Going Global - Grow your Accounting Firm

How Dental Groups Can Centralise Finance, HR & Marketing in India

• Arun Mehra

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We lay out how dental groups move from messy, practice‑by‑practice administration to a standardised, scalable model by centralising non‑clinical functions in a Global Capability Centre in India. The result is clearer data, better patient experience, and real EBITDA growth that attracts investors.

• why acquisitions create non‑clinical complexity for DSOs
• standardising finance, HR, compliance and marketing to unlock scale
• moving admin to India for 50–70% cost savings and elasticity
• freeing practice managers to drive treatment coordination and referrals
• adding data science and software skills to improve decisions
• tackling culture, training and trust for one global team
• a practical 90‑day blueprint from feasibility to go‑live
• investor appeal through predictable, repeatable operations

Give us a call. Their calendar links will be available in our website, similar global.com. So give them a call, have an initial consultation, and we hope to speak to more of you guys.


Praju:

Hello everybody. Here is part three of the GCC webinar series. I'm here with Arun Mehra and Deepak. How are you guys today?

Arun:

Great. Good.

Praju:

Hi pleasure. Doing good. How are you doing? Yeah, not bad, not bad. So remember the first two sessions we spoke about opening up a center in India and basically covering base the basics of what a GCC is. So today I think we're going to be focusing on something a bit more specific, which is dental groups. A lot of people would not actually think how can a dental group use this sort of a service? Or how can somebody affect who runs a dental practice effectively use this sort of a model? So could you guys explain exactly how a dental practice can go about this?

Arun:

So I think uh a dental practice on its own is probably not the right way to look at it, Raji. It's more about uh an accumulation of dental practices, which is ultimately a group or a DSO, a dental service organization. And what we've seen over the last years is a lot of dental groups emerge or DSOs emerge, primarily through acquisition. They've been acquiring other dental practices, whether they're in the UK, the US, or different parts of the world, these groups have emerged. But the big the big problem that we see in so many practices, or so many groups rather, is that every practice they add does contribute to the e-bit daar of the guru, but every practice has a different way of doing things. Okay, so whilst the ideal situation is that every practice you're buying will have the same practice management system, the same financial system, the same way of how they record income, the same way they record costs, the same way they do everything, the reality is very, very different. Okay, each practice they buy has a different way of doing it, okay. They use a different PMS, they use a different bookkeeping software, they use different payroll systems, they pay on different days of the month. It's just completely, completely different, and it's non-standardized. So the only way to really the well, the the the the the key reason that you need to standardize firstly is firstly to is to is the DS the reasons the DSOs are emerging is because people are group or investors are buying these with a view to make further money down the line. And in order to make money down the further down the line, you have to grow the eBIT DAR. And in order to grow the EBITDA, you need to standardize your processes and procedures. So that means in a clinical context, that's down to the clinicians. But when it comes to the business operation side of things, it means the the finance and accounting department, the HR department, the compliance department, the marketing department. Everything needs to be standardized, okay? Because if everyone's doing it differently, honestly, it's just a mishmash of lots and lots of dental practices, and there's no kind of um eBit DAR creation or eBit DAR growth possibility or minimize eBITDA growth possibility. And any future investors who are going to invest in it won't be particularly interested if it's just a mishmash. So this is the real reason why kind of a real standardized process needs to happen. Sorry for a long answer. No, that's cool. That's cool.

Deepak:

Yeah, and I'll just add to this uh, you know, when a patient walks into a practice or wherever, for especially in a service uh oriented industry, you know, in a service industry, experience matters a lot, right? Customer experience matters a lot. So if there's, as Arun said rightly, if there's a standard process, a standard process, how the uh you know the appointments are scheduled, how calls are handled, how invoices are raised, if it's seemingly, we are not just creating a good dental practice, but we are then eventually creating a brand. And for these dental groups for the DSOs, creating the brand and that brand awareness is much more important. And if if we are happy, if we have created that brand, if we have tried achieved that brand creation, of course, it will have greater returns. The ROI will be much, much greater than being a traditional uh the way if we uh you know run our dental practice in a traditional way, so that standardizing the processes and you know the process, the client experience. If we focus on the client experience and the back end, the clean the clinicians, the uh in-person uh staff can focus on the client experience, customer experience, and these the retarded the repeated process if they can be offshore to a team which can handle them with quality, that of course increases your value, that uh helps you build that brand.

