The Group Dentistry Now Show: The Voice of the DSO Industry – Episode 203

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Welcome to The Group Dentistry Now Show: The Voice of the DSO Industry!

Dr. Alex Sharp, CEO of Shared Practices Group, a unique DSO that originated from a podcast joins the GDN podcast. He discusses the evolution of Shared Practices Group, which has grown from 18 to 36 locations in just two years, focusing on full arch dentistry.

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DSO podcast transcript:

Kim Larson:
Welcome to the Group Dentistry Now show, the voice of the DSO industry. Join us as we talk with industry leaders about their challenges, successes, and the future of group dentistry. With over 200 episodes and listeners in over 100 countries, we’re proud to be ranked the number one DSO podcast. For the latest DSO news, analysis, and events, and to subscribe to our DSO weekly e-newsletter, visit groupdentistrynow.com. We hope you enjoyed today’s show.

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Bill Neumann: Welcome everyone to the Group Dentistry Now show. I’m Bill Neumann, and as always, we appreciate you tuning in. We are well over 200 podcasts now, so I really enjoy this part of my job. got pulled into it kicking and screaming, didn’t want to do a podcast. And 200 later, you know, just learned quite a bit and have quite a bit of fun. And our next guest, Dr. Alex Sharpe, he is the CEO of Shared Practices Group. The interesting thing about Shared Practices Group is they started from a podcast. So there’s a little bit in common there, for sure. And they’re probably the only group out there that I know of, Alex, unless you know of another one that happened to start from a podcast. I think you’re the only one.

Dr. Alex Sharp: I think you’re right, Bill, and thank you for having me from one reluctant podcaster to another. It takes one to know one. But no, I mean, the origin story is pretty cool, just because as you figured out, as you were dragged kicking and screaming into podcasting, It’s hard to have that much leverage on your time and on the reach of your opinions being made manifest in your audience. So I love the format. Congratulations on your success, because I, for one, love tuning into your show every week. And I love the content that you and Kim put out. It’s huge for me and my development and my role. And I love hearing what other people in the industry are doing. So thank you for the work that you do.

Bill Neumann: Thank you, Dr. Sharpe. That’s great. And just a little bit more background on Shared Practices Group, and then I don’t want to steal too much thunder from Alex. He can fill in some of the blanks. But if we go back two years, Shared Practices Group, and I’ll drop this link in the show notes. One, the Emerging Groups to Watch in 2023, which is crazy. It’s already been two years. So I just have to read this because this is going to give everybody a little bit of perspective. So this is the first paragraph, and then I’ll just drop this in the show notes for everybody else to read the link to the emerging groups to watch 2023, which came out in January of 23. So two solid years. Shared Practices Group is a remote DSO which was founded in 2021 by six equal dentist partners through merging the existing locations of its founding partners. Now, the reason I bring all this up is at that point in time, two years ago, you had 18 locations. And so we’ll just kind of leave it at that. So now maybe let’s kind of fast forward to 2025, where, you know, where’s Shared Practices Group now?

Dr. Alex Sharp: Yeah, now we’re at 36, and we’ve done all de novo growth to this point. You mentioned the initial merger that comprised SPG back in the day. And since then, we’ve shifted the focus from having kind of the co-mingling of the original GP offices and all of the de novo denture and implant offices to really just focusing on the denture and implant offices. Because even though we formed by merging our locations together, we found that by getting narrower in our focus, we were able to get that much closer to achieving mastery in one pursuit rather than trying to be the jack of all trades. And so the de novo growth path has been the one that we’ve chosen to this point. And it’s been really, really educational for us because we’ve seen what works scalably. You mentioned the remote nature of our company. We don’t have much of a physical headquarters to speak of. And part of that’s by design, just because we like the fact of our ability to leverage technology and to leverage geographical flexibility so that we can go exactly where the best opportunities are for our doctors and where we can demonstrably predict the best demographics to be to create the best outcome. So I think it’s interesting because COVID changed the world in so many ways, and I can safely say that SPG would not exist were it not for the forcing function provided by COVID, because we had to figure out creative ways to do things remotely and to make an impact in the way that we were able at that time. And so we’re very much a product of COVID. And now you’re right at five years later, because I think that that fateful day when the bottom fell out and we all were, I think it was a Friday. I think it was Friday, March 13th, if I remember right, where we got those emails and got those notifications that the world was shutting down. That was the jumping off point for us in the Shared Practices Network to think about what do we want to do? What do we want our careers to look like? So it was a really interesting time to re-underwrite what do we want out of our careers? And for me, the answer definitely was, I want to create the opportunity for other dentists that I wish I would have had right out of school. What is the company that I wish I could have worked for that would have treated me well, developed me, invested in me, and put me in a position to maximize my own individual impact as a dentist? And that’s been the rallying cry for all of us ever since day one.

