Episode 483: Tips to Expand Your Practice

We all like to stretch our wings … Are you considering going bigger for your practice? This episode includes key information for practice expansion. Kiera goes into what to consider, how to get creative with space, how to inexpensively outfit an operatory, and loads more.

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0:00:05.6 Kiera Dent: Hey everyone. Welcome to the Dental A Team podcast. I'm your host, Kiera Dent, and I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants, where we have traveled to over 165 different offices coaching teams. Yep, we don't just understand you, we are you. Our mission is to positively impact the world of dental, and I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress and create A teams. Welcome to the Dental A Team podcast.

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0:00:51.3 KD: Hello, Dental A Team listeners. This is Kiera, and I hope you guys are having a fantastic day today. I am actually headed home. I have been with my family for the last couple of days, and you guys know I tend to do a nice drive between Reno and California to see my parents. I'm actually driving back, we're carpooling back today. I've got my sister headed to college, my brother and sister-in-law headed back for college, my husband in front of me in the DAT truck. Yes, we bought a truck and we did put on our license plate, D-A-T truck. [chuckle] So that is kind of our carpool today. And I just decided, "Hey, I'm traveling by myself. Why not podcast with my favorite people out there?" So for all of you listening today, thank you. Thank you for being a part of our team. Thank you for being a part of our Dental A Team family. And as always, guys, if this podcast is serving you in any way, if it's giving you ideas, if it's helping you in your practice, if it's helping you personally, please leave us a review. Those five stars definitely help us out. They help more people find our podcast.

0:01:55.5 KD: Also, if you can share it with friends and colleagues, post it on social media for us. If you're listening to us, I'd love to hear from you guys. And honestly, I know it sounds silly. You're thinking, "Everybody else is doing it," guess what, everybody else is not doing it. So this is going to you, so please help us out, guys, our goal this year is to definitely go after over a million downloads, and so I need your guys' help to get there. So please help us out, share, download, help other people. Our goal at Dental A Team is to positively impact the world of dentistry in the greatest way possible. So really that's kind of our mission and you guys are all here to help us out. So with that in mind, today I wanted to go onto a fun topic of expansions. I've got a practice right now, expanding her practice, I've got several other people are just expanding. I think a lot of people are outgrowing. I think with COVID we had a lot of practices go out of business, and so a lot of practices are expanding due to doing better dentistry, doing better Google Reviews, SEO, all those different pieces.

0:03:03.5 KD: And so having a way for you guys to expand. And so I kinda wanted to just go through some pieces that I've seen work well in other practices that are expanding. And so first and foremost, are you expanding in your current location or are you gonna be expanding somewhere else? I think that's a big deciding factor. If you can, guys, expand in your current location. I definitely took a practice and we went from our location, excuse me, that we were at, and I had to move an entire practice about two miles down the road. Now, that might not seem like a big deal. However, for the next six to 12 months, I was on every voicemail telling patients where to go, trying really hard not to have any of them go to the wrong location. I had to have big signs. We were super fortunate that the place that we did move out of, I was able to leave signs there. But bottom line is, it was just a lot for us and so if you don't have to do that, awesome, stay at your same location. I do have a couple of practices who've been able to expand and they've been able to expand right on their plot of land, if you will, so if those are options, I would definitely search there before you go and expand somewhere else. If you can add...

0:04:12.6 KD: I was actually at a practice, I remember I walked in and they told me, "Kiera, the number one thing we're struggling with is space," and within 10 minutes of being there, I already had found space for two more operatories. One spot was in the break room, actually, I know, didn't wanna give it up, but there was space upfront. And so there was already plumbing in there, so we were able to put it up there. And then also doctors' offices. We were actually able to... There was a bathroom there, so plumbing right there. And we were able to put it there. Doctors' offices were able to go up front. I actually had one office where we turned their doctor's office into their spot, and they were able to put a tiny house actually outside of the practice, wired it, had a phone out there, and that's where they were able to go. So again, getting creative with your space, I think, is something to look at. And so if you're looking for maybe just look or have a friend come and look to see... When I go into a practice and I'm looking for a space to add another operatory, I'm looking for plumbing, I'm also looking to see, could I possibly put a hygiene op in there, which doesn't take as much space as a doctor op, because that's going to be able to be something I could flip into a quick hygiene op.

