The Alimond Show

Geith Kallas & Francesca Pregano of Smile Makers Dental Center

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Hey there, it's your hosts, and this time we're taking you on an adventure deep into the world of dentistry! Have you ever wondered what it takes to manage a multi-location dental practice? Well, wonder no more. We're joined by Dr. Kallas, a master in his field who knows a thing or two about running a successful multi-faceted dental practice. Hear about his journey from a humble associate dentist to becoming the owner of several thriving practices. He and his operations manager share the blueprint for their strong team culture and how continuous learning has been the secret sauce in their growth story. 

Hold onto your seats as we recount our rollercoaster ride of acquiring three dental practices. We faced challenges, yes, but who doesn't? We focused on what mattered most - maintaining an unrivaled company culture and recruiting the very best team. We'll also blow your mind by telling you how we leveraged technology like AI to supercharge our efficiency and patient care. Then, brace yourself as we reveal our audacious expansion plans and our unyielding commitment to our team's growth. 

But that's not all! We also had a fascinating chat with Francesca, the powerhouse CEO and COO of a dental support organization (DSO) with six locations in Virginia. Taking a peek into the future of dentistry, we delve into the burgeoning trend of DSOs and the trials of scaling in the present market. Francesca shares her inspiring vision of reaching 50 practices and her unwavering dedication to independence. All in all, this episode is a collage of insights into the transformative landscape of dentistry and a must-listen for anyone in the industry. So plug in, sit back, and let's get this show on the road!

Specialty Dentistry at Multiple Locations

Speaker 1

We have multiple locations and those multiple locations we do with general dentistry and specialty dentistry and those six locations we have multiple general dentists and multiple specialists.

Speaker 2

What type of specialty do you guys work on?

Speaker 1

We have all specialists from oral surgery, endodontist, orthodontist, pediatric dentist, periodontist, implant specialist.

Speaker 2

So we cover all of it, what's in your company, swallow Makers Total Center, nice that's where I met you from I knew under your face was leap into practice. Last year you were one of the attendees, right With Rachel. Where was it? It was in Alexandria. It was a dinner event, a day event, a day event. It was Natasha Gillis. No, no, no, it was a dental event. That's why I was like, maybe that's where I started, maybe not. Okay, my memory has failed me here. Okay, okay. So in terms of how did you guys get started?

Speaker 1

So I started like any other dentist. So I was an associate with another owner Locally, locally in Washington DC. Okay, that was back in 1993. Okay, so I'm just celebrating my 30th anniversary. Congratulations, thank you. So from there I started my own office. That was in 2001. An office in Tyson's with four rooms, four treatment rooms.

Speaker 1

So, from there, worked hard, very hard, six days a week, sometimes seven days a week, and then got the business girl. I had it next door and then I did five more treatment rooms, so now this location, nine rooms, so more patients. I had to have help with other doctors and other specialists and then business got stronger and stronger and those patients, they won't be seen in this office only because it was really booked. So went to other location. I started it also from scratch, and then it's crossroad. Then, three years after that, started another office, the novel from scratch and perfects so, and then then Managed the growth Go with it, and last year we acquired three new established locations. Well, one in Lisburg, one in Foscher and one in Woodbridge.

Speaker 2

What was your decision making Like? How did you make those decisions to grow versus just stay?

Speaker 1

It's the need, the need for patients. So we had the model that we take care of all patients To do all dental services under one roof, and then this model has not existed much anywhere, so concentrated on that and to do it we had to grow and grow geographically, so multiple locations to serve so patients won't travel much for their needs.

Speaker 2

Because you guys saw a trend that people wanted to stay so many miles around where they live.

Speaker 1

Yes, yes, and then each location will grow with the existing patients or people around. So so it's, we had to do it.

Speaker 2

And why all the specialists? Why not just stick to general?

