"Is Doing Better and Being More Careful Actually a System?": Why Erin Glending's High Reliability Framework Can Cure Burnout and Transform How Dental Practices Really Work

"Is Doing Better and Being More Careful Actually a System?": Why Erin Glending's High Reliability Framework Can Cure Burnout and Transform How Dental Practices Really Work

What happens when a college student working at Barnes & Noble for $7.95 an hour sees a newspaper ad for an orthodontic assistant position (no experience necessary) paying $10/hour, takes the job in Columbus, Ohio, quickly moves into clinical coordinating across four locations, gets the opportunity to open an orthodontic practice from scratch with an orthodontist (and learns everything about designing and managing a practice on the fly), then goes to graduate school for a Master’s in Healthcare Administration (essentially an MBA for managing hospitals), works in hospital-based dentistry associated with teaching hospitals and residency programs, and realizes she can take enterprise healthcare techniques and apply them to private dental practices? Erin Glending does exactly that, and after starting her consulting company in 2014 while still working in hospitals, she makes the full transition to consulting full-time during COVID when hospital systems became unmanageable, recognizing that private dentists suddenly needed the same systems, protocols, and reliability frameworks that hospital systems had been using for decades. In this incredibly practical and eye-opening conversation, Erin introduces the concept of High Reliability—a system developed in aviation, nuclear power, and the military, adopted by enterprise healthcare, but almost completely absent from dental practice management—and reveals why the difference between a thriving multi-seven-figure dental practice and one stuck at $50K/month production has almost nothing to do with clinical skill. Most powerfully, she reveals that the entire culture shift of high reliability starts with one radical idea: problems that happen are NEVER people problems—they’re always system problems—which means if you have an underperforming team member or lots of errors, you don’t retrain or PIP the person, you redesign the system so that the error can’t happen regardless of who’s in the room. If you’ve ever wondered why some practices have teams that seem happy, engaged, and energized while others have constant turnover and burnout, why some doctors can work fewer hours and make more money while others work themselves to exhaustion, or what the real difference is between a practice that feels like it’s running on talent versus one that runs on design, this episode will completely transform how you think about systems, culture, burnout, and what it actually takes to build a reliable, sustainable dental practice. This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you’re not growing, you don’t pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. As Denae powerfully illustrates in this episode, having a clear vision for what you’re building—both personally and professionally—is what separates practices that thrive from practices that just react by default. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. But as Denae emphasizes, marketing is just one lever to pull. You also need leadership, systems consistency, and communication frameworks that empower your team to make your practice work for you instead of you working for it. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it’s a good fit.

"If You Don't Track It, You Won't Improve It": Why the DSO Model Failed and How Dental Partners Can Find a Better Alternative with Ian McNickle

What happens when a mechanical engineer spends 10 years in high tech, quits cold turkey in 2005 with no great plan, builds a small consulting firm with his grad school roommate, pivots to start a dental marketing agency in 2009, focuses exclusively on dentistry by 2011, works with a general dentist who built a traditional corporate DSO from 2005-2015, watches that doctor exit and get bombarded by other doctors asking him how to build a group, becomes partners with that doctor's consulting company in 2018, spends years learning the DSO model inside and out, and comes to a profound realization: the DSO model is fundamentally broken—like a taxi service where the customer experience is terrible but the incumbent dominates because there's no alternative? Ian McNickle does exactly that, and by 2021-22, instead of building another DSO, he interviews over 200 doctors across an 18-month period, asking them what stresses them out about private practice, what they'd like to delegate, what would attract them to join a group, AND crucially, what horror stories they've heard about groups. He also talks with investors, attorneys, accountants, and investment bankers to understand how to build something legally compliant, attractive to capital, and actually good for doctors. In 2024, he officially launches Icon Dental Partners as a DPO (Dental Partnership Organization)—not a DSO—with a radically different structure where the doctor's clinical autonomy, team employment control, work schedule flexibility, and branding all remain completely in the doctor's hands, while Icon handles HR, payroll, recruiting, IT, cybersecurity, marketing, financials, bookkeeping, accounting, leases, and legal. In this eye-opening conversation, Ian reveals why DSOs concentrate too much power at the holding company level (where investors can change agreements and eliminate autonomy), how he decentralized Icon's structure so that what defines a doctor's control is in individual agreements that NO board change can touch, why he made his board majority doctors so they have a real seat at the table, and how Icon offers doctors the best of both worlds: the culture, control, and branding of private practice PLUS the negotiating power, expertise, centralization, and potential financial upside of a group. Ian McNickle started his career as a mechanical engineer in high tech, spent 10 years there enjoying the work and management positions, but felt an itch to be an entrepreneur. Around 2005-2006, he quit his job cold turkey without a great plan—he admits in hindsight it was a dumb move, but when you're young and ambitious, you just go for it. He and his roommate from grad school started a small consulting firm in the northwest for a few years, then in 2009 partnered with another person to start a marketing agency. By 2011, they decided to focus exclusively on the dental industry. He built that company for many years while also getting to know dental practices as clients. One of his former clients was a general dentist who had built a dental group using a traditional corporate DSO model from 2005-2015. When that doctor exited his group, other doctors started asking him how to build a similar group. That doctor started a consulting company and approached Ian to be his partner in 2018, knowing Ian was an entrepreneur who understood the dental industry. From 2018-2021, Ian split his time between the marketing company and the group consulting company, learning deeply about the DSO models. What he realized was that the DSO model is fundamentally flawed. Doctors don't typically like it, it's not necessarily better for patients, and team members don't like it either. He compares it to the taxi industry—a terrible customer experience dominated by an incumbent with no alternative. But whenever you have that situation where customers aren't happy, there's an opportunity for disruption and innovation.

