Episode : Looking Ahead: __% of the Market Will Go DSO

Podcast Description

Kiera is joined by Ryan Isaac of Dentist Advisors to dive into DSOs. They discuss such questions as: Are they the best financial choice for your practice? The best life choice? Are the horror stories true? And so many more.

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Transcript:

Kiera Dent (00:00)

Hello, Dental A Team listeners. This is Kiera and I am freaking jazzed for today's podcast. It has been way too long. Me and this guest talk quite often on like life and personal and business, but podcasting it's been a hot minute. I've got Ryan Isaac from Dentist Advisors, my personal advisor, one of my dearest friends. I think we're siblings in another life. Ryan, welcome to the show today. How are you?

 

Ryan Isaac (00:07)

Mm-hmm.

 

Thank

 

Thank you.

 

I'm really good. just realized I was trying to hit mute and cough, but I hit like a chapter marker instead. So there you go. To your listeners or your ⁓ editing team, then there's a chapter marker while I'm coughing. So in your intro. Yeah. Tis the season.

 

Kiera Dent (00:35)

You're welcome. Yeah, that's fine. I'm

 

okay with it. This is real life. We're sitting on, I mean, Ryan, you're sitting on the couch. I should get like my posh chair. I've been considering changing up my podcasting zone. Yeah, of course. All of us can see it. We're excited for that.

 

Ryan Isaac (00:40)

Hahaha

 

Can I show you? Can I just give you a little vibe check here? I mean, it's actually, that's

 

the ocean. I'm on a little summer getaway for a second. So yeah. Yeah.

 

Kiera Dent (00:54)

my gosh.

 

That's amazing. So that's Ryan's

 

life. Ryan's living his rich life over there. He's like truly. So, okay. If you're new to the podcast, Ryan is my personal advisor. Like truly he actually works on. We talk about my life. He's helped me make some really good decisions and not make some bad decisions. So I feel like financial advisors. My best advice is you gotta just find someone you trust. And I know Ryan is way more conservative than me, but cares about me as an individual so strongly. And Ryan, huge kudos to you.

 

And so we talk about it a lot, but something we talk often is like, what's our rich life? And I remember Ryan for years, you were like living in your van, truly driving to California all the time to be by the beach, because you love surfing so much. So it just makes me so happy to see that you are living your best life by the ocean. You're doing what you teach all of your clients to do of living their version of a best life. Something that we try to do in dentistry and dental team too, like, hey, let's help your business provide you the best dream life you want. So that's Ryan.

 

Ryan Isaac (01:36)

Yeah.

 

Thank you.

 

Yeah, yeah.

 

Yeah, thank you. And there's no there's no right way to do that. I mean, everyone has their own thing that's worth the money or worth spending on. We're just kind of joking around about this, too. There are people who will sit in ⁓ small rentals or apartments on millions of dollars because to them having lots of security and liquidity is more valuable than houses or everyone's got something different. But, you know, we're all we're all chasing it, hopefully.

 

Kiera Dent (01:57)

Catch y'all.

 

I think it's called the like emotional ROI and what helps you sleep at night in your financial world. So Ryan and I usually get on the podcast and we'll talk about finances. I mean, obviously dentist advisors, Ryan do a spiel. What is dentist advisors? Just so people know. I think you guys are financial advisors for dentists specifically. I'm not a dentist, but I can speak honestly, but a spiel. And then we're going to actually go like a hard left turn of what we're going to talk about today. Like really.

 

Ryan Isaac (02:26)

Ooh. Uh-huh.

 

Yeah. Thank you. ⁓

 

Yeah, yeah, our

 

on ramps coming up here really soon. We got to get over it. We got to get into the right lane. Dentist advisor started ⁓ almost A Team years ago now with me and Reese Harper. Shout out to Reese Harper. And yeah, we were dedicated to being ⁓ an independent fiduciary fee only ⁓ advisor for dentists to manage investments and give financial advice. Ultimately,

 

Kiera Dent (02:51)

Yep.

 

Shout out to Reese.

 

Ryan Isaac (03:17)

you know, a dentist path through school and debt and taxes and all the stuff they go through, ⁓ you know, buying a practice, building businesses. There's no reason why all of that should not pay off every it should pay off for every dentist. There is enough money to be made in dentistry. And so our job really and you kind of said this with the you know, in the intro, ⁓ I really do feel like just protecting my clients, you know, and that's a philosophy that we've.

