Scott Leune (00:00):

What does it mean to be a strong CEO and a practice? That's not actually what managing expenses usually is.

Richard Low (00:07):

The thing that surprised me the most was how much you talked about auditing.

Scott Leune (00:13):

They need to become the priority and the fruits of that are definitely worth it.

Richard Low (00:23):

Welcome to the Shared Practices Podcast 2.0 conversation today of a new series, a new sort with Dr. Scott Leune. Scott, welcome to the show. How's it going?

Scott Leune (00:34):

It is going great. I'm excited about this topic today. The dental CEO. Boy, do we need to talk about this?

Richard Low (00:42):

Okay, this is great. And it is going to be funny for me because at one point I was a dental CEO of a group of 30 plus practices and felt at times very unqualified to be so. And I think it's very common for a dentist, even in a single practice to feel unqualified or unclear what it means to be the CEO of that single practice. So I'm excited for the framework and to be able to dive into the different aspects of this.

Scott Leune (01:13):

And you know what? Let's, for the purpose of this episode, let's just assume we're talking about one location.

Richard Low (01:19):

Yeah. Let's make it easy.

The Path to Becoming a Dental CEO

Scott Leune (01:20):

Can we be a CEO, an effective CEO of one location? And of course if we have more than one all of those habits, that framework will be expanded to cover more, but we need to get the foundation set. What does it mean to be a strong effective CEO in a practice for one location? And I'm curious, you didn't just go to 30 or more locations, so what was that path for you? You started with how many locations that you were kind of overseeing and where did you go from there?

Richard Low (01:54):

Yeah, you mentioned in the last episode getting through this ugly middle of a smaller number of practices without enough profit to be able to have an organization and support adequate to support multiple practices in the growth of multiple practices. And so when George and Alex and Matt and Matt and Austin and myself merged our practices together, we had somewhere between 11 and 13 and sold a few within the first six to nine months, and were able to share the roles and responsibilities of an executive team between the six of us. And because we had enough locations, we were able to also start to hire and bring on really talented good people who were better at a lot of these roles than we were. And we could hand off here, here is this role, this piece, we trust you. You have the expertise and the experience.

And so that was the process for me. And part of that too was as founder of the podcast and as the founder of shared practices and where our partnership was at the time, that was the role I needed to take. And there was some hesitancy on my part of do I really want to be the CEO of a growing dental group? And I even said to my partners, depose of me, if I'm getting in the way of the growth of our group, please get rid of me because I care about what we're building. I care about you all and I don't want to hold us back. So there was some scale. We added 10 practices the first year, we added 20 practices the next year, all de Novos, which was some intense growth and there was a lot of scars and pain and some challenges and some amazing doctors, amazing teams, amazing opportunities. And despite having educated myself over years and years and years, being the leader versus learning about being the leader is always different. And it's unique every time. There's unique challenges, but I love frameworks that set us up for success and allow us to kind of piece together these are the major roles and responsibilities. Am I strong across all of these or is there an area I need to focus on?

The Three Pillars of a Dental Practice

Scott Leune (04:13):

Yeah. And maybe in your story when you have 20, 30 locations, maybe developing a CEO at the location is also part of this kind of solution, this vision. So this episode where we in the future ones where we talk about a dental CEO for one location is going to apply to the solo owner, it's going to apply to the DSO because in essence there are things that have to be done and decisions that have to be made, reactions that someone's got to have to the single location on site right now. And if we get reactionary primarily, then we're not really a CEO, we're more of like a fireman.

And so if we can have a framework, if we could have clarity on what do we do every day, every week, every month, what are we really kind of managing as a CEO, that gives us a lot of effectiveness and efficiency in how we spend our time. So I'd like to kind of introduce the concept of there's three big pillars to running a dental practice as a CEO, these three kind of categories. The first category is what I think everyone thinks of the first category I call operations. The operations. That's what we're used to seeing when we walk through the practice, how people answer the phone, present finances. Are we rea appointing 'em? Are we getting case acceptance? The operations, when we look at metrics tracking software platforms, they're mainly tracking operations, the day-to-day tasks and what's the result of those day-to-day tasks. The result is we collect money, so operations create collections. We probably need to have an entire episode on optimizing the operations of the dental practice as a CEO. I think there's people that have built their whole careers, their whole companies around that. We at least need to have an episode on that. But I view that as just the first pillar. I'm curious, when you were the CEO of multiple locations, were you in charge of that of operations down to the practice level or did you have a COO? Did you have regional manager who was really kind of putting their hands on operations?