Arun:

So correct. If I just add to that, what Deepak said is that we're not positioned, we're not clinicians, okay? This is not our remit, but the clinical teams, the clinical leaders, the clinical directors will need to guide the group of practices to have a standardized clinical process. But where we do excel in and where we do have the knowledge is is making sure that you've got the um standardized processes for the accounting and finance function, for the marketing, for the HR, for the compliance. It's all standardized. And therefore, to kind of kind of just look at where we are today in this economic climate, a lot of those processes can be standardized, but then they can also then be um operated globally. They don't have to be done in home country, they can be done in places like India, where you have the accountants, you have the IT people, you have the marketing people to support this initiative. Um, and that's kind of where I see it going. Um, some groups are already starting to do this, um, but and some people are just outsourcing it to third parties. But where I see it really going excelling in the future is where groups actually set up their own entities in India as a subsidiary of their UK company, which ultimately is a GCC, and then they run and manage those teams um globally. Um, and so the finance function, the marketing function, the um HR function, a lot of those operational aspects can be actually run from a GCC or a global capability center.

Praju:

So just to be clear, it's basically the mishmash that dentists have to go about in terms of their non-clinical side, which is the finance.

Arun:

Yeah, I think that's the key thing, is it's it's the admin side, it's to finance the marketing. It's not the clinical side, it's we we we that the clinicians have to have to make the call, they're doing the dentistry in their clinics, but it's the systems they're built on. In order to deliver good quality care, you need to make sure you've got good financial and standardized finances, you need to make sure that the bills are being paid on time, you need to make sure that the um the payroll is being done properly, you need to make sure that the associates are being paid properly, all these things, okay? So they all have to be standardized. And whilst it can be done in country, um the costs are rising, and just the sensible approach is to standardize them and then ship them to uh another location such as India and set up your own GCC. That's when you get EBITDA expansion, and that's ultimately what investors are looking for. If the EBIT DAR is growing, um, and the uh the kind of leadership of the DSO are savvy enough to actually see and grow this that way, that's when um more interest becomes become you get you get more interest in the group, and therefore there's demand to buy those such DSOs and groups.

Praju:

So, with that being said, in terms of centralizing all these functions in, let's say, a respective country outside their their home country, what are the real-world cost savings that a dentist will go through in terms of like you know increasing the EBITDA and making an Yeah, I I I wouldn't say a dentist, you need to really get the terminology right here, Project.

Arun:

It's more about the dental groups, the DSOs, exactly. So I I think it could be well in excess of 50% of savings, okay, on those particular costs, maybe more, 60, 70 percent. It all depends on the roles and where and location and and how they set it up, but the costs um can be significant, okay. Um, it may be 60, 70 percent, and it depends on what you do and how you do it. So you still might have in some key in-country people, but you have a much bigger team out there doing the bookkeeping, the payroll, account, accounts payable, all of that tough being done in India. I just look at our own organization, that's what happens in our organization in terms of the marketing side of things, for instance, marketing stuff that's created in the UK but then edited and reviewed and made and recreated in our team in India. Again, it's a saving, okay. Um, and um therefore, we live in a global workforce. And as we saw in yesterday's budget, to be honest with you, okay, costs are rising in markets like the UK, greater taxes, um, greater national insurances, greater problems for small to medium, even large businesses. So you have to start thinking strategically. What am I going to do? And therefore, um, one of the options is to start thinking, okay, I'm gonna move my admin side of things, a lot of the centralized costs to another jurisdiction, and then um uh run the business that way. Deepak.

Deepak:

Yeah, I just add to this that any any process or any role which does not need a person in a person uh you know uh uh a B to B in UK for that process or a job profile. I think that can easily be offshore to your uh GCC team in India. And as as Arun rightly said, on the operation side of things, the operation cost can uh drastically be reduced by 50 to 60 percent cost saving. And uh, you know, our our uh dental DSO slide deck available on our website also illustrates this with a great example. You have the cost comparisons there for a team of five to ten people you know working in a dental practice. So if we if you see the larger people, uh larger picture and compare it to a crop operating four or five uh dental practices, and if we compare the cost savings across the crop, they are huge, they are seriously huge and uh rightly said, increasing the beta and the valuation.

Praju:

Correct. So, with this being said, which non-clinical function drains the most time for a DSO today?