0:05:21.5 KD: Sometimes people have really uncomfortably large waiting rooms, especially with COVID, we're not using those waiting rooms as much, so could you maybe get by with a smaller space in the front room and have maybe hygiene right there. So a lot of people... That's one of the things I love when I consult is going into a practice and looking to see where could we actually get creative within this space we already have. I'll be completely honest, you can outfit an op very inexpensively in your own practice a lot cheaper than going to another location. And let's just be real, if we have one of those ops, let's say it's a hygiene op, hygienists tend to produce about a thousand a day on average. Let's say you're open for 12 days a month, let's be very conservative, that's 12 grand in the first month that that op is going to produce. So kind of just looking into... And that's, again, on a very conservative side, you could probably get it to produce more than that, but just looking to see, could we do something like that in our practice?

0:06:18.7 KD: So like I said, this office that I went into, they had four ops. Within my first 10 minutes found space to put two more ops and within I think three months of my visit, they had already added another op running a third column of hygiene, and we also had used it for another column of doctor that they were able to start producing immediately out of that. We were able to use Dansereau. Dansereau chairs are one of the least expensive chairs, so if you're thinking about building another operatory or another practice, I might consider going on a cheaper but nice end, if you will, and really utilizing that right now, just because that can be something where you can get through and think of how much in the course of a year that op could produce for you before you have to have the expense. Also, it's going to pay for itself, it's going to build revenue for you that you could then put into savings or down payments or whatnot for your next building, so really just getting creative and looking in your space that you already have. I also look for any area that I could pull plumbing, so if there's bathrooms or there's a kitchen or there's a sink anywhere, maybe it's in our break room, could we turn that into an operatory?

0:07:29.5 KD: And I will say a lot of people are concerned about getting rid of those break rooms for their teams. In my first practice I had, we had a nice little hallway for our team, and we made it super nice. We had a fridge and a microwave, but that's all they had. We had lockers back there. And I will say most of the time team members are really frustrated by not having space, and so, if you chat with them, most of the time, again, this is most, not always, but most of the time, they're usually willing to give up their space and to be able to have another operatory in there. So this office that I'm referring to where we added it, yes they lost their break room, but we were able to put them up in the front, they all hung out there anyway, I noticed that when I walked in, and so I would just say really get creative with your space. Look to see what could you do in your space. It doesn't mean you have to, but again, what could you do? So Dansereau are really cheap, inexpensive chairs, also go to Home Depot, they've got those great tool boxes that you could actually use as cabinets in the back, so you're not having to actually outfit cabinets in that operatory. So you can get really, really creative.

0:08:32.4 KD: You can also use... I really love the NOMAD X-rays, that way you can have extra units that don't cost a lot, and then when you're building another location, these things are all things that you could take into your next practice space. So really inexpensively outfitting an op, still looking very nice, very chic, but something that you could do, again, to help and serve more patients, generate more revenue, and get your team on board, have them look creatively. So it could be a team meeting where we look to see what could we do. I often think that people within a practice are sometimes a little too close, so [chuckle] look at it, if you will, from the eyes of Kiera Dent. Pretend I'm coming into the practice, what space could I see? And really, I've seen some very tight hygiene operatories put into play where as long as that chair can recline. I also have another practice where they are using... Because it's hard to get chairs, they're using actually a barber chair. They turned a small space, they were able to take one of their ops and turn that more into a producing op and use a very small space with a barber chair for deliveries, for whitening impressions or scans, for ortho, because it didn't require any instruments or drills, and so just, again, getting creative like what is in there? Could you do sleep apnea possibly in a space that doesn't require a hand piece? Could you have a lab where you do have a hand piece and we could do adjustments there?

