A Deep Dive Into Private Equity - Part 2

In part 2 of our private equity discussion, Wes and Mario explore the complex relationship between private equity and dentistry, highlighting its implications for dental practices. They address concerning trends such as overtreatment driven by management pressure. They then discuss the ethical challenges of prioritizing profit over patient care. Through personal anecdotes, they emphasize the importance of seeking second opinions and informed decision-making. They also examine the structure of corporate dental practices and provide guidance for dentists considering working for dental service organizations (DSOs).

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Listen to our sister show, Next Gen DDS! An all-in-one resource for dental students, residents, and early career doctors, discussing both clinical and business aspects of dentistry, hosted by Wes Lyon and Dr. Scott Menaker.

Episode Transcript

Wesley Lyon: Welcome back to another episode of drilling it down this is your host west lion (00:02):
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Wesley Lyon: co-hosting mario santiago we got part two of the private equity stuff all right. (00:06):
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Mario Santiago: Let's get into it i'm excited (00:12):
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Wesley Lyon: Uh yes for those of you that didn't listen to part one uh recommend you listen (00:13):
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Wesley Lyon: to that one first part two we are going to talk about how this impacts dentistry (00:17):
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Wesley Lyon: and we found some very uh of interesting public articles not on dental websites (00:22):
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Wesley Lyon: relating to this I really. (00:29):
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Mario Santiago: Try not to talk about dentistry on the last one Wes it was tempting but we try (00:31):
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Mario Santiago: to keep it on private equity now we'll talk about dentistry (00:35):
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Wesley Lyon: Yes if you didn't listen to last week we don't really recommend investing in (00:37):
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Wesley Lyon: private equity now we kind of flip the script we want to give an update on hey (00:41):
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Wesley Lyon: kind of what's going on we're I think when this first started we're hearing (00:47):
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Wesley Lyon: great stories People are talking about how wonderful it was, (00:51):
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Wesley Lyon: how much money they got. And now we're kind of hearing the opposite. (00:54):
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Wesley Lyon: And apparently the opposite has made its way into the public realm. (00:57):
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Wesley Lyon: And also there is a Senate investigation and report, which is pretty fascinating here. (01:01):
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Mario Santiago: Dentists are making it on the news. I don't know if this one's a great one, but. (01:10):
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Wesley Lyon: Oh, look, I didn't even realize this. This report's from 2013. (01:15):
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Wesley Lyon: So apparently this was on their radar screen well before this got started. (01:19):
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Wesley Lyon: But even still, I think it applies today and there's some very interesting tidbits in there. (01:23):
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Mario Santiago: Yeah, and basically what they have found in a lot of these reports and a lot (01:29):
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Mario Santiago: of these investigations is that a lot of dental, let's just call them dental (01:33):
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Mario Santiago: offices for now, a lot of dental offices are over-treating. (01:38):
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Mario Santiago: And one of the concerning articles was over-treating children. (01:42):
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Mario Santiago: So I think that's where a lot of people started drawing the line, (01:45):
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Mario Santiago: and a lot of it has to do with Medicaid. (01:49):
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Mario Santiago: But it's really becoming an important topic now because as we work with a lot (01:52):
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Mario Santiago: of independent dentists, they're trying to find ways to make sure that their (01:56):
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Mario Santiago: patients are taken care of. (01:59):
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Mario Santiago: And we're just finding that not every dentist is made the same. (02:01):
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Mario Santiago: And you go to one dental office, and you might get recommended 10 things, (02:05):
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Mario Santiago: and you go to the independent dentist, and you don't get recommended anything. (02:09):
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Mario Santiago: This happened to you, right, Wes? (02:12):
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Wesley Lyon: This did. I mean, I got three crowns put in my mouth. (02:13):
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Wesley Lyon: I showed up the next time, and they were going to put three more in my mouth. (02:16):
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Wesley Lyon: So I decided to get a second opinion. (02:20):
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Wesley Lyon: And, you know, I sat there. Apparently, I went ghost white, and the guy looked (02:23):
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Wesley Lyon: at me. He was like, I'm so sorry. (02:26):
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Wesley Lyon: It's just a filling. And I was like, oh, no, it's not the filling you recommended. (02:28):
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Wesley Lyon: It's the three crowns you didn't recommend. (02:31):
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Wesley Lyon: And he's like, whoa, tell me what happened. I did. And, you know, (02:33):
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Wesley Lyon: he sat there, super nice, just what you expect out of a dentist, showed me the x-ray. (02:36):
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Wesley Lyon: He showed me, hey, you see these little white lines? that's probably what they (02:41):
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Wesley Lyon: were pointing to and I was like yeah and he goes yeah I feel horrible this happened (02:44):
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Wesley Lyon: to you but I'm going to tell you since you asked and goes, (02:49):
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Wesley Lyon: That stuff, it's just cement from back in the day. It shows up clear on x-rays. (02:52):
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Wesley Lyon: They used to use it all the time. You probably got these done a while ago. (02:56):
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Wesley Lyon: Because there's nothing here that indicates that you need any work done. (02:58):
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Wesley Lyon: Quite frankly, this just looks normal. It's just easy to manipulate people into thinking it's bad. (03:03):
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Wesley Lyon: And that was eye-opening to me. That was before I worked in dentistry. So I didn't know. (03:09):
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Wesley Lyon: But I figured out very quickly that insurance was not what mattered. (03:14):
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Wesley Lyon: I had spent like $4,000 there already. had gotten crowns I didn't need. (03:17):
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Wesley Lyon: And then, you know, I could have just paid a fee for service doctor and just (03:23):
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Wesley Lyon: paid for the dang cleaning and the filling, not paid for the dental insurance (03:26):
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Wesley Lyon: and been fine. So I got rid of dental insurance after that. (03:30):
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Mario Santiago: Yeah, no, it sounds so basic. But I think before we used to just saying, (03:34):
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Mario Santiago: you go to dentist A, you should get the same opinion as dentist B because they're (03:37):
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Mario Santiago: both dentists and they were trained in similar ways. (03:42):
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Mario Santiago: But that's just not the case. And it's pretty scary. (03:44):
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Wesley Lyon: No, it is. And we really thought they were all the same, but they're just not. (03:47):
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Wesley Lyon: Yeah, yeah. So, yeah, the public is waking up because even to this day, (03:51):
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Wesley Lyon: I went to my new dentist and, you know, the dentist wasn't going to throw anyone (03:55):
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Wesley Lyon: under the bus immediately, but the hygienist, she was like 65 years old and she didn't care. (03:59):
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Wesley Lyon: And she takes one look in my mouth and goes, have you been to and says the name of it? (04:04):
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Wesley Lyon: And I was like, yeah, how'd you know? She goes, you got a lot of dental work (04:10):
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Wesley Lyon: for a young man. Yeah. All right. (04:14):
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Wesley Lyon: That's fantastic. we're off to a great start here but yeah I mean it's everywhere and, (04:17):
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Wesley Lyon: yeah you know we have a couple articles here one's a little bit newer than the (04:24):
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Wesley Lyon: other but we did want to bring up this Senate investigation because you know (04:28):
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Wesley Lyon: people have gotten in trouble so you mentioned up, (04:32):
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Wesley Lyon: mentioned this Medicaid debacle. So I think what's happening to nobody's shock is, (04:35):
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Wesley Lyon: you know, hey, you're required or you have to produce a certain amount of dentistry (04:43):
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Wesley Lyon: and the people making you produce that don't care as much. (04:48):
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Wesley Lyon: Like one of these articles referenced that the manager that was giving the instructions (04:51):
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Wesley Lyon: on how much to produce was formerly a peer one imports manager. (04:55):
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Mario Santiago: Huh. I haven't seen a Pier 1 Imports in a while. (05:02):
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Wesley Lyon: Yeah. And now you're sitting there now. So she's telling dentists what they're (05:05):