 

built into our business. There's no reason why dentists shouldn't make it to the life they want and to the finish line financially. so, you know, ⁓ it's more about consistent, small, good decisions for long periods of time and avoiding like a few big mistakes that could derail you forever. So yeah, we have a custom financial planning process, ⁓ a lot of like reporting and data, and we just manage and track ⁓ dentist finances and make sure they end up in a good spot, safe and healthy and

 

Happy, hopefully.

 

Kiera Dent (04:15)

which I love about you guys, Ryan, and I really think you guys do a great job. And this is something you've taught me. And we have a friend who said a great quote that I feel should be your quote. I can't give it like, so you can take it and like make your version. But they said like regular investing is like vanilla ice cream. It won't make anyone jealous, but it always tastes good. And I felt like that's such a great way to look at how you've taught me how to invest. ⁓ At the end of the day, it's just a small, consistent thing. So I think Dentist advisors does really well. And Ryan, something you've done for me. ⁓

 

Ryan Isaac (04:24)

well. Okay, okay.

 

Mm.

 

Mm-hmm. Mm-hmm. Mm-hmm.

 

.

 

Kiera Dent (04:44)

Like it's so dumb, but I know you're watching me and I know like when I, like you're really not watching me, but I feel like you're watching me.

 

Ryan Isaac (04:49)

Yeah, well, let's

 

hold that disclaimer here for a second. I see your numbers. I see your accounts. I see your emails. Every time you save money, I'm like, Kiera, good job in the email thread. Gold stars. Yeah.

 

Kiera Dent (04:53)

Like, I know he's not, like, he watches my account for sure.

 

That's

 

all it is. And I just know having Ryan there where I need to send it in every single month of what we're going to invest. We've talked about the plan has been such a game changer for me. So that's why I love Dentist Advisors. And like we said, we're now like taking our off ramp because Ryan and I want to talk about DSO sales. I think this definitely implies to a financial advisor. We have a lot of clients that we send to Dentist Advisors. We work such hand in hand with both sides. Like we love what you guys do. You love what we do. It's

 

Ryan Isaac (05:19)

Mm-hmm.

 

Kiera Dent (05:30)

Truly like the best peanut butter and jelly sandwich or whatever your favorite. If you want this to be meat and cheese, peanut butter and honey, whatever it is, I think it's the best duo. Yeah, exactly. That is the best. Captain Crunch, but would you rather Captain Crunch or Reese's? Or.

 

Ryan Isaac (05:37)

Captain Crunch in 2 % milk, you know.

 

No. I would actually say

 

fruity or cocoa pebbles, to be honest with you. Or cinnamon toast crunch. Can we arrive there? Okay.

 

Kiera Dent (05:52)

We both disagree on that. So cool. Okay, can handle Golden

 

Grahams or are we like back to the s'mores run? Remember the s'mores Golden Graham?

 

Ryan Isaac (06:00)

Yeah, I do remember

 

the scores. How are we like not landing on the same one at all? What about honey butches of oats? Wow. Okay. ⁓

 

Kiera Dent (06:05)

It's okay. That's fine. I'm not like the biggest serial fan and I go through phases. I love Lucky Charms, but I'm not joking.

 

Those marshmallows give me the chills. Like I can't crunch into it without it being like full body chills. So I don't know. weird. But back on this. So we've actually had a lot of clients that are debating of do I sell? I sell to a DSO? And I'm like, talk to freaking Ryan.

 

Ryan Isaac (06:18)

Yeah, it's like biting Styrofoam. Okay. All right. Okay. Okay. Anyway. Yeah. Yeah.

 

you

 

Kiera Dent (06:32)

I don't know what you want to do for your retirement. I have no clue how this is gonna impact you with your taxes. I don't know all the stuff, but what I do know is I'm a freaking miracle girl, so we're gonna get you top dollar for your cell, but like let's talk DSO. Cause also like DSO to not DSO, like I don't know Ryan, there's a million things. So let's Rift. You wanted to talk about this. I love this. Let's do it.

 

Ryan Isaac (06:41)

Yes.