0:09:55.7 KD: Maybe not as ideal, however, could we actually start maximizing an op that we're using for a lot of limiteds if we had a nomad. So just kind of getting creative in your space. I think so many people... You guys, I'm the same way, I like it to be ideal, I like it to be brand new and flashy and shiny, but I also think we often miss opportunities. I've got a lot of people that have three op practices. Could you add another op anywhere? Could you maybe if you've got an upstairs, could we move everybody upstairs? Could we maybe move some of the business? The business people upstairs, and that way we're able to open up another space for ops? So I love going into practices. If you guys want us to pop in and just kinda give you some ideas, please always email us, [email protected] I absolutely love going into practices looking for getting creative with where I can put even more parking outside.

0:10:48.4 KD: Sometimes people are concerned about expanding in their current location due to the parking. And so with that, I say get creative on that as well. Are there maybe buildings around you, stores that you could actually rent parking spaces or have certain ones that are set up for your practice? Maybe you give that store owner free dentistry or there's a thousand different things. Like I was at another practice and next door was a storage unit. I thought, "Let's be real, their parking lot is probably not used very often, it's a storage unit. Could we use some of those spaces? Could we put our team members there?" I know at one of my practices, we had it where we were going to shuttle in our employees so we could park people further away and then shuttle them in that way we could have our employees not there and could have more space for patients.

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0:11:38.0 KD: Hey, Dental A Team listeners, how was your 2021? Have you reflected back? Where did you really win? Where did you really not win? If 2021 was a year of years, congratulations, I am celebrating with you, and I would love to invite you to take it to the next level. If 2021 wasn't quite your year, hey, it's alright, I'm there for you, and I would love to invite you to make 2022 the year for you. That's right, guys, if you're ready to take massive action, if you're ready to take your practice and your team to the next level, increase your profitability, yeah, guys, through an easy way, get your entire team aligned and you're ready to just have your life be different. That's right, team development, top to bottom, system development, top to bottom, changing and shifting your culture, improving your team morale. If that sounds like what you're interested in, guys, I'd love to invite you to join us in our Dental A Team platinum group. It's the exclusive group where we physically fly to your practice, we give you insider tips, we share with you, we have a quarterly newsletter that goes to you that shares all the updates we're coming up with and we share it with our platinum group.

0:12:42.6 KD: We'd love to have you and I would like to invite you because, guys, remember, you're always one decision away from a completely different life. So reach out guys, I'd love to chat with you, I'd love to see if you're a great platinum client or what works best for you. Email me, [email protected], and I can't wait to welcome you as our newest platinum client. Take massive action. This is your year. Let's make sure 2022 is your year. [email protected], can't wait to welcome you.

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0:13:09.2 KD: So I guess the overall message that I'm trying to push through... I know I wanted to talk more about if you are expanding, and I will get to that, but before you even jump into buying that new space, I would just encourage you to look and to get creative and see what resources you do have there, and maybe that's a full on brain dump, [chuckle] let's just dream about this dump versus it being something where we go full on and have a brand new space. Now, yes, there are massive perks to having a brand new space. There are also a lot of perks, this office, their office is not going to be... They're not going to be able to have it there until after... Their building is gonna take about a year, so we add two more operatories. Think about, again, like I said, 12,000, that's 24,000. Let's just do some easier maths, let's bump it up to 25,000. If you think about that, we've got four quarters, that's 100 grand per quarter right there. Excuse me, 25, we've got three sets of four guys, there you go. So it's 300,000 that we're able to produce with just those two operatories in one year. So just thinking about that, I mean, one, serving way more patients, and two, that's 300,000 out of two operatories that we can get into play in a year's time.