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Wesley Lyon: going to do, how much they need to produce. (05:09):
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Wesley Lyon: And it's just insane. And a couple of these articles, they used a Harvard dentist. (05:12):
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Wesley Lyon: I think he teaches at the dental school to compare and look what was going on. (05:18):
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Wesley Lyon: And it was just shocking what was going on. (05:22):
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Mario Santiago: Yeah, and to tell everybody basically what these articles are covering is they (05:25):
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Mario Santiago: found a lot of these corporations, bigger dental corporations, (05:29):
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Mario Santiago: who they operate like any other corporation that you might think of. (05:33):
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Mario Santiago: You know, there's managers, there's quotas that have to be hit, (05:36):
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Mario Santiago: there's morning huddles, similar to your morning huddles, but very different. (05:40):
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Mario Santiago: We're in the morning huddles, it's all about production, it's all about telling (05:44):
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Mario Santiago: the offices that they're not producing, as well as the other offices, (05:47):
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Mario Santiago: putting the offices to compete. (05:51):
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Mario Santiago: So it puts this pressure on the dentist, the hygienist, really anyone in the (05:52):
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Mario Santiago: practice to over-treat and over-produce and just hit numbers because their livelihoods (05:57):
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Mario Santiago: and their jobs are at stake. (06:01):
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Wesley Lyon: Yeah, there was a whistleblower in one of the articles, and it was a dental (06:03):
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Wesley Lyon: assistant. And she walked out, went to the office manager. I was like, (06:07):
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Wesley Lyon: I will not walk back in that room and be a part of what's going on. (06:10):
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Wesley Lyon: Nothing got done about it. She reported it to the corporation. (06:13):
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Wesley Lyon: They didn't do anything. So she went to the dental board of the state. (06:16):
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Mario Santiago: Was this in Ohio? (06:19):
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Wesley Lyon: It was in Ohio. and the dental board didn't do anything about it, which... (06:20):
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Wesley Lyon: You know, wasn't very shocking. Well, there's four investigators. (06:25):
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Mario Santiago: I think, in Ohio, and there's like over 500 investigations going on. (06:29):
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Mario Santiago: So, I'm not surprised they couldn't get to it. (06:33):
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Wesley Lyon: So, I know a few people have been on the board for, you know, (06:35):
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Wesley Lyon: South Carolina, North Carolina, and it was funny. (06:39):
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Wesley Lyon: I had somebody called me and said, are you sure I can give a $10 gift card every time a patient refers? (06:41):
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Wesley Lyon: And I was like, I'm sure of that. You can't incentivize them. (06:47):
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Wesley Lyon: You can't tell them I'm going to do it if you refer, but if they refer, (06:50):
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Wesley Lyon: you can show them a token of appreciation. (06:53):
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Wesley Lyon: He didn't believe me. I said, hey, look, I know the incoming South Carolina president. (06:55):
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Wesley Lyon: I'm going to call him and I'm going to ask him. I asked him that question and (06:59):
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Wesley Lyon: he just burst out laughing. (07:03):
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Wesley Lyon: He was like, dude, do you know how much stuff that's real that we have to deal with? (07:04):
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Wesley Lyon: Like we got to look at over treatment and figure out if dentists need to lose their license. (07:09):
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Wesley Lyon: Do you think we care about somebody giving a $10 gift card? Like that is not (07:13):
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Wesley Lyon: hitting our radar screen of something we're going to investigate here. (07:17):
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Wesley Lyon: That's insane. We got real problems we're trying to figure out here. (07:20):
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Wesley Lyon: So fortunately, I think a lot of the dental boards are dentists that are privately owned. (07:25):
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Wesley Lyon: I don't know that they're as corrupted as maybe some of the corporate world. (07:30):
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Wesley Lyon: But, you know, there's a few of them and there's a ton of this stuff going on. (07:34):
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Wesley Lyon: And, you know, to some extent, too, I mean, we're probably guilty of this as well. (07:39):
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Wesley Lyon: You know, nobody wants to be the person that tells on another dentist and has (07:46):
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Wesley Lyon: them lose their license. (07:50):
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Wesley Lyon: You know, we see people come in with tax fraud on their, you know, tax return. (07:51):
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Wesley Lyon: And, oh, CPA told me to do it. And we don't ever turn the CPA in. (07:56):
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Wesley Lyon: Right. I mean, it's it's just not what people naturally do. Like, (08:01):
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Wesley Lyon: hey, you need to leave this person and make your life better. (08:05):
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Wesley Lyon: But, you know, we're not going to be the ones. And, you know, (08:08):
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Wesley Lyon: truthfully, these people probably deserve it, probably need to get back to a society where, (08:10):
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Wesley Lyon: hey, if somebody is doing something, you need to go to the board and tell them (08:15):
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Wesley Lyon: because there were some just outrageous stories in here of people getting root (08:19):
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Wesley Lyon: canals on teeth that need to get pulled and to make it worse, like tiny children. (08:24):
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Mario Santiago: Yeah. And it's all, all of that stuff is very insurance driven, right? (08:29):
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Mario Santiago: Because if somebody comes in and you have a production quota to hit and you (08:33):
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Mario Santiago: realize that if you have a root canal that Medicaid pays like 1200 bucks for, (08:38):
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Mario Santiago: and then you're going to have to extract the tooth later anyways, (08:43):
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Mario Santiago: then you're getting paid twice versus If you actually made the right decision, (08:45):
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Mario Santiago: you would have just extracted the tooth, but that didn't provide you with any money. (08:49):
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Mario Santiago: We've always talked about this too, how insurance dictates a lot of this stuff (08:54):
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Mario Santiago: as well, but people are just choosing what procedures and coding them what they (08:58):
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Mario Santiago: want in order to get more money and really go up to their superiors to make them happy. (09:02):
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Wesley Lyon: Now, this was the shocking thing I saw in these articles. There's another reason (09:09):
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Wesley Lyon: that this is being driven this way. (09:14):
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Wesley Lyon: And I was shocked to see it in an article about dental overtreatment. (09:16):
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Wesley Lyon: But it's back to part one of this two-part private equity series. (09:20):
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Wesley Lyon: They had figured out that all these dental practices had been bought with debt (09:25):
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Wesley Lyon: by private equity firms. (09:29):
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Wesley Lyon: And they had put the connection together that they have to service the debt. (09:30):
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Wesley Lyon: So they have to keep the production up. (09:34):
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Wesley Lyon: And that's what's driving a lot of this stuff. (09:36):
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Wesley Lyon: So, you know, we don't want to sit here, not every group dental practice, (09:39):
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Wesley Lyon: every private equity backed thing, not everyone is the same. (09:44):
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Wesley Lyon: So don't take this as they're all bad. (09:46):
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Mario Santiago: Yeah, there's good ones out there. We know a lot of them. We know a lot of doctors (09:48):
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Mario Santiago: that have worked with good groups. (09:51):
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Wesley Lyon: Oh, absolutely. We know doctors that have sold and are just super happy with (09:53):
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Wesley Lyon: the group they're working for. (09:56):
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Wesley Lyon: We're going to come back to that, though, on how it relates to should you do it or not do it. (09:57):
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Wesley Lyon: But again, we're not demonizing all of them. We're just getting what's out there (10:01):
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Wesley Lyon: in the public realm, what's been investigated, what's been looked at. (10:05):
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Wesley Lyon: There were a lot of fines paid in a lot of these situations. (10:08):
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Wesley Lyon: So it's out there. It's in the open. And I think the more shocking part we found, (10:13):