Arun:

I'd say uh it's difficult to say which is the most, Project, but the ones that are significant, the finance function, okay, the finance and accounting function, because you've got to pay pay the bills, do the bookkeeping, um, do the payroll, do the associate pay. That's just that takes hours and manpower. And if and again, if it's not standardized, it can be a complete kind of mess. Then you've got um managing HR-related things, um, marketing. So there's no one that's more than the other, I'd say. Okay. Um, but what it also allows, if if one thing we haven't highlighted, and I think is important to highlight, is that if you've got an offshore opportunity offshore team overseas, which the costs are lower, it also gives you the opportunity to add kind of an innovation element to the business as well. You could bring in data scientists, um, software developers to help you improve the workflows, help you look at your data that you've got in all your data into in your in your clinics in a much, much more thorough and better way to analyze and say, all right, what can we do with this data to improve performance, to grow eBit Dart? So it's a re it's a fundamental re-jigging of how you structure your DSO, how you structure your organization, okay. Um, there's pricing pressure in the West in terms of patients wanting to spend, and therefore, and then and if costs are rising, okay, in the home market, you need to start thinking, well, I need to change my cost structure somehow. That means okay, I've still got to play dentists and clinicians and nurses staff over here in the UK or US, but then I have to eliminate um some other costs or reduce costs elsewhere, and that means it could be, as I'm saying, the centralized costs. Then with that saving, you can then use hire good data science people and AI people, software people to bring into your team who can then ultimately um analyze and perhaps give you greater insights into the performance of the DSO to for you to also make to make better decisions. Libak, any thoughts?

Deepak:

Yeah, I just add uh to just what Arun uh really said. We can't uh the West, the West and the practices in US UK have the pressure of reducing cost, right? And you can't compromise with the clinical cost, you can't compromise with the cost of dentist because you have to give seamless experience to your patients, you have to take care. You we are training in the healthcare industry, we can't compromise on that. But then the next factor is wherein we can utilize strategically leverage the cost-effective markets, if I say that that that is that is the main area. You can't reduce the clinical cost, but then you have to find out a way wherein the admin costs, which are the central bloc for the uh dental groups, how we can leverage and take the leverage of the cost-effective markets without compromising the quality, without compromising our standards, but then to have leveraged cost, effective costs. And India is the destination, I'd say you you talk about the role and it's available in India.

Arun:

India is leading India. I agree, I agree. I think I we may be biased, okay. People might argue, but at the same time, I having seen and worked and dealing with the the manpower availability in India, that India is definitely the market. You've got just look at the back office functions. I look at our own team. Okay, our own team is a great reflection of this. We have data scientists who we've hired are based in India, we have a qualified accountant based in India, we have people such as video editors, we have social media people, we have accountants, we have the whole spectrum of things. Now, do they have all the knowledge of the UK market? No, of course they don't. Okay, do they have all the issue understanding? No, they don't. But that comes with training, that comes with development, um, and that comes with a good attitude. And um, and and and in and in if it's somewhere like India, it's you you you you you've got to be pretty shrewd, and you need to know where to look and who to hire and where to hire them from and look at the backgrounds of these individuals, okay. But with if people come and work with us, we'll help them navigate and find the right talent because there is a huge talent pool out there, it's just knowing where to look and how to find the right people for your organization that will fit into your kind of culture.

Praju:

And so, in terms of getting this leverage, and you said like it's very important for people to hire for for DSOs to hire, and I would say like when a DSO looks at this or looks at this model as such, they they won't be really clear or they'll be a bit skeptical on how to do this. So, what would be the steps for a DSO? Is it like any other business trying to do set up a GCC, or is it going to be a little bit more different?

Arun:

Definitely um simple there's some similarities, but there are also some differences, Pradu. So I if I had to kind of the starting point is to do a feasibility study, look at your existing business and look at what roles, as Deeput highlighted, could potentially be navigated to another team or another another group of people sitting overseas. Firstly identify that and then work out with us um how feasible it is and what are the costs that are going to come to be associated with it. Because sometimes initially, if you just have a few team members, it may not be cost effective because you've still got to invest in office infrastructure, um, insurances, paid accountants, lawyers, all these types of things, okay? And it may not be, it's when you start scaling and that's when the real opportunity comes. By adding more manpower, that's when the real advantage comes. So I think um, and then in addition, working with a team that understand this market, who understand the dental market, who understand the softwares, who understands the the terminology, who understands what the prop the pain points that DSOs have, I think that's when um the the the the the the where we come into our own. Okay, I don't think anyone can really touch us on that. Um, we're not experts say in other sectors, but we in this sector, God, we know it, and we know it inside out. Deepak, any thoughts?

Deepak:

Yeah, and Raju, this is not uh uh you know, setting up a uh GCC unit in India is not a short-term goal, right? You have to have a long-term vision, you have to spend time, you have to make your training budgets, you have to train the team. You can't expect a person to be readily working as per the UKNOP. You have to have the the Western leadership team has to collaborate with the Indian GCT members and make them an integral part of the organization. You have to spend time, you have to train them, you know, you have to sow the correct seeds to read the benefits. So you have to really nourish them as an integral part of the organization. Yeah, and then and then you can.