Richard Low (06:37):

Both. So Dr. Macino was our COO and we had regional managers from day one. And for me in that role, it was more with the doctors. So I was responsible of managing our doctors and developing our doctors and helping our doctors learn and grow within their skillset. And that's what fell to me operationally as CEO.

Scott Leune (07:09):

Yeah, so that's one kind of pillar operations, but you kind of mentioned managing people. There's other, we're managing money, but operations, I'd like to, let's put boundaries around that. Call it one big chapter. And there are so many ways that operations can be managed as a CEO, maybe one third or one fourth of our job is to make sure that they are being managed properly. The second category is managing our financials. Specifically though we're managing the expenses. When you look at a profit and loss statement, nearly everything listed there as an expense. So when I think of managing financials, I personally am thinking of, okay, how are we spending our collections, the operations created, the collections, and then we've got these expenses. We need to manage those maybe as or more importantly sometimes to look at that than to look at the nuances of operations. And so that's the second category. And in a larger organization like yours, typically you'd have someone like a CFO managing the expense side, the financial side. Is that correct?

Richard Low (08:21):

Absolutely. And I'll say that I think for most dentists, especially at a single location, managing operations is more fun. So to sit down and have to look at and be responsible about where are we spending money and where is it going out the door is less exciting than figuring out how to increase top line collections, how to see more patients, how to introduce new systems and streamline the office. So I think the second one requires for most people, maybe a little bit more discipline.

Scott Leune (08:55):

And I think we think a lot of younger entrepreneurs who are doing this first time, they think of managing expenses as trying to figure out what to say no to, or do I need to switch from this to that to save a few pennies or a few dollars? That's not actually what managing expenses usually is. Managing expenses is usually the enforcement of budgeting, and sometimes it's the cutting, the permanent cutting of expenses. So like the single decision. So we'll talk about that. That should be a whole nother episode is how do you do that? So that's the second pillar, managing how we spend the money, the expenses. The first pillar is managing how we create the money that's operations. What could the third pillar be? The third pillar is managing people. Managing people. That is where you would have accountability inserted into your organization. That's where you would have frequent healthy communication put in. That is where you would also kind of put that idea of culture in there. And of course all the nuances of managing people in a large organization like yours that you built, you may have an HR executive that is overseeing a lot of those components. Is that what you had?

Managing Operations

Richard Low (10:15):

We did, but for a long time when it came to the doctors, specifically our executive team and me in particular, that was the primary responsibility. It was managing doctors. And it's amazing when you have 35 doctors, 30 of them can be phenomenal and they just need support and guidance here and there. They need some check-in and some accountability, and they do so much good. And then five doctors can be really struggling for various reasons. And the amount of time and attention and stress and firefighting that occurs for those who are really struggling can feel very unbalanced as a CEO, or at least me in this role of managing people. And ironically, I think our org structure suffered for a little while I was CEO and Alex Sharp was president, and much of the managing of the rest of the people felt Alex. And it didn't fall into a typical structure.

It was more like the executive responsibilities were spread across the six partners. And now that he is the CEO, it is much clearer and there is a cleaner hierarchy to know who is managing who and who reports to who. And in a dental practice it's very simple in that ultimately as the dental practice owner, as the dentist, you do manage everyone. And whether or not you have layers in between you and your different team members of you're managing the office manager who's managing this team or a lead hygienist or a lead assistant, really determines the granularity of that management and how much you're doing it personally versus delegating.

Financial Management and Expense Control

Scott Leune (12:05):

Well, I find this to be super ironic, this whole topic of managing people because when you go ask the people, when you go ask the people in the practice, do you feel like you're being supported? Do you feel like you're being heard validated? Do you feel like you've been trained, that people are communicating to you things about the business, about the practice, about benefits, they're addressing concerns? Oh, a whole lot of people would say, no, we're not mastering that in this organization. And then at the same time, you ask the leader, what's one of your biggest challenges? The leader's going to say, oh man, managing these people. And what happens is in organizations small and large, especially in dentistry, is managing the people sometimes took a back burner to everything else. It was the last position that was filled from the executive team. It was the last thing to get a budget to get investment in.

It was the last thing to get organized, and sometimes it never did. Sometimes we just kept growing anyway. And so we just manage people by just putting out people fires as opposed to building this kind of healthy organization where people are supported just like operations are supported, just like financials are supported. And I keep asking you about your large organization in part to point out the fact that in large organizations, these three pillars have a leader. They have a CEO of that pillar, they have an HR executive and a team underneath, they've got a finance executive, A CFO, and maybe a team underneath. They've got an operational executive, COO and a team underneath. And the CEO of a large organization is managing those pillars, those executives. When we go all the way down to a single practice location, we as a CEO have to be A-C-O-O-A-C-F-O and an HR executive.