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Wesley Lyon: and it's actually not shocking. (10:19):
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Wesley Lyon: I think we already knew, but, you know, we don't like to sit there and publicly (10:21):
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Wesley Lyon: call out something we don't know to be true. But a lot of these investigations (10:24):
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Wesley Lyon: found out that production numbers were being driven by non-dentists. Oh, yeah. (10:27):
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Mario Santiago: And which is why there are rules why dentists can't own. (10:32):
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Mario Santiago: Or non-dentists can own dental corporations. But as we probably saw in the article, (10:38):
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Mario Santiago: there's workarounds to that, right, Wes? (10:42):
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Wesley Lyon: No, absolutely. So that's another, I'm going to come back to that in one second. (10:44):
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Wesley Lyon: That's another interesting tidbit, but I know I don't call this company by name. (10:49):
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Wesley Lyon: I'm protecting, you know, the person that told me, but I mean, (10:55):
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Wesley Lyon: I specifically had somebody call me. (10:57):
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Wesley Lyon: They just heard a podcast that, hey, you might want to know this. (10:59):
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Wesley Lyon: So if you do have something we might want to know, we'll keep you private. (11:02):
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Wesley Lyon: We're not going to say the company name, anything, but please call us. (11:04):
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Wesley Lyon: You know, the more we know, the more we can help other dentists. (11:08):
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Wesley Lyon: But he called me up and goes, Hey, you know, you're talking on this podcast, (11:10):
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Wesley Lyon: but you were missing a piece on how the treatment gets done. (11:14):
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Wesley Lyon: And I was like, yeah, do you know? He goes, Oh yeah, I work there. (11:17):
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Wesley Lyon: And he just told me, he goes straight forward. You know, I walk into the chair, (11:20):
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Wesley Lyon: I do a clean or I do the exam. (11:23):
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Wesley Lyon: He goes, I wasn't the one that recommended the treatment. And then somebody (11:26):
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Wesley Lyon: in the background, he said a manager did it. (11:30):
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Wesley Lyon: So he didn't specifically tell me non-dentist, but I got the point. (11:32):
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Wesley Lyon: Non-dentist in the background, he said, I don't even know who that person was. (11:36):
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Wesley Lyon: He said when he went to do treatment, it wouldn't be the same person that he (11:40):
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Wesley Lyon: had done an exam for. So he'd be blindsided. (11:43):
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Wesley Lyon: And basically, you know, he said, hey, I get to the point where I've, (11:46):
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Wesley Lyon: you know, I've numbed the patient and now I realize they don't need dental work. (11:48):
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Wesley Lyon: And he's like, it just put me in a gut wrenching scenario. (11:53):
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Wesley Lyon: And this doctor, I mean, he basically told me, he was like, look, (11:55):
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Wesley Lyon: I don't know what I'm doing next and I really don't have any money and I got (11:58):
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Wesley Lyon: a ton of student loan debt and this is bad, but I can't walk back in there. Can you help me? (12:01):
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Wesley Lyon: We had to help him find somewhere to go and, you know, get a practice and we (12:05):
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Wesley Lyon: were able to help him, which was great, but he just straight up said, (12:09):
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Wesley Lyon: I can't, I can't take another day of it. (12:12):
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Wesley Lyon: This is insane the way we're treating people. (12:14):
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Wesley Lyon: And that's, that's the part about these private equity backed firms, (12:17):
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Wesley Lyon: how it relates to dentistry is, you know, they're in there to drive up revenue and cut costs. (12:20):
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Wesley Lyon: So material is probably going down and revenue needs to go up. (12:25):
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Wesley Lyon: So we've got to do more dentistry and we've got to find the dentistry out of (12:30):
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Wesley Lyon: people that maybe it wasn't there before. (12:32):
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Wesley Lyon: So sometimes you lose the autonomy. Like a lot of these things, they were, (12:35):
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Wesley Lyon: One company was found to be sending out monthly reports to everybody, (12:39):
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Wesley Lyon: and they would put the dentist and the office and the production numbers and the average. (12:43):
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Wesley Lyon: This was probably the most disgusting piece was the average treatment per patient (12:49):
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Wesley Lyon: that came through there. (12:54):
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Wesley Lyon: And they were tracking all this, and they were making it public and pitting (12:55):
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Wesley Lyon: the dentist against each other to drive up the average production per patient, (12:59):
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Wesley Lyon: which is just – I mean, that's insane. (13:04):
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Wesley Lyon: And, you know, it's like that's not what dictates treatment. (13:07):
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Wesley Lyon: If a patient doesn't need anything, a patient doesn't need anything. (13:10):
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Wesley Lyon: We see this, right? They were talking – one of the companies defended themselves (13:13):
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Wesley Lyon: by saying, well, this is the statistics on average that we got from this reputable source. (13:17):
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Wesley Lyon: So because of that, you know, this doctor is under-treating. (13:22):
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Mario Santiago: Yeah, I think it was in regards to like maybe perio-maintenance or something (13:26):
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Mario Santiago: like that. It's like, oh, the don't quote me on this, but it's like, (13:30):
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Mario Santiago: oh, the ADA or some someone posted a statistic about how many people really (13:34):
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Mario Santiago: have perio disease. So we need to get up to that number. (13:38):
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Mario Santiago: But even that institution came out and said, no, these statistics shouldn't (13:41):
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Mario Santiago: drive treatment or increase treatment for an individual patient. (13:45):
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Wesley Lyon: Yeah, we see this all the time because we actually do use these statistics with (13:49):
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Wesley Lyon: dental practices we work with. (13:54):
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Wesley Lyon: So we use them. However, we ask questions. (13:55):
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Wesley Lyon: You know, like on the perio, a lot of times you say, hey, you know, (13:59):
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Wesley Lyon: is this something, what's going on with the patient base? (14:02):
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Wesley Lyon: You know, a lot of times in a well-to-do white-collar neighborhood close to (14:04):
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Wesley Lyon: a city, there's just not as much perio there. And I say, look, it's just not there. (14:10):
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Wesley Lyon: You know, I know a practice in (14:14):
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Wesley Lyon: particular I'm thinking of because we run a glorified hygiene department. (14:16):
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Wesley Lyon: All of our patients take care of their teeth. There's not tons of work. And it was true. (14:19):
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Wesley Lyon: The hygiene production was about equal to the doctor production. (14:23):
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Wesley Lyon: There's quite a few of them in the same area I know about where it's just, (14:26):
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Wesley Lyon: hey, you know, it is what it is. (14:30):
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Wesley Lyon: We'd love to do more dental treatment, but it's just not here. (14:31):
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Wesley Lyon: It's just not there, yeah. So we don't have it to do. (14:35):
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Wesley Lyon: Other times we ask, I remember practice in Southwest Virginia, (14:37):
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Wesley Lyon: I pointed out crowns and endo were just extremely low. (14:41):
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Wesley Lyon: I was like, dude, you know, there's something here. So I asked them, (14:45):
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Wesley Lyon: they were like, dude, it's our demographic. (14:49):
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Wesley Lyon: We recommend it because it's the right thing to do. But our demographic, (14:51):
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Wesley Lyon: their next question out of their mouth is how much to pull the tooth. (14:55):
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Wesley Lyon: And they said, we give them the honest answer and we recommend the treatment. (14:58):
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Wesley Lyon: But when we tell them it's not that much money to pull the tooth, (15:01):
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Wesley Lyon: they just pull the tooth and move on. (15:04):
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Wesley Lyon: And he goes, that's why it's lower. And we can't control that. (15:06):
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Wesley Lyon: All we can do is educate to the best of our ability. (15:10):
