"Ask George" - Precision Growth - Pathways to Profitability

(upbeat music) - Welcome to the Shared Practices Podcast. I have back with me, my original co-host, Dr. George Horeary. George, how's it going? - Good. - Always a great day when we have George Horeary to return back on the Shared Practices Podcast. So it's very happy to be on the show and excited for today's episode. - The fun part is we've realized that sometimes Scott and I talk about stuff and we realize like, we want to continue this conversation. We want to talk a little bit more and discuss the nuances, different angles on this. In future episodes, Scott and I are getting into things like acquisitions versus startups. And we've got opinions that don't always perfectly align, but they usually align like 80 to 90%. And it's fun to find that like 10 to 20% and discuss the nuance and the freedom and the opinion that exists in this space. And so some of these ass George episodes, I think we're gonna do that is we're gonna focus on, okay, here's the topic. I wanna hear your thoughts, George, on X, Y, and Z. And that's what we're gonna do a little bit today. - I've loved listening to you and Scott. And I think that Scott, he's so elegant in his way of explaining things. And it's really fun to see the dynamic that you two have on air. And I agree with you. I think that I would love the Ask George episodes to be a deeper dive on the areas that we use Shared Practice Terminology double click on. And so we brought a few areas that definitely wanted to double click on in the Shared Practices sort of world and terminology. When I go back through the topics that you guys discussed, one of them was analytics, right? How do we use analytics to make practice management decisions? And I think that I have a whole lot to say on that subject. And so I definitely viewed that as something I wanted to bring to the episode. And then I believe in a future episode, are we talking about finances? Or do we already talk about it by the time we're listening? - By the time this episode airs, they will have just heard the managing finances episode. - Yeah, and so for me as a former CFO, well actually not former. - Former. - Excuse me, current. My primary focus is marketing at the moment, which is why I kind of said former, but I still oversee finance. Nonetheless, as a CFO, for me that's very front and center as well. So I think I have a lot to share on those two and excited to dive in. - We took about three episodes to talk about building an operations dashboard. And then I pushed on Scott a little bit to say, okay, let's get into the nitty gritty of implementation. And we dove into like phones of like, if we saw that our calls weren't being answered and we had data that things were getting dropped, how could we implement? What would it look like to implement a phone system? But I think stepping back and looking at the overall metrics and operations, we had some key areas, five different areas that we identified, a few metrics for each one. And some of our listeners might be like, well, I've got too many metrics, or I've got too little, I wanna see more, I wanna see less. And I wanted to hear your thought on how you think about which metrics to look at in these different areas of operations. - Yeah, so it's interesting. I think one of the mistakes maybe that we've made in the past is we've called our growth philosophy analytics based practice management. What that means to, it takes like hours of us explaining the philosophy to you to the point where that name actually makes sense. And usually when you name something, you want it to be quick. But we at shared practices dive really deep into data. We use data in two different ways. So we use analytics in practice management. We use up to 60 numbers for each office to classify offices into categories. We call them avatars. I think what analytics based practice management means is we use a unique data informed strategy on practice growth to make it a little bit more accelerated. And for us, we're able to have consistent and sustained practice level growth due to our analytics foundation philosophy. But I think that analytics themselves are tools. And they're only as good as what you do with them. And so you can get all these numbers. You can know what they are, but the way you drive the business using the data is the value of the data. And I think that by calling our philosophy analytics based practice management, I actually think we didn't really talk about the actual thing about our philosophy that's unique that has led to the faster growth, which is more of a focus on patient flow growth. I almost wanted the opportunity to take a step back and re-explain our philosophy and sprinkle in sort of where we use analytics to accelerate or how we know to do certain things in the execution of our philosophy. And so that's kind of how I wanted to take this explanation so that it could be a longer discussion. That's very nuanced. One of the interesting differences here, there is a sense of-- from these episodes with Scott-- of operating a practice on an ongoing basis that may or may not be at steady state. And you're using these analytics to look for, are these things broken? Do we need to improve them? And the difference here in philosophies-- not that this is a difference, but the way that we've really enjoyed using analytics is to say, how can we build an engine of growth? And using that-- here's where we are, here's where we want to go-- we can then hone in on the analytics that are going to be the bottlenecks that would prevent us from getting there. And so we get very laser focused on a few key metrics that it's like, OK, we kind of need to fix these first before your practice is going to be able to grow. And so there is almost an order of operations baked into the analytics that we pay attention to. And if these first ones aren't fixed, we're not necessarily going to move on to these next ones until those first ones are focused upon and improved within our practice. Oh, I really, really-- because I think at any given moment, different metrics matter. So if you are stuck at one step of the