Ryan Isaac of Dentist Advisors returns to continue his discussion with Kiera about the future of dentistry, including options aside from DSOs. The question a practice owner should ask themself, Kiera and Ryan say, is what that individual wants out of their life — then consider the best platform to get you there.

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Transcript:

Kiera Dent (00:00)

Hello, Dental A Team listeners, this is Kiera, and this is going to be part two of mine and Ryan Isaac's conversation where we're digging into DSOs to sell to not to sell, all of that. And I truly am so excited for you guys here, part two. And as always, thanks for listening. I'll catch you next time on the Dental A Team Podcast.

Kiera Dent (00:17)

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 (00:33)

Mm-hmm. ⁓

Kiera Dent (00:58)

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, Nevada.

Ryan Isaac (01:03)

Mm-hmm. Yeah.

Same, okay.

Okay. Yes. No, these are the questions.

You're totally influential. I think it's just in the opposite direction. ⁓ I don't think we can influence private equity. Private equity is ruthless in every industry. They don't. It feels dirty. It feels dirty. And I have a question for you, but I just want to say really fast. ⁓ I do feel like, yes.

Kiera Dent (01:30)

It's dirty. It's dirty.

Is there a way though, Brian, you

don't finance better than me. Is there a way that there could become dentists that could become in private equity where they own it? Because once you, there's no way to insulate, you don't think. Because once you get to that level, you just, I mean, I've had.

Ryan Isaac (01:44)

Yeah, but they'll do the same thing. I mean, they'll want the same thing.

Now, money's money. It's why capitalism runs

the world. mean, that's why, you know, it's like why it influences politics and money and business runs the world, you know? ⁓ Okay, hold on. There's so many good things here. Number one would be not every group will be a DSO, private equity backed DSO. And you know, many, many ⁓ clients and just dentists around the country who will end up being owners of

Kiera Dent (02:05)

Okay.

Ryan Isaac (02:19)

20, 50, 100 group practices that will stay privately held and ran by owner doctors. That will be a chunk of this ⁓ group practice ⁓ takeover. So in that space, the influence can still be huge. ⁓ I think the chance to influence the integrity of private practice is in those who don't sell to DSOs.

I think it's in the industry, educated in influencing the industry for people who aren't going to sell and who are going to maintain control. Now, I do think that in the future, more and more dentists will be in a group. ⁓ are probably, yeah, be fewer and I can see why it would make sense to do that. There would probably be fewer and fewer people with just solo doc, solo location practices. know, some towns and rural places, that would be hard to do.

Kiera Dent (02:47)

Mm-hmm.

I do too.

Ryan Isaac (03:15)

So I think you're Dorothy, is that what you said? I'm Dorothy. I think that is possible, not with private equity, but with still the owner doctors that still exist and the group practices that are ran by dentists, not private equity back. I think the influence is still gonna be, I mean, if you took the projections of what will stay private,

Kiera Dent (03:20)

Yeah, hi.

I agree.

Ryan Isaac (03:40)

and then the chunk of the group stuff that'll be non DSO non-corporate, that's still got to be 40, 50 % of the industry eventually.

Kiera Dent (03:49)

I would think so.

I mean, look at it right now. There's corporate dentistry within. And again, there's nothing wrong with any, because I have clients that are in corporate dentistry that run their practices like private. They take care of their teams. So it's one of those things I still think, like even if you are, and that's another way that we can influence this, if you are part of a private equity-backed DSO, you can still influence your practice. You're still the dentist working in the practice. You can still run culture. You can still run change.

Ryan Isaac (03:59)

Totally. Absolutely.

Yes.

and hit it.