Bill Neumann: So let’s go back to dental school with you. You’re graduating and now, kind of fast forward to now, you’re CEO of a group practice, DSO, remote DSO, whatever you want to call yourselves. But maybe take us through that career path. You graduated dental school. Did you come out of dental school going, hey, I want to start my own practice, I’m going to hang my own shingle? Was that a goal of yours from pretty much graduation?

Dr. Alex Sharp: From graduation, I really, I’m ashamed to say now, but in hindsight, my main focus after graduation was just to get good at dentistry. Because I realized in dental school that even if you put in a lot of extra effort to get the repetitions to maintain some degree of consistency in how you’re performing your procedures, you didn’t get the number of reps that you really needed to be anything resembling excellent at that time. So my focus was to find an opportunity for myself that would get me repetitions. And I found a practice to work with that gave me those repetitions to be able to get really good at dentistry. But then what I realized was that not all dental procedures were created equally. I learned early on that as I transitioned from working at an office to then buying my own office, that you could have a full day of patient care, but then no two appointments could be exactly the same. And you realize that you’re making a bigger difference for patients with one type of procedure than you are with others. And the joke that I like to make internally is that back in the day when I was doing a quadrant of fillings, for example, success meant that the patient didn’t realize that I did anything. kind of a disempowering way to approach dental care when you think best case scenario, the patient doesn’t have sensitivity when they floss. There’s no pain when they chew on the fillings that we just did. That’s a success is that we fly under the radar. What if we predicated our business model? What if we put people in positions to have the opposite perspective of how can I take someone from zero to one? How do I actually create an outcome for people that is net positive, not just, hey, we did some fillings and fingers crossed that those fillings feel good for the patient. So that was part of the genesis story of why implants spoke to me in my development, why I took so much CE on being able to provide that treatment for people. And then what ultimately paved the way for us to predicate SPG on the denture and implant model, because there’s so many people in the country that are dentally disenfranchised that have been deferring care, either due to geographic proximity, or financial reasons, or fear. There’s just a lot of people that are now at the precipice of needing more exhaustive, comprehensive care that aren’t candidates for your traditional drill, fill and bill dental model. And so that’s that’s where SPG came to be.

Bill Neumann: This leads into a couple of questions here. You talked a little bit about graduating dental school, maybe not having the reps as you call them, right? You just didn’t feel like you maybe had enough clinical experience, so you were looking to gain more of that. What are you seeing with young docs that are coming out of dental school? What are they seeking for career opportunities? Is that something that you’re hearing? Are you hearing practice ownership to a degree? What are you seeing and is it different from maybe what you came out with and some of your classmates?

Dr. Alex Sharp: Yeah, so back in the day when I graduated, I felt like there was almost a normalized bell curve distribution of if you could plot people out based upon entrepreneurial vigor on one extreme and then just wanting the safe, predictable W-2 route on the other extreme. There was kind of a smooth curve that followed a bell-shaped architecture. And then now it’s almost like a barbell, where you have some people that come out just raring to go, very clear on what they want. They’ve done enough research. They’ve done extra CE in dental school. They’re just gunners and they know exactly what they want out of their careers. And then there’s the other extreme that is very averse to getting more debt. They are nervous. They are sometimes scared of their own shadow because they’re getting fewer reps than they need in dental school. And so I think that there’s this disparity between the extremes that’s more stark than ever. So I think you have dentists coming out of school that have more confidence than ever, and then you also have a contingent that comes out of dental school less confident than ever before. So it’s kind of a tale of two cohorts coming out of dental school from what I’ve seen, because what I really enjoy is interfacing with the young docs that have experienced, hey, I love surgery. Hey, I’ve seen the transformative nature of dental implants. I’ve taken all of these CE courses while I’m in school, or I’ve gone to this implant focused residency, and I’ve done X number of arches, and I’ve just seen the transformative power of this type of dental care. And I love meeting those young docs that have gotten that perspective so young in their careers because most of us had to acquire gray in our beards to figure that out the old way. And so now with the advent of podcasts, the advent of Instagram, you have so many people being exposed to that type of dentistry or even not even surgery, just people that maybe love ortho or they love sleep apnea or they love veneers or cosmetics. You find people that have niched out earlier and earlier, which I think is phenomenal because if people are gravitating towards what drives them and what’s their passion, then they’re going to be better at it. They’re going to perform that dentistry for a longer time horizon. The quality of patient care is going to go up rather than people historically feeling like they have to be all things to all people. which is what I fell into the first couple of years of my career, and I realized that that was, for me, a thankless endeavor. I didn’t enjoy trying to keep all of the different balls in the air at any given time of trying to be able to be excellent at all these different facets of dentistry. I think for most of us, it’s very refreshing to say, you know what, I’m just going to call it as I see it. I love this type of dentistry, fill in the blank, and I’m just going to go full bore into that pursuit of excellence in that one narrow domain.

