Increase Profitability with Improved Dental Practice Management

Show Notes and Resources:

• Eide Bailly’s Dental Practice
• Decisions in Dentistry magazine
• Academy of Dental CPAs
• Business of Dentistry Webinar Series
• Contact Eide Bailly's Relief Fund Team
• Planning for Financial Independence While Building Your Dental Practice

The Transcript

Art Wiederman, CPA: Hello everyone and welcome to another edition of the Art of Dental Finance and Management with Art Wiederman, CPA. I'm your host Art Wiederman. I'm a Dental Division Director at the CPA firm of Eide Bailly. I've been a dental CPA for 37 years and I'm very excited to be talking to you today because as I've mentioned to you over the last three years that we've done this podcast, I get to share with you some of the iconic people in dentistry, and today I have someone who qualifies under that.

And I have had Dr. Anissa Holmes on my hit list to come on to the podcast and life gets in the way and travel and gets in the way and schedules get in the way. But I finally have been able to get Dr. Holmes to come on, and she is amazing. You know, Creating Wow Dentistry is her tagline, and this is her company, and this is what she does. And we're going to talk today about numbers.

And the great thing is, I've gotten to know Dr. Holmes to prepare for this podcast as she is a numbers person which is near and dear to my heart. It's about profitability, but it's a lot more than that. We're going to talk to her. We're going to talk to her about shortcuts for increasing profitability. We're going to talk about empowering teams. You know, unfortunately, with someone like Dr. Holmes, we could go days, but we'll keep it to an hour, I promise. So we'll get to Dr. Holmes very shortly.

I'm going to kind of cut my initial conversation short because I want more time for you to hear her. Please again, go to our partners Decisions in Dentistry magazine, www.DecisionsinDentistry.com. Amazing clinical content. 140 continuing education courses for a very reasonable one time price. And they are amazing and they were great through the pandemic and you should take a look at their website and subscribe to their magazine if you do not already do that. If you are looking for a dental specific CFPA anywhere in the United States Eide Bailly, we handle about 1000 dentists in our practice. I'm out of Tustin, California. The rest of the Academy of Dental CPAs is my mother ship, which I helped to form that group 20 years ago. www.ADCPA.org.

And we're going to be talking to you guys later in the year about new tax laws that are going to happen. We're going to have Mel Schwartz come on the program, and we've got a lot of other great guests and updated subjects to help you meet your personal and business financial goals, which is my mission and my legacy as a dental CPA.

But right now, I want to get to our guest. Dr. Anissa Holmes is a nationally recognized expert in dental practice management coaching. She is just, you know, it's like when you talk to somebody and you just, like, want to keep talking to them. That's what I have been in. Talking to Dr. Holmes, she is a graduate of. She did her undergrad at Southern Mississippi University. She's a graduate of the University of Alabama Dental School. She practiced for 20 years. She retired from clinical dentistry. She is still a practice owner and full time practice owner. And what you're going to hear from her today? Pull out a pad of paper. Listen to this podcast several times because the stuff that she's got to tell you is amazing. Dr. Anissa Holmes, welcome to the Art of Dental Finance and Management.

Dr. Anissa Holmes: Thank you so much for having me Art. I am so excited about today's conversation.

Art Wiederman, CPA: Well, I am too, because I wish I could be taking notes. But you know, some people can't walk and chew gum at the same time. I'm not going to take notes, but I will definitely listen to this. So one thing interesting about you is that you are involved in. I'm going to I'm going to let you tell a little bit of your story here in a second. But one of the things you shared with me is that you were involved in building schools in Africa. That sounds wonderful. Tell me about that.

Dr. Anissa Holmes: Absolutely. So a few years ago, I was actually at a conference, and as I was at a conference, there was a video that was displaying on the screen for all of the attendees, and it talked about an opportunity to be able to join a group of entrepreneurs to be able to go to Africa and to be able to actually build schools in Africa, leveraging their business to be able to have a bigger why. And one thing that it was actually with village impact, one thing that the founder said was guys like as you're building your business, you know, you can you can make money in your business, but like let's build a for purpose business because when you build a for purpose business, the profit is going to flow, right? And so he also said that the more money we make, the bigger impact that we can make.

And so our business can be the driver for us to actually do impact. And so as he said that and he invited and there are about 5,000 people, they are in the room, he invited people to step up to the plate to be able to contribute. I was actually the first one to sign up. And so this is something that my company Dental Boss Delivering Wow has been a part of for years. We have gone into Kenya and built schools. I'm actually going to be going back in March. While we were there, they said, can you build another school, a high school? And we said, absolutely. And so part of my mission for my coaching company is really to be able to help build schools.

But what's exciting is that, you know, it's not just the why of my coaching company. It's something that in my dental practice has always been very important to me, and we built classrooms. We built, we built computer labs. We built playgrounds for schools within Jamaica. And so for me, like as we continue to grow our business, having a bigger why is really what can drive us to keep us excited and motivated about our next level of growth.

Art Wiederman, CPA: Well, I will tell you, and God bless you for doing that. I mean, we all know that the young people of Africa desperately need people like yourself and the other folks that you're working with to help get them educated and build schools. I remember I took my wife, Lynne, and I took an African safari about six years ago and we got to visit a school and we bought a whole bunch of school supplies and we brought them to the headmaster. And I will tell you when we drove up to that school, I almost felt like a celebrity because they all rounded around and they loved to see us. And we talked about what they want to be when they grow up. I mean, so I can understand the amazing impact that you're having on them and then it probably has on you too, right?

Dr. Anissa Holmes: Absolutely. It's something that I involve my kids with. My kids have been a part of it. And again, even with my dental practice, doing impact projects for the community have been great involving my team, their kids. It's pretty powerful when you when you focus on your big or why, other than just, you know, going to work every single day.

Art Wiederman, CPA: Well, again, God bless you for doing that work, and that's part of your legacy. Dr. Holmes is helping the people in Africa. So with that said, let's get into our conversation. And again, as I said, I'm a numbers person. I always use the term my life is a math problem. And in a lot of cases, it is. So I know that you teach shortcuts for increasing profitability. Let's just start. What do you look at when you get into a dental office and you look at their profitability? What are the things that you can do to help them to become more profitable? Let's start the conversation there, and I'm sure it'll go off in a lot of great directions.