growth process, then there's a certain set of metrics that will get you past that step. And then there's going to be another metric that's going to be your growing edge that has the most opportunity for you and your practice. And so I almost think I kind of want to start with the beginning. And the beginning is really client identification. So when somebody comes in, I think the first thing that we want to do is we essentially identify for each dentist. Where are they at? How many people are in their practice? How many patients are coming in every day? What's their new patient flow like compared to their production? We're essentially trying to diagnose where the practice is along the growth journey of all dental offices between $0 in collections and $5 million per year in collections. And so the first place that we use data is we're going to use about 40 to 60 KPIs. And we're really just going to say, where is each practice? And we have based on number of dentists, based on number of hygienists, based on new patient flow, based on patient-based size. We're going to do an initial assessment. And so I think that we call that point A. And so that's where someone's starting. And then we ask the client or the dentist, we ask them, where do you want to go? What is interesting to you? Do you want a group practice? Do you want to have just higher income as a solo dentist? That's the really important thing to identify. And then once you have your point A and your point B, then the metrics will appear in terms of what is the appropriate steps to get from A to B. And so that's kind of on a very high level, how we use KPIs to identify where you are, and then how to inform the ways that we want to get to your ideal avatar, or wherever you want your practice to grow towards. Yeah. So it's almost like we start with a diagnosis. Like we're going to run all these metrics. And from a whole bunch of things, really fit you into a close avatar of like, this is what your practice is closest to. And the powerful part of that is by attaching it to an avatar, you can start to make like a whole lot of decisions based on where that avatar is. Are we maximizing within this avatar? Are we moving to a different one? And that becomes shorthand for a whole process of growth that comes with key metrics along the way that we're really going to be paying attention to. Of course, everything still matters, and every metric can still be relevant. But that like diagnosis and then movement is what drives how we use the numbers. And so now I'm going to give a very specific example, because this has probably sounded very vague. And so I'm going to use the example of when I bought my practice. So I graduated, bought my office, and I walked into an office that would have had two dentists. So I walked into a practice with two dentists. Their historical revenue was about 1.1 million, but there was two dentists. And so I thought I was owning a group practice. And so when I was considering how many hygienists I needed, how many front office team members I needed, when I was expecting my team size or how I was operating, the whole time I'm operating under this idea that I'm operating a group practice. And if we had run our diagnostic analysis, I would have been told I'm a productive solo. And so that would have been very nice to know on the front end, because then I wouldn't have been inflating my staff costs thinking that because there was two dentists before, there needed to be two dentists in the practice. It's like, no, there was actually the team members and patients and patient flow to support a one dentist practice. And the easiest thing to do would have just been to be the solo dentist. And I would have had an income like, and been in a much better position early. That's why we do this is because I had this very painful experience of for 12 months, operating what I thought to be a group practice. When in fact, I was a solo office. This example of the decision making that goes into and some of this decision making is like staffing decisions that are hard-fixed costs that you know you make that jump you make that leap you now have that cost and it's not as simple to turn that cost back down you're letting someone go you're changing the overall flow and of your practice these are big decisions I'll give another example in response here which is just very recently a dental student brought me a practice and it wasn't what I thought it was going to be he brought a smaller practice by patient size it was about a 800 active patients so it was true solo essentially one full time hygienous worth of patients practice doing about 400k pretty anemic to hand to dentistry there wasn't an assistant it was just the dentist cruising along but it was in a space that had nine ops and so it was like this is this is a solo this is a true solo this is a perfect example to go through point a and point B so let's go through this example the way we would look at it on an acquisition side and point A this is where it's starting using the data and then point B where the space and the potential of the office and then let's actually walk through this example to illustrate the precision growth pathway that we are now describing this is great because there is a sense when I look at this practice of like wow there's a lot opportunity and there's a lot of challenges like we're at such a point A that like point B feels really far it's more like a point like Z or point G you know like it's going to take a minute it's going to take a few years of building this flywheel but what's on the other side of it is is potentially really amazing so let's talk about you know this solo how do you go from solo to productive solo yes so the thing I really like about this example is it has the facility for what we call profitable group so profitable group is two full-time dentists with four hygienists and we typically see a practice like that doing between 1.8 to 2.5 million in top line revenue in that situation you're starting at a solo so you probably have 400,000 issues I think is what the dental student told us in revenue and in that situation you know you're