Bill Neumann: What about, what would be the ideal doctor that you’re looking for? Who is a good match for shared practices? And then maybe add to that, again, a term that’s thrown around way too much, culture. I’m sure you have a very unique culture. Starting from a podcast, I’m just going to guess that your culture is probably a little bit different than a lot of other group practices in DSO. So talk a little bit about what type of doc you’re looking for there. And I don’t know if you can define the culture, but you probably have something wrapped around what that may look like and why it’s so different and unique.

Dr. Alex Sharp: My favorite definition of culture is not just a shared set of beliefs, but a shared set of actions. Because in a remote company, you have to have some degree of belief and some way of measuring that if this type of situation happens in this practice, it’ll be handled the same way. in Spokane, Washington, as it would be in Sarasota, Florida. You have to have some mutually agreed upon way of solving problems day in and day out. To me, that’s culture. You have beliefs and, you know, the fancy charts on the wall. Those are nice. We have those. And we have our core values that govern how we handle those difficult situations. But at the end of the day, it’s how aligned are we on acting commensurately with those values? That’s what really matters for culture. And Doctor selection, doctor recruitment, doctor onboarding, that figures very, very prominently into a company’s culture, whether you are the type of company that all works in one building, in one little tight geographic radius, or whether you’re dispersed throughout the country. And so I think for any multi-site owner, for any dental practice that scales beyond four walls, You have to give this a lot of thought. And what we do at SPG is that we have a multifaceted hiring process that we’ve iterated on over time. And to me, that’s one of the, you’re reading off the little blurb from the emerging groups to watch awards. And that’s one thing that we’ve learned the hard way is that you can’t hold your current way of operating as a sacred cow. You have to be willing to be nimble and to iterate and to improve. And the doctor recruitment process has been one of those things for us. And so my role in that is once the doctor has gone through the personality profiling and we assess the clinical acumen, the clinical experience, we make sure that there’s a minimally viable fulfillment there, then I do the core value assessment. I get to know the doctor. I get to understand how that doctor will score based upon our six company core values. And yeah, it’s a little subjective at the end of the day, and it’s an imprecise art form, but it lets the doctor know that we care about this stuff and that we know that the doctors that fulfill our core values are going to be good fits in terms of being a good teammate, in terms of really shouldering as much of the load as he or she can in the practice, and seeing the value in the collaborative approach afforded by shared practices group because one of our big differentiators is the fact that we have such a robust network of doctors that at the drop of a hat can review a case, help plan a case, handle a post-operative concern, because we have so many doctors that have been there, done that, and gotten the t-shirt in every subsection of surgical dentistry. And so viewing that collaboration as a feature rather than a bug is a point on which I screen people. Because if you want to be an army of one and you want to be shut into your own turtle shell, that’s fine. It’s just not going to work at SPG because we are very, very collaborative. And that’s how we learn. That’s how we all are able to share what we gather, what we glean from every experience that we have throughout the day, and then add that into our collective repository of information going forward.

Bill Neumann: So you mentioned that the model really changing, you know, as the groups matured. So right now, these DeNovos, do you target a specific location? Do the doctors have the opportunity for some equity at the practice level? What does the model look like right now?

