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This is Laura Dirda with the Becker's Dental
Plus DSO podcast. I'm thrilled today to be
joined by doctor Raj Puri, owner at Smiles
Dental Center. Doctor Puri, it's a pleasure to
have you on the podcast today.
Thank you, Laura. It's, my pleasure. Thank you
so much for having me today. Look forward
to talk.
Absolutely.
Well, you know, I am looking forward to
our conversation as well. I know that in
dentistry, things are changing so quickly and, really
a lot to be excited about. So we
can dive right in here. But before we
do, I was wondering if you could tell
us a little bit more about yourself and
your background.
Sure. Sure. Thanks thanks again for the time.
Doctor Rajpuri,
born and raised in,
suburbs of Chicago.
I've lived here all my life. I'm 45
years old now.
I have a wife and 2 kids. We
live actually in the western suburbs of Chicago.
Well, I graduated in, UIC, University of Illinois
Chicago in 2005,
and I started,
practice ownership in 2,008.
Obviously, a really tough time, I guess, in
the economy and every in the country.
And I I guess it helped not knowing
any different in terms of, just having graduate,
being pretty green, and never owning a business,
really not having, like, a a a full
time job since I was probably in high
school
and not really knowing what a recession meant.
So maybe it worked in my favor or
whatnot, but,
kinda fell into a practice in 2008, and
I was hungry. I was like, I'm I'm
done being associate and probably the best thing
that ever happened to me,
besides my kids and my and my family
and stuff like that. But just becoming an
owner and
not really knowing what I was getting myself
into, but knowing that I was done kind
of working for others,
helped me a lot. So
fast forward now,
3 practices
in,
kinda all spread out, maybe 5, 10 miles
away from each other.
And we have 4 associates.
I think we're up to
3rd 15 team members, including associates, but, like,
closer to so 19 team members.
I love to travel. I love to kinda
get away with my family. My kids are
growing, so I wanna spend more time with
them. So that's kinda taken only me away
from the practice a little bit more. I'm
4 days a week now,
which, you know, it's still
still very full time, but when I first
started out, definitely five and a half, 6
days a week in the beginning just to
get things going. And,
again, I wouldn't take anything back or change
anything. It's just
as dentistry
has been changing, I kinda look back and
see, you know, what things that we've done
and what the the future may hold. So
so, yeah, that's that's kinda me in a
nutshell in, in my background. So
Well, it's great to hear, you know, and
really, cool to to think about that dedication
to not only a dentistry, but then running
your own business and being able to just
really push forward even when times are challenging.
Now when you look at where you're at
right now, what are some of the biggest
issues that you're following in dentistry?
I mean, Laura, the the I wouldn't call
it necessarily a big issue. It's more of,
like, the elephant in the room. Like, we
as I'm still I don't consider myself a
DSO right now. You know, I have 3
practices, but I'm not,
you know, affiliated with a larger group or
not,
the the basic corporation structure as a DSO.
But the way I look at it is
DSOs
are
are here. They're the consolidation
has obviously begun the last couple of years.
It's ramped up.
Maybe it slowed down a little bit because
of inflation, stuff like that. But it's it's
something where where individual practices or dentists
have to keep an eye on and, know
that,
DSOs are out there. Again, it's not a
bad thing. It's made us better leaders. It's
made us more systematized in our offices,
where before we could have been a lot
more haphazard, still have a very profitable business,
and go on with our day.
But really, that's truly not how to run
a business.
We couldn't take ourselves out of it and
still be profitable.
But we learn
from what DSOs did, their system,
their practices,
their even their hours, things like that. So
I feel like
that's one issue that we have to keep
an eye on in terms of how much
consolidation is going on, how fast is that
going on,
and kind of
be ready to pivot and work at kinda
nice when you are a smaller practice or
smaller group practice, I guess. You can pivot
a little bit easier
into another area. You can go more fee
for service. You can go more insurance. You
can do whatever you need to do,
quicker.
Another issue I that we run into here
at Smile Dental Center, and I think everyone
in the country is running to, is it's
it's just more of the hiring hiring issues
that we have where the
pool of qualified
team members is is very small. I think
it's getting better in terms of people wanting
to come back to work and actually
staying. They wanna have a home. They're open
for training, things like that.