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Wesley Lyon: But ultimately, if they make the decision to pull the tooth, (15:12):
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Wesley Lyon: we're pulling the tooth and we're making less money. (15:15):
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Wesley Lyon: But it was the patient's decision. We gave them everything available. (15:18):
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Wesley Lyon: So, you know, it's just to say, hey, we use the statistics. I don't have anything (15:21):
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Wesley Lyon: against them, but we never sit there and tell somebody, you know, (15:25):
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Wesley Lyon: you absolutely need this many crowns. (15:29):
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Wesley Lyon: We more sit there and go, hey, are you –. (15:31):
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Wesley Lyon: Is your number lower because you're not recommending the proper treatment or (15:34):
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Wesley Lyon: you're putting too large of fillings that you know you're going to do a crown (15:38):
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Wesley Lyon: later on because you feel guilty for the patient? (15:40):
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Wesley Lyon: You know, is there something else? Can they not afford it? (15:43):
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Wesley Lyon: Or is it just that they don't need crowns? Because if they don't need crowns, (15:45):
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Wesley Lyon: that's the end of the conversation, right? If you sit there and tell me, (15:49):
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Wesley Lyon: no, I recommend every crown that needs to get done and my patients, (15:52):
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Wesley Lyon: they do it. We just don't have as many of them. (15:55):
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Wesley Lyon: Yeah. Okay. Yeah. Great. We can't manufacture crowns. Yeah. (15:59):
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Mario Santiago: No, and I was talking to a private dentist this morning and we were talking (16:02):
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Mario Santiago: about just this and she was saying, well, Mario, you know, I'm treating my patients well. (16:06):
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Mario Santiago: I'm recommending what I should. They're super happy. (16:11):
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Mario Santiago: They're raving to other patients about me. Like, what should I do from a marketing perspective? (16:14):
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Mario Santiago: And I'm just sitting there looking back at her and I said, you just described it, right? (16:18):
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Mario Santiago: Like, that is marketing. You know, as soon as you over-treat someone and they (16:22):
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Mario Santiago: tell someone else, your reputation is at stake. (16:27):
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Mario Santiago: But if you treat people well, if they know that they're getting the right opinion (16:29):
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Mario Santiago: from you, they're going to tell other people. And that's the greatest marketing (16:32):
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Mario Santiago: tool you could ever ask for. (16:35):
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Wesley Lyon: No, definitely. I was going to come back to something. What was it? Do you remember? (16:36):
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Wesley Lyon: We'll think of it. (16:43):
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Mario Santiago: Not the Medicaid? (16:44):
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Wesley Lyon: No. (16:46):
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Wesley Lyon: Was it the Medicaid? I don't know. We'll come back to it. But that kind of twists (16:48):
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Wesley Lyon: this around to, okay, they're here. (16:53):
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Wesley Lyon: They're not all the same. (16:56):
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Wesley Lyon: You know, what should you think about when selling to them? Or should you sell (16:59):
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Wesley Lyon: to them? Should this preclude you from selling to them? (17:04):
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Wesley Lyon: So I think to start it off, this is a transition option. (17:08):
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Wesley Lyon: And when you are transitioning your practice, you should consider every single transition option. (17:13):
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Wesley Lyon: Because to be very blunt with you guys, we're not necessarily anti-DSO what they're doing. (17:18):
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Wesley Lyon: We're definitely not pro-DSO what they're doing. (17:25):
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Wesley Lyon: You know, we're just what's in the doctor's best interest. (17:27):
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Wesley Lyon: So there's been plenty of people that call up to this place. (17:30):
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Wesley Lyon: And when I say plenty, 90% of the people that call up here looking to sell to (17:34):
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Wesley Lyon: a DSO, somebody in the building talks them out of it and goes, this just isn't for you. (17:38):
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Wesley Lyon: Like, have you actually considered X, Y, and Z? (17:42):
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Wesley Lyon: And most of the time we ask them, oh, well, why are you doing it? (17:46):
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Wesley Lyon: Everyone else is, and everyone's getting all this money. We have to explain (17:48):
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Wesley Lyon: to them that's not really the case. (17:52):
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Wesley Lyon: But let's say you are in those group of practices. (17:54):
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Wesley Lyon: You know, should any of this preclude you from doing it? (17:57):
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Wesley Lyon: How would you use this information, Mario, to try to make an informed decision (18:00):
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Wesley Lyon: on whether or not you should sell to a DSO? (18:04):
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Mario Santiago: If I'm talking to someone, I would probably look at two main things. (18:06):
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Mario Santiago: Number one, what is the actual offer? (18:09):
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Mario Santiago: And that's important because a lot of people look at the offers and they say, (18:12):
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Mario Santiago: oh, well, I'm getting $10 million. (18:16):
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Mario Santiago: But really, when you take a deeper dive at what the details of that offer is, it's a lot less. (18:17):
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Mario Santiago: A lot of it's tied up in the stock of this company, which you don't know what (18:23):
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Mario Santiago: it's worth. their stringent maybe workback requirements. (18:26):
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Wesley Lyon: Yeah, if you want to know about that stock, go back to last month's episode. (18:31):
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Wesley Lyon: Yeah, to the other episode. (18:33):
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Mario Santiago: And basically, to summarize the last episode is you don't know what that stock (18:34):
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Mario Santiago: is really worth, but a lot of doctors are going to this option because somebody (18:39):
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Mario Santiago: told them that the stock is going to be very lucrative down the road. So number one is, (18:43):
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Mario Santiago: what is the actual offer? And is it actually meeting your financial needs? (18:49):
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Mario Santiago: Because a lot of people want to sell to the DSO because it's going to get them (18:53):
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Mario Santiago: across the finish line of retirement. (18:56):
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Mario Santiago: But once you sell, and then you realize that that stock wasn't really worth (18:58):
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Mario Santiago: what you thought it was worth, and you sold your biggest asset, (19:02):
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Mario Santiago: and you didn't reach your retirement goals, now we're in trouble. (19:06):
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Mario Santiago: Are you really going to go back and try to open a practice somewhere outside (19:09):
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Mario Santiago: of maybe where the non-compete is? It's just ugly. (19:13):
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Mario Santiago: Number two, which I think is equally important is the emotional side of it all. (19:16):
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Mario Santiago: A lot of people decide they don't want to sell to DSOs. And once again, (19:21):
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Mario Santiago: focusing here on maybe the ones that don't have a good reputation, (19:24):
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Mario Santiago: because they have built a reputation in their town for 25, 30, 35 years. (19:28):
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Mario Santiago: And now they're selling it to someone who might not actually take care of their (19:33):
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Mario Santiago: patients. And that's not a good feeling to have. (19:37):
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Mario Santiago: So I think the second part is, who do you want to leave your practice to? (19:40):
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Mario Santiago: And do you actually want to work back for someone? Or instead, (19:43):
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Mario Santiago: would you rather just sell it to someone you know and trust and maybe has a (19:47):
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Mario Santiago: similar treatment philosophy as you? (19:51):
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Wesley Lyon: Yeah. And I'm going to put number three in here, which is, are they actually (19:53):
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Wesley Lyon: giving me more money? Yeah. (19:56):
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Wesley Lyon: Right. When I look at the end of the day, if, you know, most of them are going (19:58):
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Wesley Lyon: to make you work back five years. (20:01):
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Wesley Lyon: So if I work back five years, I keep the profit and I sell it to Dr. (20:03):
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Wesley Lyon: New for a certain amount of money. Is that amount of money I received less than (20:06):