Kiera Dent (04:16)

⁓ I know the doctors I have, they're part of a very large group corporate and things that we have done together, like I work with them, they're my only corporate practice that I work with, but we have literally influenced the top tier CEO. They've asked what these offices are doing differently. They're taking things that I've helped bring into the practice and they've asked like, what's changed in your practice? Like we hired this girl who teaches us to run it like private practice. Their culture's incredible. We're even right now petitioning up to the top people because they're writing off things that you can actually

bill out to insurance that they're making them write off when it's like, actually, no, we can bill it as a non covered service and actually have the patients cover. So I'm like, I do still think whether you're in private equity, but I think you've got to be a strong enough doctor where you advocate for the rights of your patients and the rights of your practice. And I'm super proud of my client who does this because her and her husband, they go to bat and they're like, they write some pretty direct emails to the CEO of this and say like, hey, and they're a big enough force. Cause I mean,

Ryan Isaac (04:55)

Mm. Yes.

huh.

Kiera Dent (05:15)

They're the top tier practice in their area. have them making like, we are adding multiple millions to their offices every single year. But I'm like, I think that's also how dentists, even if you're in private equity, even if you're in group practices, I think at the end of the day, are clinicians and clinic, like you are, you are the product. And I think that they have, I think dentists have more say than they might realize that they do to influence the industry and keep it more positive and more ethical than it could be otherwise.

Ryan Isaac (05:38)

Yeah.

Yeah, I totally agree. I totally agree with that. We all know people who are in those group models that are still running like amazing, almost privately held practices. The other thing that's interesting that's different than medical, because it always gets compared to the medical field consolidation that happened, is medicine has a distinct difference and advantage in that they have hospital systems where gigantic campuses where they can house hundreds of doctors in one place, right?

It's just not that's not a thing in dentistry, which I think will will force it to stay a little unique, different than medical, because you can never have a giant campus building with, you know, 400 dentists. Yeah, like 500. I mean, I don't know. I guess never say never some some group might invent that and you know, like the dental campus of the city. I don't know. Yes, it's possible. But it seems a lot less likely. Yeah.

Kiera Dent (06:18)

Mm-hmm.

500 off, you imagine?

Say hi.

I mean, dental schools have a lot, but

I'm like, okay, I think the piece that would be really hard is to justify 500 beds, like 500 ops. You've got your hygiene that's cranking. So you gotta have, in a 500 bed, would need, like, we can only see 500 patients a day. so you can only see if it's 500 a day, that's how many patients you could actually see. I don't think that would be a full city, and we're basically taking over whole city.

Ryan Isaac (06:55)

Yeah.

No. Yeah.

Kiera Dent (07:03)

And then you might

not be pulling out that much dentistry outside of all of that to be able to fill that many doctors in their schedules. Cause so much of it's hygiene run, it's like a two to one ratio that I think that would be the zone. ⁓

Ryan Isaac (07:07)

No.

I love this analysis. Yeah, I

couldn't go that far, but there you go. That's exactly right. So I do think it'll stay different enough in nature because of that. ⁓ And yeah, I, to go back to the, love your question. We've been kicking this around a lot in dentists advisors and I want to reiterate the same thing. There's no judgment here. There's no right or wrong. For some people, it's absolutely the best decision to exit with the DSO and just find the right one. Take your time. ⁓

Kiera Dent (07:19)

There you go.

I agree.

Ryan Isaac (07:43)

to go through the deals with someone who really knows what deals look like, not just a friend or a CPA unless that CPA is looking at hundreds of deals. Call Brandon, right?

Kiera Dent (07:51)

Seriously, I'm like, why? He's got like every flavor of ice cream available of DSOs for you. And like, what are your goals with your financial advisor? What do you need to retire? And then you make sure that the deal is going to actually get you that because like you said, Ryan, it's your greatest asset. And that's where to me, it breaks my heart when people do this. And I was actually, when we were talking about assets, ⁓ there was a stress test portfolio that I heard at a conference that I thought was really awesome that I think about often. so thinking about when you said like, we're investing into this stock.

Ryan Isaac (07:59)

Yeah.

That's it.