"Stop Asking Who Made the Mistake and Start Asking What System Allowed It to Happen Again": Why Your Unicorn Team Member Is Actually Your Practice's Biggest Vulnerability

What happens when you're born into dentistry (literally—dad's a dentist, mom's a hygienist), grow up stuffing envelopes and licking stamps, travel with your parents on humanitarian trips to serve orphans in Guadalajara, Mexico right after your first baby is born, and realize that patient experience and service is what lights you up? Rebecca Herring becomes a college professor of ballroom dance at the College of William and Mary, teaches kinesiology and dance majors, realizes after 15 years her body is done but her mind is not, goes back into dentistry with her passion for coaching and working with teams, works with private practices and small DSOs on the West Coast helping them grow multiple locations, takes a break to work in the veterinary industry's HR business partner role managing huge teams and C-suite leadership, then comes back to dentistry with a completely transformed understanding of compassion, empathy, tough conversations, growth, and development. In this incredibly practical conversation, Rebecca reveals why the moment you have a "unicorn team member"—that one person who knows everything, knows where all the passwords are, knows how to schedule correctly, knows how to present cases, is the one everyone goes to for insurance problems—you've actually created a practice that ISN'T a system but a dependency that puts catastrophic stress on your strongest people. She shares what happens when that unicorn gets sick, has a family member pass away, or just burns out from being everyone's safety net: the whole practice collapses because you realize you never had a system, just one person. She walks through why teams don't need to understand every clinical detail or every revenue cycle nuance, but they DO need to understand how their role connects to everyone else's (when the clinical team forgets to mark "procedure complete" in the back, the front office can't collect the full amount when checking out the patient), why you should stop asking "who dropped the ball?" and start asking "what part of our system allowed this to happen again?" (one question changes everything from blame to problem-solving), and why the most commonly missed systems are the ones that exist but haven't been detailed out enough that everyone truly understands every touchpoint. She explains how to implement a cadence for reviewing processes (revisit every six months), why you should assume every system has never been taught to anyone even if it has (because people make different assumptions), and how the EDGE method (Explain, Demonstrate, Guide, Enable) transforms how teams actually learn and own their roles. Most powerfully, she reveals that when team members feel valued and appreciated, they will give you more than you expect—and the opposite is also true: when brilliant A-players get stuck being the unicorn, they withdraw, get quiet, start calling out sick, and eventually leave. If you've ever felt stuck at a certain practice production level, wondered why team members who started great suddenly become disengaged, or realized you're completely dependent on one or two people holding everything together, this episode will completely transform how you think about systems, culture, and what it actually means to build a scalable practice that doesn't collapse the moment your best person has a bad week. This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee that if you don't grow, you don't pay. We are truly invested in your growth and making a positive impact in the industry through ethical, honest marketing. As Rebecca powerfully illustrates in this episode, you can spend all the money you want on marketing and create all the demand in the world, but if your team doesn't have systems in place, if your front office doesn't know how to answer the phone or explain what you do, if your clinical team doesn't understand how their process affects collections, if you're dependent on a unicorn employee who knows everything—you will never feel the ROI. We don't work with everybody, but if you need help with marketing, head over to marketing32.com [https://marketing32.com]. We'll have a quick discovery call and find out if it's a great fit to work together. The best marketing in the world can't overcome broken internal systems, lack of clarity, and team dysfunction. When you combine smart, ethical marketing with solid operational systems, clear processes, and a valued team that understands how their role connects to the whole picture—that's when practices truly thrive and scale beyond their ceiling.

