How To Manage & Grow A Multi-Location Dental Practice Effectively

Chris Pistorius (00:00):

Hello, everybody. This is Chris Pistorius again for another edition of The Dental and Orthodontic Marketing Podcast. We have an excellent guest with us today. We have Candice Hansen. Candice is the practice administrator with St. Paul Pediatric Dentistry, obviously in the St. Paul, Minneapolis area of our country. She is really is the grit and the hard work behind three practices that is under the St. Paul Pediatric Dentistry name. Candice, thanks so much for taking the time to be with us today.

Candice Hansen (00:41):

Yes, of course, Chris. Thanks for having me.

Chris Pistorius (00:43):

Great. Well, why don’t we start off? Tell us a little bit about St. Paul Pediatric Dentistry. What are you guys all about and what makes you guys unique?

Candice Hansen (00:54):

Yeah, well, I think you might’ve mentioned it, but we are a multi-location multi-doctor practice. We have three locations, three dentists that practice. We’re open full-time. What we are all about, we are pediatric specialists and we really strive to provide the highest quality of care and also deliver a pretty fun experience, as fun as dental can be for kiddos.

Chris Pistorius (01:29):

Yeah. Well, that’s awesome. You’ve been with the practice for four years now, is that right?

Candice Hansen (01:35):

Yep, a little over four years.

Chris Pistorius (01:37):

Okay. Tell us a little bit about what you specifically do. What do you do for the practice itself? Everything, right?

Candice Hansen (01:45):

Yeah. I think you might give me too much credit. I work with a really great group of doctors, which makes my job fairly easy in that sense, but a big part of my role is the growth of the business, so I oversee the business, just making sure our expenses and our overhead fall in line with our production and collections.

Candice Hansen (02:18):

Then probably, and I think if there’s other practice managers and/or dentists listening to this, they can relate to that right now, the biggest thing, the biggest part of my job is staffing and making sure that we have the right team, we have a team that’s elevated and also growth-focused because at St. Paul Pediatric Dentistry we started with one very small location that on paper did not look like it was going to be thriving, did not look like it was probably a good investment, and we found a formula that worked and we’ve taken that and duplicated it now three times, so yeah.

Candice Hansen (03:08):

Overall, a big part of that has been the team. Growing the business, a big part of it has been growing the team correctly and timing that right, so yeah, I would say overall, I wear many hats depending on the day, but the biggest part of my job is taking care of my team, building my team, and building the business.

Chris Pistorius (03:32):

Yeah. There’s a lot there to unpack for sure and I’m sure some people that are listening to this are nodding their head like, “Yes,” but then their question is, “How did you get to where you are now?” so let’s unpack first the first thing where you had talked about one location maybe not doing great and then you figured it out and then you duplicated that. I guess the question that everybody’s probably asking themselves is: How did you figure it out? How did you find that way to move forward?

Candice Hansen (04:04):

Well, I don’t know that we have figured it out exactly just yet, as we always think we’re a work in progress, but a lot of it goes to the owner of our practice, Dr. Julie Hammond. She’s always forward-thinking and it took a lot of time and effort and there were times as a doctor, she was answering the phone herself. But as far as figuring out the formula for what worked, it just really was trial and error. It started first with the team and then it went into our schedule, scheduling accurately, productively. When I came on board, I brought with some past experience that I think, I hope, helped to scale the business as far as insurance companies and negotiating our fee schedules and timing, evaluating what’s worth employee’s time and what isn’t, outsourcing services. There are just multiple things that have went into this practice. Yeah, sorry, I’m not even sure exactly where to start.

Chris Pistorius (05:31):

Right. There’s a lot there, right? Yeah, I think the point here is that there’s no magic button that you just figure it out, right? It’s trial and error and what works for some may not work for others. I mean, would you agree with that?

Candice Hansen (05:45):

Yes, most definitely.

Chris Pistorius (05:46):

Yeah, yeah. You had some dental experience before you came into this. Has your experience always been pediatric, or no?