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Wesley Lyon: by a good shot the amount of money the DSO is going to give me? (20:13):
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Wesley Lyon: And this is where there's a lot of confusion, a lot of people trying to get (20:16):
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Wesley Lyon: doctors to sell to earn the commissions. (20:19):
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Wesley Lyon: A lot of times it's not, especially in one doctor practices, (20:23):
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Wesley Lyon: especially in the GP world, just on how this stuff works. (20:27):
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Wesley Lyon: It's just oftentimes not much more money. (20:31):
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Wesley Lyon: And if you're looking apples to apples and you're going to get the same, (20:35):
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Wesley Lyon: and oftentimes you actually get more money by just keeping your practice till (20:39):
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Wesley Lyon: the day you want to leave and selling it to Dr. New, it really is. (20:43):
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Wesley Lyon: Most of the time you'll get more money in your pocket doing that than you will (20:47):
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Wesley Lyon: selling to a DSO. if I'm not getting more money, why am I doing it? (20:50):
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Wesley Lyon: And you got to look a hard look in the mirror and go, okay. (20:55):
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Wesley Lyon: And then this one's tough. And I've had to sit down and you do the flip side (20:59):
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Wesley Lyon: of that because it exists. (21:03):
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Wesley Lyon: And I've had to sit down and tell people they're selling to DSO. (21:04):
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Wesley Lyon: So they're ultimately just anti-DSO where we sit down and go, look, (21:08):
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Wesley Lyon: your practice for whatever reason, if you have a super low overhead rate, (21:12):
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Wesley Lyon: you've just got a very desirable and whatever it is, If I look at these two (21:17):
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Wesley Lyon: numbers and go, look, you're getting $3, $4 million more by selling it to a DSO, (21:21):
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Wesley Lyon: depending on your financial situation, we're going to have a very serious talk (21:27):
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Wesley Lyon: about this because some doctors, it is life-changing money. (21:31):
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Wesley Lyon: So we don't want to dog them when they do give you life-changing money and that's the right option. (21:34):
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Wesley Lyon: Sometimes you got to do it. If it's half a million dollars more to sell to the (21:40):
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Wesley Lyon: DSO over the five-year period and you're financially secure, (21:45):
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Wesley Lyon: I usually flip that to somebody and I tell them, what do you want to do? (21:49):
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Wesley Lyon: This half a million dollars, if it's not going to change your life, (21:52):
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Wesley Lyon: you're going to have to work back for them. What do you want to do? (21:55):
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Wesley Lyon: Some people, though, I sit there and I look at it and go, hey, (21:59):
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Wesley Lyon: if you sell to Dr. New, you're on the verge. (22:01):
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Wesley Lyon: You'll be retired, but we ain't going first class. yes. (22:04):
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Wesley Lyon: However, you know, what your practice worth is DSO. It's an extra few million. (22:08):
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Wesley Lyon: This is life-changing money. Like, you know, I hate to be the one to tell them (22:14):
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Wesley Lyon: to do it, but I'm like, look, I'm here looking out for you. (22:19):
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Wesley Lyon: And this absolutely can be the best thing for you to do. (22:22):
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Mario Santiago: And for some people, Wes, it might be the only option, right? (22:25):
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Mario Santiago: I think we talked to a lot of doctors who maybe want to have a bigger and bigger (22:28):
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Mario Santiago: and bigger practice, but we say, (22:33):
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Mario Santiago: hey, what's the end goal because if you get to a practice that big and you hate (22:35):
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Mario Santiago: dso's well that might be your only option out (22:38):
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Wesley Lyon: No definitely i've got one in particular where um you know we helped him he (22:41):
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Wesley Lyon: had an offer we helped him get like an extra million and a half so he's super (22:47):
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Wesley Lyon: happy about that one but he's like i i really don't want to do this and i was (22:50):
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Wesley Lyon: like okay well well great, (22:54):
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Wesley Lyon: call the associates because they're the ones with the work history. (22:56):
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Wesley Lyon: The bank will be willing to do this. We can make this work if they will bite at the apple. (23:00):
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Wesley Lyon: But they didn't want anything to do with it. They were willing to work for the (23:05):
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Wesley Lyon: DSO. And we're kind of sitting there like, dude, it's not that it's really worth (23:07):
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Wesley Lyon: more to the DSO than it is an individual. (23:11):
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Wesley Lyon: It's just the fact this thing is $5 million. (23:14):
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Mario Santiago: Who's going to buy it? (23:17):
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Wesley Lyon: I don't know. It's like you can sit here and you can try to sell it. (23:18):
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Wesley Lyon: But if you get three years down the line, you can't sell it. (23:21):
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Wesley Lyon: And we're back to the DSOs anyways, now you're working an extra eight years instead of five years. (23:24):
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Wesley Lyon: So in those really large practices, sometimes it's just, hey, (23:29):
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Wesley Lyon: look, this is what's going to get you across the goal line. (23:32):
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Wesley Lyon: But they're not all created equally. (23:35):
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Wesley Lyon: There are many of them that, you know, when this started, it was really just, (23:38):
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Wesley Lyon: we're here to make money. (23:42):
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Wesley Lyon: And that gave it a horrible reputation that some of those are still in existence (23:44):
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Wesley Lyon: and still giving it a horrible reputation. (23:48):
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Wesley Lyon: Then they realized, we got to keep these doctors happy if we want to have a (23:51):
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Wesley Lyon: shot at being successful. (23:54):
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Wesley Lyon: So that was iteration number two. And eventually some doctors decided that they could do this better. (23:56):
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Wesley Lyon: And they went and go, hey, you know, went to private equity people, (24:01):
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Wesley Lyon: hey, we want to do this and we know how to do it better than you do. (24:05):
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Wesley Lyon: We want to partner with you. (24:10):
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Wesley Lyon: You've got to keep the patients happy, you knuckleheads. (24:11):
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Wesley Lyon: Like, so now we're at a point where a lot of these DSOs, again, (24:14):
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Wesley Lyon: we're not here to dog every single one of them. (24:18):
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Wesley Lyon: They do treat the patients with respect. They do want to make that patient experience. (24:20):
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Wesley Lyon: They realize that that's their key to success on making money is keeping patients very happy. (24:23):
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Wesley Lyon: However, we got to circle back. How do private equity groups make money, right? (24:30):
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Wesley Lyon: They build them, make them more profitable, and then they go to sell them to (24:36):
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Wesley Lyon: more money. That's their end game. (24:39):
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Wesley Lyon: You don't know who they're going to sell to. In that part of it, (24:42):
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Wesley Lyon: I remember we had a doctor who's going to sell to a very, very reputable group, and he did. (24:46):
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Wesley Lyon: The group had a stellar reputation. Doctors are all happy. (24:51):
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Wesley Lyon: It was an exciting thing for him to do. And he was worried about this very thing. (24:55):
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Wesley Lyon: So he sat there across the table and he just looked at the guy and goes, (24:59):
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Wesley Lyon: well, what happens if your private equity backer changes? (25:04):
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Wesley Lyon: And to this group's credit, the guy just looked at him and goes, (25:08):
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Wesley Lyon: look, that's going to suck for me and you both. (25:12):
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Wesley Lyon: Because if they're going to do something like that and they're going to make (25:16):
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Wesley Lyon: us crank up you know, revenue probation or whatever it is they're going to go (25:19):
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Wesley Lyon: after, it just self-admitted, they're going to can me too. (25:23):
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Wesley Lyon: Like you're not the only one in that boat. (25:26):
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Mario Santiago: And it's pretty common, right? Based on all these articles we've read, (25:28):