Dr. Alex Sharp: Yeah, right now the model is in what I would call its third phase, where we’ve learned a lot in the past, and now we have a pathway to partnership for our doctors. We have our own proprietary approach to earned equity that our doctors are able to opt into over time, which is really, really compelling. And it’s a great tool for alignment and for incentives to be in the right place for both sides. And I would also say that when we’re choosing new locations, it’s all predicated on the doctor. We know, those of us that have been in the DSO industry for any length of time know that the doctor is the center of the universe. And I view my role as being beholden to all of our doctors, rather than the traditional org structure being, you know, the pyramid. We view it as the inverted pyramid, where instead of everyone reporting to me, ultimately I report to the doctors because the doctors are my customer, just like all of our patients are our doctors’ customers. So the thing that underpins all of that, and I’m actually building out a revised training on this, is we’re big on the book Raving Fans at SPG. And so our sixth core value is that we create raving fans. So my job is to structure things and structure these opportunities for our doctors such that they become raving fans of SPG so that they can then create raving fans out of all their patients. That’s an inviolable order of operations, kind of like a math problem. You can’t go out of order. And so we have to choose the right doctor. We have to make sure that the location is going to be great demographically, which we have our own way of quantifying that that we’ve honed over time. And that’s really the recipe of success is to find the enterprising doctors that want to narrow their scope of practice and achieve mastery at dentures and implants. And you asked earlier about doctor selection criteria and the fact that we are podcast first, that may influence the type of doctors that we attract. And yeah, I mean, we have an amazing CRM full of doctors that have expressed interest in wanting to work with us. And from those people that have reached out, particularly through the Full Arch podcast, so if any dentists listening are clinical nerds and want to learn more about Full Arch Implantology, give the Full Arch podcast a listen because for those of us that are not as clinically focused these days, it can be a little dry. But for anyone who wants to learn more about how best to approach the patient management process or the case planning or the material selection, Full Arch podcast is the place to go.

Bill Neumann: Awesome. We’ll make sure we drop a link to that in the show notes, too, so people can subscribe and check that out for sure. I’m really curious. The de novo model seems to, in this industry, and maybe it’s driven by inflationary pressures to a degree where we were very, as an industry, acquisition heavy for a long time until all of a sudden we weren’t because it cost too much money. And I think also a lot of these groups realized maybe they acquired practices because they had free money at the time and realized that they acquired practices that maybe they shouldn’t have. So I think DeNovo is becoming more and more popular with a lot of groups. Do you have a typical when you go into a market, do you go and say, OK, we’re going to basically create what we had in Birmingham, Alabama? It’s going to look very similar in Tallahassee, Florida, or is it really is that simple or does it look a little bit different? It’s definitely.

Dr. Alex Sharp: Based upon our playbook, meaning that there’s not going to be a whole lot of variation and it’s it’s not going to be all that different based on the market because upstream of that, we wouldn’t go into the market if we had to reinvent the wheel for each market, if that makes sense. So we definitely choose our markets based upon prior knowledge of what we know to be defensible and to work well. And I also think that to your point about de novas versus acquisitions, and this was a topic of great interest on the Shared Practices podcast way back in the day. But, you know, with acquisitions, I feel like, relatively speaking, and probably at the risk of oversimplifying, it can be more low risk, low reward to do an acquisition versus to do a de novo, it can be higher risk, air quotes, and higher reward. Because if you can be efficient and effective and targeted, and you can manage the process well to do these de novos to where the timelines don’t get away from you, and the change orders from the contractor don’t get all wonky, then it can be a very predictable, formulaic process to do these de novos. But it’s a muscle that you have to build over time. You have to be really, really detail-oriented and excellent and know what you’re looking for. But I do think that with the de novo piece, it’s a great challenge because you have so much authorship over the result. And I think with multi-site, with doing the DSO growth path, it’s almost like a choose your own adventure because you can do the inquisitive growth strategy and you’re choosing your problems, which are a completely different and distinct set of problems than if you’re doing the de novo path. But I feel like if you have a differentiated type of approach to dentistry, and you have a clear value proposition, then de novo is arguably better because then you’re able to superimpose your practices, your ideas, your concepts, your procedure mix onto a blank canvas rather than trying to rejigger something onto a prior framework that you inherit with the acquisition. And to your point, acquisitions, number one, have gotten more expensive because the demand for them has gone up. And also, there’s a tendency to overvalue or to over-conflate the arbitrage that can happen when you add a practice to an existing platform. And the way that those types of groups are being valued, to me, has evolved over time. And the places where, or like the end goal for groups that do the acquisitive growth, I think the end point has had to be re-evaluated over time too. Whereas with the de novo model, if you have a predictable way of doing that, and you have a pipeline of doctors and you have a clear way that you’re serving the patient population in those markets that you choose, I think there’s not really as defined an endpoint for the de novo path if you set it up the right way on the front end.

