This is Manhattan with the Becca Dental Ds
podcast.
I'm thrilled to be joined today by Doctor
Chad Carpenter,
Ceo of West Dakota Dental Partners, Doctor Carpenter.
Thank you so much for joining us today.
You're welcome. I'm glad to be here.
Great. To start us off, could you introduce
yourself and tell us somebody about your background?
Sure.
I'm a dentist in South Dakota, and I've
been practicing
here for about 20 years. I graduated from
Nebraska in 2005.
And I live here with my wife, and
we have 6 children together.
And
I loved dentistry. I I love my team,
and there's so much happening in the industry.
And in our practices that
when I got asked to join you guys
for this conversation, I was excited to do
it because sometimes
when we get asked questions, we we get
to kinda of think about a more deeply
and and answer in a more meaningful way.
And so sometimes they get clarification on the
vision by having a conversation with someone like
You. So thanks for having me.
Fantastic. That's great to hear.
My first question for you is what are
the biggest issues you're following in dental in
20 24?
Well,
reimbursement rates
have been really
kind of lin pen for our group.
We have 2 pediatric clinics
in our ecosystem, and we see a lot
of Medicaid.
And when they bump our rem
it has significant effects on how we hire
how we compensate our team, how we make
reinvestment,
And so that's been
something that's affected us.
You know, our
regular
insurance like Delta Dental or whatever. That doesn't
change a lot from year to year.
But in our pe practices where we have
a little bit higher Medicaid
participation that's been a big deal.
For instance,
we have a surgery center
where we do our s suggestions for our
pediatric patients under general anesthesia.
And we were going through the accreditation process
to become an ambulatory surgical center, which is
pretty onerous,
really hard on the team and really expensive
And
the Medicaid
fee got adjusted just enough to push us
over into the black. And so
we had to sit down with the team
and
look at a spreadsheet and do some math
and decide. Is this worth doing?
Or
should we, you know, pause on the As
accreditation effort for a bit?
And so
the main reason to have a surgery center
is just so you can do the Ga
cases we weren't looking at it as a
profit center. And so
with the change in
rem
from Medicaid, we were actually able to be
in the black. And so that had a
huge effect on us.
So that's 1 thing I would say is
just how we're getting paid
from different payers.
Another thing is
evolutions in all on x or full arch.
In my practice for I work. I don't
work at the pediatric clinics. I work at,
a private practice that I own.
And
we've been doing a lot more all on
x or full arch cases.
It's something that
is in demand here in the Black Hills.
And my team absolutely loves it.
And we're using a fully digital workflow now.
So we have
you know, a designer that does a smile
design.
We kind of prep plan everything out, take
the teeth out This is, like, a it's
an un guided approach
on using this workflow. And so
after we take the teeth that we put
the implants in, And then we take a
Ios scan with, like, a prime scan or
It terror,
and then we'll use something called photo.
We use Ic cam
but there's different iterations. There's pick, there's micron
map or there's Opt plant and there's other
different other different
modalities, but
that gets you a super passive accurate fit
of your printed
provisional. So then we'll print
their temp hybrid on our 1 of our
Sprint raise.
And we have a full time laboratory
technician that handles all that. She is awesome.
So, yeah. Those are kind of the 2
things that...
I think about a lot is just
the all on side of my practice. And
then on the pediatric side, just the explosive
growth that our clinics have had and how
we manage expenses and hire and stuff like
that. They'll answer your question well?
Yes. Thank you for sharing.
For sure.
So what are you most excited about and
what makes you nervous and dental until?
You know, the thing that gets me the
most excited is just...
Being in the with my patient.
I was looking on social media this weekend
and 1 of my
I've been in his dentist for 12 years.
He sadly passed away from Leukemia.
And I just saw him last week, and,
you know, we got to hug and
and talk about his diagnosis a little bit
and my he got a little teary eyed
in the conversation and
you know, I know is why if they
go to my church,
it just meant a lot for me to
be able to provide that care for him
over the years and then had to say
goodbye.
And just reminded me that
I'm part of the community, I'm part of
my patient's lives and what we do matters.
Really matters to people. They get to keep
their teeth or if they don't have teeth,
they get to get teeth.
They get to look and feel their best.
So it's a really important
mission that we're on.
And so when all this crazy stuff happens
with
overhead and people quitting and people get stressed
out and interest rates, my loans are rep
pricing. How am Gonna make that up. My
rent went up,
all these problems, my assistance quitting, She can't
make enough money in assisting is a single
mom. So she's leaving for nursing. You can
make 20 dollars more an hour.