starting at a solo so you're starting at the very first step on our precision growth pathway the average United States dental office does 675,000 in collections you think about 400,000 like you're starting at like what you said right A to Z in this situation and so the way that we get there is what the dental analytics informed us is our strategy and what we've learned is that at this practice right now there is one hygienists worth of patience to get to Z or the group practice profitable group we need four full-time hygienists and so the precision growth pathways are the methodical growth from one hygienist to two hygienists which would occur with this dental student being the dentist right so they would buy it then they would have one hygienist they would use our retain open fill strategy to get to that second hygienist pretty quickly and then they're going to go through what we call a solo to group transition and then that would take them from one dentist with two hygienists and then that transition is a little bit that's the part of the journey that we call the ugly duckling face that takes about a year and then you get to the point where you have a profitable group where you have two dentists full-time with four hygienists when Scott came on the podcast and was talking about the super solo or the smart solo you know we used to call it the super solo that's a different path for that person to optimize for income and then hold that income and the way we've always taught it is that we get that person into ownership to their avatar in the fastest way possible and then we go through the ugly duckling for 12 months which is a constrained income period and then on the other side they're at the larger practice and so these precision growth pathways as we now call them they incorporate like you could go the smart solo route right so this individual could choose to maximize their income from productive solo to smart solo and expand and focus on their productivity increase their income and then take a longer path to the group or they could choose to focus on growth and then they could get to the group in a shorter period of time but have that income constrained period to break it even into the simplest ways is we've got 800 patients one full-time hygienist worth of patients we need to quadruple the patient base and do we want to do that kind of the the slow but profitable all along like the comfortable way or the fast but now we're at our full capacity and now every little decision we can tweak and improve profitability on the back end of that and we've gotten through this kind of like shifting gears adding personnel adding team members phase a little faster and and that is the difference the choice the options that people have in a situation like this when you've got the facility it's hard to not want to go fast because you want to fill out that facility and maximize what's possible when you don't have the facility you've got four or five ops then all the sudden you're like okay and maybe I need to kind of cruise at this spot first for a while and then decide okay are we are we willing to make the facility leap to expand this office to go to a different location and it's a much kind of bigger decision so I think this example is is just kind of primed for we would lean more into the growth side of things I think it's really cool because let's walk through like how do you go from 800 patients to 2400 patients right or whatever I do yeah yeah 3200 right so it's like in that situation it's going to take two things the reason I said 2400 and you said 3200 is because in my world I want to fill up hygienists with like I want to have the largest percentage of my patients be regular with their re-care coming in as often as possible even that just simple nuance and the answer kind of was funny for me but I think it's interesting because when you're growing so like now I want to get into what we call analytics based practice management we're used to call it that is this idea that if I'm trying to grow the number of patients and I would like to do it as fast as I can which is the question that we ask right that's the question we saw for so when you do it that way you realize that hygiene openings become gas right so if we're trying to drive a car really fast we're going to need to burn more fuel and in this situation hygiene openings are what the analytics have informed us to be the most efficient fuel to burn to go and build that patient base we really promote an idea of staying ahead of your capacity in hygiene and constantly having some breathing room in the schedule and then once you get people in the office you just aggressively retain and then that leads to a snowball effect of growing the number of patients that are regular in hygiene and it can have powerful effects on increasing the number of patients that subscribe to the hygiene pool of that practice and that ultimately is what we found to be the most predictable and fastest way to grow from 800 patients to 24 to 3200 patients let's get into a few metrics here because I think we have found that new patients is going to be dependent on area marketing what works what doesn't work but we use capacity of like hygiene openings as well as retention metrics to look at both sides of this flywheel of a patient pool so talk to me a little bit about the capacity metrics that we look at and think about yeah so I'll talk about AFD because that's the practice that I'm still in the tune on the operations I think you know we have a great team there and I'm not as involved as I used to be every month they're going to go through and count their openings so they're going to count they're going to say okay typically they see roughly 60 new patients every month so you say okay we see 60 new patients a month roughly we look at our openings at the beginning of the month and we say how easily can we fit in those 60 new patients and we want to be able to fit people in with additional openings that's I think the unconventional nature of our philosophy is that we tend to really promote excess openings because we want to be harnessing all of the demand