0:14:29.9 KD: Much easier way to do this. So, and we're able to then build... A nice thing about that is you're usually going into a much, much larger space, you're gonna wanna have that filled up with patients. So if I can bring in two more operatories before I expand to, say, six, seven, eight, nine, 10 operatories, definitely a benefit there because we're building up that patient base while we're working, while we're building our new space, able to have more patients there, so we're able to fill the new space faster and easier than going from, say, four ops to 10 ops. Well, that's a lot more patients than we're trying to do. So with that said, just some things to keep in mind getting creative there. Now, if you are expanding to a new location, I'm definitely happy to look over some plans for you guys, give you guys any input that I've got. I am no expert on this, I've just seen a lot of practices, so always happy to give some insights if you'd like us to look over any of those architecture plans. Really thinking about... One of the biggest things when you are expanding to a new location is think about your flow, check-in/check-out, because the check-in/check-out desk is always one of your busiest areas, and so I love to be able to catch practices before they design this whole thing.

0:15:36.9 KD: Because if you can have separate entry doors, especially for these larger practices. Most of the time we have smaller practices, these smaller practices are going to these larger practices. And something that the smaller practices haven't ever experienced going to larger practices is having more patients within their practice. Well more patients means more foot traffic, which means more check-in, more check out, more phone calls. So if you can get very creative looking at that of, "Okay, what exactly do I want?" You guys, I'm super pro. If you could have a check-in door and a check-out door so you can flow it that way, it's going to cut down drastically, and it's going to make a much better front desk check-in/check out experience for your patients. Also, I love to set up three little bays for check-out desk space because you're going to have a lot more, so three, five, six, seven, whatever you can fit in, it doesn't even have to be crazy, it can just be within that area.

0:16:29.2 KD: But those things can really, really, really help your practice as well. I'm big on... I love breakaway practices, I think they've got a phenomenal style. There's several others, Jayme Amos is great for startup practices, but really being able to just kind of think about how are these patients gonna be going in. If you can have a sterile that's a walkthrough. And then I know in some of my larger practices, I really am picky. I'm real, real picky on a flow of traffic, so just like we have on roads where we flow traffic certain ways, making sure patients can flow in and out. So again, it might not make sense because hygiene is just right across the hallway, but flowing all the patients, so there is a one-way traffic of taking patients in and taking patients out, you'll notice much easier for your front desk team, also a lot better experience for your patients and also for each other. I say just get those steps in, [chuckle] get a Fitbit or whatever you need, so you get more steps in for your day, but watching that. So as you're building this expansion, look to see, I would say that's probably the number one thing that I'm picky on in practices when they are expanding is get smart with your check-in/check-out experience, because as you get bigger and you have more operatories, it gets funky.

0:17:40.6 KD: Also looking to see, as you're expanding, "Can we add in in our smaller practice before we expand to our larger one? Can we add in check-out in the back? Can we add in payments in the back?" So hygiene being able to take payments for simple things like fluoride and SRPs, nothing crazy town, but being able to take those simple payments will cut down drastically on the amount of traffic going up to the front desk. So you guys know I'm a huge proponent of Modento. I think their forms and treatment planning is fantastic. So can we start practicing in our smaller practice chair side treatment plans with our clinical team taking payments in the back office? And I get it, a lot of clinical team members think, "Kiera, don't have us do more work, we're already so busy." And I say, "Absolutely, you guys know I'm pro. Let's make your lives easier. Let's make the patient's life easier." And so in doing this, the reason I'm very pro you guys having this in the back is because it actually cuts down your wait time in the front office. It cuts down your wait time with your patients having to wait for check-out. And also, it just makes it faster for the clinical team to be able to flip their rooms.

0:18:45.6 KD: So ensuring that you guys have that is something I'm always pro for you, so being sure that you think about those items too, of could we be doing that in our smaller practice, before our larger practice is put into play, preparing for that. Also, if you're going to have... I am... [chuckle] I'm big on going at least 10 ops. The reason being is if I'm going to have two doctors in there, I want each doctor to have, typically, we say at least two hygienists per doctor is my average that I like to have. So right there, I want at least four hygiene chairs, and then each doctor in there, I want them to have at least three doctor chairs. That way I have got two, technically, overflow chairs, so if I wanna have, let's say five columns of hygiene, I've got an extra chair, and both of my doctors are able to have a minimum of two chairs with those two extra overflow chairs. So I really like 10 op practices, if you're going to go there. Beyond that, you can absolutely do that. I've seen 18, 25, 36, they would just become monstrous on the amount of team members that you have, which, again, is totally fine, versus having smaller ones. I really love that 10-ish. Again, this is Kiera Dent's opinions of what I've seen work well for teams and patients, but again, there's a thousand different ways you can do this really well. I say pick what you wanna do and do it really, really well.