Dr. Anissa Holmes: Absolutely. And I'm really, really excited to share because what is now happening when practices start learning, how to focus on the right things, focusing on what they really love to do and are good at what they start seeing? And when I start seeing as practice owners being able to, you know, in a third quarter, once you're planning properly, be able to buy scanners cash, be able to buy a new piece of equipment, putting in new opportunities, being able to have a rainy day fund and is really focusing on one thing at a time.

But like before we get into the strategies and I've seen practices grow by two hundred percent, our practice owners come to me and they say Anissa, I've grown 200 K revenue over last year and I'm going to share exactly how they did that.

But like for me, it's really getting back to like why? Why is this important? And for me, as you said before, I'm a real dentist. I practiced for 20 years clinically. I still have a dental practice that I own. This year, we actually added two associates, so we went from two to four associates this year for my dental practice.

And you know, and the power of it is that I now have a dental practice that I own as the CEO. I have an office manager that runs as my COO. All of our team members are leaders. We have the right people, processes and tools. And now as a business owner, I have financial freedom, I have time freedom, my practice is serving our patients and our community hard, we're implementing new services.

But on the financial side, right, this is a podcast that's really all about understanding numbers and profitability. I'm able to get passive, a lot of passive income coming from my business and my business continues to scale. And so what I love is how what I'm going to share allows you as a practice owner to be able to get to that point. And what I see happening is that once you start implementing what I'm going to share, you look back a year from now and you're like, Oh my gosh, I got the right people, the right processes, the right tools, communication is on, marketing is on. And we have grown by 40 percent in a year. We've grown by 100 percent.

And what's really interesting, as I was talking to a doctor just last week, so within our coaching programs, the first thing that I want to do before I do anything is I want to learn about your practice and you know, what are your goals? But I want to look at the numbers for the last year, and I want to be able to see what were your revenues each month. I want to see what made up that revenue. And I want to be able to actually reverse engineer a process for you to grow and grow, to double. And because I've seen it, it's possible.

And so I was talking to this doctor. And the interesting thing is they're not they're not driven by money. They're this doctor. It's a husband and a wife. They are driven by serving people hard. They've got a great culture in their practice. And I remember going through this exercise, and all of a sudden, Dr. Nisha says to me, she says, Anissa this is crazy. She said, You know, I've always heard of people saying that they want it to or that they have doubled their revenue in a year. And this is not a startup. This is a seasoned practice, right?

And she says, but honestly, I was never willing like that scared me. The thought of that scared me because and it actually made me anxious because I thought about how much harder I would have to work and how I would have to have less time with my kids. And I'm already pretty tired at the end of the day, and so I wasn't willing to do the work to be able to get that result, to be honest with you.

And she said, But what you just shared with me, she was like, This is so doable and it means that we get to eliminate so many things. We do what we love to do. And she's like, That number is crazy because it's doable. And oh my gosh, you just showed me how to double. So again, what we're going to be talking about today is like, what is that process? How can you create your circle of focus to be able to grow and scale and to be able to take care of your team, serve your patients hard and really be able to create that practice that you went into dental school to be able to create. So I don't know if that sounds good to, you know.

Art Wiederman, CPA: Well, anything you say sounds good to me. It's really it's a really easy podcast. This is what we'll call it Dr. Holmes Art of Dental Finance and Management or something like that. But empowering the team I used to be part of. My audience knows that I started out as part of the it was the Pacific Institute, and then it was the Pride Institute. And for you gray hairs like me, Dr. Jim Pride, Dr. Phil Whitener were the ones that ran the Pride Institute, and they used to have a little triangle and it would say dentist manages team, team manages office. And I'm assuming that empowering a team to do that. So I'm going to let you kind of take this conversation. You want to talk about empowering a team or do you want to get into some of the numbers first.

Dr. Anissa Holmes: You know what? Let's talk a little bit about what it takes. And I say this often when I speak on stage, when I talk to teams, right? The first thing that I say to team members when I'm working with an owner is like, you know, we're going to talk about numbers. I'm going to help you with verbal skills. We're going to understand how you're going to schedule. We're going to help your hygienist create systems to scale like we're going to do all of that.

But before we get there, we've got to enroll your team right. Because here's the thing, right? If I try to pick up my dining room table by myself, it would be really hard, right? As a practice owner, if I call Tammy, Tammy is my office manager. I call her my CFO because she runs the business for me. If I say, Tammy, can you come help me pick up this? This table it might be a little bit lighter, like we might be able to go a little bit.

But if every member of my team picked up one little piece of the table, all of a sudden we could grow and we can go so much faster across the room. And so what our team members and our doctors need to know is that we can do it by herself. But it's just so much easier and we can get there faster when we go together. And so the enrolling of teams and I get doctors saying, Well, how do I enroll my team right?

Because before you create your circle of focus, you have to get your team understanding that like, why are they there? And what I often tell teams again, when I'm lecturing, when I'm speaking at events, when I'm coaching, what I'm training is guys like, how many of you want? And this is an important question. How many of you want more? For your kids. Then you had growing up.

And I'll look at the doctor and I said, Doctor, I know your team members are sitting next to you. It's OK. Like, can we get permission and just be real for a minute? Like put up your hand like and that's OK, team members, I don't care that your doctor sitting next to you. It's OK. Right? My hand is up. How many of you want more for your kids than you had grown up and they put up their hands and they're honest and they're real.

And I say, Guys, we're all the same. Like, we all want the same thing, which is to be able to take care of our families. We want to be able to help our aging parents. We want to be able to put our kids in the best schools. We want to be able to create life experiences because we all only get one life. And that's what I need you to understand is that this business, this dental business, like only four percent of all businesses, ever grow past a million dollars in revenue and a dental practice can do that.

And so I need you to understand that guys, when we grow this practice and how do we do that by serving our patients hard, by not letting things slip through the cracks. By having conversations with people. Because we know that the treatment is going to help them. You know what happens? Our patients are going to be served by our team, just like what you just said. And I call that the business cycle. The doctor takes care of the team. The team serves the patients hard. The patients are rating fans. They tell more people the business grows and the cycle continues.