Bill Neumann: And great, great points. It’s always one of these interesting issues. And you’ve got successful DSOs that have done it both ways. Some have done both acquisitions and de novos as well. I think you get the benefit of cashflow immediately from an acquisition, which is nice. But to your point, And back to one of the original questions about culture is you, you are acquiring a culture as well when you acquire a practice that, and you’re also acquiring the PMS that they’re using and habits, good and bad, where with the de novo, you can pretty much come in and say, this is the PMS that we’re using and to a degree, very, very similar to what you’ve done in other markets. So I think it’s, It’s fascinating to me. I think we’re going to continue to see more DeNovos. That’s just my prediction. I think there are fewer and fewer acquisitions out there, quality acquisitions. That’s another one that the quality acquisitions are still, even though I think valuations are down, quality practices are still pretty close to all-time highs, maybe not quite where they were. Beyond that, then there’s a step or two down and most DSOs don’t want fixer-uppers.

Dr. Alex Sharp: So that’s okay. You read my mind. I was going to say that there’s always the opportunity to buy the fixer uppers, but then you have to have an extremely well built out process for fixing the fixer uppers, which isn’t attractive to everybody because there’s a, there’s an amount of crossing your fingers and hoping that you’re going to be able to rebuild, uh, the, that practice into something that is viable, whether to hold on to and to cash flow or to build into a larger infrastructure. But I do think that that’s what’s so attractive about dentistry is that there’s so much blue sky available, regardless of if you choose the DS, the de novo route, or if you choose the acquisition route, because I’ve been doing a lot of research on some of the parallel types of multi-site health care, just multi-site service businesses in general. And a lot of other types of businesses and other types of healthcare verticals are not as flexible in dentistry as dentistry is. There’s so many more defined, quote unquote, best practices that people follow in these other domains. Whereas in dentistry, there’s so many different ways to get to lead to success. There’s lots of different paths forward, whether you want to participate with all PPOs, or you’re going to go full Medicaid, or you want to go completely out of network. I mean, there’s lots of different paths to success. which I think is simultaneously really alluring, but it’s also analysis paralysis for some people because you just don’t know which direction to choose. But that’s what I would recommend to anyone listening is that sometimes fortune favors the people that are able to have the presence of mind and the wherewithal to say, you know what, I’m going to lay down the gauntlet and this is the direction that I’m going to go because You have to make a choice, and it’s like the quote from the old Rush song, even if you choose not to decide, you still have made a choice. You have to choose something, so you might as well go one direction.

Bill Neumann: Yeah, love it. Quoting Geddy Lee. I love that. I didn’t think that would happen on this show. So.

Dr. Alex Sharp: Yeah, I didn’t have that on your bingo card, did you, Bill?

Bill Neumann: I did not. I did not. Let’s switch to technology. Again, another topic. It seems we are, as an industry, overwhelmed with options, whether they’re technologies that help clinicians, whether they’re technologies that help the front desk. There’s so many out there. And I think it can be overwhelming for an organization, for sure. And technology is advancing so rapidly that, you know, I do think we’re going to find ourselves in the not-too-distant future where we are going to have a new C-suite position, a chief AI officer or a chao, right? Somebody that’s going to be because it is evolving so quickly. But again, this topic being really important, how are you leveraging technology? And if you want to focus on the clinical side of it, that will be great because You know, I think when you touched on coming out of dental school and needing, you know, maybe, you know, more experience, and I think that’s not uncommon. And I think maybe it’s even more common now with COVID and, you know, docs that were in, you know, dental students that were in school that were not really able to do a lot of hands-on dentistry, wet finger dentistry. They’re coming out of dental school even, you know, less skilled than, you know, people in the past. Talk a little bit about technology and how that’s helping out your dentist.

