The current and future state of the solo and group dental practice

My passion has always been dentistry and my commitment is focused on how I can enable the members of our dental profession to be successful. My travels have taken me to all 50 states and every major meeting. I am honored to present my interview with one of the true masters of the dental world, Dr. Marc Cooper, founder and president of The Mastery Company. The focus of his company over the past six years has been on group practice of all sizes. 

Dr. Cooper, the context of dentistry has changed. You have stated that we have reached a “break point” and it's not going back to the way it was. What makes you confident that you are correct about the future of dentistry?

Dr. Cooper: My background includes working in a number of other industries. I’ve worked in healthcare, hospitals and Fortune 500 companies. So, I am able to look at the future from a different perspective, which allows me to look from the outside in, giving me a perception of the future from a meta view. Most consultants look from the inside out; they’ve only been inside the dental industry. Therefore, I feel I can predict the future; specifically what will happen, probably not. But in general where things that are going to change? Absolutely.

What is the future of solo practice?

There will be a definite change in how the business of solo practice is performed. For the last 100 years, dental practice has been performed in small solo practices, with maybe one partner. That was sufficient in the system or the context that it was in. But the context has changed, and context is decisive. With the changed context, the system has changed. Solo or small partner practice will no longer have the viability that they did in the old context. In the old days, any dentist could just put up a sign and they were in business. Not anymore.

Okay, so where is dentistry today?

Today dentists are holding tightly on to the past, hoping that things will get better. But it’s not going to get better. The changes that are occurring are dramatic and irreversible. When was the last time you saw a pay phone? It’s been a while, right? So what happened? It’s outdated. The current way solo docs are practicing dentistry will soon be outdated. They can’t practice like they did yesterday. What’s going to occur is that the economy and the dental healthcare system are going to call for a greater capacity to treat more patients more efficiently, which simply can’t be done within the solo practice model.

Are dentists getting ready to change their performance and learn what’s necessary to practice dentistry in the future?

Unfortunately, no. My experience is that there is huge resistance to change. This is painfully evident when I am in front of an audience talking about future strategies for the dental profession. I truly feel the unrest that exists within the audience. They reveal their upset and anger when I present the news about what’s happening with regard to dentistry’s system, the new context and the new competition. Their reaction to these predictions of the future creates a lot of resentment in the room and the volume of their responses is overwhelming.

Why are most dentists not ready for your message?

They’re afraid of the change. In Stephen Covey’s book, Seven Habits of Highly Successful People, the first habit, “Be Proactive,” needs to be read and re-read. The truth is, dentists don’t want to hear that, but it is a truism that must be endorsed and repeated often. “If they want things to change, they have to change themselves.”

Change is difficult and it’s upsetting. The first slide in my PowerPoint presentation is one about the difference between the messenger and the message, because they really need to get the message. Dentistry has been permanently altered; it’s changed and it’s not going to go back to the way it was.

What makes you different from the other consultants?

Great question! The benefits of our consulting are numerous. We have a whole orchestra of business resources that we can utilize. Other consultants have maybe one instrument and they have only one tune. Many consultants attempt to “fix” practices, but The Mastery Company is about the transformation of dentists as leaders and owners. I define transformation as the ability to think beyond your past, your identity and your personality, to think new thoughts, to provide a new way to see the future. We make every effort to assist our clients to develop strategies that will help them be successful in the future.

Is the objective to get doctors to think bigger? Larger? Help them have a larger vision?

When you take “you” out of the picture and insert what you want to create with your life, there’s always largeness to it. Most people are afraid of the risk, so I enable them to go for it. This is a major part of our ongoing coaching.

Describe the relationship you have with your clients.

Our relationship is like being a committed partner. Many clients have gone from single providers to multiple provider group practices with my coaching. Having taken this particular path, some end up with 7-8 practice locations. Therefore, I am engaged in various ways throughout the growth period of their transition from solo practitioner to group practice.

What is the vehicle that you utilize to convey your information to make these transitions a reality?

We have a curriculum called Get Smart in which we break them up into learning groups. Each learning group learns to operate as a Board of Directors. We train them how to think like a director. Not like an owner of a small business, but like a director of a major, for-profit corporation. At the end of the Get Smart program they are required to present a strategic plan, as a CEO of a large company. They are required to generate a model that is going to generate $25 million a year in business. Now the prize for this small group will be in terms of their ability to capitalize their futures. There is an awful lot at stake in this game.