Kiera Dent (08:20)

portfolio, like we're basically putting so much of our biggest asset and so many of our dollars into one single stock. And they said, just stress test your portfolio. If my two biggest portions of my portfolio. Okay. So the two biggest portions right now. And I think about this often, even you and me, Ryan, if those two asset classes dropped yesterday, cause I always do like, if they dropped tomorrow and you're like, well, I'd freaking move things. No, if it dropped yesterday, so there's nothing you could do. Do you have the staying power for things to recover? So like, I don't need to liquidate my assets.

Ryan Isaac (08:24)

in one single, yeah.

Mm.

Kiera Dent (08:50)

can still have income from our other assets and buying assets that are down. So looking at that, and I think about that often, like, so if your biggest ones are in the stock market and in your DSO and both of those dropped yesterday, like that's all that's gone. Could you still be okay? And if not, maybe look at other ways to diversify that portfolio. I'm not an advisor, Ryan. So you speak to like, if you agree or disagree on that, because that's my thoughts on it.

Ryan Isaac (09:11)

Yeah.

Although yeah, no,

that's a really ⁓ logical way to look at stress testing something. If the stock market disappeared as a whole yesterday, all, yeah, well, we just, every publicly traded company in the entire world would be gone simultaneously. We would all be in so much trouble. Like we just wouldn't have cell phone service or gasoline or, you know, like a million things. Yeah, for a minute.

Kiera Dent (09:26)

You say that we're all gonna go to the apocalypse, like.

Good thing you're by the ocean. You at least have a good time there, Ryan. I need

to get out of Reno, Nevada for that one year fact alone.

Ryan Isaac (09:44)

Yeah, yeah. For me, yeah,

it would work for a minute, but then we would have no grocery chains, there would be no shipping distribution, there'd be no trucking, there would be no like, you know, we'd be done within like a week. You know what I mean? So, but you're the logic of it is true. It's almost like what if we just looked at stress testing a deal, you know, and you said there's usually three parts in a DSO deal, there's the cash up front, there's usually some kind of earned back, or bonus system, that's usually a smaller piece. And then there's the equity piece.

And if one of those didn't exist, if one of those dropped off, what would this deal look like? And I think the question we have to ask is if the equity didn't hit, you know, if they don't get returns on multiples on their equity, like they're projecting and always, of course, the projections are huge, you know, always, always. If this does not come in like you expect, let's just say it's half of what they expected that which would be probably fair to say, or it's all you do is get your money back one day.

Kiera Dent (10:32)

always.

Ryan Isaac (10:43)

What does this now look like to you? Is this a survivable thing? And is this even something you would be interested in doing? But again, you said this before, I've been saying this, go talk to someone who knows what these deals look like, like Brandon. I'll give you an example. with a client a few weeks ago who had an offer. They were getting a lot of pressure from the group where this came from. They were kind of involved in like, well, I won't even say it. It was just a group of people of other dentists that were kind of pooling practices together. And this buyer,

Kiera Dent (10:50)

you

Ryan Isaac (11:14)

just a lot of pressure, a lot of hype, right? A lot of hype. And the deal as the details started coming through started smelling really weird. And even he was just like, I don't know. He talked to Brandon for 30 minutes and it became so obvious so quickly how bad this deal was. And now he's pushing the brakes a little bit. He's going to ramp up his profitability, work on the practices some more. He still wants to consider a sale, which is great with that's fine if that's still what you want to do.

Kiera Dent (11:38)

Yep.

Ryan Isaac (11:43)

But I think that conversation probably just saved him millions of dollars, literally in 30 minutes of conversation. So just talk to somebody, please, about these deals. There's every flavor out there. There's so many ways that they can twist and bend these things. And yeah, there's just a lot of moving pieces in there. So just be careful. Yeah, just talk to someone. Be careful.

Kiera Dent (12:02)

I would like, and what

you said, also think like, make sure that you're also selling it for top dollar. This is something I really love about working with you guys, working with clients is if we know that there's a sell on the horizon, think one of the best things you can do is truly like pulling a consultant, pulling somebody. And like I was talking to a doctor the other day and they're like, KK, we want you to come in and help us like with our systems, but they're selling in a year. And I was like, well, respectfully as your consultant, I'm not going to sit here and deal with systems.