Speaker 1

General dentists. They can do all procedures but when it gets complicated you have to have a specialist. So like root canal or surgery or surgery, to do it you need to have a license of putting patients to sleep under a general procedure. So you have to have a specialist Pediatric dentist. You need a specialist how to deal with those little kids. Or the orthodontist. That is another specialty. So you can do general work, but when it comes to mastering the procedures, the treatment, the outcomes, you have to go for a specialist.

Speaker 2

When did you enter the picture?

Speaker 3

I started in 2007. In 2007, we were a one location practice, like Dr Callis said, with four treatment rooms, so I've been able to see the company grow through its different seasons.

Speaker 2

That's awesome, and where do you fit?

Speaker 3

in. I am the operations manager, so I oversee all of the six locations. I help to build the high performing teams. We work together on the systems and protocols and adapting to the needs of the industry.

Speaker 2

So something that I've noticed just from listening in the few minutes that we've been talking is you focus on the operations in team culture. Yes, and I'm going to say a lot of your success is attributed to that, because that's not normal in a lot of dental practices.

Speaker 1

That's very true. That's when you start the business, you have this entrepreneurship, that, okay, I'm going to do it. But when you start doing it, you go through stages. So that stage that it will hit you and that I'm doing something wrong here, so you go back to get the systems and the processes, the protocols, and then you put it into action and you monitor it and you confirm it.

Speaker 1

But sometimes it doesn't go the way you want the reason that off. That is culture. So you need to go back to the basics and build the culture. Why, why do we do that? And then what we can do, then how? So it's, those are the basics, especially when you do this multi locations, and I am personally not there to see how it's going. So if the culture is missing, everything is missing. So yes we can concentrate on building those culture very much.

Speaker 2

Where did you learn that?

Speaker 1

So well. First of all, I learned it because of failure. So you notice that something not going well and you go and you look for an answer. So you have now companies that teach you how to do it, how to look for the what's going on. And then there are scaling companies, there are dental scaling companies, and this education and this is never ending keeps going. And so today we are way different from last year, way different from five years. So we keep going forward in that direction 30 years later, here you are.

Speaker 2

Can you tell me a little bit about your background before you got into dentistry?

Speaker 1

Well, I.

Speaker 2

Like what led you there.

Speaker 1

Maybe my mother. She's told me that you have to be doctor, so and help people.

Speaker 2

What country is she from?

Expanding Dental Practice and Acquisition Challenges

Speaker 1

Syria, Syria, okay, so this is the way it started. So I started this with in mind to help, and then in mind that you can give something, and that's something based on education. This is the way it started. And then it's you start adding components, you start reading and learning and be in atmosphere with people, with successful people, and you learn that you can keep growing and growing and go forward. And then you look okay, what I'm gonna do in this life for my legacy, what I want to be remembered for, but how can I make a difference in the community, in the people around me? And this is leads for all what I've been doing.

Speaker 2

So thanks mom and dad for oh absolutely, this is number one. I love that In terms of moving forward. Just lately, you guys purchased three practices after COVID. What was that process like? Was it easy, was it hard? Did you need somebody to guide you through that?

Speaker 1

Well, I have this entrepreneurship in me. So everything like this you do. It is big, it's huge, but when you surround yourself with good people, it thinks go smoothly. Even you run into some issues but you can go through it and you do it. So when COVID hit and so many people were scared to go to dentist and a lot of dentists that they even they're sick or they're getting older they start losing faith and keep working on daily basis. So I learned from that time so many people will want to end their career as practicing dentist, so unlocked for opportunities, for good locations, for good practices, for good dentist to take the baton from and keep going. And so you have a team that look for good practices, you have team to analyze those practices and then you have our internal team that make it happen.

Speaker 2

Teamwork yes everything Speaking of teamwork where do you I'm gonna ask you next where do you see the business heading in the next five, 10 years?

Speaker 3

Five, 10 years, probably maybe 50 offices by then. The plan is to expand across Virginia and it's a lot of offices it is, but we're up for it. I love it. Yeah, I just wanna add to the acquisition process so we were talking about culture, and the challenge when you're acquiring the practice is you have to change the mindset of the existing team because you're coming in as someone completely new. They're fearful. Do they have a job? What's it gonna look like for me? And then you have the patients, who you also have to help gain their trust. So it's many moving parts, but we've been able to keep every employee that we've acquired as well. So I think that's a testament to the culture that we have and the systems that we've put in place.