 

Yeah, yeah. Yeah,

 

well, and so you said something a few minutes ago about ⁓ dentist investments. And yeah, like our job is to help manage investment money for people ⁓ in a really long term kind of boring way, if we're being honest. But yeah, it's very yeah, it's just like it'll be there forever. Just let it do its thing. But the biggest investment any owner is going to have is their practice. And that is the thing

 

Kiera Dent (07:08)

vanilla ice cream ish.

 

Ryan Isaac (07:18)

is why you and a team is so important because the thing they should protect above everything is their practice investment, their business investment. There's nothing more impactful to a dentist's entire life and not just their money, but their entire lifestyle, probably their mental health, their wellbeing, where and who they spend their time with. So it is by far the most important factor in all of this. And so the world that we're in now is that

 

DSOs are an option to sell to, to work with, to become a part of. They are in some shape or form, you know, supposed to become the majority of the industry in the future. I think that's a broad category. think the category is more like group practice will become the majority of the industry. I'd love to hear what stats you've heard and what you actually see. think people talk about, you know, 60 to 70 % consolidation in the industry.

 

becoming some kind of DSO or group practice. ⁓ yeah.

 

Kiera Dent (08:19)

Yeah, I was actually at an AI conference with

 

that just literally this last week. And they said that they're estimating 65 % of the market will become in the DSL world in the next like five to 10 years. So I think a lot of people are expecting, which is so funny to me because I remember, gosh, I think I was Mark, this is a long time ago, we were at the dental college. And so we're probably talking like,

 

Ryan Isaac (08:32)

Uh-huh.

 

Yeah, okay.

 

Kiera Dent (08:46)

2018, 2019, I remember talking to the students, like, what do you think is gonna happen? And I'm like, I know I'm unpopular, because even Mark wasn't on board with this. And I'm like, I think I'm unpopular, but I'm pretty confident DSOs will be the future. And they're like, you're full of it. They're like, there's no way. And I'm like, I mean, I'm not emotionally invested in this, but if I look at what's going on, my husband's in healthcare. This is what happened to pharmacies. This is what happened to mom and pop shops, like for medical.

 

Ryan Isaac (08:57)

Mmm.

 

Yeah.

 

Kiera Dent (09:14)

I cannot think for one second the dentistry and with the EBITDA like offers that you're getting, it doesn't matter. And Jason, were talking about this the other night. I'm like, even if doctors want to have a legacy practice, that's great. You sell to this person, but this person now is younger. They have more debt and DSOs is like one bad day and this DSOs right on their doorstep. They're going to sell. Like it's just, I mean, you've got to some really strong guts around you to not think about a DSO. And I think DSOs,

 

Ryan Isaac (09:42)

Hmm.

 

Kiera Dent (09:44)

can often hit you at emotional times. Like Brian, you know me. There have been times that I told you like someone offered me a buck for Dental A Team, they could have it like one bad day. It's just like shirt. Like everybody has it in business ownership. So I think that that's where the DSOs are super attractive to people. But like I was talking to an office yesterday who's considering working with us and they're like have a one year buyout. And they're like, we're thinking about doing this DSO. And I was like, all right, but like what's your ultimate end game? What are you trying to achieve?

 

Ryan Isaac (09:46)

Mm-hmm.

 

yeah. Yeah. yeah. We all have those days. Yeah.

 

Kiera Dent (10:12)

you met with other people to talk about DSOs, there are other options and he's like, well, it's too big for these partners to buy. I'm like, well, it's actually not like there's ways for partners to buy you out if you want. think it's just, DSOs feel like the easy button, but I don't know if they're really easy. And I think that that's where I'm a little bit on the fence and I'm super jazzed for us to rift on. Is it really the best financial choice? Is it the best life choice? I don't know, Ryan, you know, the finances more than I do. just.

 

Ryan Isaac (10:14)

It's on.

 

Mm-hmm.

 

Same. Yeah.

 

Yeah.

 

Kiera Dent (10:40)

I do good job of helping people get their assets where they want them to be. So they have choices and options of what they want to do.

 

Ryan Isaac (10:42)

You do.

 

Yeah, so I think, you know, it makes a lot of logical sense, especially the way it started with DSOs, that it would have gobbled up a lot of the industry. Hearing 70 % made a lot of sense to me. Maybe we're just in a dip in a lull, which we totally have become, we've entered into that because of the, you know, the debt and rate situation that happened over last few years in inflation and, you know, just interest rates. Money got really expensive. It was hard for a lot of companies to grow across a lot of industries.