that is available we never want to have that situation where somebody goes online to book an appointment and for whatever reason they're not thrilled with how quickly they can get in right and so we find that we have more success reactivating over due patients we find that we have more success scheduling patients online and we find success scheduling more new patients like when we call when somebody calls us on the phone an aft we have a dashboard so a I will recognize whether it's a new patient or not and then we're going to know how many of those new patients to be closed and we want to be closing over 50 to 60 percent of those calls and they're able to close in even higher percentage and I believe the amount of openings we have is a factor to that where it's very easy and convenient for people to come in I've been like focusing on exercising and protein and macros and all of that and there is like some debate around how much protein should someone be consuming and what is like the max that you'll still get benefit from and there's like formulas out there that it's like 1.2 to 1.5 grams per kilogram of body weight and that's like the average amount but there's evidence that's actually shows sure there's this like the bell curve of like you're going to get your most effect out of the early amounts of protein and actually be like the back half of a bell curve and over time as you get more and more there's less and less benefit but there is still benefit and what we're saying is is we want to find that sweet spot of like maximizing the availability for both new patients, reactivating old patients, keeping people unscheduled with when they should be seen. We want to get all of that out and leave ourselves room to not only do that right now, but to do that in two months when we've grown a little bit more. We want to be ahead of the curve so that we are always getting every last little bit out of growth. I don't know if my analogy made any sense. Yeah, and I think that was great. And I think when we think about it, we have two sources of patients for growth. We have retaining as many of our existing patients as we possibly can, and the more you retain, the more you've grown your patient pool in hygiene, or attracting new patients and retaining them. Those are really the two vehicles that practice has. In this situation, we started talking about new patients, so like I'll finish talking about new patients and we'll transition into existing patients where your first place is right on the phone. You want to be converting those people into appointments. Right when they come in for their first visit, you want hygiene to be the super sticky part of your practice. That's through proactive retentions, we call it, and measured by your reappointment rate. But your reappointment rate for existing patients will generally be much higher than your reappointment rate for new patients. And so for new patients, we would maybe like to see 75% of those patients choose to come back. Versus an existing patient, we would be upset if we're reappointing less than 90%. And so you just kind of have to, there's a different challenge with each set of patients. But then if you can continually retain 75% of your new patients and 90% of your existing patients, you're not going to have room in the schedule for more new patients unless you continually have a practice of reevaluating and opening the schedule because your retention is too good, you'll get full. And so that's part of our philosophy is like almost a constant reevaluation of our capacity to make sure that we are truly staying ahead of the demand because that's how we get the most out of our growth is by making sure that when people are trying to come in, we have ample availability. I love that. And when we talk about the financial side of things, this is not trying to fit our staffing percentage within a certain percentage because we're in that ugly duckling growth phase. But I think people can get scared. They're like, well, but aren't my hygiene costs going to be too high? My staffing costs, you know, I'm overstaffed. They start to get worried about their percentages and their PNLs, but we're saying, we don't care where we are right now. We care where we're going. We're driving long term recurring revenue, right? That's what we optimize for is building long term recurring revenue in your practice. And that maybe last month's profit and loss doesn't reflect the future recurring revenue that's been created by seeing those new patients and keeping them and adding them to the schedule plus more. That's what we optimize for is building the practice to have a stable floor of revenue long term. We don't optimize for like staffing costs below 20% or whatever, you know, like the lean and mean philosophy, like we actually think that's almost counter to growth sometimes. Let's go through the stages, you know, because when a patient comes in, a new patient, right, they're going to get added to the schedule and they may have some short term needs. But as the practice grows, eventually it gets to the point where there's two dentists, this nine-opt facility that we've been talking about, it'll have two dentists, four hygienists, and it'll be so full of patients, that's the point that we care about the profit and loss, the staffing overhead percentages, all of those things because we have a stable operation. But if we're constantly hiring a new hygienist every six months or adding hygiene days and growing the practice and adding new patients and trying to retain them and expanding our patient size from 800 to 3000, we're not going to have a stable profit and loss statement until that process is somewhat stabilized. You know, so we're going to have to get fully filled with the nine-opt, fully refined in our processes. And then after that, the accounting statement will have more relevant insights to the practice. Agreed. So we're actively normalizing being outside of the norm on this metric on your PNL and be okay with that and understand where you're going and all of a sudden you're no longer worried about that. When we start with a practice, or like let's just