"We Tend to Work IN the Practice, Not ON the Practice": Why Your Team Already Knows the Solution But Doesn't Know How to Articulate It

What happens when a 1992 Alaska Airlines flight attendant moves from Seattle to Eastern Washington, decides she can't leave her kids for four days at a time, falls into dentistry through a friend of a friend, and spends the next 30+ years discovering that every dental practice has essentially the same challenges but solves them so differently that results vary wildly based on culture, engagement, and systems? Callie Ward stayed with her first practice for 10 years, went back to school for a master's degree in education, taught for 3-4 years, then realized dentistry was where it was at and came back—managing single locations, multi-locations, teams from 4 to 30+ members. When her youngest graduated high school, she'd done every report for that practice and cleaned up everything, got bored, wanted more, and started understanding "the game of dentistry" beyond the day-in-day-out routine. She spent about eight years with Productive Dentist Academy, then took the entrepreneurial leap herself (because you have to walk the talk), worked with Support DDS during her non-compete year, and opened her own consulting firm. The name? Dash Dental Consulting—named after her grandma name from her grandson (who turns nine next week) because we're born, we die, and what's in the middle is our Dash—what do we do with that Dash? In this deeply practical conversation, Callie reveals why morning huddles must start with positivity and celebrating yesterday ("who can we shout out?") before unpacking opportunities (because neuroscience supports that we're more likely to try differently in safer environments), why the year you took technology from paper charts to computers you were taught "do things this way" but never told WHY (so you never questioned whether a different way might work better), and why the most successful practices aren't the ones with perfect systems but the ones willing to experiment and celebrate what they're learning as they're learning it. She shares why hiring "really nice people who are good with people" for front office doesn't mean they're great at collecting money or training patients to show up for appointments, why nobody told her at 25 that the goal of a shopper call is to get them on the schedule (basic, right?—but nobody said it), and why you can produce $3,000/hour but if you're not collecting and you've got $100K in the over-90-days bucket because Mary's been doing collections for 30 years and she's friends with everybody so it's uncomfortable to call, you'll never feel the ROI from marketing. If you've ever wondered why some practices with the same business model thrive while others struggle, how to create a culture where team members catch each other doing jobs well done instead of only focusing on negative, or what it really means to work ON your practice instead of just IN it, this episode will completely transform how you think about leadership, systems, accountability, and what it takes to build a practice where people actually want to show up. Callie Ward never planned a career in dentistry—she was an Alaska Airlines flight attendant in 1992, moved from Seattle to Eastern Washington, and realized she couldn't leave her kids for four days at a time. A friend of a friend had a dental practice looking for somebody to hire, and Callie fell into dentistry. What she absolutely loved was the heart—the people. In a small town in Eastern Washington, patients became your family, you knew their families' families, the circle just got bigger with connections. She stayed with that first doc for about 10 years, decided she needed to go back to school, got her master's degree in education, taught for 3-4 years, then decided dentistry was where it was at and came back. She's managed single locations, multi-locations, teams as small as 4-5 members up to 30+ members. She transferred into consulting when her youngest child graduated high school—she'd done every report for that practice, cleaned up everything she could, and was bored. She wanted more and was starting to understand "the game of dentistry." It wasn't just the day-in-day-out routine; the business side was intriguing, and she likes to gamify things. She fell into consulting, had a friend doing it who made it look fun, and spent about eight years with Productive Dentist Academy. She loved her time there but knew she always felt like we need to walk the talk—if she's working with entrepreneurial dentists, she should be more entrepreneurial herself. She took a year off, worked with Support DDS during her non-compete, then opened her own consulting around 2022-2023. Dash—her company name—is actually her grandma name. Her grandson (who turns nine next week) named her Dash, and it really fit into something she's passionate about: we're born and we die, and what's in the middle is our Dash. What do we do with that Dash? Looking back at being in the trenches, it was a great job, consistent, she loved it—but it wasn't feeding her, wasn't filling her cup. She was working with providers not necessarily in the mindset of having their team work ON the business. They were looked at as clock punchers (which we need), but they weren't involved in the process of growing the business. Once she got into the management role and started seeing that side, she became passionate about helping people who show up every day. How