Candice Hansen (05:54):

It has not, no.

Chris Pistorius (05:56):

Okay, okay. When you came in, you took this job four years ago or so, what did you start to figure out? What are some of the biggest differences? Obviously, I mean, you see kids and not adults, but other than that, from a business standpoint, what are some of the nuances that you found with pediatric that maybe didn’t exist with general dentistry?

Candice Hansen (06:16):

Yeah. Well, I actually have been in a specialty my whole career. I was in oral surgery as a specialty prior to this, yeah, so 10 years in total with oral surgery, or about 10 years.

Chris Pistorius (06:31):

Jeez.

Candice Hansen (06:32):

But when I came into this office, and very open-minded, I would say that is the one thing when you’re transitioning or going into any new business, you can see it from a different lens because the people working in the day-to-day, they’ve got their normal routines, right? I came into it really open-minded. I knew I was working for a doctor that our values aligned and I took the first few months to really just watch and observe what and learn what was working.

Candice Hansen (07:09):

Then after that, I started to give some feedback as far as things I saw and the first one was the insurance companies that we were in network with and saying, “I see that we’re charging out for this and we’re packing these schedules full, but do you know that you’re getting paid 30% of your fee on that? What if we cut out this insurance company so that you had more room to see?” I’m going to reference, say, Delta Dental that pays us 70% of our fees versus… Those were the first things, yeah, that I really started looking at. It was that, then looking at the hygienist schedule, and saying, “She’s always consistently getting done with these appointments 15 minutes early. If you add that up in the day, we could fit an additional four appointments in today, so why don’t we change her standard appointment lengths to 30 minutes?” I do a lot of time auditing. Yeah.

Chris Pistorius (08:30):

Yeah, I see where you’re going. I mean, those things make a huge impact and I can see where bringing experience from even outside of that specialty can make a big difference. You brought up hiring before. I hear that a lot from dental practices that we work with or just people I interview on this podcast and they’re struggling right now. I mean, COVID obviously us all hard, and I believe pretty much every dental practice in the country shut down. Obviously, there were some layoffs that happened there. I know some practices that didn’t lay people off, but I guess from your perspective in hiring, in my opinion, that’s one of the most critical aspects of growing any type of business, no matter what you are, but what advice do you have, specifically in dentistry? How do you hire people and find them and keep them, I guess?

Candice Hansen (09:25):

Magic question, Chris.

Chris Pistorius (09:28):

Yeah.

Candice Hansen (09:30):

There’s so many things that play into this. If my team listens to this, I am going to have to just give them a little shout-out. I do really feel I have a really strong, solid team, but we pride ourselves in what we say, choosing wisely. We do really follow the theme that hire slow and let go fast if it’s not [inaudible 00:09:57]. We also look more for, honestly, personality traits. There are a lot of skills that we feel can be taught to the right person, so we have started hiring more to culture than we have to the actual position or job description.

Chris Pistorius (10:23):

Yeah. Yeah, I’m hearing more and more of that and I’m getting more of people are having more success with hiring, perhaps, people with no experience, right, and because they feel as though they can teach them the job, it might take them a little longer, but then they can craft them the way that they want because if they don’t have experience, you’re really teaching them the dental industry and how to do things. Would you recommend that as well, then?

Candice Hansen (10:51):

Yeah. Minnesota specifically for dental can be tough because they do require every assistant, and I know it varies from state to state, but that they have a license, they’ve graduated from an accredited college. You can hire unlicensed assistants, but then they’re very limited as to what they can do within your practice. But hiring with no experience, I actually, we do love that. We say that coming in very green allows us to teach you specifically to our practice and the best compliment I can get is when an employee has found a position where they feel like they’ve maybe outgrown us and need to look at a different opportunity and whomever that hires them says, “Oh, I’m so glad you were trained at St. Paul Pediatric Dentistry.”

Chris Pistorius (11:46):

That’s great, yeah.