say this dental suit, we're to acquire this practice, let's kind of close the conversation on analytics and transition to financials. Right. So when they're going from one hygienist to two hygienists, there may be a different focus in their analytics or they may have different weaknesses as they add those two team members, maybe they're AR all of a sudden gets better. Maybe their reappointing starts getting better, right? So at each stage of growth from one hygienist to two hygienists to three hygienists to four hygienists in between those transitions, like there's going to be different focuses along the way. And so the data shows us what do we need to focus on right now? Then we focus on that. And then maybe something else pops up in the future and we just make sure that we're kind of focused on what we're doing. But it's playing into a bigger picture of where this practice wants to go from 800 patients to 3000 patients over the course of maybe two to three years. Right. The data along the way will kind of be pointing into the right direction. The context of this takes a re-care cycle. And so in that re-care cycle of growth, there are other things to be working on. And that is where the metrics inform us, what are the bottlenecks and what is our practice going to need in that next phase when we have two hygienists, when we have three hygienists. Yeah. So that's what we call precision growth pathways now. And the reason we've changed that is because precision growth is what we've realized this is. And the process of being extremely precise at each step and there's a pathway there. And I think that we've learned that a lot of things happen where there's pathways from a solo to group, a solo to productive solo group to a mega group, right? There's just these distinct pathways along the journey. That's sort of our new terminology that we hope is more clear. Now I think that that transitions into profitability, right? Because I'm a CFO and active and current. I think that from my perspective, I've learned. I think of the business through what I call cost structures. And so I just kind of want to explain this and then we'll go through it. So let's just say I operated a business where I was the end all be all a prover of every single transaction. And I just had like the tightest control over every dollar coming in and out. How the business performs at that point would be solely based on the cost structures in place, the rent, the team size, the way the business operates, the vendors, just like all of the things in place leading to the machine that then leads to the profitability of the business. And so I find that there's so much more return on your time invested, making sure that your business is set up for like a downhill journey to profitability where it's just like everything's aligned. It's just like it makes sense. It's your cost structures are aligned towards your profitability. So like the way your team is built, the way that your facility is structured, your lease, like all of these things work for you making profitability easier versus if you had challenging cost structures, that would mean that you would have to have a great month every month in order to be profitable. And you really want it to be the case that when you have a great month, you're super profitable. And then when you have an okay or maybe bad month, you're a little profitable. You're somewhere profitable. Yeah. You want to be in the black and your cost structures and the way you set up your business is really what allows for that to happen consistently. So another way to say this is you need to be able to weather the storm in your practice. And if you are dependent on good months, like you just said, and a bad month is going to do you in, then like you're just not only financially in for rough waters, like the stress levels of seeing everything go up and down and up and down. And I think there is a sense that certain cost structures are harder to get out of or are less in our control. So if you're in a high rent market, high staff cost market, those are things that unfortunately, while you might want to set up for those in the first place with what practice you buy or where you do your startup, there's not much you can do once you're in those cost structures. So I'd like to break them down in the three categories and then let's just go through each one. I almost want to begin on, so I have in the dental money ball, I write the journey of the dental dollar. And so like I actually want to walk our audience down the journey of a dental dollar from the time the practice first gets it to the time the owner gets it at the end and help maybe them maybe understand the way that I look at it. Let's just say you come in and you do a crown for a thousand dollars, right? So that thousand dollar crown, it begins in the opportunity, all money that the practice makes begins in the opportunity, that is where the services are provided. And so it begins in the opportunity, no matter what you do. And the first thing that has to happen is you have to pay for what happened in the opportunity. So in this situation, right, if we're doing a crown, we had to pay for our supplies, we had to pay for our lab bill. So let's just start there. Since most dentists don't have an associate, let's just start there. So your first cost structure is the cost of producing dentistry. It's your supplies and lab. And this is going to come off the top of all of the money that comes through your office. So every single dollar that comes through your front door or in your collections, you are going to pay production cost on. You're going to pay your costs. So how efficient you are with supplies, lab, all of that is going to dictate that initial tax. That's why I've learned that But as a CFO, I actually put way more emphasis on variable costs than I used to as an entrepreneur because I've realized that you pay it for everything. And so if you just have an efficient system, you only order what you need, you're very organized with your supplies, you may be taking off 8%. If you have a very inefficient system, you could be taking off 12 to 15%. That's