Speaker 2

You've been around since 2007. Yes, how have you kept somebody like this on the team since 2007?

Speaker 1

So Francesca started with me back 2007 after 30 seconds interview as a part time. And then she was in the front desk. She was going to Nova at that time and then I noticed in her that she likes to do more. I noticed that she knows the names of those patients by heart and I give her more tasks and she does it all the time and she's still doing this till today in different caliber. So and she grew and then I give her advice to do psychology. So she moved from Nova to Mason.

Speaker 2

Why psychology?

Speaker 1

So, because this is, if you wanna work, that you need to know, you need to know people, and she likes people, she's people's person, so she needs to know more. And she went there and then she learned more the dental business. So then she did her degree in business master's and from there she kept learning about the dental world. And this is huge because you take it from a solo, one small practice and then to two practices, then three, then four. This is you have levels. So she kept going through this education and she is seeing herself how she transformed from a admin in front desk to where she is right now.

Speaker 2

Helping build 50 practices yes. Keeping that culture yes. Yeah, now it's a blessing when you've got somebody next to you that cares about the company, who sees the same vision as you do and believes in the vision.

Speaker 3

Yeah, and that's also a reason to stay. So we fully believe in promoting from within. So we have also helped a few other individuals. We've picked them out of their current roles and they are now part of our middle management team. So there's continuous growth and that is a huge motivator to stay with the practice, but I feel like it's mine just as much as his at this point.

Speaker 1

And when you build this now six locations you have hundred employees and other contractors. So you beside you are in patients, life changes, you are in those team life changes. So some will pick it up and take themselves to higher level, but depends on their readiness, about their leadership qualities. But this is when you do that. I mean this is everything. So that's why I'm joining this journey. Yeah, and you know wherever we are today and where I'm looking forward, but I'm enjoying it. So you're gonna have challenges, you're gonna lose sleep about certain decisions and when you're getting bigger and bigger, it comes so much pressure on you. But that's what keeps me going forward. That's that I wake up every morning at five AM just happy to start my day. How I plan it, how I make changes in people's life, patients, team other we have multiple different companies also we partner with. So it's the level of happiness is unparalleled. The level of happiness is unparalleled.

Speaker 2

What's some of your biggest challenges as you guys are up leveling?

Speaker 3

Finding high quality team members in terms of being the right culture fit and having the right skill set. So if we can find someone who fits the culture, we can train for the skills. Usually, staffing has been an issue since COVID for most companies, so one way that we overcame that was we created a full team of virtual employees. We have about 15 who work overseas. Some are in a call center and some do accounting, some do insurance verification, others help with HR duties, so I manage that team separately as well. And then another way would be technology. Technology is changing.

Speaker 3

Ai is huge everywhere now, but there are so many new AI companies infiltrating the dental world. So one is for x-rays. It will read the x-ray and help with the diagnosis. So it takes out any you know confusion from the doctor or the patient of do I need this treatment? Well, they see it because AI has identified that it's a problem. And then we also use AI in the call center to track even things like tone of voice. So if this scheduler has a poor tone of voice, we know to replace that scheduler. Wow, yes.

Speaker 2

Wow, I haven't heard of that. So that's awesome. It's very cool what it can do. Wow, that's cool. Do you remember the?

Speaker 3

name of it, this AI for the phone system is PureLogic PureLogic I'm going to look that up. Yes, I love that. It's amazing.

Speaker 2

You guys are that detailed and wanting to make sure that the experience is yes.

Speaker 1

Because you need to measure. If you cannot measure, you cannot make the decision on. So we went through some pain to get into this level.