So
as a company, we have to really focus
on our onboarding skills and systems,
making sure they're tight, making sure they're consistent,
not just for our sake of people that
are in the in the office already at
a party here, but, you know, the that
future employee, that future associate, what whoever happens
to be. If our systems aren't tight,
they will see that, and then it kind
of goes goes along where we're not getting
the quality out of them,
especially if if these new employees are fresh
and they're they've never worked in the dental
field.
That's okay. As long as we have our
systems tight, we can train them up
and get them to that point that, you
know, we're all comfortable and we're the machine
is still running.
Small things that we see as issues in
the next year or so is patients
accepting treatment plan
and financing.
I still think we're okay with that. I
I think it was too early saying that's
gonna be, you know, drastically change our industry,
but,
you know, there's always issues with patients
getting lots of treatment plan a plan, especially
during a, you know, tough financial time. And
then financing, that's kind of like it's not
really in our in our hands as dentists.
It's just more of like what is what
is the country gonna allow us to do
in terms of our the credit,
Our patient's gonna be denied,
like,
financing. So it makes our treatment treatment
a little bit difficult to to go through
because we still treatment plan ideally for our
patients.
It's just how much can they do and
when can they do it. So those are
some of the some of the bigger to
smaller issues that we see that I see
in our practice. And,
you know, tell the truth, Laura, we probably
tackle 1 to 2 of those, you know,
bigger issues a year. I feel like if
we take on too much
as an owner, it's just it's just too
stressful, but it's we're not gonna get anything
done. We're not gonna get a headway with
any one issue.
So it's kinda nice. You know, I have,
you know, good managers at each office, but
kinda nice where we can
really laser focus on 1 or 2 things
that will move the needle for our practices.
That makes a lot of sense, you know,
and it's really interesting to think about, that
kind of changes and shifts, especially as you,
look into the future towards growth.
From your perspective, what are you most excited
about right now, and what makes you nervous?
Oh, yeah. There's there's plenty to be excited
about with dentistry. I still think it's the
greatest field in the world.
I'm so glad I got into it.
Some of the big, like, new things that
are that are getting me excited is,
more AI, like artificial intelligence coming into the
the field.
We already have it with x-ray,
helping us give a second second opinion or
second set of eyes
for our radiographs in terms of bone loss,
tooth decay, things like that.
But helping us out on the,
front end with our KPIs, like seeing where
our patients are coming from, doing some,
demographics for for us. For for a smaller
office or smaller group, that's been great. Like,
using companies that you know, 3rd parties that
really, really fine tune us on our production
collection, but just not I mean, just add,
like, each provider, each
each day, each week, each month, what should
we be doing with those numbers, but also
then, well, what does that tell us what
the future looks like for our practice? And
that's really exciting.
I I think AI is only just gonna
get better and more seamless
into our practice, and that that
that I cannot wait for. So that's an
exciting time to be practicing right now.
On the technology side, you know, I'm still
a dentist. I'm still wet finger dentists, you
know, 4 days a week.
The 3 d printing,
I believe that will be a game changer
for,
practices that want to get into it. If
I had to make a guess, it's probably
less than 5%, maybe even 2% of offices
do 3 d printing. Some just just do
it for fun.
It's mostly
I think what is it?
Not even crowns, maybe, like,
retainers, some night guards are being fabricated.
But my my theory is in the future,
it will be the majority of our same
day crowns will be 3 d printed.
Hopefully,
direct print aligners
will be perfected in the next 2 2
to 5 years.
But, the only different the only thing I've
seen come around really that that's that's changes
is, one, it's in, digital x rays. I
think most offices have gone towards that route.
And scanners, I think maybe 50% of the
offices now have a scanner in their office.
So I I hope that 3 d printing,
gets better and better, and so that can
be something that can be implemented into each
office
pretty affordably and and
use it in a in a timely manner.
So those those are the kind of the
things from
that get that get me excited. Get me
nervous.
You know, it's it's it's a whole lot
of stuff that
has really little to do with the dentistry
part of of what we do. I guess
if you own a practice long enough and
people will tell you that the dentistry should
be the easy part. When you walk into
your office, you know how to do a
filling, you know how to do a crown,
you know how to do a root canal
to a certain extent.