So these are real problems that we're facing
and it's easy to
let that kinda weigh on you and take
your mind in the dark place. But then
as soon as I get into the operator
with my patient,
I just pour into them and all that
just goes away.
And so
that's what I'm most excited about is just
continuing to build relationships with my patients. And
having my team might buy me. I on
my side each and every day. And,
you know, they make my day better. I
make their day better and together,
we create great outcomes for our patients. So
that would be the number 1 thing is
just
providing great care and not just dental care,
but also
being there emotionally for the patient and just
showing them love and
treating them you, at the highest level that
we can.
Yeah. Absolutely. It's good that you have that
opportunity to, you know, really foster that that
doctor patient relationship.
Oh.
It's
it's I think it's 1 advantage of a
private practice
with a owner dentist that lives in the
community that's not moving.
You just get really ingrained
and people, they trust you, they know you.
They believe you,
you can get
really great cases on patients that
accept care with value. They pay with value.
And they come back into your hygiene program.
Year after year
you know, with the dentistry that you did
still in their mouth,
you don't have to
convince people to do treatment when they already
know you and they've known you for a
long time.
And so
I do have colleagues at travel,
nothing wrong with that at all. We have
a lot of traveling doctors at our hospital
here in town. And a lot of them
are, like, super awesome people. But,
you know, when they're not from the town,
it's a little bit different because people don't
know you. They don't know your parents.
Their kids aren't in school with your kids
because your kids maybe live somewhere else. And
so I think that's a huge advantage to,
you know, just like a more traditional model
of of a private practice where it's like,
you're the friendly local dentist that everybody knows
when they see you in the grocery store.
I think we have a leg up on
you know, people that just
kind of blow in and then blow out.
I've seen some
patients come in travel very long distances to
see me,
they maybe had a big, implant case done.
Now they have some problems and they'll say,
like,
Oh, you know, my dentist, he moved away
or he closed practice,
and it wasn't like a retirement situation. It
was just the the gal or the guy
whoever just decided to move on. And I'm
not saying that they were doing anything bad.
It's just
when people leave
you know, now there's a big void there.
And so if you're just kind of like
a a rock
in your community, you're there, you're not going
anywhere. You're not planning on moving,
and you kind of execute that, you know,
that gives people a lot of confidence.
Is you need to do a good job,
you need to have high integrity because if
you don't,
you know, you're gonna be there. You're gonna
have to be accountable to that. And so
I kinda welcome that extra layer of accountability,
just being there for the long haul instead
of just looking at no short
short time horizons.
So
that's another way that I think about it
about what it's like to practice and us
smaller community. I understand like, in a big
city,
maybe these things don't resonate as much because
you don't know anybody in the grocery store
anyway,
a couple my friends practice in Denver
And when I tell them about stuff like
that, they don't really, like, get it. Right?
Because I live in a smaller town. So
it's like, about 80000 people,
Anyway. Interesting. Yeah. Thank you for sharing.
Oh, you're welcome.
So what about what makes you most nervous
in dental?
You know, it isn't really in dental. It's
just sort of there's the une right now
with, you know, what's happening with the economy.
Stock market seems to be hanging in there,
but, you know, is this gonna last? We
all fight... You know, we were gonna already
deed maybe on our second or third rate
cut. So far, and we haven't even had
1.
You know, there's even some people predicting that
rates could go up,
maybe 1 time in 20 24
not go down.
I think most people still
expect at least 1 rate cut before the
election. But when I'm looking at the economy
as a whole, I'm thinking, okay,
if something happens and 4 1 values start
dropping
and retirees start panicking,
how's that gonna affect our ability to do
what we do
because
I was around in 2008
and 2009?
And I saw
you know, patients delayed treatment and stuff like
that. And
that's where,
you know, it's easy to poo poo, like,
oh, medicaid yuck. Right? Like, well,
yeah. Until there's a recession,
and then it doesn't change at all. Like,
there's no drop. Right?
And so
heavy insurance practices,
lots of Ppo,
You know, there's a lot of, like, more
boutique dentists that
they'll say things like, oh, I comprehensive the
treatment plan and it's more of a boutique
office.
Patients will pay for things that they value.
I agree with all of that. That's how
I would like to practice.