Arun:

Sorry, carry on. Yeah, I I I stress, I'm I think I stress that point that Deep was highlighting. It's not a matter of just hiring a few people overseas and letting them get on with it. No, that that that ain't gonna work. You'll have the biggest disaster, it'll be a big disaster for you, okay, if you do that. It's about hiring a team, nurturing, as you said, nourish them, build them, develop them, build that trust. They be they'll build trust in you, you build trust in them. Um, and really kind of make them as part of your global team, okay? Not just some sitt some people who work for your business sitting in India. That ain't gonna work. That ain't gonna wash. The world is too small now, okay. And um the the team members will get very disheartened, um, there'll be poor communication, and culturally it just won't work. So you've really, really got to focus on getting that culture. And you, as if you're a DSO leader, it's all about that leadership and getting that culture right.

Praju:

So, I mean, going into that, then I have a question here which like just caught my eye. Why is practice-level admin one of the biggest blockers in Dental Group Group? And would practice managers really be if they didn't focus on the admin work, then what would their roles be if a GCC was formed?

Arun:

So, okay, so kind of city is it because that's an interesting question. So, if if a lot of the administration roles, as we're saying, would move overseas, okay? That then frees up manpower in the UK to focus on growth, okay. That means focusing on um treatment coordination, focusing on um referrals between clinics, focusing on other things that can actually grow the growth, grow the business. Um, and that's what ultimately a good business come practice manager should be doing. But if they're bogged down by the day-to-day processes because they have to submit payroll data or they have to submit timesheets or whatever it may be, and it's just not automated, there's no system in place. Honestly, it's just a there's no scope to growth, and and and really what you'll see is and I've seen this, I've seen so many DSOs emerge over the last few years, and people buying clinics and they might have 15-20 clinics, and it sounds fantastic, but they're they've got no strategy to actually think about how can I um strategically bring everything standardized and reduce my costs, grow the eBIT data on a consistent basis going forward. And that's when you've just ultimately got a mishmash of practices, and no one, no other investors really that interested in buying you, and um that time and time again has happened, and that the only ones that will grow well are the smart ones who have actually understood these issues and looked at okay, what am I gonna do? How am I gonna change things and make these strategic changes?

Deepak:

Uh, I'll add to this, you know, I'll just give you an example. Like you walk into a dental practice and you see the receptionist being busy in cause, not paying attention to the patient who is there to get treated, and then there's a different scenario where in you walk into a dental practice and the you know the receptionist is free, she's talking to the patient, and he's waiting for his turn to come and for his appointment. So this makes the difference. What we started as in customer experience. If the receptionist is free from the rescheduling the appointments, attending the calls, and someone you know, a team met in India in your GCC team in India is handling and rescheduling those calls for the dental practice, the customer experience elevates, and this makes the difference. Absolutely, you know, you're not going to be able to do that.

Arun:

Because you can then take away the emails or the WhatsApp messages or the scheduling calls, rescheduling calls, or rescheduling appointments away by someone sitting at there, and that person sitting in the clinic in the UK can be building the relationship with the patient, understanding their issues, and ultimately then selling other services to them as well. So spot on.

Praju:

So the message is basically the people in the UK focus on the patient care and India will handle the rest, and we'll make sure that everything's centralized and this will be as easy as that. If only it was that easy to do.

Arun:

Yeah, yeah, in theory, yes. Okay. In fact, reality is never that easy, but in a nutshell, yes, okay. But I think it lead in this type of approach needs a visionary leader, it needs people to actually um really see what the potential is for them also to stick out of their comfort zone. I appreciate going to set up an operation in India is not a small move, it's a massive move, okay? And it's a fundamental change in how you do things, okay. But if you've got that willingness to change and see the benefits from it, then it's a solution that will compound and only make things better. Will it be easy initially? No, it won't be. I can guarantee it. It will there will be struggles, there'll be challenges, there'll be problems, there'll be cultural issues, there'll be resistance from team members in the UK, US, wherever you're doing this from. 100 there will be resistance, I can tell you that now, okay? But if you're serious about growing your business, that will be the um kind of real opportunity for you.

Praju:

So, in terms of let's say doing this, so what's stopping a DSO owner from taking the sleep?

Arun:

Fear, maybe, not fear, I think it's the unknown, okay? I think fear of oh my god, it's overseas, they've never been to India, they don't know what's possible out there. I get that, okay. But I hopefully we can bridge that gap by talking to people, uh, explaining the situation, helping them understand the good, the bad, and the ugly, because it won't always be smooth sailing, as I said earlier. Um, but if they've got an appetite to see and they can see the potential long-term benefits to have a scalable team, and that's the key thing India really offers, it's a scalable team to help you grow further. Because if you can start adding, if then you can start adding more practices in the in your home market because you've got that scalable infrastructure to support that growth, it's when you don't have that scalable team to support the growth that's when it all starts kind of falling apart.