Do you think you have the answers to change the world of dentistry implementing the different breeds of managed group practices?

Yes and no. There is no right answer. One size doesn’t fit all. The variations in group practice are massive. I do think I have a way of coaching people to be able to see and act in a way that changes their future and enable them to create a group practice that fits their values and their region. It’s about them, not about me. I am committed and convinced that I can help turn it around utilizing different models of managed group practice. I have done this with success.

Who is the typical client and what are the different services you offer?

I don’t have a typical client, but I do have a range of clients. In addition to dentists, I coach and consult large group practices, insurance companies, biotechnical firms and companies throughout the supply chain in the area of dentistry. My typical client, though, is as much as anything else committed to success. Their driving intention is to make a difference with their lives and with their work.

How do you go about advising, consulting and coaching your clients to be successful?

We offer monthly coaching, some formal programs, in-house programs and education via the Internet. We have a pretty broad range of vehicles in which we deliver our consulting. I have also written several books. One of the most important books I have written is entitled Mastering the Business of Practice. I also have clients learn from other masters such as Jim Collins, because it gives them a different perspective of what they’re working on. I find that in dealing with doctors across the board, they will read business books and study business methods and strategies.

Describe the profile of your most successful practitioners?

We have discovered that the most successful practitioners are those that are the most coachable. With clients that are very coachable, I can predict that in the end their efforts will be rewarding. I find if you ask what’s typical about the clients I work with, whether it’s a third party, a technical firm, or a small concierge practice, they are great learners and they are coachable.

What’s your success rate?

My success rate goes up and down the scale. You don’t stay in this business unless you’re successful. It’s usually word of mouth that generates the referrals and the clients coming to us. So, helping dentists from solo practice to group practice is what I do. I am proud of our current record.

Let’s jump into the future of dentistry. Where is it going and what are you doing to prepare dentists for that?

The future of dentistry is large managed group practice. Right now, if you go on social media or Dental Town, where you find conversations amongst dentists, most are very much opposed to managed group practice. The truth is that dentistry is going in that direction and they don’t want to go there. They like working alone. Dentists are like eagles and eagles fly alone.

Who and what are the major forces reshaping dental practice?

The amount of revenue generated in dentistry this year was $106 billion. It’s a remarkable amount and more than the GDP of many countries. When you consider the money that is spent on dentistry, and the fact that it’s going up 5-6% a year and is recession resistant, there is huge potential for the future of dentistry. The money markets see dentistry as a good place to put their money. Investors understand that larger group practice entities have a greater profit margin than the smaller solo practices. Also, they have a capacity to generate a greater market share. Therefore, the money from capitalists is beginning to rapidly move into dentistry, mostly into group practice formation and management.

How soon do you believe that’s going to happen?

What will happen is that these larger entities (group practices) will force the little guys, the solo practice, out of existence. They are like a Home Depot, Costco or Walmart, who killed the mom-and-pop stores.

Well it’s happening right now. There are entities called MSOs that have 300-500 practices under management and are acquiring or building 70-100 additional practices per year. It’s ambitious; it’s everywhere.

What are the options available to dentists?

Let’s look at the dentist as an entrepreneur. Our Get Smart program, which I mentioned previously, is a transformational exercise where we take the small groups of dentists who generally think in terms of “I” and enable them to think “we.”

Why aren’t dental schools teaching their students entrepreneurship?

I was involved in teaching dental students and their capacity to take all this in is nil. Information without experience has no power. They have to be working in a practice to understand the game of business. And they have to have something at stake. When you’re in dental school, the business of practice exists way over there. But when you’re in practice and you have bills to pay and staff to pay, then this stuff has a deeper meaning and penetration.

Can this process be an easy transition, to bring on a partner or two partners?

It will be if you have the right structure, the right foundation, the right know how and utilize coaching with starting a business relationship. When you have money, ego and psychology in the game, it’s tough. I have only found it to be easy when the commitment is larger than the individual. If it is about something that is beyond each individual, the answer to your question is, yes. If they are in it for the right reasons: not just to make money, but also to help people, it will be successful.