People Management and Accountability

And luckily there's not a lot of operations happening compared to 20 or 40 locations. There's not a lot of people compared to 40 locations. It is not as complicated. So we can be all three, but if we're just a dentist cutting teeth and we haven't thought about how to be a good CFO or how to be a good COO, that means that we are also a reactionary CEO dentist owner. We become a victim of the business as opposed to a leader of the business. So to be a CEO of a single location or a huge location, we have to have specific habits, specific checks and balances when it comes to operations, checks and balances, when it comes to money specific habits, checks and balances when it comes to people, those habits, I view that as visually. I view that as the glue that holds it all together. Habits. An example of a habit is once a month I'm looking at my supply budget to see if we're on budget or not. And if we're over budget, I'm going to the person that was supposed to be on budget and I'm having an accountability moment,

Okay, that's a monthly habit. That means once a month for five minutes, I look at this thing and I have this meeting. A people habit could be I'm going to have a specific format of a morning huddle every single day, or maybe that's a weekly meeting or maybe that's a once a quarter strategic planning session with my team. But this habitually scheduled and habitually performed with this framework. It's like a people habit. Operational habit could mean that I'm going to perform an office walkthrough audit once a day to make sure that the operational components that I can see are actually happening, or I'm going to look at a specific metric, a specific number once a week. And that becomes a CEO style habit to manage those types of pillars or categories. And here's the beautiful thing, and this is how my slightly autistic mind works.

I work in outlines like lists, and if I can outline what I have to do, if I can put it on a calendar, I got to do these 10 things every day, these 10 things every week, those two every month to me that now feels very manageable, emotionally manageable, time manageable. And so we can actually do that. What is the job description of A CEO down to the list of tasks? Can we make culture a task, like manage people, just a series of tasks? Can we manage financials without needing to be financially astute, without needing to have an accountant mindset? Can we just say it's these eight tasks if we can? We've taken away a lot of stress and added a lot of predictability in how a single owner operator dentist can also be the CEO of that operation. Does that make sense to you?

The Importance of CEO Habits

Richard Low (17:17):

Absolutely. And I love this because we've talked about many of these topics in the past on the Shared Practices podcast and in particular we've talked about as you introduce systems and operations and checklists for your team, you would think that people really don't like that and that they're like, oh, resistant to checklists or real strong expectations. But in fact, we find that many people relax into their role when they have a clear picture of what it is to do, and they've got accountability and they've got a checklist and it's very unambiguous what they're doing. But very often, we as owner operators don't have this for ourselves. And so at times we almost want someone to tell us what to do. What is the plan? What is the formula? And when our coaches work with dentists, there is a very clear metrics driven, and here's where we need to go to drive your practice, and here are the systems that we need to work on now in order to grow next and eliminate each bottleneck.

But this is the role, the job description, the onboarding of the dental CEO, and it reminds me a lot of the first conversation you and I had on the Shared Practices podcast eight years ago. The thing that surprised me the most was how much you talked about auditing of what's going on in your dental practice and that being such a principle responsibility of a practice owner. But for some reason, dentists have a hard time auditing and auditing consistently and checking up and following up, and this is a large part of the role that you just talked about in these different pillars is we've established systems and now I need to have habits and patterns of auditing and checking in to ensure that we're doing what we should be doing.

Scott Leune (19:22):

Yeah, you don't need checklists when your job is to react to something that happens in front of you. You'll work all day long and you could be productive as a hygienist because patients are showing up and saying, clean my teeth. Right? You don't need a checklist, say, remember to clean their teeth. No, no, no. It's happening right in front of you. You're being told, you're being asked by that situation to immediately act. What's hard to do are the things that are silent, like auditing a phone call, no one's showing up saying, Hey, Richard, it's time to audit these next five phone calls. They're waiting on you. No one's waiting on you to audit them. The silent things are the things we really need to be organized and proactive about. We have to be putting them down on something like a checklist. So we build this life habit of doing those silent things that are so important.

If we look at all the positions in a practice, the one that has the most silent things is the CEO. Everyone else has work walking through the door talking to them, so they're going to be busy and they're going to be operating this practice. But the CEO, it's all silent. And what happens is we abandon our role as CEO, and we just sit in the role as dentist where we too have these loud things. Patients walking in saying, help me. I'm ready. I'm here for my appointment. And we don't need a checklist to remember that we have to do something on them. So we abandoned the role of CEO of all the checklists we might have in place in the dental practice, the number one checklist is that of the CEO the most. If only one person even uses a checklist, it's the CEO that's got to do it, because with that CEO's checklist, we do the important silent things that create massive change.