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Mario Santiago: those groups change all the time. (25:31):
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Wesley Lyon: Yeah, they change. And when they do, sometimes they bring in new management (25:32):
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Wesley Lyon: teams. So you really got to think about that one. (25:35):
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Wesley Lyon: But yeah, there's a lot just going on in this world. And I'm, (25:38):
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Wesley Lyon: You know, I think big takeaways. Oh, I remember we're going to come back to. (25:42):
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Wesley Lyon: So that's going to be an interesting one. But big takeaways for you if you're considering it. (25:46):
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Wesley Lyon: Hey, we're not against it. Everyone should at least consider it and figure out, (25:52):
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Wesley Lyon: is this a viable option for me? (25:55):
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Wesley Lyon: However, most of you are going to discover that my practice is not actually (25:57):
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Wesley Lyon: worth a whole lot more to a DSO. They'll give me more upfront payment. (26:00):
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Wesley Lyon: Some of it will be in stock, though, I can't get my hands on. (26:04):
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Wesley Lyon: And then I'll have to work back for five years, give up the profit. (26:06):
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Wesley Lyon: And what we talked about in the first one was what they do is they straddle (26:11):
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Wesley Lyon: the businesses with debt and the businesses, you know, have to basically pay off their own debt. (26:14):
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Wesley Lyon: So what they're doing to your practice is they're straddling it with the debt. (26:20):
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Wesley Lyon: They're forcing you to stay and continue production. So the profitability stays (26:23):
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Wesley Lyon: and they're paying off the loan with your profit. (26:27):
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Wesley Lyon: And that's why it just, you look at the numbers most of the time, (26:30):
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Wesley Lyon: you know, unless your practice has characteristics that make it very sellable to a DSO. (26:34):
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Wesley Lyon: Most of the time, you're going to be better off keeping the profit for five (26:40):
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Wesley Lyon: years. That's what would have paid off the loan. (26:42):
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Wesley Lyon: Then you go to Dr. New, and they give you a nice number for it. (26:44):
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Wesley Lyon: It's not as nice as the DSO. I call it the dinner party number. (26:47):
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Wesley Lyon: You don't get the dinner party number, but hey, you still get a really nice number. (26:50):
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Wesley Lyon: To the positive that we've talked about on this podcast and elsewhere and really (26:55):
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Wesley Lyon: right here in this newsletter, if you're not getting this newsletter, (27:00):
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Wesley Lyon: you need to make sure you get it, all this information and much, (27:03):
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Wesley Lyon: much more for $300 a year. (27:06):
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Wesley Lyon: You get it delivered to your door, sit them on your desk till you read it. (27:09):
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Wesley Lyon: It's a must, must read. I was actually talking to a dentist yesterday. (27:12):
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Wesley Lyon: He wanted to know if he should come in for our tax and business planning. (27:16):
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Wesley Lyon: He told me he had done everything in this newsletter for the last 10 years. (27:19):
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Wesley Lyon: So I poked around, asked questions and he goes, are you impressed? (27:22):
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Wesley Lyon: And I was like, honestly, I am. And. (27:25):
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Wesley Lyon: I don't know that you need me. And, you know, he wanted me to take a look. (27:29):
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Wesley Lyon: Like, I don't know what I'm looking for. (27:34):
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Wesley Lyon: You're going to pay so much per hour per, so how about you just come to one (27:35):
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Wesley Lyon: of our seminars and make a decision and, you know, hey, you'll get a day, (27:38):
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Wesley Lyon: you'll figure out if you need it or not, but you might just get a pat on the back. (27:42):
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Wesley Lyon: So make sure you're getting this. If not, mcgillhillgroup.com slash seminars. (27:45):
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Mario Santiago: I think one of the biggest things I found, Wes, too, I don't know if it's the (27:50):
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Mario Santiago: younger generation, but you get all these email newsletters nowadays, (27:53):
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Mario Santiago: they kind of get lost in the inbox. And I've heard from a lot of young dentists (27:57):
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Mario Santiago: that they actually really like the print version that gets to their home. (28:01):
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Mario Santiago: They read it maybe at breakfast or before they leave versus just deleting a bunch of emails online. (28:06):
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Wesley Lyon: I may not do it. It drives my wife up a wall, but I get my newsletters for tax (28:11):
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Wesley Lyon: stuff sent to the house. Yeah. My wife's like, can you throw this away? I'm like, no. (28:15):
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Wesley Lyon: It's like, it's just on a pile. I'm like, it's in the pile because I'll throw (28:18):
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Wesley Lyon: it away after I read it. Yeah. (28:21):
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Wesley Lyon: But I have to read it. So make sure you're getting it because we really put (28:23):
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Wesley Lyon: all the details in there, all the devil in the details is in it. (28:26):
undefined

Wesley Lyon: But we talk a lot about what practices have the characteristics, what don't. (28:29):
undefined

Wesley Lyon: If you have the characteristics, this can be good. (28:33):
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Wesley Lyon: If you don't, though, in all likelihood, you're going to be better selling. (28:35):
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Wesley Lyon: But the entrance of the DSOs has actually raised the average sales price, (28:39):
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Wesley Lyon: which is really, really neat to think about. (28:44):
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Wesley Lyon: Dental practices, not to say they were undervalued, but the banks were putting (28:47):
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Wesley Lyon: caps on kind of, hey, what a practice could be worth. (28:51):
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Wesley Lyon: So, if you have one of these practices, like we just did one where the practice (28:55):
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Wesley Lyon: sold for about 125% of revenue. (28:59):
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Wesley Lyon: Now, on average, practices are worth 70% of revenue is what we've always heard. That's deceiving. (29:01):
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Wesley Lyon: Some are worth 20% of revenue. Some sell on a per-patient basis just because (29:07):
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Wesley Lyon: they're not that sellable. And others... (29:13):
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Wesley Lyon: Like this one sold for 125% of revenue, no questions asked. (29:15):
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Wesley Lyon: The buying doctor was so excited to get in there and buy it. (29:19):
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Wesley Lyon: And it's truly because she saw the cash flow of it. The cash flow justified the price. (29:22):
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Wesley Lyon: 10 years ago, out of your mind, if we were going to sell one for over 100%. (29:28):
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Wesley Lyon: These days, not a big problem. (29:32):
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Wesley Lyon: Banks are willing to play ball. They understand that, hey, if we want to stay (29:34):
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Wesley Lyon: in this market, we want to make these loans, we're going to have to keep up (29:37):
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Wesley Lyon: with valuations. Now, it's never going to be the same number you get from a (29:40):
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Wesley Lyon: DSO because then you're required to work back for five years. (29:43):
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Wesley Lyon: But that gap is getting bridged a whole lot closer than it was. (29:46):
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Wesley Lyon: So that's great news for everyone selling a practice. (29:50):
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Wesley Lyon: Now, again, it's not to say everybody's practice value went up. (29:53):
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Wesley Lyon: But if you've got one of these that are a target to a DSO, make sure you reach (29:57):
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Wesley Lyon: out to us if you're thinking at transitioning because, hey, that thing may be (30:01):
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Wesley Lyon: worth more than you think. (30:05):
undefined

Wesley Lyon: And some of that's going to be location-based, what the demand is. I mean, (30:06):
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Wesley Lyon: I hate to break this one to you, but if you're in the dang middle of nowhere (30:09):
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Wesley Lyon: and somebody comes and you want 120% and cash flow justifies it and they offer (30:13):
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Wesley Lyon: you 80%, 80% is going to be better than shutting the doors. Oh, yeah. (30:18):
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Wesley Lyon: But if you're sitting here in Charlotte and you're thinking of selling and the (30:21):
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Wesley Lyon: valuation justifies 125%, it's going to sell for that if it's justified. (30:25):
undefined

Wesley Lyon: But this will move into our last topic, something I found funny. (30:31):