Ryan Isaac (12:13)

Yes.

Please.

Kiera Dent (12:31)

If you're selling to a DSO, odds are a lot of those systems they're gonna bring into you anyway. Our best thing we can do is make your life easy right now, boost your production, reduce your overhead, increase your EBITDA so you get top dollar on the sale while making it like amazing. Like we'll still put systems into place. We'll still take care of your hot fires with your team right now. But like, why not go, it's like, if I know I'm selling my house in a year and if I did a few things to make it exponentially higher.

Ryan Isaac (12:32)

.

Yeah.

Kiera Dent (12:56)

in the next year of my sell, why would I not do that now? And for us, it's not even like a house where I'm just painting the walls. We're literally boosting your production. We're pushing your overhead down. We're helping your whole team get on board for that. So that way your asset really is the best asset you can get. And we're not doing it in a hard way. So I know it feels like a push, but just know Dental A Team's way is ease. So it's like, it's going to be an exponential growth for you, but with like ridiculous ease. And most of our clients, we just did a huge study across the board of hundreds of our clients.

Ryan Isaac (13:13)

Mm-hmm.

Kiera Dent (13:24)

And on average, they're seeing a 30 % increase in their production and a reduction in their overhead within their first three to six months of working with us. So like even if you have a year or two year timeline, that right there, so getting the right deal, making sure you're selling it at top, like squeezing the juice out of every single thing we possibly can get out of your practice. ⁓ But then also I feel like what happens in that scenario, Ryan, I see it all the time, is when we come in and we like powerhouse it up with them.

Ryan Isaac (13:34)

Thank

Kiera Dent (13:51)

They're like, wow, I'm working two days a week and I would make what this DSO was going to offer me and I don't even have to work. Why would I get rid of this practice right now to the DSO? That happens more than I can tell you because it's like they didn't realize it could happen this way. And I'm like, just tell me what you want. Like you want the DSO, you want to work two days. Why don't we build you that right now and like keep the asset that you've got and sell it when you want, which is going to make you the same amount of money as the DSO, but it's on your terms.

Ryan Isaac (13:59)

Yes. Yep.

all the time.

Kiera Dent (14:20)

So I think that like people don't realize that you can have the benefits of the DSO today. I think the only piece you can't have like, but I give air quotes on can't is like, you still are an owner, but I'm like, there's literally ways for you to sell to partners, have it pay out to you. And you can actually get rid of that ownership piece if you don't want it ⁓ and still have it be the same type of a deal. I think like, don't forget that there's also deals outside of DSOs that you can do internally. ⁓

Ryan Isaac (14:26)

Yep.

Kiera Dent (14:48)

but it is shocking Ryan how many practice, like I had a doctor and he's like, Kara, I'm going to get 5 million for my practice on this. And I was like, rock on in two years, we literally will make you 5 million net post-tax in two years. was like, literally, and that's net that's post-tax like in two years. I was like, this is not a good deal for you financially if you're going after the financial dollar. So I think just be smart with how you look at this because I don't know, right. And you do it to me all the time. You're like, Kara, yeah, go sell.

Ryan Isaac (14:58)

That's what you're make in two years of income. Yeah. Yeah.

Mm-hmm.

Kiera Dent (15:17)

but you can also just get the life you want and have your practice and your business run differently, why not consider that scenario too? So I think.

Ryan Isaac (15:19)

Yeah.

Yeah, I'm,

yeah, okay. Sorry, finish your thought. I just like what you just said. I just love that. I was gonna ask you this exact thing. I was gonna ask you this exact thing. I was gonna say, Kiera, aren't there ways someone could step back and pause and say, why am I interested in selling to a DSO and then just try to create it through the work you guys do easily?

Kiera Dent (15:27)

Okay, so yeah, take it.