Speaker 1

When you measure, it and you have data on all certain protocols or processes, then you make that decision and this is where you this is the sum of the part that you're going to go through which is not easy to move yourself from point A to point B unless you go through this. So now it's, it's amazing and you can. Other thing that we do we get all the records of patients, x-rays, and we take digital photos, called through machine called ITERRA. So you see it, you can see the bite, the occlusion, the shape of teeth, you can see that there is any broken piece, you can see decay, you can see occlusion, and we have the AI for the X-rays that can read the X-rays can detect decay, detect calculus, should the tartar between teeth, infections.

Speaker 1

Oh yeah, so you can go through all of this. So we have a dentist looking into this for every single patient just to confirm this patient got every condition they diagnosed correctly and treatment plan correctly.

Speaker 2

Well, here's around top of this, Because a lot of medical as long as you're not part of like the big hospitals but they are not as like somebody's really got to push them the technology onto them.

Speaker 3

They kind of want to stick to what they've currently been doing and they don't want to get with that's what we've learned in the last year with the three acquisitions is that we had to change our mindset from a small business to now. We are a full operation and if we want to expand we have to have those systems in place where we know who made the error and then we can address it.

Speaker 2

What was the pain that got you there?

Future of Dentistry and Team Training

Speaker 1

So before, when it comes to this AI, we are the first officer, maybe in the whole nation, to start this AI for x-rays and it's definitely the number one in Virginia, number one in DC and the number one in Maryland. So you bring it, you introduce it, but you're going to have some resistance, also from the team how to learn about it, how to perfect it, how to believe in it. But when you pass that stage, you cannot live without it.

Speaker 1

So now all the dentists. They rely on this AI system to read any condition. So this is a challenge when you bring something new Other than that, also when you bring a system, when you bring protocol, so you need a training how to do it. So training needs multiple levels. So we always go through best practices and first you need the culture, Second you need to have the training and training and training and then you need to keep watching that is going through this. So that system we do it for all of our protocols.

Speaker 2

How big is the internal team, meaning like who's doing the training, who's monitoring the different operations? So we have myself.

Speaker 3

So Dr Callis is the CEO, but also the visionary of the company. Myself, as COO, I work to implement and build, so he'll give me an idea and then I'll build a system Underneath me. I have two really wonderful individuals. One is full-time HR, so she's constantly recruiting to fit the needs of each of the locations working to onboard employees. She has a 90-day training protocol that she follows. And the second is someone who manages all of the clinical team and compliance in terms of OSHA, state regulations etc. Also onboarding new specialties and doctors. Aside from that, we have practice administrators in each location who oversee the KPIs per their location. So that's a key performance indicator and everything from number of new patients, production collection, accounts receivable, percent of accounts receivable over or under 90 days and things like that, so that they track on an office level.

Speaker 2

Nice. And then, in terms of how do you know when someone's not a good fit, you guys have so many KPIs that you're looking at. You've got so much training, 90-day onboarding protocol.

Speaker 3

Generally, when someone is not picking up the skill, you can easily identify are they giving their effort or not, and if they are. If they are, then we continue to work with them. If they're not, we identify that they're probably not a good fit. And we also rely on the team. So we are not in every location every day, so we have those individuals that we trust in each location to give us feedback on what you're asking. How do you know if they're a good fit? Got it?

Speaker 1

And also it comes with the sizes of the operation. When you have one location, two locations and you have two, three dentists working with you is way different. When you have six, you have 20 different dentists, you have 118 members, it takes completely different shape. And if you go on scale beyond six, that's going to be way more. So what I always say? That we always work against time so you can function for certain procedure, for certain protocol in certain time and you need this time to be the shortest possible with the best outcome.

Speaker 1

So if you're going to take more time to get this, great results you're going to lose, so you need to do it the fastest ever to keep going forward. And this is where we are struggling now, too, because COVID hit and so many talents are not working today. So and then we compete with other industries for those talents. So we rely on putting more work on myself, on Francesca's, on other team members, to compensate for those talents. So we try to do whatever we need to do in the shortest time possible.