Take a look at Zappos, Intel and Starbucks. They are about something beyond the individual. They are about making an impact, generating something that leaves a legacy. If dentists can have that kind of character in their game, the transition is much more likely to be successful.

Do you operate like a dental specialist, to show dentists how to get it all together to form a managed group practice?

When I am speaking to a group of solo dentists and developing the idea of future strategies, I ask them, “How much money do you think is in this room?” People look around a bit absently because I’m asking them to consider a bigger picture. But for the purpose of the exercise, most practices generate between $800K-$1.2 million. Then I ask, “How many employees do you think you have?”

With these simple questions I can demonstrate to them that sitting in the room is the foundation for a $20-25 million company with 200 employees. This simple exercise demonstrates the potential they have access to with substantial money and resources behind them. And the collective result that could be accomplished over what the individuals in the room are currently doing.

Describe some of the other resources that are necessary to form a managed group practice.

Solo dental practices as small businesses cannot hire executive talent. They don’t have the money. But in larger groups they can bring on CEOs, CFOs and human resources. They are able to bring in a potency that small businesses cannot. That’s why the larger businesses, like the group practices, are going to gain momentum in the future of dentistry.

What about those dentists sitting around waiting or ignoring the problem?

Basically, they are blind. Solo practices with their business numbers are decreasing all over the place. I know regular guys who are successful clients in group practices that have figured it out. They understand now that working with ten to twelve to fifteen doctors, with access to larger facilities or a network of locations, they can access the potential and capacity to reach every economy, and get good high-paying executive talent as well. And they can generate the money.

Is insurance a major force that is going to reshape the dental practice?

Insurance companies are under the same influences as medical insurance companies. The purchaser now is the employer and they want to know what they are getting for their insurance investment. Now they are asking dental insurance companies to give them the same thing, so there’s an influence about results and outcomes that never had to be reported before by dentists to third parties. The influence of these insurance companies is very strong and will only get stronger.

What should tenured dentists do now?

Those doctors are looking for an exit strategy. Their only realistic exit strategy might be these large DSO corporations who are buying/purchasing dental practices. So, right now, they have a pretty good opportunity. Lots of practices are going this way, so it’s not a seller’s market any longer. The final glitch is that younger dentists are freaked out because of their student debt which on the average is about $250-300K and less than 20% of dentists that get out of school are seeking ownership.

Are you optimistic about future of dentistry?

I think the future is going to be fabulous. By 2019, this is going to be a $180 billion industry. There are still 100 million people that don’t even get care, so if access to care starts happening more and more, dentistry will be a good profession to be involved in. There are seven new dental schools and they are graduating dentists more than ever, but the population is growing faster than the number of dentists being produced. So, there will be more pressure and more market share available for dentists than ever before.

For doctors are reading this interview, how do they go about getting involved with you?

I offer a free consultation to find out if what we do is a good fit. I want to know whom I am dealing with and whether the person is up to a game worth playing. If it’s only about their survival, there are other ways to go about doing this. But what I am really looking for is people who are up to making a difference and changing the face of dentistry. I can be reached at info@masterycompany.com

About the doctors

Dr. Marc Cooper's professional career includes private periodontist, academician, researcher, teacher, practice management consultant, corporate consultant, trainer, seminar director, board director, author, entrepreneur and inventor. Dr. Cooper is founder and President of the MasteryCompany.com and his client experience in dentistry includes solo private practice, small-partnered practices, and managed group practices. Dr. Cooper has authored seven successful books; his electronic newsletter reaches thousands of subscribers in 31 countries. Dr. Cooper also co-developed a suite of online dental practice management assessment tools. You can contact him at 425-806-8830.

Dr. Hugh Doherty is a Certified Financial Planner, national speaker, author, business and financial coach to the dental profession. He founded and is CEO of Business of Dental Practice LLC, a company dedicated to coaching only dentists to develop and implement cutting edge business strategies. His varied background in the field of dentistry, years of research and study at Harvard University Graduate School of Business and the College of Financial Planning, make him uniquely qualified to educate in all aspects of the business and financial world. He can be contacted by email, hughdohertydds@comcast.net.