The other stuff, the other
variables, you can't control you can only control
yourself, but the other variable variables and other
people,
your team members, your patients, your
sales and vendors, whoever, those things you can't
control. So those are things that can kinda
keep you up at night a little bit
where it's, you know, what is is is
when I come in on Monday, is my
office manager gonna tell me she has to
leave because
her husband got a new job and they
have to move out of state?
Or are 2 of my assistants gonna leave
because they're getting a dollar more somewhere else?
Are a couple of my patients upset, and
they want a refund because
something my associate did. Or and that's still
that's still as a leader or a practice
owner, these are all my fault. These are
all my responsibility.
Doesn't mean I have to put all all
these fires out, and it we've discovered,
you know, how to deal with that, how
to delegate.
And as time goes on, we I think
we get better and better at that, and
those those fires become smaller and smaller. So
it doesn't doesn't mean that we're kinda nervous
about it. Sometimes we actually get excited about
those
those, obstacles
and how to tackle them,
how to
approach,
difficult conversations, difficult situations, and say, you know
what? I I can remember back when this
happened, and we can use that experience. So
that's always,
a little nerve wracking.
Other things like
taxes,
those are things that we can't get kind
of get away from. But as a business
owner, we have to watch our overhead. We
have to watch you know, what really is
coming out the door. Are we
you know, heavy PPO, you know, what's our
tax rate kinda at? Like, those kind of
things tell me help me
decide, okay, where is our profitability
at?
Is this still a viable business? Should we
be looking at other places?
How should we raise collection?
How should we bring on those team members
and making sure that the office is running
efficiently?
So I guess if you want to say
those things are what makes us nervous,
is
it getting easier or more difficult
to actually run
a profitable business?
They'll do great clinical work and have that
kind of balance in the office. So
those are those are kind of the small
things that are the those things that we're
seeing.
And, I know we're not alone. I know
a lot of the offices are going through
kind of the same same stuff. So it's
kinda nice to talk to people, a lot
of our colleagues, and, people like you that
are in the industry that that have that
30,000 foot view and looking down and saying,
hey.
This part of the country is going through
this. This might help you. Can this help
this other
group or bunch of dentists out? So but
yeah. So we'll see what happens in the
the next year or so.
Absolutely. I I think all of those things
are so important and, you know, fascinating to
think through, the technology element, how those things
are becoming more pervasive within different practices and
how that could spread. And then to, as
you mentioned, some of the just people issues,
I can imagine a lot of our listeners
are nodding their head in agreement and looking
at, where they're trying to make an impact
and continuing to
move forward,
with just those challenges.
From the technology side of it, I know
you mentioned things are getting more affordable, but
especially for some of the independent practices or
or smaller,
you know, group chains.
How do you select which technology is gonna
be most meaningful for you,
knowing that as you're trying to run for
the future, of course, having more information, more
data, and more ability to, you know, treat
patients is gonna be important, but it is
certainly an investment upfront.
Yeah. Yeah. And that's, you know, that's literally
the $1,000,000 question.
Because there's basics now. I believe there's still
basics now in dentistry if you want to
run not just a proper business, but a
business that you would wanna go to. Like,
as a patient, you're a patient yourself, I'm
a patient.
Do I wanna walk in this office? Do
I feel safe in this office? Do I
feel like they are investing in in new
technology, early technology that looks not dated. You
know, they don't walk in and still are
dipping film in the back. I don't even
know if you know what that means. But,
basically, like, developing film that isn't just seen
on a computer.
You know, that might not seem like
a a big deal to you, but it's
like as a patient walking in, it's like,
I don't know if I wanna send my
family here. I don't know if I wanna
start referring patients here. So the basic stuff
like, again, a scan like,
digital imaging,
a scanner.
I believe I believe a CT is standard
of care now because I do a lot
of implants, and I think that should be
standard of care in terms of what the
what the doctors or clinicians need to see.
So those kind those technologies, I think those
have to be almost like the basics to
to be in the game.
After
that, you have to decide, okay, if you're
running business, if you're already been in practice
for 3, 5 years, let's
say, you need to know your numbers, you
need to know where you're at
and what the future may look like. So
I believe that
now that investment in AI and
technology at at the front desk is is
key for your office managers, for insurance coordinators,
for treatment coordinators.