 

And, uh, but, and I, I'm, uh, I want to say these statistics correctly, uh, from smarter people than me in the DSO space. I think there's something like maybe, you know, 350 to 400 technical DSOs in the country right now. And I've heard in multiple sources that up to a third of them are in some kind of financial receivership right now. Meaning, and I know you've seen this with clients too. DSOs have grown and they purchase and they borrowed money and then

 

rates hit them and they grew too fast. They went ahead of themselves and they defaulted. And ⁓ there are some major DSOs, huge ones that I did not ever think would happen that went into default that are going bankrupt that are changing ownership. ⁓ People are losing their equity money, they're not going to get their payouts. ⁓ And they're they don't own their practices anymore. I mean, there, we have some clients in that situation. So

 

Yes to the consolidation in the future of that because of just that's the nature of economy sometimes in industries. And I don't know if it's going to hit 70. I don't know. It makes me wonder. ⁓ Those multiples are down a lot than they than they used to be. And they'll probably you know, they'll probably fluctuate, come back up a little bit more when money gets easier. ⁓

 

Kiera Dent (12:22)

I don't know anything.

 

Ryan Isaac (12:36)

Also, I think people are getting a little bit wiser to it. Do you see this? I mean, let's say three to five years ago, it was the most exciting thing to get an offer sheet across your desk and be like, know, some multiple of you, but this is insane, I'm done. I do find people way more hesitant and not as excited about that number anymore. What have you seen with that when people see those initial numbers?

 

Kiera Dent (12:47)

Made it.

 

think people are way smarter. think the grads coming out of school have been trained on business a lot more than say dentists 20, 34 years ago are trained and not to say dentists 20, 30 years ago weren't. I just think it wasn't like we weren't talking EBITDAs. You weren't selling like this. So you didn't there was no need for it. ⁓ And I think in the past, I think the reason people are more skeptical right now, Ryan, is because they're hearing the like horror stories coming through. So people are like, hold on. Maybe it's not as like

 

Ryan Isaac (13:12)

It's different. Yeah.

 

Kiera Dent (13:28)

rosy as it was. I honestly like DSOs might be a little bit of dentistry's dirty secret. Like there's a small piece of me feeling that way and not all DSOs I'm not here to blanket statement it, but I do think there's like, think the dentist is the one getting ripped off in the whole scenario. like, because Ryan helped me, this is where I, guys welcome. This is what Ryan and I used to talk about off camera, but I'm just going to like have the conversation here because I'm curious. So your clients, okay, so hold on.

 

Ryan Isaac (13:43)

Mm-hmm.

 

Yeah, let's do it. Yeah, huh?

 

Kiera Dent (13:58)

answer your question, no, they're not as excited about it. And also I think that they're being flooded with a bajillion offers. And so almost like overwhelm of who the heck do I have? Who do I trust? Who do I know? 400 DSOs out there. They're being bombarded every single day. I have heard dentists tell me they get four to five offers every single day of a DSO, which is why I'm like one bad day, you click open an email and like bottom, bottom, there you go. So I do think Bron and Man.

 

Ryan Isaac (14:02)

Yes.

 

Yep. Yeah.

 

Yeah, you're done. Like, yeah, that's the buyer. Yeah, take it. Yeah.

 

Kiera Dent (14:22)

Brandon Moncrief with Dental Transitions is probably the smartest DSO man I've met and I think you and I have circled. He's really brilliant on like who he knows offers that you can get like he kind of knows how to navigate the DSO world of what you want, which I think is awesome. But what I'm curious on Ryan. Okay, so you said you have clients. So when you sell to a DSO, there's lots of different makeups of how they can do these deals for you. But let's say there's I think the most standard one I usually hear is they pay you about 50 % of your practice is worth like you're giving it to them.

 

Ryan Isaac (14:24)

Yes.

 

Yeah, I still send people there. Yeah.

 

Mm-hmm.