But I say, guys, listen, if we do this together, guess what happens? We're all going to earn more because we're all people doing the same thing, and I am not more important than you. I'm just doing the team. And how many mouths are being fed in this practice? Well, I think about it. We've got the doctor, the hygienist, the front office team. There are partners or spouses and our kids like, can we all agree that the best use of the doctor's time is not, you know, looking at supplies and ordering supplies? Like can we all agree that they should be doing what nobody else can do? Same thing with a hygienist.

And now we have enrollment of the team and I say, OK now that we understand that like, we're all just people and we're all here, like we've chosen to go into dentistry because we are healers or we would have done something else like we would have we would have gone into law or we would have worked at a retail store or whatever, right? We chose to go into dentistry no matter what our role is, because we are healers, whether we're on the phone, whether we are following up on their insurance, we're there to help them. Can we all agree? Yes.

And I said, great. So now that we can all agree that we're here to serve people, what is my role? Why am I here? Like, why am I here speaking to you today? Why am I here as your coach? Why am I here training you on how to grow your practice? Because I figured out shortcuts in my own practice, I work with hundreds of practices and I know what actually works.

And so if it's OK with you, let me share with you how we were able to double revenue in my practice that was 17 years old. And then the next year do it again because it's the right people, processes and tools like Are you ready? And they say yes, and then now we can get into it.

And so for me, as we start looking at what are the steps, what are the processes that, for example, this Dr. Nisha took to be able to say, Oh my gosh, without stress, I can actually double or for doctors to come to me. And in Q3 say I was able to put in two new operatories cash or I was able to buy a new scanner, or I was able to take my entire team to the ADA conference and put them up in a really nice accommodation. It's like, what makes that happen? And it really does start with deciding what is it that you really love to do and what do you really want to do to serve people? And how can we, as a team all be aligned?

And so before we do that, what I like to do is, again, as I'm talking to a doctor is we create this process and this is something that I've coined I've created, called the Circle of Focus. And so what that means is, and I know many people don't love Excel sheets like, I get it right. I do. I love it. I get it. I know you love them, you know, but a lot of people don't?

And I say, Listen, I'm going to talk to you. Like, I'm talking to a five year old. Because if I can talk to you, like I'm talking to a five year old, I can help you and you can grow. So like, we're going to we're going to break this down. It's going to be simple. And so what I typically will want somebody to do is to just have their team member. They can do it or their team member again, delegate to your team, delegate and elevate so they can become leaders. Take this off your plate. That is not the best use of your time.

But I provide a template and it could be. It could be anything in Excel, right? And so what happens is that now you go in and you put in pulling a production by procedure code report from your practice management software, you don't need anything fancy or any additional cost and you're able to pull from that report the revenue or your production for each month. So you have a month, a column for each month, January, February, you know, all the way out. And then you have the total at the end and then you now break down your production.

But I want to know what made the production. So how many what's what was the revenue for crown and bridge? What was your revenue for sleep appliances? What was your revenue for clear aligners? What was your revenue for even sealants, right? What's your revenue for it? And so now we can look at your revenue or your production, and we can see what made the best month, the best within the last 12 months. And we start to see some interesting observations from there.

We also want to make sure that we're putting the collections because that's what we're really are making. And the difference between those is, of course, our collection percentage and we want that to be as high as possible. And if that number is off, why is it off right, either? We are giving discounts to friends and family. Why? Because they went to church with us, so they went to grammar school with us and we know them. If anybody we know, we're just going to give up a discount when we start to have this information and understand profit margins, we realize we can't do that.

Or maybe there's checks that have not been entered into the computer or maybe their statements that have not been sent out. And so now that we have this information that I like to have our practices actually update weekly, which is takes about five minutes a time, then now you can see where things are slipping through the cracks. Now you can see where your profit margins are off and you should really look at POS and we'll talk a little bit more about profit. Oh, yeah, right? But get started, absolutely.

But going back to this, looking at our historical with our production. Now we're able to look at it, I'm saying, oh, my gosh, look at that like. Isn't that interesting that in August you actually had like, let's look at patterns here. You actually did twenty five grand in implants that month and the rest of the months you did like two or three. Like what happened that month that made that the best month? And then all of a sudden they're like, Oh, I did it all on four case. And I'm like, Oh, that's interesting. And then we start looking from left to right month to month to month, and we start looking at different services and we start looking at how things are dipping and trends are going up and down.

I'm like, Oh my gosh, look at that. Sleep appliances you did like you did like eight grand and then you did eight grand and you told me, you do sleep. But like, you're only doing eight grand and you charge eight grand for a case. And then you did like twenty four grand and then you went back to eight and then and then eight, and then you did forty eight. So like, there's a lot of inconsistencies, you're all over the board. And why is it all over the board like?

And so now I can start asking questions and I can say things like, OK, now that we have information and look at your ceilings like, and then I'll ask them, I'll say how many of you truly believe and I'll teach some verbal skills right now, if that's OK, like, Oh yeah, I'm all good. So I'll say, let me ask you your question do you truly believe that silence will prevent a cavity? Right? And some people don't believe, and if you don't believe they prevent a cavity, you should not be doing silence. Just like if you don't believe that a bell scope can detect oral cancer early, you should not be doing it. You should not do anything you don't believe in, but I am actually a true believer of silence. When I was in dental school at Alabama, there was an instructor whose name was Dr. Filler. Believe it or not, Steve Filler.

Art Wiederman, CPA: You made that up.

Dr. Anissa Holmes: No, that is. Look him up, Steve Filler. OK, OK, Steve Filler and I are in the clinic comes to me and I'm a first year dental student. I hadn't learned about sealants yet. And he says, unless there's something we can paint on your tooth to prevent a cavity, you want us to do it. You want, you want to learn more. I said, sure. He says, Well, it's a sealant. And basically, I'm just paraphrasing, you know, we painted on the top of the tooth food, bacteria, sugar can't get through it. Then you'll prevent a cavity. Would you like to go ahead and do it while you're already here? And I was like, Of course, like, why would I not like, how would I know how to do that? Why would I like? I know what happens? You get a cavity, then a filling, then another filling, and then it becomes a crown and then a root canal, then implanted extraction like, I don't want any of that stuff, right? So I'm like, Yeah.