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Wesley Lyon: This is an old Senate investigation. (30:35):
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Mario Santiago: Yeah, you're smiling way too much, Wes. I'm excited. (30:37):
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Wesley Lyon: I talk about this one. It's a risk. (30:40):
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Wesley Lyon: And I talk about this when people say, oh, well, this dental practice is going (30:44):
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Wesley Lyon: to go public. I go, it's not. (30:47):
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Wesley Lyon: I don't think any of these are going to go public. I could get proven wrong. I'm not world's genius. (30:49):
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Wesley Lyon: However, in most states, you have to be a dentist to own a dental practice. Mm-hmm. (30:54):
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Wesley Lyon: So if you know what the term friendly doctor is, it's the dentist that owns (30:59):
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Wesley Lyon: the corporation that doesn't receive any profits out of it. (31:03):
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Wesley Lyon: So these days, you're seeing a lot more of the models go in that the doctor (31:07):
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Wesley Lyon: retains 30% ownership, so they do it as a sub-DSO structure. (31:10):
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Wesley Lyon: I haven't confirmed why, but I'm thinking maybe the legal teams are thinking (31:15):
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Wesley Lyon: they're at risk because they've got a doctor's name on a corporation, (31:19):
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Wesley Lyon: but the doctor doesn't actually get any of the profits from it. (31:23):
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Wesley Lyon: So it's not truly doctor owned. (31:25):
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Wesley Lyon: It's just a mechanism around it. (31:27):
undefined

Wesley Lyon: And I think it was so it was Chuck Grassley. I know how to say his name. (31:30):
undefined

Wesley Lyon: We're going to we're going to botch this. So I do apologize for this guy from Montana. (31:34):
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Wesley Lyon: But there was a Republican and Democrat that did that. His first name, we got it. It's Max. (31:39):
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Wesley Lyon: Mario, best guess on how to say his last name. (31:44):
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Mario Santiago: I want to guess Max Bacchus. (31:46):
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Wesley Lyon: Bacchus. I think I'm going with yours. I was going with Bocas. (31:48):
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Wesley Lyon: But Max Bacchus, B-A-U-C-U-S. (31:52):
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Wesley Lyon: I don't even know if he's a senator anymore. (31:55):
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Mario Santiago: We can call him Max B. (31:57):
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Wesley Lyon: Yeah, Max B. I like that. He was a Democrat from Montana that got together with (31:58):
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Wesley Lyon: Chuck Grassley, a Republican in Iowa. (32:04):
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Wesley Lyon: And I have no idea. I think Grassley's still there. (32:06):
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Wesley Lyon: I'd never heard Max B's name before, though. So he might not even be there anymore. (32:10):
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Wesley Lyon: But they did this investigation, came up with a report, and their recommendation (32:14):
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Wesley Lyon: was for the states to start enforcing their own laws. (32:19):
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Wesley Lyon: And just said, you can put an end to this right now by just enforcing your own laws. (32:22):
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Wesley Lyon: So the reason these things aren't going public, which could impact that ability, (32:27):
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Wesley Lyon: is when you go public, you're subject to a lot of disclosures. (32:31):
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Wesley Lyon: Well, if you start having to disclose that you've got friendly doctors owning (32:35):
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Wesley Lyon: these things, but they're not really owners, (32:39):
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Wesley Lyon: do you open yourself up into a Department of Justice or a state investigation (32:41):
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Wesley Lyon: where they squash the whole thing and all of a sudden you're left selling them (32:46):
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Wesley Lyon: for pennies on the dollar? (32:50):
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Wesley Lyon: So that's a really interesting one. I'm not on that side of the table, (32:52):
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Wesley Lyon: which next time I see one of my private equity guys, I'm going to ask them what (32:56):
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Wesley Lyon: they think their risk is. (33:01):
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Wesley Lyon: I'm sure they think it's zero because they made their management fees, (33:02):
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Wesley Lyon: but I want to see if they actually think there's risk there. I have no idea. (33:05):
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Wesley Lyon: I'm not an attorney, but I just found that tidbit very, very interesting because (33:08):
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Wesley Lyon: you are supposed to be a doctor to own a dental practice or you're supposed (33:12):
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Wesley Lyon: to be a dentist to own a dental practice. (33:16):
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Mario Santiago: Wes, I think I told you somebody called in a couple months ago. (33:18):
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Mario Santiago: It was like someone, friend of a friend or something like that, (33:21):
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Mario Santiago: and they were just very interested in getting into dentistry, (33:24):
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Mario Santiago: and then I find out that they're not a dentist. (33:27):
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Mario Santiago: So it's like people are starting to get interested in this industry because (33:30):
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Mario Santiago: they think there's money involved and they have already figured out that there's (33:33):
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Mario Santiago: workarounds to the whole I don't have to be a dentist part of it. (33:37):
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Wesley Lyon: Yeah, that part's crazy to me. And to some extent, it's still going to work (33:41):
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Wesley Lyon: because you can't switch the public's minds. (33:44):
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Wesley Lyon: Like, you know, I don't know if you get these calls, but every time someone (33:47):
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Wesley Lyon: gets a big treatment, you know, they it's usually my wife's friends. (33:50):
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Wesley Lyon: They call her like, you know, what does your husband think? (33:53):
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Wesley Lyon: And every single time this phone call happens, they've gone to some corporate (33:56):
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Wesley Lyon: shop that takes every insurance. (34:00):
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Wesley Lyon: They've gone because they're insurance. And I'm like, no, no, (34:01):
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Wesley Lyon: you need to go see. Here's your doctors. Go see one of these. (34:03):
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Wesley Lyon: And some of them do it, but the overwhelming majority do not listen to me and (34:07):
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Wesley Lyon: will not go see a dentist that is fee-for-service. (34:13):
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Wesley Lyon: And one of the funniest instances I have is there's a book club in our neighborhood, (34:17):
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Wesley Lyon: All the Wives. And for those of you listening regularly, Tyler and I went to (34:22):
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Wesley Lyon: college together. He lives in the same neighborhoods. We hang out a lot. (34:25):
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Wesley Lyon: Him and his wife and my wife are in the book club. And once every other month, (34:28):
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Wesley Lyon: they get us all together together. (34:33):
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Wesley Lyon: And the Patterson sales rep that's actually in the building right down there, (34:34):
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Wesley Lyon: we can see it out the window. (34:38):
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Wesley Lyon: You guys can't see the window, but we can see it. He's there. (34:40):
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Wesley Lyon: So me, him, and this other guy are having a beer and he starts asking us what we do. (34:43):
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Wesley Lyon: And he's like, I never knew dentistry was that big. We're like, (34:48):
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Wesley Lyon: yeah, there's a whole world of industry around dentistry. (34:50):
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Wesley Lyon: And this guy just starts telling us the most ridiculous stories of getting mad (34:53):
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Wesley Lyon: at the pediatric dentist because he had to pay $100 out of pocket and now he (34:57):
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Wesley Lyon: went somewhere else and he chases this stuff around. (35:02):
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Wesley Lyon: And me and him tried to explain to him that, you know, your problem is that (35:05):
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Wesley Lyon: you're going places off of insurance. (35:09):
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Wesley Lyon: You need to pay the out-of-pocket fee. And I mean, we could not convince this guy. (35:11):
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Wesley Lyon: We're just sitting there like, you know, I asked him, I'm like, (35:15):
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Wesley Lyon: I thought it was interesting, a sales rep, like he sells dental equipment and supplies. (35:18):
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Wesley Lyon: And I was like, what do you think of it? He goes, I'll never go to an insurance-driven practice. (35:23):
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Wesley Lyon: Like, that's insane. Like, I know enough about it. I know these guys, (35:27):
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Wesley Lyon: I will only go to a fee for service dentist. (35:30):
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Wesley Lyon: We were laughing. I was like, oh, who do you go to? And I knew who it was. (35:32):