 

Kiera Dent (14:52)

You also have them 50 % in equity in their business, hoping like with stock shares, hoping that it builds and that's like basically your payout. So it helps with tax. It helps with like future investments of the EBITDA. Those are the things that they're going to be dealing with. But my question is, so like your clients, they sold, they don't own their practices anymore. They're an associate there now ⁓ and they're getting paid. They don't have to do the management, billing's taken off of them, hiring, all that. But let's say these, so let's say I sold to Ryan Isaac DSO.

 

Ryan doesn't have a DSO just for clarity, but let's pretend I'm dentist. We got to make sure I don't want him getting in trouble. He's a financial advisor. So Ryan doesn't have it. okay, we're selling, okay, lies. We're selling it to Captain Crunch DSO. All right, let's just go safe. Captain Crunch DSO. Captain Crunch buys me. I'm now, I got my 50 % payout. have 50 % equity in Captain Crunch DSO and I'm now working as a dentist there, but I don't own my practice anymore.

 

Ryan Isaac (15:23)

Yeah, just so we're clear here. Yeah, yeah. I've highly regulated. Yeah, might be in trouble for that.

 

Kiera Dent (15:49)

Captain Crunch DSO is growing, growing, growing. Everything's looking good. I've got my stock in it. Captain Crunch loses its funding. They go bankrupt. What happens to me? Because odds are they go bankrupt. Another like lucky charms DSO is going to come buy Captain Crunch. Like they get a penny, dollar. What happens to me as the dentist when Captain Crunch goes under, but then lucky charms comes to buy me. How does that work for me as a dentist?

 

Ryan Isaac (16:02)

Yeah.

 

Yeah,

 

I'm watching that happen right now with a gigantic national specialty DSO with some clients. And what has happened is that their equity money is likely gone. So they got their payout money.

 

Kiera Dent (16:19)

Mm-hmm.

 

Even

 

with Lucky Charms coming in to buy it. My equity money's gone because it was with Captain Crunch. Do you love that I did cereal for you?

 

Ryan Isaac (16:28)

Thank

 

I love it. It's so good. And I'm trying

 

to like, like who's more evil in this hierarchy, you know?

 

Kiera Dent (16:35)

I think Lucky Charms isn't more evil. Lucky Charms is one who capitalized. They saw a dill. They don't care about the dentist. I'm not saying that they don't, but it's like hungry, hungry hippos. One goes out, someone's going to come buy it all. That's what they're going to do.

 

Ryan Isaac (16:37)

Who's more well capitalized? Yeah.

 

Yeah.

 

Yeah.

 

Yeah, this

 

would be such a good question for Brandon again, and I'll just second that every time someone has questions about deals, or they want to compare things, ⁓ or get to know the space a lot more, I send them to Brandon. So just find Brandon Monacree, if he's on all over the internet and all of our content. Yeah, there you go. So it depends on the structure of the deal. It depends on the fine print and the paperwork. ⁓ In the ones I'm seeing right now, these dentists

 

Kiera Dent (17:04)

dentaltransitions.com. Yeah, he's everywhere.

 

Ryan Isaac (17:17)

lot, their practices are not there. So their practices are still gone. And they likely are not going to they're definitely not going to get any return on their equity. Some of them depending on how early they got in might get their equity back or, or parts of their equity back. But a lot of it's just, you know, when another company when a big financial company comes in to save a bankrupt company, it's ruthless, you know, I mean, they're they're cutting and they're scrapping

 

as much as they possibly legally can. they'll do that, of course, because that's good business for them. So what I'm seeing, and again, I'll just say that it's probably different in every single scenario of this. But what I'm seeing is one that happens. ⁓ These dentists are losing their practices, they're not getting any return on their equity money, and many of them probably won't even get their full equity back. Luckily, some of my clients that I'm thinking of were in early enough and the fine print of their deals was good enough that they're going to get some of their equity money back.

 

Kiera Dent (17:48)

course.

 

Ryan Isaac (18:15)

⁓ that's it. They're done. So what really happened in that transaction was they got front loaded a certain amount of years of income, paid some taxes, paid off their debts and lost their practices and worked a job for three or four years at a very low salary compared to what they produce. ⁓ many of them got really burned out, bombed out, kind of lost their fire and spark for the work. ⁓

 

And they're back to square one. Some of them have enough money to be finished. What is interesting though is even the ones who have enough money to be finished are still contemplating starting or buying another practice where they can legally and doing like a really chill lifestyle two day a week thing. Really common. Other people will fully lose their equity. And in a situation, again, back to your point, a lot of people are

 

Kiera Dent (18:54)

and

 

Ryan Isaac (19:05)

Maybe it's not as excited about this. The multiples aren't what they were. Then they could come back. I don't know. A lot of people just say the longer this goes, the smaller the multiples will become, which is, yeah. No, we're definitely not. And so now we're talking about an offer where someone's coming to you to take away like your main, main asset, your cash cow, the biggest thing in your whole life. They're going to front load five or six years of income. You have to pay taxes and pay off your debt with that money first.