do we help them fill their cup? Even if their role is limited (there are only so many positions in a dental practice), what blew her away working with so many different practices is that we all have the same challenges, essentially the same business (different models, different sections), but how differently we solve those problems. How different the results can be based on culture, engagement, and systems. When she came into dentistry in '92, it was a book they were scheduling. She was the technology girl taking paper charts and putting them into computers. You do things the way you were taught but don't necessarily understand WHY you do it that way. In coaching, she started learning: well, why DO we do it that way? What if we tried a different way? Could we possibly see a different result? That became fun—looking at data, getting real numbers, basing decisions on facts, but then asking "what if we tried this?" and working with the team so THEY'RE telling her what their solution is, what they could try differently, instead of her telling them what to do. It comes from teaching: she can't dictate to students "this is what you do" if she wants it to stick, if she wants them thinking outside the box. She has to ask questions that lead them where she's looking to go. But oftentimes they come up with answers she wouldn't have, and when they collaborate on that system or solution, they're more likely to do it because she wasn't just telling them what to do. She loves helping people feel great at end of day, helping docs learn how to communicate. They're really great at dentistry, but there's a whole human being behind that mouth. How do we help them connect to the human being FIRST before going to dentistry? That's where we see impacts. That's how team members continue to be passionate about their practice and not leave. COVID was brutal in the industry, and the docs seeing success are the ones able to create culture where their team is engaged, wants to show up, and looks at patients as if they're THEIR patients. The game of business is: well, there's this problem, how do we solve it? Do we have to keep solving it the same way? The irony is it takes a special person to hire a coach or consultant—it's somebody holding you accountable, it's uncomfortable, change is uncomfortable. But reality is if you've tried all the tools in your toolkit and you're still seeing the same result, you need somebody else's eyes. To Callie, consulting is like raising teenagers: if she did her job right, they're going to leave and be successful on their own. They can always come home, always have a meal, always realign, but if she did her job well, they don't need her. That's different than consultants who want to be needed, want to be right. She just wants to get them excited, line them up, get them fired up to be happy—empower them. This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you’re not growing, you don’t pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. As Denae powerfully illustrates in this episode, having a clear vision for what you’re building—both personally and professionally—is what separates practices that thrive from practices that just react by default. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. But as Denae emphasizes, marketing is just one lever to pull. You also need leadership, systems consistency, and communication frameworks that empower your team to make your practice work for you instead of you working for it. If you need help with marketing and growth, reach out at marketing32.com [https://marketing32.com/] for a quick 15-minute discovery call to see if it’s a good fit.

"I Reduced My Overhead by 20% Just Like That": Why Private Practices Are Paying 60% More Than DSOs for the Exact Same Supplies

What happens when a dentist who's been talking about becoming a dentist since he was eight years old (literally playing a dentist in a school play) builds a multi-practice portfolio, gets incredible vendor discounts due to economy of scale, then sells off practices one by one and watches those discounts dwindle—and realizes private practices are getting crushed while DSOs thrive on pricing advantages that shouldn't exist? Dr. John Montoya has been practicing dentistry for over 25 years in Boulder, Colorado, and after owning multiple practices throughout his career and experiencing both sides of vendor pricing (the economy-of-scale benefits and the single-practice penalty), he founded Dental Purchasing Partners to level the playing field. His revelation was brutal: single-location practices might think they're doing great with a 5% discount on supplies, but DSOs are getting 10-60% discounts on the exact same products—and the company is still making money at those lower prices. When he scaled down from multiple locations to one practice, his discounts disappeared, and he thought "this is insane—why is the private practice paying the most out of anybody in dentistry?" So he approached his vendors, asked what he needed to do to get those discounts back, built a formulary, and started Dental Purchasing Partners to help doctors stay independent while getting the same pricing as big corporations. In this eye-opening conversation, Dr. Montoya reveals how he reduced his own overhead by 20% with just a couple simple changes (money that immediately hit the bottom line), why practice brokers have to deliver devastating news to dentists producing $1-1.8M with 80% overhead versus 60% (the guy