0:20:06.9 KD: Also, some tips on expansions that I found is we think that we're going to be done, say, in six months. So what do we start doing? We start filling the schedule because we're so excited, we wanna make sure we're using those ops. I can't tell you how many practices have filled those chairs and had to call those patients and reschedule because guess what, guys, construction is rarely ever on time. So I... This is Kiera Dent's opinion guys, so I'm just gonna give it to you of what I've seen with hundreds and hundreds of practices that I've worked with, I'm actually not pro-filling the schedule until you get those chairs actually there. I know that sounds scary, I know that sounds like, "Ugh, I don't really wanna do that." But the bottom line is, guys, if you can wait until, yes, you can get those patients, but a lot of times we start marketing because we want the marketing in place to have those chairs filled, but when you have to constantly re-schedule patients because your construction is not done, that actually makes a very poor patient experience and so just making sure that I found it typically is best to start to fill those operatories once you actually have it done, or you know your permits will be done, start ramping up your marketing 'cause if you market it too soon, you're trying to fill all these new patients into your smaller space preparing, but it can actually backfire on you.

0:21:23.3 KD: So there is a sweet spot, it's very tricky to get that ideal sweet spot, however, I've just found wait until construction is actually done before you start filling those chairs. That tends to be a much easier path for you to go on, something easier for you to take on. And then other things, so that's typically when I'll start doing marketing. I've got some great marketing companies, if you guys want some help with that, email me, [email protected] I'd be happy to share those companies. And depending... And I'm not gonna put them all out there. There's some great ones, like Evan Lazarus is great with SEO, we've got Grace Rizza that's helped quite a few of our practices. Ryan Gross is one of my absolute favorites for new patients. So again, depending upon the type of marketing you're looking for is really where this is going to be at for you. So with that said, that's kind of how I like to set it up. Also maximizing what are those ops going to be for.

0:22:16.5 KD: Also looking to see, where does it make sense? Could you create doctor pods? So maybe getting the hygienists closer to the doctor operatories, that way you can get doctors to the exams faster versus putting all hygienists in one area. Those things really can make a big difference on, again, the flow of your practice. The number one thing I am called in for consulting is help with... You guys having help with your communication, and second would be the flow of your practice. So those are the items that I would say are really the number one and two things. So if you can be smart on your flow and just know no matter how great you do right now, you're also going to have issues because we'll forget things, we won't think about it. You'll get in there and be like, "Oh, this didn't work out as well," and that's okay, but if you can think through some of these things faster and easier, it's going to help everybody out. So just wanting you guys to keep that in mind thinking about those items from the get-go versus later on.

0:23:18.2 KD: So those are kind of some of my tips for you guys for expansions. So try it out. If you guys have any other questions, this is what we do consulting-wise, really working through a lot of these different areas: Where do we get the best supplies? How do we outfit this? What have you seen in other practices, Kiera? What are some of the best things to do? Those are some of the best things that I would say. So guys, reach out. I'm excited for expansions. Get creative in your current space. What could you do now that could help out? A lot of different tips and tricks for you guys as well. And as always, I'm always happy to help you, so email us, [email protected] Get ready for those expansions, help more patients, benefit your community better, serve those people that you're around, serve your team members. And as always, thanks for listening. I'll catch you next time on the Dental A Team podcast.

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0:24:07.7 KD: And that wraps it up for another episode of the Dental A Team podcast. Thank you so much for listening and we'll talk to you next time.

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