Speaker 2

So that's what you're opting for, like that's the number one criteria is let's move back.

Speaker 1

You need to do it the fastest that you can, or you're missin' the boat.

Speaker 2

Yeah, did you think this is where you were going to be?

Speaker 3

20 years ago? No, I definitely did not. It's funny because I see this in other people who have found themselves in dentistry. I like to say that dentistry finds people because once you start either as an assistant or front desk receptionist, you kind of fall in love with it. You start to love the process. The people and most of us in dentistry didn't really if we're not a provider, we didn't seek it. If that makes sense, it's Seek to you, yes, it had found us.

Speaker 2

I'm trying In terms of I know we talked about what does the future look like and you answered 50. You're getting to at least that 50 practices marked within Virginia. But outside of that, in terms of industry-wise, just to kind of wrap this up, how do you see the world of dentistry in the United States in the next five, ten years?

Speaker 1

So today the DSOs, with this dental support organizing organization that owns multiple locations owned by private equity, is growing very fast. So the future is going to be less and less individual dentist owner of their own practices till it will disappear completely.

Speaker 2

And why does that matter to the listener?

Speaker 1

Because for the listeners, I think the systems is, this is where we go into, and those DSOs companies.

Speaker 1

They are going through restructuring the way they see patients, the way they work on patients. So it's going to be the norm, that's going to be good outcome, for sure. But that changes when it happens. You lose something. So you go to a one dentist owner. So it's a small operation. That dentist will follow some regulations. Sometimes don't follow some regulations, this is will end, and then the scale of equipment, of technologies, of the way you answer the phone is all changing. So in the end that's going to be much better for the consumer. But to go through this is going to be some hiccups, but this is where we want.

Speaker 3

Yeah, the care will be standardized and probably more consistent than you see today, because you get a lot of patients asking for second opinions. Well, this doctor told me I need XYZ and I'm coming to you now and I don't need anything. So care will be standardized based on the technology that we're seeing. But the issue, like Dr Callis said, is it's going to feel different to the patient, so it's probably going to feel more like a medical facility where you really have to maybe do a lot of follow up for yourself Because that personalized family feel might be jeopardized. That'll be a struggle for dentists.

Speaker 2

And you guys don't see yourself ever getting bought by a DSO or signing up with a DSO right.

Messages of Growth and Kindness

Speaker 1

Financial component is very important to last. So with six locations you can manage If you want to grow to 50, 100. So you have to have a financial support. That's financial support will be through partnering with existing DSOs or with private equity, but the most important is to keep the dentist running the medical part of it.

Speaker 2

Got it. That's interesting. What are your thoughts on the next within the industry?

Speaker 3

Pretty similar to what Dr Callis said. Definitely, the standardization and the growth by partnership is something that's happening more now also.

Speaker 2

Actually, this is my last question. What's your? One message to the world Could be about anything.

Speaker 1

Maybe multiple. That's a good question, so that needs thinking.

Speaker 2

He says tag, you go first.

Speaker 1

So for me, I always believe in working hard. When I started back in 1993, some consultant will tell you work smart, not hard. I have completely different opinion on that. Working hard, this is the way you can prove yourself and dedicate yourself to your message, to your growth. So it's amazing the amount of information you can learn and bring it back to yourself and you'll be better than yourself yesterday.

Speaker 3

So it's growth and growth.

Speaker 1

It's always that makes you going forward. So my message is to keep working on yourself to know more and then take action for what you learned, to bring yourself in a different level that you can also give back to everyone around you, love it.

Speaker 2

That wasn't too hard for you.

Speaker 3

My message, I would say to remain kind and optimistic. So I study leadership every day, I live it, I breathe it. I listen to podcasts every day that have also become a habit of mine. So staying kind, staying optimistic in the right mindset can get you very far in life. So I think that would be my message.

Speaker 2

Love it. Yes, thank you both so much for being on this show. I learned so much from both of you. I appreciate your time because I know how valuable both of your time is. I appreciate your time, thank you for having us Thanks.