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Wesley Lyon: It's not who I go to, but you know, he had clearly with his knowledge, (35:35):
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Wesley Lyon: he had also discovered, yeah, absolutely not. I'm only going to the most reputable dentist. (35:38):
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Wesley Lyon: And you know, he's, he's working for Patterson. He's like, I don't know if he (35:43):
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Wesley Lyon: has dental insurance. I'm like, no, my kids, everyone, like we don't mess around on that. (35:45):
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Mario Santiago: Well, just think about it this way. We've been reading these articles about (35:49):
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Mario Santiago: people getting nine more crown than, than they need. (35:51):
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Mario Santiago: Well, what if you just paid an extra 50 bucks or a hundred bucks, (35:55):
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Mario Santiago: whatever, to go see an independent opinion and then you didn't get recommended (35:59):
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Mario Santiago: those things. So it actually might be cheaper. (36:04):
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Wesley Lyon: Oh, it's definitely cheaper. I've been down that road. (36:06):
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Wesley Lyon: Like I will laugh, my dentist, and I might've said his name on this podcast a few times. (36:09):
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Wesley Lyon: I love my dentist. He's phenomenal. But (36:16):
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Wesley Lyon: you know, I go in there last time and I, you know, now that I'm in there, (36:19):
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Wesley Lyon: I kind of look, I'm like, Oh, that's a hole in my tooth. (36:22):
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Wesley Lyon: And, um, he's like going through, he's like looking good and he hadn't finished (36:25):
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Wesley Lyon: yet. I was like, no, you're not there yet. I got a cavity. (36:28):
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Wesley Lyon: He's like, no, I think you look good. And he goes like one more tooth. (36:30):
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Wesley Lyon: He feels the hole and he goes, Oh yeah, you got a cavity there. I'm like, yeah, I saw it. (36:34):
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Wesley Lyon: He's like, you know, not a big deal. It's whatever out of pocket. (36:38):
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Wesley Lyon: Uh, you know, I can't quote exactly what it was. (36:41):
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Wesley Lyon: I think I paid him like 250 bucks to fill a cavity. And I'm like, (36:43):
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Wesley Lyon: I couldn't be happier than a guy trying to sit there as I'm telling him, (36:46):
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Wesley Lyon: there's a hole in my tooth. (36:50):
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Wesley Lyon: And he's going, I don't know about that. And he's like, okay, okay. (36:51):
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Wesley Lyon: Like that's the type of dentist you want to go to. You don't go to the person (36:53):
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Wesley Lyon: that, you know, they haven't even looked in your mouth yet and you got four (36:56):
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Wesley Lyon: holes. They're just going to find out which ones they're going to see. (36:59):
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Mario Santiago: That was one of the examples of one of the patients, you know, (37:02):
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Mario Santiago: they got recommended something like that. (37:05):
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Mario Santiago: And she was like, how could you tell? You didn't even do an x-ray or you didn't (37:07):
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Mario Santiago: do this. You didn't even look in my mouth. (37:11):
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Mario Santiago: And he was like, oh, I just know. And she trusted him. (37:12):
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Wesley Lyon: So, and I think in this story, she went and got a second opinion and the dentist (37:16):
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Wesley Lyon: told her, no, there's nothing wrong with your mouth. (37:20):
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Wesley Lyon: And her immediate reaction was, can you please look again? And he had to sit (37:23):
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Wesley Lyon: down with her and be like, yes, I'll look again, but there's nothing. (37:26):
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Wesley Lyon: And they even had the x-rays in the article and they had the Harvard dentist (37:29):
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Wesley Lyon: review it to see what he found in the x-rays. And he couldn't find anything. (37:33):
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Wesley Lyon: So it's a little bit of a wild world. (37:38):
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Wesley Lyon: So big takeaways though. I think we're getting up on our time here a little (37:41):
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Wesley Lyon: longer today, but this is a topic we get pretty excited about. (37:45):
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Wesley Lyon: Big takeaways, though, you know, hey, look, we're not against selling to them. (37:48):
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Wesley Lyon: A lot of people might get a lot more money. (37:52):
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Wesley Lyon: And if it's going to financially change your life meaningfully, (37:53):
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Wesley Lyon: you definitely need to consider it. (37:57):
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Wesley Lyon: However, you need to be very, very careful, know who you're selling to. (37:59):
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Wesley Lyon: You know, don't sell to a group that is going to screw you over. (38:03):
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Wesley Lyon: Make sure you have somebody that can guide you sell to a group that you're going to be happy with. (38:06):
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Wesley Lyon: Like I said, we probably tell 90% of people that call up here thinking they're (38:11):
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Wesley Lyon: going to sell to a DSO, that they're not selling to a DSO. (38:15):
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Wesley Lyon: So make sure that you know if it's right for you, but also you've just got somebody (38:18):
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Wesley Lyon: good that's going to guide you. (38:22):
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Wesley Lyon: You know, Jonathan and Wade here, they do all the guiding dentists to it. (38:23):
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Wesley Lyon: They do a phenomenal job. (38:27):
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Wesley Lyon: And, you know, they're the only practice brokers in the industry that tell 90% (38:28):
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Wesley Lyon: of the people, no, you can't do this. (38:32):
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Wesley Lyon: But when it is time to do it, they make sure they get people with really, (38:34):
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Wesley Lyon: really good talent that, hey, this group's going to work out. (38:38):
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Wesley Lyon: You're going to be happy here. (38:41):
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Wesley Lyon: But otherwise, very interesting things going on in the industry. (38:43):
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Wesley Lyon: And we are seeing it flip back to where this is more publicly out there and (38:47):
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Wesley Lyon: they're educating the public as to this. (38:51):
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Wesley Lyon: So hopefully that continues to happen because the more that the public is educated (38:53):
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Wesley Lyon: on the benefits of an independent doctor, the more the independent dentists (38:58):
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Wesley Lyon: are going to be able to survive and thrive. (39:02):
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Mario Santiago: Yeah, absolutely. (39:05):
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Wesley Lyon: Make sure, for those of you listening that aren't members of the McGill & Lion Dental Advisory, (39:06):
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Wesley Lyon: make sure you become a member because we actually have an hour-long video podcast (39:13):
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Wesley Lyon: that we do once a month, sometimes twice, and we go into all of the details (39:18):
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Wesley Lyon: in that. We're not hiding anything. (39:23):
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Wesley Lyon: It's super valuable information, $300 a year. (39:25):
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Wesley Lyon: You get it mailed to your house, plus you get access to the long-form video (39:29):
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Wesley Lyon: content where we don't hold back. So make sure you're subscribing to that. (39:33):
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Wesley Lyon: Otherwise, can't wait to be with you all next episode. Make sure you subscribe. (39:37):
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Wesley Lyon: Make sure you hit the like. Leave us a review if you loved it. (39:42):
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Wesley Lyon: If you didn't, let us know. (39:44):
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Wesley Lyon: Please don't blow us up, but hey, let us know. You can always email or call in. (39:47):
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Wesley Lyon: We would love to hear from you if you have any topics, anything that we want to cover. (39:52):
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Wesley Lyon: Actually had a subscriber yesterday tell me, hey, could you do a series in your (39:56):
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Wesley Lyon: newsletter on how to retire early? (40:02):
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Wesley Lyon: Yeah. I love that feedback. He's like, you don't have to. I'm like, (40:03):
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Wesley Lyon: no, if that's what you want to hear about, that's what I want to write about. (40:06):
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Wesley Lyon: That's what we want to talk about. So we always love to hear your ideas. (40:09):
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Wesley Lyon: We're doing this for you, nothing else. So please let us know anything we can do to help. (40:12):
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Wesley Lyon: Otherwise, we'll be back next time. All right. (40:19):
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Mario Santiago: Looking forward to it. (40:21):
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