But if you have
a nice base of people that depend on
their insurance benefits, they come in every 6
months for their cleaning,
They'll do a crown or 2,
you know, they'll do a canal, they'll do
an implant.
They're willing to invest in their in their
mouth.
As long as they don't lose their job,
probably if there's a recession, they'll still do
the care. It those big
kind of comprehensive cases
that I'm doing more and more of all
the time. I think I'll be affected
if something hits if, like, there's a big
downturn The economy.
But, you know, I mean, They've been talking
about that for 2 to 3 years now
that, oh, you know, it's coming and it's,
like, well, hasn't come. And so
just kind of pressing forward and
knowing that you can always pivot, you can
always
cut your spending personally
if
if there's some sort of a crunch and
even if you had to
sell off some assets or I mean,
I guess what I'm saying is
dentists should be ready and have a plan
for if something does happen with the economy.
How they gonna react to be okay and
hopefully not have to lay off any other
team. So
that's probably what I'm
concerned about is just general economic conditions and
and how the country is doing as a
whole because I think
the the dental industry follows
will follow that, especially at the higher end.
Yeah. Absolutely. Thank you.
What are the most effective health leaders need
to be successful in the next 2 to
3 years?
Well,
taking care of your team, and
that means listening, that means investing in them,
you know, getting together, sitting around the table.
Talking about,
you know, the question that you asked me,
like, what am I most worried about? I
tried to ask that to my team.
Like, hey. What's stressing you out at work
right now. Is there anything that we need
to be doing better? So
just trying to listen
but my team happy and engaged, you know,
we take better care of our patients. And
I shared with you that I have a
really awesome dental assistant that's leading the profession
because she can make more money as a
nurse.
And in my state, south Dakota,
they control what the assistance can do a
little more.
Like, for instance, in Colorado,
if the dentist prepares a cavity and a
tooth,
it's okay for a trained non dentist to
come in and, like put a filling in.
And so in our state, like, that's not
allowed. And so
it's not all, you know, kitten whisk and
rainbows, of course. If you have a non
dense performing
things is it gonna be as good.
They don't have the training. They don't understand
the biology. It's like, well, okay, there may
be some truth to that.
But only looking at the economic side and
how much I can pay my assistant,
you know, if all you can do is
really
traditional classic chairs site assisting,
there's a ceiling to how much you can
get paid.
And so
if we wanna be able to retain and
attract top talent into dentistry,
it it's my feeling that we need to
explore ways to allow our team members to
do more. If I could delegate more, I
could pay more. And so
you know, trying to keep a team together
when the economics doesn't always support, like, a
super
high pay.
You know, the hydrogen is do do pretty
good. But if you're a single mom
trying to buy a house,
making 22 dollars an hour,
like,
really hard.
And maybe in some communities,
home prices are still, like, more affordable by
in the Black hills,
have a mountain town out here.
Things are already expensive. And then during Covid,
like all these people from
like, California, Oregon,
Washington,
Colorado, they're all sort of moving into the
black Hills. And so
there's a lot of migration that or, I
guess, not migration, but, like coming in from
other states into South Dakota, and so that
really drove our property prices up, so it's
even more difficult.
So to answer your question about, like, leadership,
just,
you know, keeping your finger on the pulse
of what's going on with your team and
possibly even advocating at a state level.
So I have the opportunity to, you know,
advocate for expanded
function
of my team,
at the house of Delegates coming up in
May. And it came up last year
didn't pass.
Failed like 19 to 13. So their support
for allowing us systems to do more things,
but not enough.
And I was at a meeting sitting around
the table with a lot of dentists and
it's overwhelmingly against.
And I heard a lot of
you know, people saying, oh, you know, they'll
never be able to do it as good
as a dentist and
Frankly, I think there's some clinicians that don't
really train their team very well.
Maybe they don't have the leadership skills to
take people to a higher level. And so
they don't want they don't want someone like
me to be able to do that. Because
that would be a threat. Right? So they
kinda wanna, like, protect their little corner. They
understand how it works. They don't want it
to change
and we're doing okay without it. So,
you know, it is what it is. But
if I can if I can find a
way to elevate my team and take them
from the place where they're at,
improve their skills, improve their mindset, make their
life better pay them more,
give them a greater sense of meeting and
purpose, make sure that they know I really
appreciate that they're there that they're with me.
Those skills are are super valuable.
I think so any healthcare leader, you know,
I have hospital privileges at our local hospital
and
got a really big,
you know, monolithic
organization
it's harder for
the leadership to really impact
all the team members because it's just such
a big team.