We can't have accountability without auditing and without communication. Well, we're not going to audit or communicate. If we're waiting for someone to say, I'm ready for my audit, no one's going to say it. We have to proactively remember to do it, and we have to do it consistently. Otherwise, see, accountability doesn't happen from one audit. Accountability happens when there is a regular audit with communication. The regularity of that means us, the CEO, have to also be disciplined to always do these silent things. We have to start maybe with the checklist of ourselves, what's on that checklist? Well, the things that audit and bring accountability to operations to financials and the people to support the people. Of course, those audits give us the information we need to also make one-time decisions. There's that aspect of A CEO as well where we have to decide to pivot, decide to implement to change, but even the decision to implement could be a habit.

We call that our monthly implementation project. So on our checklist, it says, every quarter we're going to have a strategic planning meeting where we pick the next three months of things to implement. See, we even make this one time decision, a checklist able habit that A CEO will have. When you think about A CEO hiring a coach, in essence, the coach is trying to instill these decisions and these habits. You hire a personal trainer, they're trying to get you on a regimen of habitual exercise to achieve the health you want to achieve. It's all about those small habits. You got to show up, you got to do 'em. A trainer's going to make you with accountability. Calling you up a checklist is going to be your way to do it in a dental practice.

Overcoming Challenges and Maturing as a CEO

Richard Low (23:11):

Yeah, I love this concept so much because the truth of it in what I've seen is that our emotional inability to manage ourselves and build discipline and habits is what is holding practice owners back very often because a lot of times we don't feel like doing these things that are on the checklist. And if that emotion or that feeling is what dictates whether or not it gets done, then the practice will be forever limited by that capacity, the dental CEO of the leader. And recently I've realized that a blind spot in my life was my physical fitness and personal health, and I joined a men's group that focuses very exclusively on this. And I have a daily audit on where I am with my workout, my journaling, my spirituality, reading scripture, and my macros. And right now, my alarm was going off during this call to tell me to hop on my accountability call and check in.

And for nine months, it was a struggle to build in this habit. It took resistance because it was hard. It was waking up at 4:15 AM it was tracking everything that went in my mouth, but now it's consistent. It is a true ingrained habit that I look forward to and enjoy. And so there is a period of, as a dental, CEO really starts to ingrain this checklist and embrace this checklist that it might be difficult. It might feel like a lot because you weren't doing these things before, but over time, this turns into a habit that happens no matter how you feel on a given day, no matter how stressful the office was this week or if there were fires or there weren't fires to put out. And I think that's where the traction of the dental CEO really starts to take place. And it is a mindset shift, and it takes time to build that discipline.

Scott Leune (25:20):

Yeah, it's a lack of maturity to not make this a priority. It is hard, you say, to check in with the group to give updates on where you're at with your health, with your spirituality and so forth. It's so much harder though to have a heart attack, to lose a marriage, to disconnect with your kids, to never feel good about what you wear, and to not be able to hike in Colorado in the fall when the leaves are changing with your family, that's so much harder than checking in and getting fit. It's so much harder to not be fit. And it's a maturity issue. What's happened is you have prioritized this. And so when you prioritize to be a CEO, if you find that you don't have the energy or the time to do it, but it becomes a priority, you cut other things away.

You stop seeing as many patients per day, you stop working as many hours as you work, you stop doing the things that drain you because now you've prioritized needing to have accountability in your business and organization and focus and growth and control. That becomes your priority now. So you start cutting away the things that kind of poison that away from you. And that is a phase of maturing that happens as a practice owner. It's so interesting to me how there's practice owners that just feel like they can't take off half an hour, an hour a day to work on their business. They need to cut more teeth. And in doing so, they're living that life of unhealth on the practice side. They can't take the time to work out, so they live the other 23 hours of their life unhealthy.

And that's so much harder. And so what helps us make that change is so sometimes we get knocked down, we have a crisis, we hurt, we change because it hurts enough to change. Sometimes we change because we're inspired. We look at other people and we're inspired to change and we make that change. And maybe that can help someone on this podcast, maybe for someone, a podcast like this becomes an inspiration. Some people change because they finally know enough, they've learned enough and like, oh my God, I get it. Of course, I need to do it that way. Now. I know, right? And maybe this podcast can be that for some people. I've also heard the quote that some people change because they feel like they've been given enough, given the opportunity, given this kind of, they've been blessed to live a life differently, and so therefore that is enough for them.