So for 10 years, Art, for 10 years, every time I went to get my teeth cleaned, I would go to the hygienist and I would say, Check my sealants, OK, now I was being the biggest hypocrite ever in my practice because I am an adult and I can more than likely promise you that at the University of Alabama. Dr. Filler was not trying to sell me on a sealant, right? Like, like, he's an instructor. It was free and he was an instructor at a dental school talking to an adult. About a sealant. And I said yes, and I did them for 10 years, and I'd never talk to my patients. Why did I not do that? Why any idea?

Art Wiederman, CPA: You didn't believe in them?

Dr. Anissa Holmes: I believed in them, I was doing them on myself. I didn't do insurance. Oh.

Art Wiederman, CPA: Oh, you? Yeah, insurance. Yeah, of course. But does insurance cover it? That's a whole another podcast, right?

Dr. Anissa Holmes: So, here's the thing. Like when I got my first business coach years and years ago and we started looking at numbers and how numbers drive accountability, how numbers drive, if your behavioral changes, how numbers drive, like where you are having inefficiencies and where you need to train because you and your team are not yet understanding how this can help people, all of a sudden I'm like, Oh my gosh.

So she says, and it's like, you're doing like five sealants, so. So let me just say this. When I started talking about sealants, once things changed in my practice. And so now when I coach doctors, I'm like, Look, let me just give you some verbal skills because I believe in them. I believe them. So here's a verbal skills, because since then and that moment and with my coach, I have spent a few years understanding neurolinguistic programing, psychology of communication because I was perplexed of why case acceptance was so low, and I tried to figure this out for my own practice of my clients.

So I started studying with masters of NLP and creating frameworks for my clients. And so here's a framework for sealants. So there's something that we can do to prevent a cavity. Would you like to learn more? They say yes, of course. I said great. Called a sealant. How it works is that we paint it on the top of the tooth and once we do sugar, food and bacteria cannot get through and it reduces your chances of getting a cavity.

Now here's the thing. Insurance doesn't cover this, or insurance doesn't always cover it. But why are patients choosing to do it anyway? It's because, number one, it doesn't take a lot of time. In fact, it takes just five minutes. It doesn't cost a lot of money. In fact, it's a fraction of the cost of a filling and number three, it's going to give you that peace of mind.

Now we have time while you're already here today to go ahead and get your sealants done and completed. Should we go ahead and do that now that you are already here now? I asked doctors and I say, Guys, do you feel like I was selling you anything? And I would say nine out of 10 say no. They say Anissa like, I felt like you were just offering me a solution and giving me an option of something I can do. And I said, great. I said, Is this something you can do? They said, yes.

I said the issue with insurance and dealing with the insurance question is that we've been objection block for so long because we have not been trained and have not trained our teams on communication, verbal skills. And because of that, when we say, do you want to do it? They say insurance, we get objection block. They tell us, No, we stop talking about it. Exactly. That write this down, guys like rewind. Write this down, right? The major benefit is here's a thing. Insurance doesn't cover it. It could be sleep appliances. It could be veneers. It could be clear aligners. It can be whatever. But why are patients choosing to do it anyway? Is because right?

And now you talk about the time and money. And so I asked the doctors to say, guys, like if you were to now use this script or your team, how many CEOs do you think you can do? And they're like, I can probably do, and they give me a like a big number ten more day or like four more day, I'm like, What if you just did one patient a day? Just one? One patient out of all your patients, your hygiene patients. Your restorative patients. One patient a day. You know how much revenue you get. Twenty five hundred dollars charging, thirty dollars for a sealant. You might charge more than that.

Art Wiederman, CPA: Let me throw something at you because I get this call. I don't know five, six times a year from the office managers of my clients. Here's the call. OK? Hey, Art. He did it again. I said, Did what? He let six crowns walk out of here that my two year old could have diagnosed. And I said, Well, what? Because he's conservative and he doesn't like to sell.

So I get on the phone with the doctor. Dr. Holmes, I get on the phone. I say, So, Doctor, this is what I'm being told by your front office because I hit him right between the eyes. And I said, Why? Well, you know, they don't really need. I said, Well, let me ask you a question on a scale of one to 10, how conservative are you in diagnosing a crown? Well, I'm probably a four.

I said, Could you live with yourself if you want to be a six? Do you know how much more money you could make? The marginal profit on a crown is over a thousand dollars for each one if you did five more crowns in a month that's sixty thousand a year. Now we're getting in the numbers, right? I mean, is that kind of thinking kind of what you're doing?

Dr. Anissa Holmes: You're 100 percent. But like, I like to take it a step further than that and I say, listen, like, let's think about this. Right, and this last yesterday, I was coaching a doctor with this on the phone, we were doing her Circle of Focus call instead because for her, it was, it was it was in this. No, it was the nurse she loves doing veneers. She loves that when she finishes a veneer case, how the patient is grateful and crying, and she loves how it makes her feel OK.

And her team loves how it makes them feel. And she's good at it. She's very good at it. And I said, Well, that's interesting, because that was one of the things on her board one month she had like twenty thousand or whatever it was in veneers, and it was only like two months of the whole year. She'd said veneers. And I thought, Well, what do you want to do more of? Like, let's think about what for Q for the next quarter, what do you want to focus on? Is it going to be sleep appliances? Is it going to be clear aligners? Is it going to be veneers like choose if you had to choose what you love to do the most outside of fillings, right? What would it be?

And she said veneers and I said, Well, tell me I need to understand like what was the issue of why did you only in two months? Why did you do veneers? And she said, You know what, Anissa honestly. She said, It's my mind. It's in my mind, she says. I just feel I'm exactly what you said and I said, All right, let's reprogram that a little bit. So what exactly are you right now? So let me ask you a question. I said, before we do that, let's stop talking about your practice for a minute. Can you do me a favor?

Just close your eyes. And I said, I want you to go back to a time in your childhood. Our child and your time, your teenage years or time in your life where you didn't feel accepted. Go back to that memory for me for just the minute. Go back to that memory where you didn't feel good enough. Go back to that memory when you didn't think that you look pretty enough because the fact is that everybody has those memories and experiences, including me.