 

Kiera Dent (19:13)

which I would agree on that completely. I don't think we're half as high.

 

Ryan Isaac (19:33)

The deals that you mentioned, some are 50-50. I've seen them in thirds where it's like third buyout, third earn out where you have to keep producing and then a third equity. I've seen them 70-30, 60-40. They can really be any shape or size. ⁓ Yeah, but they're smaller. And so now we're talking about, you know, five or six years of front loaded income. You pay taxes, pay off your debt, and then you just hope that this company that bought you and essentially what's happening if you think about it.

 

Kiera Dent (19:48)

They really are.

 

Ryan Isaac (20:02)

You're taking like seven figures of money and you're putting it into a single stock. You're investing into a single stock and it's a very small privately held company. I know it feels safe and secure because it's your field, it's dentistry, know, all these things are, but you're taking seven figures of your money and you're putting into one single company where right now maybe up to a third of these companies are failing.

 

Kiera Dent (20:08)

Thank

 

Ryan Isaac (20:30)

It's not not a gamble, you know, and the whole kicker in all these deals, as you know, and your audience knows, Kiera is all in that equity piece. Everything else is just front loading your income for the next five or six years and taking away your ownership. And then, you know, really changing the nature of your career and your work. And it really does change people. It changes. And I'm not saying it's always for the worse, but it is change changes, teams changes, the patient experience changes, the culture and the vibe.

 

Kiera Dent (20:34)

huh. ⁓ huh.

 

Mm-hmm.

 

Ryan Isaac (21:00)

And so if that one little equity piece does not pan out the way that they say it's going to, ⁓ you know, that's the part that everyone's kind of wising up to. And if you're under, let's say, your late 50s, if you're younger than your late 50s, I think it's becoming a tougher decision for people to make. in late 50s or above, it's kind of like, I'm done anyway in three or four or five years. Might as well get top dollar.

 

even if the equity doesn't fully pan out all the way, it might be more than a private buyer. But even then, I've seen the math on a lot of things and like, it's close. And yeah, you've seen it all too. So yeah, it's tough. It's tough to watch the ones that fail. ⁓ Some of these, some of these, and you've probably seen, we're not going to name anybody, but you've probably seen them too. Huge practices, multi-location, huge DSOs that now...

 

Kiera Dent (21:25)

Mm-hmm.

 

Agreed.

 

Mm-hmm.

 

Ryan Isaac (21:52)

own these practices. And okay, here's a question for you. What do you think is going to happen, let's say 10 years down the road or longer, when all these DSOs have been bought by the next company and been bought by the next company? And then in the end, some like third and fourth party removed private equity firm, international private equity firms holding 10s of 1000s of dental practices around the country?

 

What is that like in the industry? mean, you're in the practice as you know that you're like in the heartbeat of that. What does that mean for the industry? What does that feel like? Does it feel weird?

 

Kiera Dent (22:27)

It does feel weird. And I think this is where I've been, I don't know, Ryan, you know me. just sit over here and think of ideas all day long. I've been like, how can we like, hi, I'm Kiera. I live in Reno, Nevada right now. It's like, how can some, I feel like I'm like Dorothy in Kansas right now. It's fine. It wasn't the destination, but it ended up being, it's fine. It's got really great. No state income tax. All right. That's really one of the main reasons we're here. It's not.

 

Ryan Isaac (22:42)

I like to write now by the way. Just a little shout out. like to write now. Yeah. Loud and clear. Yeah.

 

Yeah, fine. It's pretty in some seasons. There you

 

Kiera Dent (22:55)

But it's okay. We have Lake Tahoe. ⁓

 

Ryan Isaac (22:55)

go. Okay. Okay. All right. Okay.