Candice Hansen (11:48):

Yeah, and it-

Chris Pistorius (11:49):

That’s an interesting perspective. It’s not like some people where somebody leaves and goes to somebody else and you’re all kind of upset over it. If it’s a good opportunity, a growth opportunity, that’s kind of a compliment, huh?

Candice Hansen (12:01):

… Yeah. I think in dentistry sometimes that’s where we maybe need to have a mind shift is that some of these team members, there’s fear of plateauing or fear of, “Where do I go next from here?” so what we look for in our practice is really, and I think any business probably wants this, is you want employees, you want longevity. Being a very growth-focused practice, we instill that in our teammates from day one: Where do you see yourself in five years? What are your goals? What do you want from this position? Being very honest, we have a lot of open, upfront conversations from the get-go in saying that, “Okay, you’re a dental assistant, but you hope someday to be an office manager. Let’s see what kind of track we can put you on within this practice to grow your skillset. Then if in five years, that position isn’t available here, but you feel like you’re ready for it, if we can help you, even if it is moving on from us.”

Candice Hansen (13:15):

But I think where we have success with keeping our employees long-term is that we do instill that, again from the beginning, that if you are looking for growth or for your future, that we’re going to help to get you there, and we hope that it will be within St. Paul Pediatric Dentistry, but if it is not, that’s okay, too, because we see that we see that you have it.

Chris Pistorius (13:45):

Right. Yeah, you can tell. Yeah. That’s great. I mean, I was referencing a little bit also towards front desk people, that when we have clients bring them in, it seems like people have been in the business 15 or 20 years don’t work out as well as people that maybe don’t have that experience and can be molded a little bit more freely, if you will. I think that’s an interesting perspective. Do you guys do anything in terms of employee retention in terms of bonus structures or goals or anything like that?

Candice Hansen (14:28):

Yes. Yep. For employee retention, the first thing that we do is a lot of communication. To start, we’re very transparent and we do a 30-day check-in from hire, a 60-day check-in, and then a 90-day check-in to graduation, which means 90 days you’re fully ready to be independent. We remind them what assets they are to our practice and then we say, “Okay, the next time we’ll sit down again at your six-month checkup,” referencing the dental world there, so then we do a six-month checkup, and then we do an annual checkup or an annual, what is it called? Just an annual performance review. The transparent communication upfront is huge for them from what we’ve found because every employee, we do surveys and we ask for feedback, and the one thing they say, when you’re a practice of multi-locations, is “Communication.” Everybody wants to know what’s going on, everybody wants to know how they’re doing. As you grow your team, that can get really hard. We’ve gone from a team of three in 2000, gosh, ’13, to now we have 24 employees total, and they all want to hear how they’re performing.

Chris Pistorius (16:05):

Wow. Yeah.

Candice Hansen (16:05):

I think the biggest thing I’ve learned in this industry is that a lot of people get comfortable and start to say, “Well, no word is good word.”

Chris Pistorius (16:13):

Absolutely.

Candice Hansen (16:14):

In the year that we’re living, that is not how people perform. They want to hear, they want their accolades, they want to hear what they’re doing well, but they also want to hear what they could work on because they don’t want it to come up in one year and say, “Oh, if you would’ve told me that six months ago, I would have done it differently,” so that’s our first big thing is giving consistent feedback.

Candice Hansen (16:39):

The second thing we do as far as retention is we do offer for individual positions. We do different goals. Say for the scheduling managers or scheduling coordinators within our practice, we offer a production goal, right, so if you’re scheduled to this production goal, you get a bonus. It’s a daily bonus and it correlates to our clinical team, too. The way we structure those bonuses is we are always trying to incorporate fostering our team, so the bonuses are something that they do at the end of every day when they meet those goals and they actually pull a poker chip from a bag and whatever amount they draw, that’s their bonus for the day.

Chris Pistorius (17:27):

Oh, wow. It’s a daily thing, huh?