So can you just for a minute go back to that moment when you didn't feel good enough, you didn't feel pretty enough, I said, because the patients that we're talking about here, I said, we're not just improving their smile, we're improving their mental health because people are having depression and anxiety and are feeling they're not worthy, like these are people that in their own mind might be a schoolteacher and the kids are not teasing them, but in their mind, they think the kids are teasing them. These are people that in their mind or in actuality, it's frustrating for them because when they go to dinner, they have to be picking food out of their teeth. And that is embarrassing to them. Have you ever had dinner with somebody who was picking food out of their teeth?

And how can you imagine how they felt like we are helping people with their psychological barriers like we have a gift to heal them? And so like, we can't even think about money or an insurance like we have a gift to get people back smiling and competent and stop telling themselves stories that are making them not be free in their life. So it's just like, Oh my God, like I said, that's why we have to do it.

Art Wiederman, CPA: Well, I will tell you, folks, you've heard me preach on this podcast. You as dentists and I love this. I could do this. Have this conversation with Dr. Holmes all day long. You are not people that fix teeth. You are about a better life, a better profession, a better self-esteem, a better attitude. That's what you're about is helping people.

And when I also sell dental practices, Dr. Holmes and I've told my audience this when I do a closing, I say to the seller, I want you to think about the thousands of people whose lives you changed for the better. And that's what this is all about and a podcast, folks. What I do every other week, what Dr. Holmes does on hers. And in a second, I'm going to let her tell you a little bit about what she does in her coaching program. But what we do is a call to action. So I'm hoping that you listen to what Dr. Holmes and I are talking about, mostly what Dr. Holmes is talking about. And you wake up and you say, I need to make a change. It's not all about money, it's about helping people.

So with that, Dr. Holmes, I want to get into the numbers part and give some examples. But first, tell our audience a little, my audience a little bit about, you know, what you do in your company and your coaching program and you're speaking and you have a you are a fellow podcaster. So tell us a little bit about that.

Dr. Anissa Holmes: Absolutely. So I as a dentist, that is a dentist that has a practice that I own, that's been in the trenches and has been able to create a practice that runs with the right people, processes and tools, understanding leadership and verbal skills, and how do we get our team enrolled. Understanding scheduling and all of the things that are important. We have programs that are able to help colleagues to be able to do the same thing.

And so we have, first of all, our free Facebook group for doctors, which is Dental Boss Movement. So we've got lots of great training and a great community there, which is completely free DentalBossMovement.com invite you to join us there. But we also have programs, so Dental Boss Academy is a 24 seven online training academy where we're helping you to understand how to be the CEO while we're training your office manager to be the COO and to lead your team, while also training your team on scheduling and insurance and hygiene profitability, helping them understand insurance. And so that program is DentalBossAcademy.com.

We also have within that program a monthly startup call, a monthly marketing call and a monthly systems call. And for people who are wanting one on one coaching to work with me, we're creating your roadmap with training your team on Zoom calls with having your own accountability coach and holding your hand. We have our Dental Boss Platinum Coaching program and again, to learn more about that. You can go to DentalBossAcademy.com.

But yeah, I mean, for me, it's really just about helping empower doctors. And so like getting back to the numbers part of it, like once we start to understand what is it like that doctor? She wanted to do veneers and I said, OK, what if we just focus on veneers? Work for this quarter, like you already are good at it clinically, you're competent in it, like you don't have to do any more training. So let's start with that. And what if you started to use these verbal skills? There's something that we can do to improve your smile. There's something that we can do to be able to prevent that food from catching. Would you like to learn more? Right?

And they say, yes, it's great. It's a veneer. And how it works is that we within just a matter of weeks are able to beautify your smile, have your teeth strong and beautiful. Now here's the thing insurance doesn't cover it, and I was not technobabbling. Right? So we put in the verbal skills and I said, What if now you focused on it with your marketing? What if now for the next quarter, you were going on social media and you were talking about veneers you're talking about not a patient's name, but an experience of a patient that came in and how it changed your life?

What if you started to talk about care of veneers or whatever it's going to be, right? You're becoming known. What if now you're emailing your patients? What if now every patient that came in, you are talking about it? What if the patients really understood how they were changing lives? What if you had your financial policy in place that now you have a third party financial that can now go in and approve these patients so that their lives can be changed? What if everybody went all in? Like, do you think you could do at least one patient a month? Just one?

Art Wiederman, CPA: Yeah.

Dr. Anissa Holmes: And she's like, Yeah, good, let's just do one. And what if we did one in month two. What if we did one in month three, you think by month three, we'd have our systems in place, we now have people saying, yes, we'd have more confidence because our verbal skills are on. Yes, great. What if we did two now for two months? What if we we're able to now by month five do three.

And so you look at that and next thing you know, you are at the point where you have significantly grown and going back to that doctor that we spoke about sleep appliances. They have been doing training for sleep. They and I said, Well, what's the issue? Why are you only doing two cases? She says, Honestly, my team needs more training. They're not that confident. They don't understand how the process works. And I said, Great, so you know what we're going to do? We're going to focus on that this quarter. We're going to make sure they get the training. And literally this week they are, they're at an event in Vegas and they're getting that training.

And now you're going to focus on your verbal skills. Do you think you could do two more cases like let's look at rings, how many rings are you're going to give out for sleep studies? Let's just track that because if we do 20 rings, that means you're having conversations. If you're having conversations and you suck at the conversations, twenty percent are going to start treatment. And we started doing that. Well, what if you started with just two cases, not overshoot two worth eight grand each? And what if next month you did three and then four and then you left it at five for the rest of the year, they were at a point where they were making a half a million dollars extra in one year by focusing on one thing as a team.

Art Wiederman, CPA: Well, and I want to encourage you, doctors, because you, my audience knows my story. Fifteen years ago, my dentist diagnosed my sleep apnea and I didn't know what sleep apnea was, and he probably saved my life. And I've been on a CPAP, and it's the best thing I ever did. So I am a huge, huge proponent. Folks, you are going to save lives. You're going to improve lives. The marketing that you're going to get from convincing with the proper verbal skills like Dr. Holmes is talking to you about, you're going to get they're going to become raving fans of yours because this is what it's all about. You're going to save people's lives.

I mean, I've talked about I'm a big football fan. Reggie White, all Pro Hall of Fame defensive tackle for the Green Bay Packers died in his sleep at the age of 42 or 43 because he never did anything about his sleep apnea. These are the things that you need to do. And again, focusing on one thing. One mistake I know Dr. Holmes. I see lots of dentists. Well, I went to a course. Now we're going to put in sleep apnea and we're going to put in veneers and we're going to go ahead and get a CBCT.