And in a dental clinic, we have a
unique opportunity,
typically, our clinics are smaller. And so if
we want to
we can know our team. We can notice
when they look sad, dick in on them,
Ask them him if they're okay, you know,
just kind of be in their form creating
like a family environment. And
I think that's been something that we've
been able to do it wasn't by design,
and it's just sort of how what happens.
We have a meeting once a week for
1 hour,
where we sit down the whole team.
We don't see any patients. We don't even
answer the phone. So from Tuesday morning from
8 to 9.
And sometimes we'll go over,
like, Kpis, like, how many new patients have
we got? What's your hygiene retention
hygiene retention and whatever other little new software
things you're gonna be doing, but sometimes we'll
just watch, like a motivational video or listen
to something
that maybe helps us away from work. But
maybe it's also apple applicable to work, but
it's not necessarily dental centric.
And so that's been another way to engage
my team is just
maybe it's a ted talk or Jake, we
even had a book club where we read
Daniel Go book called emotional intelligence,
just sort of learning about how,
how to read people, body language,
how to get into rapport with a patient,
and how to build trust, how to listen,
that type of thing. So investing in my
team in a way that isn't always just
dental. We go trips how you know, 1
of my friends, that's the dentist system to
my community,
he took a clinic over that his dad
had and they used to go on trips.
Together.
And he told me, like, he didn't think
it was worth it. And so he wasn't
gonna be taking the team on any trips
anymore, you know, and
And it is expensive when you're flying people
across the country and you're putting them up
in hotels and buying them food and paying
for the tuition to the course.
Can be, like, 30 to 40 grand, depending
on how big your team is.
But if you do that, like, once every
so often once every few years. It's like,
it means a lots of people, and
you, when they're around each other outside of
work, they they're able to build relationships and
trust and
you know, I feel like
if you're trying to spruce up your your
P and L because you're gonna sell and
you're trying to drive it, your No you
Eb up, because you think you're going to
get some multiple on, like, what your profit
is.
And so for 2 years before you sell,
you kinda clamp it down. Like, I get
that.
But I would rather sacrifice a few percentage
points of profit
and have, like, absolutely kick ass culture.
And,
you know, I... I'm a client of this
accounting firm that publishes,
like guidelines. Like, here some ranges you should
try to stay in as a dentist.
You know, keep your staff salaries at, like,
38 percent, no higher
keep your rent at 6 percent or whatever
it is. And you kind of get those
out and look at them to kind make
sure you're not out of range and
you know, if you're a little bit high
on c,
maybe a little bit high on
payroll.
And you feel like your top line revenue
number is really solid. Like, the productions there
you guys are kicking butt. You're doing the
right kind of dentistry, your busy, hygiene schedules
are full.
Mean, you could always do top line revenue,
but assume that you're already doing really good
there, that how could you how could you
explain
being off target in a few other categories.
And it's like well,
because you're making
a decision to sacrifice
perceived profit for these other intangible things,
like, people are happy. I like my job.
I have 2 assistants in my room all
the time.
So my neck and back feel better than
they ever have. That doesn't show up on
a P and L. So,
you know, doing some of those things spending
extra money where maybe I shouldn't
from an accountant standpoint. My Cfo would Wag
finger at me, but And maybe it's a
excuse for lack of discipline,
Whereas, you know, I probably need to rein
it back a little bit. But, I guess
that's just what I'm trying to say is,
not being afraid to invest in the team.
Even if it
might drag your, you know, profit and loss
statement in a direction that you don't wanna
see. Because it seems like the balance sheet
keeps going in the right direction.
Even though the P and L doesn't always
look that great. And lastly, as we've added
Den in, when it was me and my
5 chairs,
I had like the best lowest overhead in
the history of whatever. It was just like
amazing.
And as I've added dense in
and grown. It's like, what happened to my
margin?
Like, they went poof.
It's not that bad. I'm I'm exaggerating, but
I think I think what you got my
point.
Yeah. Thank you so much. For for sharing.
It sounds like you have some really great
strategies there and really prioritize culture will be
really helpful for health leaders in the next
few years.
Doctor Carpenter. Thank you so much for joining
us today, and for all of your fascinating
insights. I look forward to connecting with you
again in the future.
Alright, R. I appreciate you giving me a
chance to talk. Have a great day.
Thank you. You too.