Maybe their family came from something else, but their family's done everything they can to then put them in the position to do something, and they realize I need to change, so I can do that. I need to use the gifts I've been given to change. And I think I can look at my life and say that the majority of my change has been because I've been knocked down. Sometimes my visions come from being inspired, but I can say recently in my life, my change hasn't been from being knocked down. And I really feel like that is a maturing of who we are when we don't have to fail in order to see that we need to do something right, that we can see ahead of failure to do something. Right? So as a CEO, you got to be a CEO. If you own and run your company, there are things that have to be done if you intend to do it right. And the fruits of that labor are so much more valuable than the cost of the labor. But when we don't do 'em, the cost of not doing it is insanely high, but it can feel normal. It can feel silent. Okay, enough. It's the trap of mediocrity.

And we will spend hours watching Netflix and hours scrolling, and we'll spend our time on ridiculous things, but we won't spend 20 minutes auditing something that impacts the rest of our career. That is a lack of maturity. And when we have that lack of maturity, we better go connect with some coach or some men's group or some environment that holds us accountable to becoming a better version of what we want to be. And for me, that's a personal trainer for me. That is hiring someone to make my food. Otherwise I'm eating donuts. I am going to build an environment around myself for me, and I bet for a lot of us men, if I go down the sexist route for a second, dare I do that on a podcast? For us men, a lot of that comes from a really good woman or wife or spouse where they also bring that accountability.

They come with boundaries, they come with an inspiration. And so if we're open to seeing that, then we really start maturing and we really find the drive, find the energy to do the things we are telling ourselves. We don't like to do, we don't want to do. I don't like so many aspects or want to do so many aspects of being a parent, but of course I'm doing it. That's my priority. And being great and happy in life isn't filling your day with easy, wonderful things. It's enjoying the journey of doing something significant, a life of significance. That's where happiness is feeling like you have significance in life. So you got to be significant as a CEO. You got to do the things you're telling yourself you don't want to do. They need to become the priority. And the fruits of that are definitely worth it.

Encouragement for Non-Owners

Richard Low (31:11):

Well, if our audience can't relate to your ability to learn from not getting knocked down, I'm still in the phase of learning from getting knocked down. So we've got both sides covered here. So I'm learning through current pain, you've learned from past pain and now you're learning to learn not from pain. But yeah, no, I've had a lot of those moments very recently, and I'm learning and improving and maturing, and I think a lot of practice owners, when they are struggling, they have not matured very often into what you're talking about, and they have settled into mediocrity. So I'm excited for these next three episodes to start talking about this blueprint of these systems and audits and checklists for that dental CEO. I think our listeners are going to get a ton of value out of thinking deeply and creating structure for themselves and creating a path for themselves to be successful in these areas.

Scott Leune (32:14):

Also, if you're not an owner, if you learn these three pillars, you'll of course be a better dentist. You'll also be a better leader in your organization. You will be a better colleague to the people that are shoulder to shoulder with you. But you know what else can happen? When you start understanding the framework of being a good CEO, that might be enough for you to say, I'm ready to be a CO. I didn't know if I was ready. The time kind of never feels right to go through the process of owning, but if you start studying how to be an owner, that alone may trigger you to say, you know what? Let's do this. I feel so much, I feel like I have a foundation now. It is not so unknown to me anymore. So please, non-owners that might be listening here, oh my, please listen to the next three episodes. Maybe more so than the owners.

I'm actually maybe more excited about non-owners going into the world of ownership because of what we talk about than owners getting better. But of course, I think if you own a practice, especially the next episode, I think we're probably going to do the next episode on operations, the day-to-day operations. How do we manage that as a CEO? That is going to apply to every single owner listening to this because that is so much of where your daily stress points can come from, and that's where you always look to try to find success. Let's make this part clear. Let's bring some kind of organization into how we approach that pillar of being a CEO so that we go back to the business and we have clarity on what to do.

Richard Low (33:53):

I love it. And the other shared practices has always been, originally was aimed at that pre owner and was very excited about creating this path for that pre owner. The other thing I love about pre owners is there's a humility and a hunger to absorb everything. And once you've been an owner for so long, you start to discount advice. You're like, well, that doesn't apply to me. And I already know this, and I heard that it's somewhere else, and I don't agree with that. But absolutely, this is going to be a great ride and a great set of episodes. Thank you, Scott, for outlining this framework, and I'm excited for the next one.

Scott Leune (34:31):

Yeah, thank you for having me. I'm super excited. We need to record it as soon as possible.

Richard Low (34:34):

Sounds good. We'll talk to you next time on the Shared Practices Podcast.