Dr. Anissa Holmes: That's the problem sometimes, we're trying too many things. So what I told this doctor who wanted to do because they were ready with Vivos. And sleep. They were doing OK and there are different solutions that are out there. That's the particular one. So that's why I just call the name and I said, OK, so we're going to focus. And her next highest. When I looked at her historically with implants, she wanted to do more implants. I said, Listen, I am not giving you permission to focus on implants until January, OK? We are not focusing on any of that. I said, we are doing sleep. That's it. The marketing, the verbal skills training, the role, playing with your team, getting your systems in place for patient financing. I am. We are not doing implants right now, OK? It's just like, All right.

And I said, But guess what? In January? All of the sleep is on autopilot, our marketing is on, everything is working, so guess what we're going to do? We're going to shift our focus. And for the next quarter, we're going to do the same process, but we're going to be talking about implants. There's something that we can do to close up that space and prevent teeth from shifting in and cracking and getting gum disease. Would you like to learn more? Like we're going to shift focus a guess what's going to happen when you start doing this guess what happens in quarter three?

Quarter three you got cash, right? Because now you're focusing on high value. And when you do that, you don't have to worry about PPOs because you're doing high value, life changing things that are saving lives and healing people. And so now you do an eight thousand dollars sleep case or you're doing a $20,000 implant case or even a smaller case, but you're focused on it. Your entire team is looking for it. You're having conversations. You're not being objection blocked.

In third quarter, what happens is on a consistent pattern. When you use this process, you have something that you can buy cash. And I tell doctors, let's reverse engineer from now. Let's just decide from now what you're going to buy cash in quarter three, because that can be your why that's going to drive you to hold you accountable to the behaviors that you have to do to actually make that happen. To get you trained, your team trained on using whiteboards to track performance daily. Right. Because we're not going to use these expenses and budget sheets on a daily basis. But how do we use a different tool, maybe a whiteboard that's tracking the quantity of services versus the revenue on services, which is another tool that I like to have practices use to be able to accompany it, right?

Art Wiederman, CPA: So I am required by law to talk numbers on this podcast or they kick me off the air. So give us a couple of examples of I know you and I were talking the other day about, you know, profitability on procedures. You look at those things too. What are you doing with the numbers? Give some specific examples of what you're doing with the numbers. And I understand, you know, focusing on the sleep apnea, focusing on veneers, and that's going to grow the top line. But how do we get the bottom line to grow? What are the things you're looking at?

Dr. Anissa Holmes: This is so exciting. So one thing that I often ask people is, do you know how much you actually make when you do a procedure, right? And before I do that, I typically tell a little story about when I was like seven years old and I wanted to buy a Rainbow Bright doll. And so I reverse. I love reverse engineering. That's just how my mind works. I believe that we can do everything we want. And the question is not I can't, but how can I? And so I said, I'm going to get a doll. How can I get a doll? I'm going to have a lemonade stand.

So I go to my mom. I'm like, Mom, I want to have a lemonade stand. She's like, Great. I live in New Orleans. We go to Winn-Dixie, we are shopping Friday night. We get the lemons and the cups and the ice walking down the aisles. Saturday morning I knock on all of the doors in the neighborhood and I'm like, Hi, I'm Anissa. I live around the corner and I'm going to be having a lemonade stand. I live at seventy one 40 Yorktown Drive. If you can come at 12 o'clock, I want to buy a Rainbow Brite doll right?

Now. Twelve o'clock comes and there's a line down the block and my lemonade sells out. OK, so I'm excited. Like because I'm about to get my doll right? So I'm like, Mom, I'm so excited. Like, I made seventeen dollars and fifty eight cents. I'll get my doll and my mom was like Anissa I am so proud of you. Like you created a great product. Like people, people drank it. Your marketing was good. People came and you, you know, you had great systems like everything was on. But what I need you to understand is you did not make seventeen dollars today. What you made today was two dollars and 58 cents. That's right. Wait, wait,

Art Wiederman, CPA: Wait, what? Mom, I got 17.58.

Dr. Anissa Holmes: No, but that's the truth.

Art Wiederman, CPA: I'm calling Child Protective Services. You're taking my money away.

Dr. Anissa Holmes: The cups, and the ice, and the lemons. That's what it costs you. That's what it takes to be able to get the money, the two dollars and fifty eight cents. And so inside of a dental practice, we need to understand what we're really making and what we're putting in the bank is not what we're making. And so.

Art Wiederman, CPA: I think what they need to do is I think they need to put in an accounting course for seven year olds, don't you think?

Dr. Anissa Holmes: Oh, my gosh. Like, it's the same thing, right? So I'm like, All right, so can you just tell me how much not what you put putting in the bank? Because that is like lemonade money. Like, can you just like, do you know how much you're really making? And the answer of most times is absolutely not.

So one of the other exercises that I'd love to do with the owner, and interestingly, when we do in-person workshops for doctors and team leads, I like to do it with the team as well. I need them to understand this and I need to understand the lemonade story, the lemonade principle, if you will. I just need that just now I'm going to be using that again. Lemonade principle is that when we have a dental procedure, let's just take an account filling.

OK, what does it take to do a filling? Well, first of all, we've got our fixed expenses. OK, so we've got our rent, we've got our phone bill, we've got our power bill, we've got a water bill, we've got our internet right. We've got all of those expenses that whether we go to work or not, we've got those things to take care of, OK. So we've got that and we've got our team costs, right? So let's not include our office manager, our hygienist on this example. We're going to talk about a filling. OK, so we've got our office manager, maybe a front office. We've got a dental assistant, right? So these are our support team.

So let's put in the total cost of all of our expenses for the month. We're going to divide that by the number of weeks that we work, the number of hours that we work. And so you're going to get a cost per hour of those expenses. You're going to add up your team costs for those team members again, excluding your hygienist for this example, we're talking about fillings, and I want you to divide that again by the number of weeks and the number of hours so that now you have your fixed expenses and you have your team costs per hour.