Dr. Alex Sharp: To me, it helps you institutionalize excellence. And what I mean by that is for any of us who have bought practices in the past and inherited patients and inherited aging dentistry, we’ll just put it delicately. you know that dentistry that was done without the benefit of x-rays is probably, on average, not going to be up to the same standard as dentistry that’s done with x-rays being immediately available, chair-side, immediate feedback loop where you can do a root canal, you can measure the length of the apex, and you can know immediately if your gut aperture point is the right length, for example. versus in the in the good old days you didn’t have that feedback loop you had to wait an hour for an x-ray to develop for example. We use technology primarily for clinical quality control, for assisting and treatment planning, for making sure that we are all on the same page alignment wise with, with how we’re presenting cases and how we’re delivering care and how we’re planning those cases, because there’s so much opportunity nowadays to be able to measure twice, cut once, and to plan cases remotely and digitally. And so I think that that’s the main thing that we think of as being the beneficiary of technology is the ability to just have really great clinical outcomes across the board and to take dentists that have gotten the requisite clinical experience in their residencies and parlay that into what we know and what we’ve developed and what we train our doctors on. So when you merge that existing corpus of experience with what we know at the company and the technology that’s available to really democratize that level of success, I think that’s a recipe for some amazing outcomes. And then also to your other point on the non-clinical side, just from a remote workforce perspective, there’s a lot that you can gain from leveraging technology as it pertains to workforce management, task management on like a CRM type platform, the way that you communicate with patients. And that’s not even thinking about the advances that come into play in like the garden variety GP practice where you have Pearl AI and you have the ability to read radiographs and to interpret radiographs and to offer spots to look at for clinicians to be able to run through the list and say, is this something that I need to be worried about? Is this something that I need to watch? There’s just a lot of efficiency gains and quality gains that come from technology. And I think that’s true for dentistry and for the workforce in general, because you can look at them on those two vectors of efficiency and quality. You can do things to a higher caliber. And then you can also just make the fulfillment of those functions more efficient over time too. So I think we’re just at the ramp up. I think we’ve, to me, we’ve seen nothing yet. There’s still a lot of meat on the bone with how technology is going to either add value or intrude upon our operations, depending on your glass half empty, glass half full. I had a LinkedIn post the other day where I was quoting a podcast that I listened to recently about whether it’s good to be a techno-optimist or a techno-pessimist. And I think the proper answer is being a techno-realist, understanding that the genie’s out of the bottle. And it’s, it’s sort of pointless to view things other than dispassionately, just like technology’s here. It’s not going away. It’s probably going to keep accelerating so we can get our surfboards and ride the wave, or we can, we can hunker down in our bunker and hope that it passes us by.

Bill Neumann: I think there’s a parallel when it comes to the group practice model in dentistry. And there are people that are still wishing it away, definitely not optimistic about it for whatever reason. And I think this was a battle 10 years ago that was being fought a lot harder. I think they’re the realists now for the most part that solo practitioners, dentists practicing by themselves. I think the number is like 7% declining year over year for quite a few years. And so where are those docs going? So they’re going to a couple of different places. They’re either going to somebody like Shared Practices and partnering with you, or they’re dentist entrepreneurs and they’re working in their own small group. But kind of working on an island by yourself. And this may be, you know, is part of maybe what the new docs are looking for is they don’t want to work by themselves. They want to work in a group and be able to have the ability to shared practices, right? So to share clinical opportunities, to have mentorship, I think that the old model just doesn’t exist anymore. So I just see that as kind of a parallel to technology. Back to technology though, I kind of went off on a tangent there. Beyond Pearl, any other technologies, feel free to shout it out by name. I’m curious if there’s any others that you’re really excited about, clinical or non-clinical.