with 60% gets way more value at sale), and why dental schools desperately need to provide MBA-level business education since the lion's share of dentists graduate and open small businesses with zero clue how to run them. He shares how DSOs buy practices producing a lot but then strip out costs (supplies, credit card processing, payroll) to make investors happy by revealing the profit that was always there but hidden, why you could run a successful million-dollar practice with 80% overhead and still take home a paycheck but miss the much bigger paycheck waiting at 60% overhead, and why Michael Jordan and Tiger Woods both have coaches despite being at the top of their game—so why don't you? If you've ever wondered whether there's a better way to negotiate vendor pricing, how much overhead is really too much, or what it takes to compete with DSO buying power without selling your independence, this episode will completely transform how you think about supply costs, profitability, and what it really means to run a lean, profitable practice that's worth more when you retire. "I Reduced My Overhead by 20% Just Like That": Why Private Practices Are Paying 60% More Than DSOs for the Exact Same Supplies What happens when a dentist who's been talking about becoming a dentist since he was eight years old (literally playing a dentist in a school play) builds a multi-practice portfolio, gets incredible vendor discounts due to economy of scale, then sells off practices one by one and watches those discounts dwindle—and realizes private practices are getting crushed while DSOs thrive on pricing advantages that shouldn't exist? Dr. John Montoya has been practicing dentistry for over 25 years in Boulder, Colorado, and after owning multiple practices throughout his career and experiencing both sides of vendor pricing (the economy-of-scale benefits and the single-practice penalty), he founded Dental Purchasing Partners to level the playing field. His revelation was brutal: single-location practices might think they're doing great with a 5% discount on supplies, but DSOs are getting 10-60% discounts on the exact same products—and the company is still making money at those lower prices. When he scaled down from multiple locations to one practice, his discounts disappeared, and he thought "this is insane—why is the private practice paying the most out of anybody in dentistry?" So he approached his vendors, asked what he needed to do to get those discounts back, built a formulary, and started Dental Purchasing Partners to help doctors stay independent while getting the same pricing as big corporations. In this eye-opening conversation, Dr. Montoya reveals how he reduced his own overhead by 20% with just a couple simple changes (money that immediately hit the bottom line), why practice brokers have to deliver devastating news to dentists producing $1-1.8M with 80% overhead versus 60% (the guy with 60% gets way more value at sale), and why dental schools desperately need to provide MBA-level business education since the lion's share of dentists graduate and open small businesses with zero clue how to run them. He shares how DSOs buy practices producing a lot but then strip out costs (supplies, credit card processing, payroll) to make investors happy by revealing the profit that was always there but hidden, why you could run a successful million-dollar practice with 80% overhead and still take home a paycheck but miss the much bigger paycheck waiting at 60% overhead, and why Michael Jordan and Tiger Woods both have coaches despite being at the top of their game—so why don't you? If you've ever wondered whether there's a better way to negotiate vendor pricing, how much overhead is really too much, or what it takes to compete with DSO buying power without selling your independence, this episode will completely transform how you think about supply costs, profitability, and what it really means to run a lean, profitable practice that's worth more when you retire. Key Moments * 00:00 - Introduction and sponsor shoutout to Marketing 32's performance guarantee * 00:30 - Shoutout to Rita Zamora's episode on social media strategy * 01:00 - Meet Dr. John Montoya: 25+ years in Boulder, founder of Dental Purchasing Partners * 01:30 - Mission: Help private practices compete with DSOs without sacrificing independence * 02:00 - Laura Brenner introduction; knowing he wanted to be dentist from early age * 02:30 - Playing a dentist in school play at age 8 * 03:00 - College journey: Considering medicine vs. dentistry, interning at hospital * 03:30 - Working at gym, meeting older gentleman who turned out to be dentist * 04:00 - "What do you do?" "I'm a dentist." "No way!" * 04:30 - Interning one day a week: Dentist loved his work, staff loved it, patients loved him * 05:00 - Four days a week in college: Different dental office every day (general, ortho, endo, oral surgery) * 05:30 - Applied to Creighton University, practiced California 7 years, moved to Colorado * 06:00 - Origin of DPP: Every practice added = better vendor deals (economy of scale) * 06:30 - The Costco model: More volume = better pricing * 07:00 - Sold last practice December 19, 2019—right before COVID * 07:30 - As he scaled down, discounts dwindled: "Why is private practice paying most?" * 08:00 - Single practices get 5% discount; DSOs get 10-60% on same products * 08:30 - Approached vendors: "What do I need to get discounts back?" Built formulary, started DPP * 09:00 - Selfishly