Now let's go to a filling. And let's think about how many materials we use for a filling and people don't think about this. But we've got cups, we've got mouthwash, we've got a needle, we've got adhesive, we got burrs, we've got floss threaders, we've got polishing paint like there's about 20 to 25 different things that we use. And so when we start breaking that down and interestingly again, I'm a little bit of a nerd, a geek. I wrote this down in a template for our owners, and they're able to see how is it packaged, how many uses per package, how many patient uses per package. Now what's the cost per patient?

And so what do we look at this, what happens is that a lot of doctors, by the time you add up, maybe it takes you a half an hour to do the filling. So you take that other cost. You divide it by half, right? And then you add in the actual cost of your supplies. What most practice owners tell me, on average, is that it's costing them between 100 and one hundred and ten dollars in expenses to do a filling.

OK, now the next question that I ask is, OK. And they do it for their own numbers. So when we do it in an exercise, I say, write your own numbers down in terms of your team costs. So it's going to fluctuate depending on how much you're paying your team and like your rent and all that stuff. And I said, OK, now we don't want you to tell me now is how much do you get paid for a filling? OK, now a lot of them are like, Oh, our fee is two hundred and fifty dollars, but insurance, I might be able to get insurance, so I need to know how much you're getting from for the filling. Like, I can charge five grand for filling if I want. That is Disneyworld. Like, I'm never going to get that. So like, let's just be real and put your real. Can we be real for a minute? Write down how much you really get. And all of a sudden they get quiet. And they're like, holy crap, I get one hundred and eighteen dollars for a filling or I did this exercise in a workshop last week. DR Team leads in Florida in Fort Lauderdale and the doctor was like, I'm taken. And she named of who she's taking and she says, I get eighty dollars per filling. I'm like, Oh, so you're upside down. So now you're probably wondering why you are busy. Busy, busy, busy, a lot of patients, and you're not getting any money.

Art Wiederman, CPA: Not making any money because you might as well just be writing a check to that patient every single time you do a procedure.

Dr. Anissa Holmes: It's crazy, insane, and so now that you have information, you can make decisions, that's what numbers allows us to do. It allows us to see again behavioral changes, it allows us to make decisions. Because in this decision you can say, do I want to take these PPOs. I can't take these anymore. Or you can say, you know what? I'm going to take this PPO. I'm getting twenty three dollars per filling. But what I'm going to do is instead of seeing patients in four visits, if I can now do those seven fillings in one visit, guess what that means? That means one cup. One bib. One needle. Right. And so now what happens is that we can cut down our expenses, our overhead costs by 70 up to 75 percent. And now we have more profit. And so now we understand how we have to schedule. It's based on data.

Art Wiederman, CPA: And also talking about the way the schedule and the way to be more profitable. I would hope that you would believe in this is, you know, it's much more profitable to do two or three or four units at the same time than to do just one, right?

Dr. Anissa Holmes: Absolutely.

Art Wiederman, CPA: Because, you know, when you're sitting there prepping crowns, OK, doctor, I'm your dentist. How long does it take you to prep one crown versus prepping four?

Dr. Anissa Holmes: Not that much longer. And the real time that comes in there, as we all know, is taking the scan or, you know, preparing, doing the pre scan or the post scan or if you're still doing impressions, taken the impressions right. So if you're able to again prep, yeah, that's going to add some time.

But now it's the time chair time for the scans right over or over four visits or the time waiting for the patient to be numb. Right. So if we're able to do more per visit again that way, we're able to also increase our profitability.

Art Wiederman, CPA: And you also know, as a dentist, I don't have to tell you this is that, you know, you're going ahead. And if you don't have enough treatment rooms, you go ahead and do the prep and then you're waiting for everything to be done. And if you don't have another treatment room, you can go to and do the same thing for the next 15 or 20 minutes, you're losing money. So doctors, I can't afford to add a fifth treatment room. I can't afford to add a fourth. You need to because that's how we scale, right?

Dr. Anissa Holmes: Absolutely. I'm actually building a new office next year and it came in guys, because we just hired and interestingly with my cohort, my Circle of Focus for my dental practice, everything that I teach, I do it my own business, OK? And so at the beginning of January, I said, I want to be able to increase my revenue in my sorry. I want to increase my profits, not revenue, not eliminate money, but the real money by million dollars this year in my dental practice.

OK, I know it's crazy, but I just want to reverse engineer how am I going to do that? So first quarter, I was like, we've been doing perio protect. We're really going to focus on it. Second quarter, we're going to put in lasers. Third quarter, we're going to put in sleep. And so second quarter we bought lasers. I flew Elaine in and she trained my team. Third quarter, my team is now training in Vivos. We're going to be doing some sort of sleep group solutions to get the.

And I said by Q3, I'm going to hire an associate because I have to have another provider for the producing. The more producers I have, the more profitability that we have because we have shared overhead expenses of our front desk and our rent or whatever, right? So we brought in exactly on third quarter, we finally found our associate and I knew it would take me to two quarters to do that. We found one.

And then about a month later, all of a sudden we get another doctor who says, I want to join your team. She just finished her Ph.D. at like NYU great training. She was number one in her dental school class. She is very well known in our community. She does a lot of community service like she's a beauty queen. So, I mean, I couldn't say no to this doctor, like number one in her class, like great in the community. So I said, Guess what? Join us. We'd love to have you. I did not plan for four doctors, right? I don't have enough operators for four doctors, but I said, You know what? We're going to make this work, and we have.

And so now guess what? We're building a new office next year. We're not going to have two locations. I'm going to have one because I want to share those expenses with one. That's just my experience that works for me. But yeah, the more providers that we have, whether it's going to be doctors or hygienists, doctor owners as the CEOs, this allows you to be able to scale your profit significantly and allows you to be able to have more wealth and to be able to have your time back because you do have other providers that are they are working, that does allow you to be able to choose when you work or even if you want to work in the practice.

Art Wiederman, CPA: I want to throw one more thing out. I want to throw one more thing out to you, and then we've got to kind of put a wrap on this. As I always say to doctors that it's more important that you work on your business and in your business. So, doctor, how do you in your coaching, do you set up like times, once a month, twice a month, once a week where we're going to schedule no clinical treatment, no staff meetings. We're going to be working on the business, looking at the numbers, making a plan.