like one person paying potentially almost close to double what the other is on every single dollar that they collect. And so the first cost structure is the cost of producing dentistry. It's the efficiency of which you pay your supplies lab, all of that. The next one is after we've produced our dentistry and we've paid for the cost of producing that dentistry through our supplies and lab, then the next cost structure is all of the costs of owning and operating a business. And so let's start with the people and then we'll get to the facility. The fixed costs. So the people are going to be your biggest cost category. This is a reflection of how efficient your team is. If you have an efficient, high performing team, this cost structure will be very favorable for you. If you have a not productive team, then it's going to be a larger cost. It's really about, and I think that this is something that Scott, his philosophy does very well in the way that he has always taught is that team members are very high performing and there's very little waste on the team size. And so I think that in a lot of the episodes that you guys have been talking about, I've seen very healthy practices on the keeping the people costs and that cost structure very in line. Well, I love the emphasis on, it's not we're trying to find the most inexpensive employees or cut in different areas. It's like how can we empower the team to get the most out of them so that they are high producing and therefore very easily justify being well compensated because ultimately if you've got a team who is doing great work and is well compensated, they're not incentivized to leave. They're incentivized to stay because they're like, yeah, I work hard, but I get paid well here and it's worth it. I can tell that I'm valued. I can tell that I'm essential to what's going on here and that's what you want. You want to be able to have the room to take care of your people. So when we talk about, let's go through like each position very briefly, patient care coordinator. If you ask like the difference between a few dollars an hour and their pay versus scheduling more new patients when they call or confirming less cancellations or you know, reschedule rate of overdue care patients like the value that all of those bring is way more than an increase in wage relative to like a highly paid PCC versus you know, on the lower end. And same with treatment coordinator case acceptance, hygienists, your productivity per hour with fluoride and perio and you know, all the things that a hygienist can bring or treatment coordination and helping, you know, co-diagnose with the dentist and then you know, an assistant like you think about how much you can clinically delegate and how much more you can do. I think that if anyone is operating their practice trying to minimize their staff costs by getting like on the lower end of the market normal in wages like I think that you would have a lower staff overhead percentage if you are on the higher end of wages and you had strong performance at each position, your total percentage would be less and your staff would be paid more. That's just the fallacy. And you've got the appropriate number of people too because you understand your avatar. You understand where you are and what is required to produce the dentistry for this number of patients. It goes hand in hand of there's this growth phase where like it gets a little like okay, we're a little flexible on, you know, our percentages because we know we're investing in growth. But then on the top end, we do need to know like when to stop hiring team members and that is informed by the avatar and the size. I think of the story of you and I. We went and saw this kind of mega practice. It was obvious that this is like a two story building that was built from the ground up and they had these six op pods. And as we talked with them, they realized, okay, actually a dentist kind of works out of four of these ops and then each one four of them are used and then this other dentist kind of works between these pods and there was a fundamental like lack of understanding of the ratios of team members to dentist patients. And once you've figured that out, it's not a hard equation. No, I mean, it's one dentist, two hygienists, 800 patients per hygienist. Like that is like the data has shown that that is a very consistently high performing number and you go bigger than that and you go smaller than that and then you'll see problems on both sides. You know, there are practices with a very healthy hygiene population that's not trying to grow into another dentist and sure maybe assisted hygiene, you know, any of those things. There are exceptions, but when you understand the core avatar, you can appropriately deviate depending on your patient base, your market, the demographics. That makes sense. I think we've covered that. Where else do we have to go on costs? Well, I have one more thing to say on team. I think with team, it's also really important. You set it, right? The number of positions you have, right? So let's go back to that avatar, right? Misclassification of avatar leads to staffing errors all the time, right? Like you think about it, I was operating a quote unquote group practice in my head, but I actually had a productive solo. And so I had three high genists when I only needed two. I had three front desk when I only needed two. I had two dentists when I only needed one and I had three assessments when I only needed two. So you think about it. It's like my cost structures were so far off that no matter what I did, if I was over every single dollar, it wouldn't have mattered because the foundation fundamental cost structures in my business were broken. It wasn't going to lead to profitability. When we talk about precision growth, it's like, no, no, at this point, you need this many people. I just needed one dentist, two hygienists, two assistants and two front desk. That's really all I needed. And I didn't know that. I think that there's probably a lot of that out there where there's a lot of people that think that their practice is the size that needs, maybe the team