 

Kiera Dent (22:59)

But only half of Lake Tahoe because California owns the other half. So it's okay. But I've thought about it. like, how can, like, it's like I'm Dorothy in Wizard of Oz right now. It's like, how can we somehow influence these private equity firms? And there might be no way. But these are the questions I think of often, because I do think if we're not careful, it will radically shift the way dentistry is done. And it will turn into a business rather than into our

 

Ryan Isaac (23:02)

Yeah, you're half.

 

Okay.

 

Kiera Dent (23:24)

our healthcare profession. I mean, I look at modern medicine, my husband's in it and it is a freaking drill machine. Like his number one thing was patient productivity and they had to have so many patients, otherwise they were going to fire providers. And their providers worked hard. They weren't getting paid what they like want to get paid. And so I'm actually watching in healthcare, lots of my friends in healthcare, nurse practitioners, doctors branch off and go open up their own practices because they're sick of working in modern medicine. So I'm like,

 

Ryan Isaac (23:24)

Mm-hmm.

 

Yeah.

 

Kiera Dent (23:51)

if we can look at modern medicine and see how the healthcare system has been working and how can we do something now as like you said, third, fourth remove private equity, owning all these dental practices, like is there a path? And I don't know, right? Like this is I feel like I'm like Dorothy sitting in Kansas of like how on earth can we influence it? But I'm like, if enough brilliant people start thinking this way, what can we do now to show that you can be profitable and ethical and still give great dentistry where we're not having to like,

 

Ryan Isaac (24:08)

Hmm.

 

Yeah.

 

Kiera Dent (24:21)

not running it like a private equity business, but still showing. so Britt was like, we need to become the Wegmans. Like, have you been like up north, like Wegmans is an amazing grocery store. They're not the biggest, but they still are ethical. And I'm like, if we even had a few private equity that's third and fourth removed that would still run practices that way, I think dentistry would still feel the same. Something else though, that I think of like new dentists coming in that I think is really paramount is you've got to look at the future of the industry. I think the current doctors,

 

Ryan Isaac (24:39)

Mm-hmm.

 

Kiera Dent (24:50)

that have been in dentistry have like safeguarded and kept dentistry like we're healthcare when we want to be and we're not healthcare when it doesn't benefit us. Like we literally have straddled the spine line. It's still a little bit of the wild wild west dentistry is not as regulated as far as like our fees and like what we're able to charge in every single practice and like insurance is schmuck. get it. But I'm like, you also only have $2,000 of max most of the time that we're dealing with rather than it being like a hundred percent of what your patient base is and like what the patients are paying out. So I'm like,

 

Ryan Isaac (25:11)

Yeah.

 

Kiera Dent (25:19)

I feel the pioneers of dentistry have actually done a really good job of setting it up to where dentistry is still very profitable. It's still able to be its own thing that I'm like, let's, again, I feel like I'm like Dorothy sitting on my soap box in the middle of prairie fields and saying like, hey, why don't we take a pause and just think of like, what's the future of dentistry as now the future pioneers of dentistry? And what are we going to do to our profession? Yes, there's top dollar. Yes, there's things about it, but is there a way to influence?

 

and make sure that the integrity of dentistry can maintain long-term. I have no answer to that, but again, this is Kiera Dent sitting on my podcast where I think that there is a voice and an influence and like on Dentist Advisors podcast, is there a way that we can influence our industry in ways that will protect and still pay out? Because I'm like, even if you don't get the 10X EBITDA, you still can get a freaking great payout if you do your life right to where you can be financially set up.

 

Ryan Isaac (25:51)

Mm-hmm. ⁓

 

Kiera Dent (26:17)

still be able to sell your practice, not have to sell it in ways that could potentially hurt the industry. I'm not saying one's the right answer or the wrong answer. There's no judgment on my side. It's just, let's maybe think and consider how it could influence. Can we get people that could be private equity higher up that could help protect it? Those are things that, and again, I'm just Kiera Dent here in Reno,

 

Ryan Isaac (26:22)

Mm-hmm. Yeah.

 

Same, okay.

 

Okay. Yes.

 

Kiera Dent (26:38)

Yeah, of course. And for everyone listening, thank you for listening and we'll catch you next time.

 

Ryan Isaac (26:37)

Thank you.

 

Kiera Dent (26:42)

the Dental A Team Podcast.