Because if if
and then it now we have all the
tools in the back end to do all
the diagnosing.
What is that gonna do us any good
if we don't know if the patients are
accepting treatments? They need you know, they want
this treatment in this area
and how to get them to,
you know, afford this treatment.
And those numbers really help us. They really
kinda try the practice and what kind of
practice we really have and what it'll take
to get to that practice that we really
want or want.
So those things, I think, are are more
important to be budgeted for, and they're not
really
they don't break the bank. It's more of
again, a lot of places are subscription models,
which is great.
Like, you pay x amount per month and
you get access to the software.
So I love that. When we're bringing on
something like,
let's say, a,
a 3 like, 3 d printing. We bring
in something on 3 d printing, it has
to be used
minimum once a week. And I don't I'm
not saying this is a arbitrary number. We
know we're open 4 days Fridays a week,
let's say, in these offices.
But you're never gonna get good at it
unless you're doing it consistently. Meaning, each doctor,
one one time a week minimum. They'd be
using it for something.
Obviously, we have to
scale it up as we do more procedures
and we get more out of it, but
it cannot be something we just put our
coat on in the in the closet. It
cannot be something that we show off to
a patient and it looks cool, but, you
know what, we don't all use it. And
when we try to use it, we look
inefficient to do it.
So, yes, we have, you know, certain benchmark
number wise
and saying, okay, we hit this or we
brought on another associate. Now we need x,
y, and z. Maybe we need another scanner
to get us over that edge. It's not
a perfect science
and it's not just going by feel.
It may be going by how many patients
walk through that door and but it definitely
comes down as a treatment mix and
saying, okay. We're here x amount of hours.
We may we produce this much.
What does another scanner look like? We run
the numbers. And within 90 days, we will
make a decision one way or the other
if that's if that's the route we're gonna
go.
That's really fascinating to hear. It makes a
lot of sense, you know, when you look
at the decision making process and trying to
figure out what's gonna be most beneficial for
patients as well as the
practice. Now you also mentioned the people part
of it.
I I think it seems like that,
just kind of competitiveness for staff and really,
you know, those who are trained in very
talented people is continuing to rise,
you know, in and especially when looking at
how,
practices are able to pay their staff and
what really Yep. Is the standard continue to
rise without that reimbursement
to match. So, you know, when you look
at those,
factors in that situation, how do you really,
try to respond and make sure that,
for your teammates, you can offer whatever you
can possible to try to, build a great
team there.
No. I I, I agree. It's it's
it hasn't gotten any easier since
I purchased my practice back in 2008.
It is it is still always a struggle
to not just
onboard
new team members, great team members, but keep
the team members you have. And I I
I really wanna make sure that's a focus
on
keeping the team members you have on your
team, treat them like gold,
make sure they come to a place that
they're happy, that they're respected
because it starts from that core. You have
your core values that starts with the core
people that you have in your team. As
long as you want them on your team,
and they wanna be there,
those people will find you other team members
as well.
Obviously, they're coming from, you know, other sites
and, and 3
d or third party places, but you keep
that core intact as best you can
by obviously playing them well.
There's
different, platforms you can use for, you know,
with the payment and
pay in the area and things like that.
And,
you don't wanna be, you know, the maybe
you don't wanna be the highest. You don't
wanna be the low definitely, the lowest.
But
you wanna have them not focus as much,
obviously, on the pay, but having that respect.
And everybody
wants something different. You know, the majority maybe
will want that pay, but some people just
want the appreciation.
Some might want gifts. Some might want time
off with their kids. Some might just want
flexible hours. We find out and this is
this comes into a leadership. That's really what
I'll do with the dentistry. Just the leadership
part is figuring out what does this
person really need, what do they want, how
can we give it to them. You don't
need as many team members as you think
to run an efficient office if you got
again, you you've taken these people and and
turn into great team members already.
For the new hires, it again comes back
to onboarding,
making sure your systems are tight.
To stay competitive,
We try to do more of a tiered
model
instead of just saying, okay. Here's x amount
for you because you have 1 year experience.
Then let's bring in. These are the these
are the markings these are the amounts that
you can make as long as you hit
these tiers. So you have you have goals
throughout the year almost.