that they have, maybe that truly isn't the case in terms of the number of patients that they're seeing on a consistent basis. They talk about how work will expand how much time you have available to do that work. Sometimes a patient base will expand to the size of the team members you happen to have on hand. So you might feel like, well, everyone's busy. How could we possibly have one less person? The reality is that for the number of patients coming through your practice, this team that is a little bit more of a smaller team can handle it and does when they have the appropriate training, they have the appropriate systems. So I think there's also a multiplication of the efficiency of your team and therefore a direct impact on your cost when you've got good systems in place, when your business is operating efficiently. And when that's the case, then all of a sudden it makes sense to have the right number of team members. Very well said. I think to transition to fixed costs, right, these are, I think there's really two categories of fixed cost facility rent utilities, you know, all of the things that come with owning operating or not operating in a facility. And then the second thing is all of your service subscriptions fixed costs, right, like your software subscriptions, your anything that's a monthly cost is going to be in that last category, right? And with fixed costs, you should know all of them. That's the key. You should know all of them and make sure you're choosing all of them. Make sure everyone is needed and they're all providing value and you just know them, right? If you know your fixed costs, then you're good. It's when you're unaware, then there's usually waste there. But I think if you know them and you pick them and you know that that's what you need, then it's good, right? And so like we haven't talked about really percentages the whole time. I think that that's always been my perspective as a CFO. I have my two VPs and they are very financial both of them in their backgrounds and they will give me a lot of percentages and we will have a lot of that conversation. And I always take it in the necessary context that it's a view of the business. But if I'm really trying to drive profitability, I'm more interested in setting up the whole business so that profitability is a downhill battle. And then I'm just trying to drive as much revenue as I can. And I should look good when I look back, it'll look good. I think that that's always kind of been my approach. And then I agree with a lot of what Scott was saying about financial controls, right? And I think that that's the other structure that you need to put in place to then make sure that all of these are in line when you look at them from a percentage view. My gripe with the percentage use, by the time you're looking at it, there's almost nothing you can do. And I believe that there's more actionable relevant information in the business that will drive a better percentage view in the future. And I also think that the frame of, are we at capacity in terms of how many patients fit into our practice, the team members? And at that point, the percentages is where the gains are to be made. Whereas are we in growth mode? And at that point, we need to make sure that the cost structures are in place so that as we grow, that we can be driving revenue and growth and looking back, like you said, there will be this profitability. But if you like get too much into the minutia of this percentage that is fluctuating anyways as you grow, it's hard to stay focused on the growth and also stay focused on like controlling these percentages that are just going to be a little bit more fluctuating in the growth process. So when I teach financials and lectures, I use gut a lot. And I tell entrepreneurs, dentists, I tell them all the time that like you need to have [BLANK_AUDIO] the real gut understanding of how profitability in your business works. What we just went through is how to build that gut understanding, where you're like, "Okay, where are my variable costs? Who are my suppliers? How much do I pay? How often?" Then when you get ideas or suggestions from your team or when you hear an idea on Facebook or whatever, your gut will tell you whether or not that's a good idea, just based on how deeply you understand the way the cost structures in your business work. I truly believe that that's the level two. I think level one is awareness. What are the numbers? What do they say? But then that level two is a deeper understanding of the numbers that allows you to understand when an idea is good for the numbers or bad for the numbers. I love it. If a listener wants to understand this cost structures, growth approach, getting the book, dental money ball would be a great place to start. Then courses. What are the courses they should take? Yes. This is something I'm, like, Scott and I right now are in the middle of planning our level two practice management course. This is a lot of what I'm bringing into the course. I want to teach entrepreneurs how to have a gut sense in their cost structures and how to see it from the level two practice management lens. I think that course in January would be an absolutely great place to learn more because that's where I'm actually going to be teaching a lot of what we just talked about. Beautiful. All of the courses are up on Scottluna.com. People are going to register there. George, this has been an awesome discussion on thinking about these from a different perspective. It's more like using metrics in motion of like practice is moving. We are changing. We are evolving. And therefore we have to focus on different things in that process. Love it. And I couldn't agree more. And I love the chance to come on and like, you know, when I'm listening to you in Scott, I think there's a lot of times that I just want to jump in and like, you know, I have something to say. Raise your hands. Yeah. So this as George will be the opportunity for me to raise my hand and contribute what I have to offer. I love it. This was great. Thank you so much, George. We'll talk to you all next time on the Shared Practices podcast.