling that connects all of the support people Like. For us, we want to democratize the full arch and in dental speak that means we want to make the new set of teeth available for as many people as possible, serve the people who have been dentally disenfranchised.
Speaker 2:Open practices in those secondary and tertiary markets where a lot of the big implant companies don't tend to go, and serve that very thankful cohort of patients that oftentimes have the funds, they see the value of the care but they don't always have the geographic access to care.
Speaker 2:So that's been our sweet spot, and then you just have to reinforce what you do, and so for us that's in the form of we take before and after pictures of our patients. We show the transformations, we show those to our support staff that aren't in the chair being clinical every day, so that all of our marketing people, our legal people, our finance people, they all see what we do and they understand that the folks at the practices could not do what they do without the central support that they receive. So there has to be some cohesion between all of the disparate elements of the company, because if one part of the company thinks that we, our whole purpose, is this, but if the other company, other part of the company, swears up and down that your job is over here, then you can't have alignment, you can't row in the same direction.
Speaker 1:Yeah, so true. All right, man, as we wrap up, is there anything that you want to talk about that we didn't get a chance to talk about yet?
Speaker 2:No, I just love. I love your angle on this, austin, and I love your expertise and what you bring to the table from your training and your passions and overlaying that with the healthcare industry, and I just think that it's an interesting intersection between your skills and the people that need them the most. So thank you for having me on and thank you for the work that you do.
Speaker 1:That was. Yeah, that was. That was nice to hear, man. Thanks, alex, I appreciate that. Is there any thing? If people want to learn more about what you guys are doing, get in touch. What's a good resource for that?
Speaker 2:Yeah, definitely so you could for doc, any dentists who are listening to this that are interested in broadening their horizons full arch wise with dentures and implants? Sharedpracticesgroupcom. There's a form to fill out to express interest there to be put on our CRM, on our waiting list of open practices. I'm on LinkedIn, Alex Sharp, and I'm also on Facebook, so message me if you want to.
Speaker 1:Yep, I've been liking LinkedIn for the past couple of years. It's a good resource for connecting, so that's good, man. Okay, hey, thanks so much. We, yeah, we got into it, man, and that was really good. I've enjoyed it. Thank you, austin.