100 % and right you do

it to me all the time. You're like Kiera. Well, what would you want your life to look like if you were to sell it? I'm like, I would care if you stopped if you sold what would your life look like? And I'm like, I do this. I do this. I do this. You're like, all right, then why don't we just make your business do that today? I don't think people realize how like you can manipulate your business to truly support the life, the finances, everything you want. Like it's shocking. I'm like just basically give me the North Star and we will manipulate the entire thing for you.

Ryan Isaac (15:59)

Just do it.

Yeah.

Yeah.

Kiera Dent (16:14)

in ways you didn't even know. like, I need Ryan to know our North Star where we need to get. Then we break it down to your, like what lifestyle you want to have. And then we just crank, like, it's like shake and bake. It's such an easy thing for us to do. And we're still doing it with like amazing ethics. It's under your control. It's your culture. It's your business. It's your life. But I mean, I have a doctor who's producing over 5 million a year, working two days a week, taking home DreamPaycheck and they were going to sell it to a DSO. And I'm like, it took us two years to get them to the offer.

and they're like, they're so happy and they're able to now, like you said, I think one of the best pieces on this is they got everything that they would have gotten from the cell. But in addition to that, they didn't lose everything that they've built to where now they can go build and create, like you said, the two day a week practice where they're having it, but they've kept their huge asset over here. And so I just think like, I don't know. I feel like there's so many more options on the table than people necessarily think there are. And so.

Ryan Isaac (17:03)

Mm-hmm.

Kiera Dent (17:12)

Maybe don't listen to all the noise, be the smarter. It's like when everybody's doing X, maybe there's a Y that would actually benefit your life.

Ryan Isaac (17:16)

Yeah. A million percent.

Yeah. I mean, Warren Buffett has a quote around that. It's a little bit different with stock market buys and sells and greed and fear. But yeah, that's exactly it. Yeah. I love that you said that. I assume. What are we like 45 minutes already? I assume that you probably want to wrap this thing up, but I wanted to end it with that exact question you went there, which is like, can't we do this? Can't you? No. I mean, that's not the job we do. The Dental A team can help design.

that what you're trying to accomplish that you think some private equity firms gonna come in and give you. And again, let's all just remember, private equity firms, ⁓ they don't love you.

Kiera Dent (17:57)

It's true.

Ryan Isaac (17:58)

They love your money

and they are not stupid. There's a reason why they gobble up every industry in the economy is because they make us believe they're just giving us sweetheart deals. Like, they're gonna give us so much money. Isn't it so crazy? Like, no, they're really smart. They're gonna get so much more money from you than you're gonna get from them. So if they want your thing so bad that they're gonna chase you down and send you offers and every time you decline, they're gonna be like, okay, wait, what about this one?

Kiera Dent (18:15)

They are.

Ryan Isaac (18:26)

They want it so bad. You must really be holding something really special. So how can you make that thing become your dream scenario without having to give it up? First, just consider that again, no judgment. There is no right or wrong. Maybe that is your path and that is best for you. Great. If you do the work and the, you know, the research and you're just sitting and you're asking smart people like here in the Dental A Team, you know, about all the details and you're asking yourself why through all this process, that's just, that's the whole thing. So I'm glad you

Kiera Dent (18:31)

Mm-hmm.

Yeah.

Ryan Isaac (18:56)

Assuming we're ending it soon. I'm glad you ended it with that because that's what I was thinking about

Kiera Dent (19:01)

Well, and I'm glad I'm going around the same beach because I feel like DSOs can be such a buzz. I think it's, I don't know. I just thought about, I remember when Jason and I were graduating from pharmacy school and we had a lot of debt on us and it was so tempting to go the 10 year loan forgiveness plan. So tempting. And Jason and I decided like, Hey, we don't want to like hope and bank that in 10 years, we're actually going to get all this paid off.

Ryan Isaac (19:07)

yeah.

Mm-hmm.