Dr. Anissa Holmes: Oh, 100 percent. And it's so funny because when I first started with my first coach, I mean, this was like back in 2010. I remember she told me, I can meet with you on a Wednesday morning at 10 o'clock and I was like, 10:00 o'clock. That's what I see patients like I can't do ten o'clock, can we do at eight o'clock or my lunch time? She was like, she was like, You just told me that you want to have the ability to earn more and work less, right? And I was like, Yes.

And she says, OK, so like, first of all, your business owner, you can choose when you do what in your business? I just need to let you know that. And she's like, number two, like you just said you want to work less. So that's one hour that you're going to be working less. And with that, you're going to learn how to work one less day a week and then another less day a week. And I was like, Oh my gosh.

And so 100 percent what we do in my practice and what we do in our coaching programs is every Thursday at 1:00 p.m. Eastern. We do training every Thursday and we're training on the business side of the industry. We're getting the team enrolled, we're making sure we have accountability tools and the teams are understanding how to be able to implement the whiteboards and scorecards and all of these tools.

But then we have training on Tuesdays and on Tuesdays we have calls that are on the first month week and the month is leadership. The second is case acceptance. The third one is we're working with the office managers on how to lead the business and we're working with the schedulers, right? So the practices that are in my programs that are in our coaching program, we do have our online academy, but in our coaching program, they're training. They don't train the fourth week of the month, but they're training twice a week, the first, second and third week of the month.

Now what does that mean for them? That means for them that at the end of the year, the doctors typically going from working five days a week to three days a week, that means at the end of that first year, they're in a place. They've got the right people, processes and tools. The verbal skills are on, the marketing is on, the team are leaders. They're ready to hire an associate, right? So the thing is that we've got to put in the work on the front end so that we can benefit for the rest of our careers in our practice, too many people are like, Oh, well, I'll do it one day. We cannot afford to miss out on the opportunity of growth that can happen if we take action now.

Art Wiederman, CPA: Well, that is incredible, and I wish we had another five hours to do this. I really do because I just I love this kind of conversation. And folks, if you do not feel that a that your practice is going right, something is not right. I would go take a look at Dr. Holmes's website. What's your website?

Dr. Anissa Holmes: Right? So you can go to DentalBossAcademy.com and guys like I am super approachable. So you can even find me on Facebook, Anissa Broussard Holmes send me a message like I'm committed to working with colleagues like, this is my calling. And this is my passion, and this is why I've chosen to retire from my practice, even though I have it because I love empowering. I love hearing the stories.

We fly teams out to practices every month and we get two or three stories every month of practice owners that are saying, Oh my gosh, I got my life back. I'm able to do things with my family like it's super empowering and so reach out to me. I'm here for you. Again, we've got our Facebook Group www.DentalBossMovement.com. But you know, there's no reason for you to be able to struggle. There's always somebody there that can help you.

Art Wiederman, CPA: Again, this has just been so inspiring to me. I always, you know, you do this day in and day out, and then I hear someone like yourself just have the passion and excitement for dentistry and for helping people and folks the definition of insanity is doing the same thing over and over again and expecting a different result. So if you're willing to have if this podcast gives one of my listeners an epiphany, whether you call Dr. Holmes or not, I suggest you take a look at what she's got going on. If it gives you an epiphany then I've done my job because I want you to do better.

You work so frickin hard and you've got insurance companies beating on you and trying to cut your profitability by 40 50 percent. And it doesn't have to be that way. I've got clients that are fee for service, and I've got clients that are focusing on the right things and they're making a really good income. And for me, what's important, funding a kid's college fund. Funding your retirement plan so that when you get to the age of 55 or 60, you can retire, not because you want to, and maybe you won't even retire, but because you can.

You know if an epiphany has been created then I've done my job. Dr Holmes, you're amazing. I am very excited about going down the road and talking to you more and hearing more and you're on your website or your outside lectures on your website so people can see where you're talking.

Dr. Anissa Holmes: Oh my gosh, I am talking. Yeah, we need to get that down there and that will be on our main site, which is DentalBoss.com. But upcoming, I will be speaking for Vivos at their institute. Add a bunch of different events. I'm doing some stuff for Henry Shine, but in March I invite all of you guys to join us at our Dental Boss Summit that will be happening in Montego Bay, Jamaica, March the 11th, 12th and 13th. So definitely would love to have you guys to join us there. That's actually our event that we've had for many years, and we're excited to be taking it back after covid.

Art Wiederman, CPA: Don't tease me now. Don't tease me. I had one of my best vacations I ever had in Jamaica. I don't know maybe. Well, let me say the word taxes at your seminar and I'll show up. Who knows. But no, it's one of the best vacations I ever had in Jamaica. So it's a gorgeous, gorgeous place.

Dr. Anissa Holmes, you are a gift to the dental profession. You've helped thousands of people. You're going to help thousands more and definitely go, What did you say, DentalBoss.com?

Art Wiederman, CPA: Hang with me as I take the podcast out. And again, thank you. Thank you so so much for all your valuable insight and using your valuable time to talk to our thousands of listeners who really, really appreciate it. And folks, if you want to again, check out our partner www.DecisionsinDentistry.com and also check out the Academy of Dental CPAs website www.adcpa.org. My phone number is six five seven two seven nine three two four three. My email is awiedeman@EideBailly.com.

And promise me that you'll if you listen to this podcast, that you're going to think about some of the stuff that Dr. Holmes and I talked about today, about thinking about working more on your practice than in your practice, working more and focusing on one thing at a time instead of trying to make 20 changes in your practice at the same time.

Promise me that you're going to do something. It's going to improve the quality of your life. It's going to improve the enjoyment that you have in your practice. It's going to get you to your financial goals so that one day you wake up and you say, you know, I've been doing this for 35 years and I really like it, but I got other things in my life I want to do. And then you've made the money and you've saved the money and you've paid your house off to do these things. And isn't that a great feeling.

And I'll tell you what, I have clients that sadly, they're never going to get there, and that's why I am just beating people over the head to save money and the way you save money as you make more money in your dental practice. You're not going to make a ton more money by having your team spend four hours a day finding a box of gloves that's 50 cents cheaper. But what you are going to do is by focusing on one thing at a time and really getting good at it. You're going to make more money.

All right. I'm off my soapbox folks. With that, that is it for this episode of the Art of Dental Finance and Management with Art Wiederman, CPA, and we'll see you next time.