Dr. Alex Sharp: Yeah, I think we still have a lot of ground to cover when it comes to integrating AI workflows into what we do. We’re beta testing some, but really the three-dimensional imaging is probably the most ubiquitous piece of the puzzle for us technology-wise, clinically, that we really hang our hats on. I want to also go back to what you said a second ago about what dentists are looking for because the technology to me is just emblematic of the underlying thesis. And what I mean by that is when you think about why do you have technology, You want to assure amazing outcomes. You want to always be chasing mastery with the types of dentistry that you do. But man, it just really allows connectedness in our workflow, right? Because we have some amazing clinical leaders that we’ve recruited and that have come to SPGU over the last couple of years. Dr. Stephen Vorholt, of Implant Pathway fame, big Instagram presence. Dr. Aaron Miller, who I’ve known forever, who was also at Implant Pathway. Dr. Derek Williams, who’s been in the doctor coaching sphere forever and ever. These are amazingly talented people that get the vision. It’s clicked for them. They see the power of going further together because we can obviously go in our own directions and maybe go fast. but we can go further in a more compelling direction by working together. And that is what so many of our SPG docs, they come aboard and they realize like, oh my gosh, this is the way to do it. This is the way to practice because anyone who experiences that isolation of being on a dental island, like I’ve been there. And that’s part of the reason why I started contributing to the original SP podcast and interfacing with our network is because it’s pretty darn lonesome being an army of one in four walls, and you’re, you’re the boss of everything, of everyone in the practice, you’re responsible for every piece of dentistry that walks out the door. There’s so many inefficiencies just laden in that traditional dental model. And to your point about folks frying wolf and being pissed off about the the DSO quote-unquote intrusion, it’s a market inefficiency that is causing there to be a demand for DSOs in the first place. If there weren’t benefits to DSOs, they wouldn’t exist. The market demands it, dentists see the value of it, and I think we’re in the realm of being like not your grandpa’s DSO. Because obviously we’re all familiar with DSO 1.0, DSO 2.0, and we’re definitely squarely in the timeline of DSO 3.0. And what I like to tell people is that we founded our company, not necessarily in the information age, where the currency was access to the best practices, access to the best people, But now influences the currency, the ability to be between people’s ears, the ability to help people to learn and steer their own careers the right direction. Because what you’re doing with your podcast is you’re influencing the DSO landscape. And what we do with our podcasts, whether it’s the Full Arch podcast that’s clinical or the SPG pod that I host, that is kind of my stream of consciousness, uh, as to what I’m thinking about and what I’m focusing on week after week, we’re influencing folks. And that’s where I think as we get more instantiated with the technological changes that we’re seeing every single week and every single month. Influence is what matters. That’s the current currency. And I think the more that we can shift and steer and guide folks in the right direction, uh, the better off we’ll all be. And the more amazing career outcomes that we’ll be able to quarterback.

Bill Neumann: Yeah, great, great points. Speaking of DSOs, let’s talk a little bit about the challenges that you have in scaling up. Again, pretty rapid growth. You know, we talked a little bit about where you are in 2023, where you are today, focused on de Novos, but can you go through a little bit of the challenges that you’ve had and, you know, how you’ve overcome them?

Dr. Alex Sharp: What’s interesting about dentistry is that we are a service industry. And one of my favorite lines that I go back to, whether I’m speaking at one of our internal retreats or I’m doing a doctor training or a front office team training is that I think about being a dentist as being all, not all that dissimilar from being a waiter at a restaurant where it’s my job to say, here’s what I recommend. Here’s what’s good. If you were my mom, here’s what I would recommend that you go with. But at the end of the day, it’s your mouth. You do what you want. So we’re serving people, but it’s made more difficult by the fact that people come in and they already say, it’s nothing personal, doc, but I hate the dentist. So you translate that amount of weird mental voodoo that gets stuck in your brain, you think about that happening in the restaurant industry or any other service industry, it just doesn’t happen. So there’s just a lot of complexity in dentistry that doesn’t pervade other industries as much. And so for us, it’s just the people part, I think of any company is always the uphill battle, clarifying what you’re about, getting people aligned over something that is compelling, that people want to come to work for every single day, because people have options, people can vote with their feet. And if you’re not over delivering to your team, then they can’t over deliver to their patients. So that’s, that’s been a struggle historically that we’ve, we’ve come a long way on. And that I’m, I’m very proud to say that we’ve, we’ve, we’ve gotten that to be definitely a strength. And, and another thing you, you mentioned earlier about like economic pressures. And I think economic pressures are something that every group handles differently. And that’s what I’m excited about going forward is that I feel like whenever, ever since we were founded, the economy has gotten incrementally more challenging to thrive in, which has been interesting because it’s forced us to get that much more fit and that much more efficient and that much more excellent quickly because there just wasn’t a forgiving economy for the majority of our lifespan so far. So I think understanding what your value proposition is to your patient and making sure that you’re nimble and able to say, okay, maybe going out of network for this type of procedure mix doesn’t behoove us. It might sound good in theory, But maybe we’re better off taking insurance for this period of our development and then peeling off plans later on. So I think for us, some of the bigger challenges have just been maintaining consistency across all of our locations. Because when you scale from 1 to 5, 5 to 10, 10 to 20, There’s different things that you see as opportunities at each level, at each plateau, that you didn’t necessarily see before. And I think that if I could boil it down to one thing, it would be you can never over-communicate. It’s impossible to over-communicate. No matter how many different channels you’re communicating through, whether you’re sending emails or instant messages or Loom videos or podcasts, you have to repeat yourself so much for it to really register and resonate. And so when you’re, whether you’re leading a single practice or you’re leading a regional group, or you’re looking to make that jump from a DSO that has to this point been in one state, you’re wanting to go across state lines, just understand that people are not mind readers. And even when you think someone is pretty crystal clear on what your vision is and what you think they know about your growth path, it never hurts to repeat it about five more times.