Kiera Dent (19:29)

And if it doesn't happen, what's it going to cost us at that point? And so we elected to just go for it to pay for it and to basically have it like, it's within our control rather than someone else holding my future. And I think that's how I often live my life of like, is there a way that I can get my dream life or I'm not banking on someone else holding up their end of the deal, hoping and praying that their equity makes it and it's something that we can actually do with ease? Why not do that?

Ryan Isaac (19:33)

Mm-hmm.

Kiera Dent (19:55)

Ryan knows it was a huge issue with me and Jason for about a year to pay off his student loans, but the growth and the life that we were able to achieve that we wouldn't even be done. We still would not even be done with our debt right now. And it would have ballooned and not all of the debt's being eliminated. Like there's so many things around these loan forgiveness programs that I think about that with DSOs too. You have so much banked in, the hope, the promises, like everything has to go right for this huge multiple to have it there.

Ryan Isaac (20:07)

yeah. Yeah.

Uh-huh.

Kiera Dent (20:24)

Is there maybe a few other paths that you could look at that might get you what you ultimately want, give it to you with more control on your side, and also be able to allow you just more flexibility and freedom. Again, no judgment. think what Ryan and I are trying to bring to the table is maybe just consider looking at things differently to see what's the best path for you. And I say like, right back at you, Ryan, use your financial advisors, know what your magic number is, know what you need, and then figure out which option is going to be that.

Ryan Isaac (20:48)

Yeah.

Kiera Dent (20:52)

while also providing you the dream life that you want. So Ryan, thanks for the riff today. It was a solid time.

Ryan Isaac (20:54)

Yep. Thank you.

It almost felt like planned. was so smooth.

Kiera Dent (21:01)

So, mean, it does help when we're good like peanut butter jelly. Like we're very aligned on how we see, that's why I think our clients work so well together because like Denali team clients going to Dentist advisors, it's amazing. We think on similar investment strategies and like just the planning and the protecting clients. And on the other side, it's, Hey, here's our financial number. Denali team literally can like give the gas and give the pieces to it of tactical. So thanks Ryan. was a good time.

Ryan Isaac (21:04)

Yep.

Hmm.

We all want to do. Yeah.

Yeah. Yeah. We want to grow and protect that business and make it, you know, it's your whole life. Make it as good as you possibly can. You guys are so good at that.

Kiera Dent (21:34)

Great.

Well, Ryan, if people are interested in connecting with you, how do they get connected? Because again, I think for me, before I even talked to DSOs, I always tell them like talk to your financial advisor, figure out your project number. That way you actually can then have even one filter on what deals you're looking for, what plan you need your business to be. So Ryan, how do they connect with you?

Ryan Isaac (21:41)

Yeah, totally.

Million

percent. So I'll always say friends of the Dental A Team always can email me directly. I'll always have a conversation with anyone no matter what you're looking for. You don't have to be trying to hire a financial advisor. You might just have a few questions and I will always get on the phone and talk to someone. Just email me directly if you ever want to. Ryan at Dentist Advisors dot com. It's with an O.R.S. You can all just also just go to our website dentist advisor dot com. have

probably thousands of hours of free content on there, podcasts, articles, webinars, everything. You can book a consultation with our whole team there at any time. go learn as much as you want, listen to anything, tons of free stuff on there, but that's the best thing. I'm always happy to have a conversation.

Kiera Dent (22:29)

It's amazing. And just so you know, Ryan does not take very many clients. So that's why I love him being on here. He's one of the founders. I think Ryan's one of the smartest people I've ever met. So definitely take him up on it. I know tons of our clients love meeting with Ryan because Ryan will tell you like, Hey, you don't need me or Hey, here's someone better for you. So I think it's just like, you're just an incredible human who ultimately cares and loves about these dentists, which is why I just appreciate you. So check him out. Yeah, of course. And for everyone listening, thank you for listening and we'll catch you next time.

Ryan Isaac (22:31)

Yeah.

I do. Yep, I do. Thank you. Thank you.

Kiera Dent (22:59)

the Dental A Team Podcast.