Deepak:

Deepak, any thoughts in terms of uh I I say also also a myth that cheap is not good, right? We we we see it as a as a uh reduced, we always talk about the reduced cost, but I can guarantee that uh you know uh this myth the West has that cheap is not good. This is not necessarily correct. If if the resources are properly trained, if the team is formed a part of the global team, as Arun said, and if they are if you know uh uh there is proper investment in the resources in the teams in India, then they give you great outcomes. So, of course, as Arun said, fear and methods gave this again.

Arun:

And I'll add to that, Deep, I think um by investing, it's about it's about availability of smart manpower. That's the key thing. India has definitely got more expensive over the last few years, no doubt about it, because of inflationary pressures, more demand for good people in India, etc. etc. But the reason you should go and do this is not because of being it being cheap, okay, definitely not, like in my mind. The reason to do this is because you're ultimately going to get great talent, which will help you scale your business. And if it's a saving financially, okay, which it is usually even better, okay. If the if costs aren't hugely saving, if the costs aren't hugely um uh better, okay, you could you could question is it is it worth doing? But in my mind, it still would worth be worth doing because you've got that trained team and you can scale that team, and that team can grow as you grow your clinic um sizes or clinic group sizes accordingly.

Praju:

So, I mean, based on all your answers you've given, I would like to tell any DSO for any further information, just call us. But no, I mean, like, I'm pretty sure there'll be more to it. But if you guys could just simplify, let's say, in like a step-by-step process in terms of let's say DSO doing this, how would the steps look like? Um, what I think you said feasibility. I mean, you said, let's say we go through a feasibility study, right? And so then from the feasibility study, we look at which department exactly we feel should be outsourced to India or offshore to India, see what goes from there, and then what is the process for someone to do that?

Arun:

Well, I guess it's it's it's sorry, you go deeper, you go on, you're the expert in this role for me.

Deepak:

So I'll just say, Rajah, that uh you know, uh the our our website, and like the we have discussed this in the uh last webinar also, that uh the approach we take is a 90-day approach. As I said, the first step should be the feasibility study to understand the expectations to expand the anticipated cost savings to expect the operations will be moving on, like whether it's feasible at this point of time for a TSA to move the operations to India or not. Once we have done that, once we have done that, then we come to extensive discussions with the leadership team in the West and then prepare a blueprint, which which takes around, we we target it as phase one and which is for you know launch force uh around initial 30 days of that. Once we have the blueprint, we have the hierarchy set, we have the processes in place, which processes have to be uh systematically moved to the offshore team in India. Then we come to give structure to the plan on papers. We incorporate the entity, we hire the initial local directors in India, we hire the initial team in India, we take care of the infrastructure, the ID vendors, the equipment required, whether the team is to be working remotely or it needs to be settled in an office, which is the most uh uh you know idle uh setup for the entity for the DSO. So this is this is the second phase which by which we are at uh you know day 61. And from 61 to 90 days is the integral operations where the operations go live. So for instance, we have started with the associate pay, we started with the uh bookkeeping, the accounts function. We work parallelly with the team. So 60 to 90 days is the uh tenure wherein we work parallel with your India team to streamline standard processes, establish processes, to align the West and the India team to uh you know have those uh training sessions, collaboration sessions wherein we can integrate both the teams, the headquarters as well as the India team. Of course, it sounds it sounds very simple but realistic. It will have hurdles, as I rightly said earlier. Also, it will have hurdles, but then I think the first the uh foremost important step is the first step to move on.

Arun:

Correct. I think that first step. I appreciate it's not easy. Once you take that first step, then but you need to be certain you want to do it and you've got to be ready for the the the the the the the the the the the kind of challenges that will come along because there will be some.

Praju:

I mean, in terms of like making it sound simple, I think you put it pretty clear to these guys in terms of like what is expected or how it's gonna be, and giving out a 90-day plan. So if there's any DSO that's looking to scale, looking to improve, or looking to grow further in 2026. Well, we're right here. And this is a service that's not just for cost saving, it's more about just helping your DSO group get to where it needs to be, not to where it is now. And so give us a call. And you have Aaron right here, you have Deepak, our GCC expert. So their calendar links will be available in our website, similar global.com. So give them a call, have an initial consultation, and we hope to speak to more of you guys. Thank you all. Thank you.

Deepak:

Thank you.