We have that our good 30, 60, 90
where we kind of talk to them, sit
down with the new team members, know they're
on track,
know what the benefit package looks like. So
a little more professional than maybe when we
first started.
And I think that's helped us a lot
getting those,
professionals that wanna be here in the field
for the long term. So by 90 days,
they want they know they wanna be here.
We know we want them to be here.
And, again, we just try to
treat them as well as we can,
be professional,
document everything,
and, you know, be as competitive we can
in the area. I say that, Laura, to
you, but it is it does get more
difficult every year
with especially if you're
in an insurance driven industry,
like, we're probably 70%, 80% PPO,
where our reimbursements aren't going up,
our overhead, including supplies, lab bills, maybe
team members, stuff like that keeps going up,
where is
that breakeven not just breakeven point, but where
is that Okay. I'm I wanna take the
x amount of profitability to be happy with
it. Otherwise, we have to look at other,
other options with team members. And I don't
wanna do that. I think that's one
line item where we don't mind overspending or
being over because we want great people here
and want people that wanna be around. And
for the majority,
we definitely have that.
We have very little turnover. I have people
on my team that have been with us
for 16 years, And but still we bring
on people probably every
6 months, maybe every year,
because people come in and out or part
timers and things like that. So
we we're always constantly looking for good
team members, good potential fit.
That's great to hear. And, you know, a
really strong strategy, it sounds like. Now before
we wrap up here, I'm wondering what will
the most effective health care leaders need in
order to be successful
dental industry will continue to evolve and some
of these challenges will, you know, persist or
evolve as well?
Sure. And I don't wanna, you know, kind
of restate everything again, but it's it really
is important to say, like, knowing how to
onboard
new team members efficiently, especially ones that are
not from the dental field,
really incorporating
more technology or different technology that
it might seem cool to some patients or
something might seem great to a dentist, but
make sure that you can actually get a
functional,
technology that you're gonna use on a daily
basis. And it's gonna really, again, move the
needle, drive your practice forward.
A big thing is for me is keeping
keeping owners
or keeping dentists, really, in control of their
future. You know? This is this is still
a cottage industry. We're still we're not medicine.
We're not ginormous where we can, again, pivot.
We can do things
that they can't still.
And
it's very important to me to know that,
okay,
we're business owners. We control
everything from the marketing, from who we hire,
who we fire, the hours we work.
We do it for a purpose, and we're
starting we're definitely learning that you know, there's
a there's a rhyme and a reason to
what we do and how we run our
practice and
who we bring into our our practice. So
the next, you know, couple of years will
be very pivotal in dentistry and saying, okay.
Where
where does this future lead to? You know,
where are those those dental students want to
go? Do they wanna be practice owners? Do
they wanna go straight into
a, a DSO or even my practice to
become an associate?
And I've I don't care either way. You
know, I I meaning, I would love them
to, one day, want to own or at
least try it out and see if they
like it or not, but it's more of
as long as they came into dentistry for
the right reasons, I'm assuming most dentists are
still they wanna help people. They wanna be
part of this, you know, fantastic field and
kinda grow with it. But, really,
as health care leaders I love that word
leaders. We're constantly learning how to lead our
teams.
Even if you're only if not only even
if you're an associate, even if you're a
dental assistant, hygienist, whatever, you're still team leaders
and act like that. Have that ownership mentality.
I think all our practices will be fine
will will be will be okay. It's more
of, okay, we're gonna bring someone else new.
We're gonna bring a new piece of technology.
How do we incorporate these things
going forward, and how do we use that
efficiently? Because, again, things are changing,
for me, I feel like quite rapidly.
So
how to just to keep up with that
and not how not
make it part of your
whirlwind, like, get
throw your practice into confusion or chaos on
how to use those things
to your advantage.
So I hope I hope that helped. I
don't know if that made any sense there,
but
Absolutely. No. I think you're spot on, especially,
in trying to remain steadfast. Like you said,
getting more,
dentists and dental leaders into the the field
and,
making sure they have the opportunity to serve
patients and the communities in the best way
possible. Doctor Puerri, thank you so much for
joining us on the podcast today. This has
been such a fun and interesting discussion, and
I look forward to connecting with you again
soon.
No. My pleasure, Laura. Thank you so much
for having