Bill Neumann: Great points. OK, so we start to wrap things up here. Vision for growth for the organization, you know, in the next five years or so. I’m kind of curious where you see Shared Practices Group in five years, and maybe a little bit of, you know, thoughts on just where you think the industry’s headed.

Dr. Alex Sharp: Yeah, I mean, for us, I see us as having different inflection points over the course of our lifetime as a company. I’ve got about probably, I don’t know, 30 plus years left in this gig, and I’ve found my forever job. I love what I do. I love leading this team and helping to chart the course. And so I think for us, at this phase of our journey, we’re just going to continue plodding along and opening amazing locations with incredible doctors and growing our reach, growing the impact that we’re able to have in the denture and implant realm. And there may come a time when we diversify and look to incorporate other types of dentistry, but right now I just see there being so much value in remaining focused and being relentless about the type of market that we’re serving, both pertaining to the doctors that want to work with us and also the patients that so desperately need the care that we provide. And as for the industry at large, I’m extremely bullish on dentistry because I recently subscribed to this publication. It’s like a quarterly publication. I think it’s called Colossus. It was from the Colossus podcast network. And they put out a quarterly written like hard copy of some essays that they write. And I’m reading about other industries and other multi-site industries. And there’s just so much in dentistry that we don’t have to think about as much, that we don’t have to be as tuned in to all of these little dials and some of the things that plague other similar industries. There’s a lot of protection. There’s some moats that we benefit from, whether we realize it or not. And at the end of the day, we are pretty recession resistant because you can always just change your procedure mix. Like if it all goes to hell in a handbasket and the economy tanks and the world changes, there’s always going to be toothaches. There’s always going to be people that need the services that we provide. And I think that for an industry that has such low expectations of its patients, like patients come in expecting it to be painful, expecting it to be costly, expecting it to take forever, expecting it to be inconvenient, expecting to be talked down to, The bar is so low that all we have to do is just slightly step over the bar, slightly over deliver, and it’s like we hung the moon for our patients. So I love dentistry as an industry, and I think that we’re getting a little better every year at maximizing that opportunity.

Bill Neumann: Excellent. Well, I really appreciate the conversation today. This has been a lot of fun. I mean, we get to see each other from time to time at shows, but never get a ton of time really to talk. You’re getting pulled in one direction and I’m getting pulled in the other. Or maybe it’s vendors trying to get your attention in a lot of cases at some of these shows, for sure. That never happens, Bill. Come on. Yeah. You’re too tall to be able to hide from people. If people want to find out more about Shared Practices Group, what are the best ways? And you also, you’ve got two podcasts, so we’ll make sure we drop them in the show notes, Full Arch Podcast, and then you have your SPG podcast as well, right? So there’s two podcasts. And then what’s the best way? Hey, I’m a dentist. This sounds great. Probably find out more about joining your organization.

Dr. Alex Sharp: Yeah, sharedpracticesgroup.com. We have a link to a questionnaire to fill out if you’re interested in being considered to join the company and work with us. Again, we have a pretty buttoned up recruiting process that we put our doctors through, but it’s been an amazing journey building out that following of doctors and serving them every day. And yeah, I recommend we err on the side of transparency. So the SPG pod is great for people that are internal to the company and people that are external to the company just to learn how we think about training our teams, collaborating, listening to feedback, pushing out changes org-wide. I learned that from Sam Korkos, who’s the CEO of Levels. the, the wearable, uh, blood sugar monitoring, uh, company. And so he, he publishes a lot of his, you know, meeting notes and, and all hands meetings online. And I just think that that’s really cool to get that bird’s eye perspective into how that company runs. And I think that, uh, having a similar level of transparency is a, is a way to have a rising tide that lifts all ships. So yeah, give, give that pod a listen.

Bill Neumann: Excellent. Well, it’s great to see you, Dr. Alex Sharpe. Appreciate you taking some time with us today. And like I said, we’ll make sure we drop all that information in the show notes. And until next time, I’m Bill Neumann. And thanks everybody for listening in or watching us on YouTube. This is the Root Demonstry Now Show.

Kim Larson: Thank you for joining us today. Don’t forget to subscribe to the podcast to stay up to date on the latest DSO news, insights and events. Also subscribe to our DSO weekly e-newsletter at groupdentistrynow.com.