Candice Hansen (17:30):

It is. We’ve structured it daily. I’m going to be honest, they don’t hit it daily, but it’s something that the team is working to get towards.

Chris Pistorius (17:41):

Yeah, that’s cool, the daily thing. I didn’t even think of that. It keeps everybody engaged on a daily basis, huh?

Candice Hansen (17:48):

Yeah, and then at the end of the day, the great thing is when I say about fostering the team is then they get to celebrate together, right, because if they each draw a $100 chip, they each get a hundred bucks.

Chris Pistorius (18:00):

Wow. Nice, so there’s a lot of pressure on the person that’s drawing the chip.

Candice Hansen (18:06):

Well, actually, Chris, we let them all draw.

Chris Pistorius (18:08):

Oh, I got you. Okay. Gotcha.

Candice Hansen (18:10):

Yep, so they each draw their own chip, yep.

Chris Pistorius (18:12):

Gotcha. Nice. Well, that’s a great idea. I might have to steal that. That’s a cool way to do it, yeah. We’re going to wind things up here soon, but it seems to me with pediatric dentistry, you’ve got some extra pressures that maybe a few years ago you didn’t have in the sense that, and really, all the specialties, in that general dentistry really tries to encompass more than what they used to, right? We see them doing a lot more ortho procedures within their own office, like Invisalign, things like that. We also just see them turning to specialize in seeing kids, even though they’re not officially a pediatric dentistry. Do you see that as well, and do you think because of that, there’s education that needs to happen in a market as a pediatric dentist to inform parents that pediatric dentistry is specialized and there’s a reason that it’s there?

Candice Hansen (19:06):

Yeah. I think there’s a place for everybody, right?

Chris Pistorius (19:09):

Yeah.

Candice Hansen (19:12):

I think for pediatric specialists, yes. There’s definitely some education to be had around the specialties. We specialize in a specific industry for a reason. It’s all we do, it’s what we focus on, it’s what we know, and we do it well. But as far as the general dentists doing orthodontics and that kind of thing, there also is so much opportunity for dentists now. Sorry, I’m going to wait for this phone call.

Chris Pistorius (19:43):

No worries.

Candice Hansen (19:46):

Yeah. There’s a lot of opportunity for dentists right now as far as continuing education where they can expand their practice and I think really, as a specialist, it’s just finding a way to have relationships with your general dentist and other specialists in the area to set yourself apart because knowing that there are going to be those doctors that want to keep everything in house, and that’s understandable, but there is a time and a place for pediatrics and referring out those that we see children with special needs, we see children with behaviors, we see parents that just would prefer to have a specialist, so there’s education that needs to happen there.

Candice Hansen (20:37):

Then as a pediatric specialist, there is also education that needs to happen within our medical community as far as pediatricians and people in general understanding that really your child should go to their first dental appointment around 12 to 18 months of age. It used to be three years of age was the old saying, and now, it’s just educating people around that the sooner you get to the dentist, the less likely you are to have decay, kids aren’t going to get comfortable, and all of that.

Chris Pistorius (21:18):

Yeah. Yeah, totally makes sense. Totally agree with all of that. Pediatric is one of my favorite niches just because of the power of a lot of these pediatric dentists in terms of how they can really sculpt a young person’s oral health and make sure that they’re on track to be as healthy as they possibly can be, so it’s always fun working with pediatrics and crafting marketing campaigns specifically towards parents and things like that. Candice, I know you’re extremely busy with three practices, so I want to thank you so much for being a part of the show today.

Candice Hansen (22:01):

Oh, yes. Thanks for having me. I hope whoever’s listening, they took even just a little something from anything I said.

Chris Pistorius (22:09):

I know that they will, for sure. We always get feedback and I’ll be sure to share that with you once we get it. For Candice and myself, I want to thank everybody listening or watching this for tuning in. Make sure you check back next week for another great episode of The Dental and Orthodontic Marketing Podcast.