wanted to help himself and friends; grew into business helping doctors stay independent * 09:30 - Hard part: When had single practice initially, didn't know any different * 10:00 - Doctors don't realize options exist; margins are astronomically high * 10:30 - Sales reps: "10% off!" You think it's great; DSO pays 40-60% less * 11:00 - Many doctors don't know bundling/group rates available * 11:30 - Stay independent without selling to organization telling you what to do * 12:00 - Over 80+ vendors with 10-60% average savings * 12:30 - After COVID: Staff costs up, supply costs up, doctors not making shift * 13:00 - Even 5% overhead change drops so much profit to bottom line * 13:30 - Practice brokers' bad news: "Producing $1-1.8M but overhead's 80%" * 14:00 - "When I made couple simple changes, reduced overhead by 20%—just like that" * 14:30 - That 20%: Hire staff, give raises, 401k, benefits, buy CBCT with cash (not retail) * 15:00 - Running lean and mean machine—what DSOs do * 15:30 - DSOs strip costs: "Profit was there all along—just hidden" * 16:00 - Why DSOs having such impact: Economies of scale * 16:30 - Wish dental schools provided MBA: Lion's share of dentists open business with no clue * 17:00 - "Dentistry: We're successful despite ourselves" * 17:30 - $1M practice with 80% overhead = paycheck; 60% overhead = much bigger paycheck * 18:00 - Most don't know how to get from 80% to 60% * 18:30 - DPP has coaches available; practice consultant evaluations super important * 19:00 - Michael Jordan had coach, Tiger Woods has coach—dentists should too * 19:30 - Marketing 32 part of DPP with offers for group * 20:00 - Golden nugget: Sit down, look at industry average figures * 20:30 - Where is practice vs. where should it be? What simple changes help? * 21:00 - Don't have to do one more dime in dentistry to be more profitable * 21:30 - If someone's not going over numbers with you, maybe not right person in corner * 22:00 - Need financial advisor and accountant supporting you * 22:30 - Take time, look at numbers, understand what's going on * 23:00 - Sometimes CPAs not aware of what marketing takes * 23:30 - Contact: Visit dentalpurchasingpartners.com to see vendors, schedule call Episode Summary Dr. John Montoya knew from an early age he wanted to be a dentist—so early that he played a dentist in a school play when he was eight years old. When he got to college, dentistry was still on his mind along with medicine, so he went the medical track and interned at a hospital. But the physicians he worked with weren't excited—the insurance industry had taken the love out of medicine, and they couldn't practice the way they wanted. While working at a gym (he jokes he was in shape at one point), an older gentleman kept asking about college and his career journey. When the conversation finally turned to "what do you do?", the man revealed he was a dentist. He invited John to intern at his office one day a week, and John discovered the dentist loved what he did, his staff loved it, patients loved him—he was happy. That dentist introduced him to an orthodontist friend, then an endodontist friend, then an oral surgeon. Four days a week during college, John spent each day at a different office, falling more and more in love with dentistry. He applied to dental school, got into Creighton University in Omaha, Nebraska, graduated, practiced in California for seven years, then moved to Colorado to raise a family. He owned multiple practices throughout his career before scaling back to one while building Dental Purchasing Partners. The idea for DPP started when John began adding practices to his portfolio. Every time he added a practice, his vendor deals got better due to economy of scale. When he approached vendors asking why pricing was different now, they explained: "You're going to order more." It's the Costco model—the more volume going through, the better the pricing. Originally, John planned to build an army of practices, sell the bundle, and exit dentistry on a white horse. But he changed his business plan and sold practices one by one, selling his last practice December 19, 2019—right before COVID hit (he feels bad for the doctor who bought right before the pandemic). As he scaled down, his discounts started to dwindle, and he had a revelation: "Why is the private practice paying the most out of anybody in dentistry?" DSOs thrive because 5, 10, 50, 100, or 1,000 practices get better deals through economy of scale. Single practices might think they're doing great with a 5% discount, but other places are getting 10-60% discounts on the exact same products—and the companies are still making money at those prices. John wanted his one location to get the same opportunities multi-locations were getting, so he approached vendors asking what he needed to do to get those discounts back. He put a formulary together and started building DPP. Selfishly, he wanted to help himself and several friends, but it grew into a real business with a mission: help doctors stay independent without selling portions or all of their practice to organizations that tell them what to do, while still getting the benefits of being in a huge group. The hard part for John was that when he had only a single practice initially for ~16 years, he didn't know any different—he was paying higher prices without realizing other options existed. But then he saw the other side (the benefits of multiple locations), had it ripped away, and was back to where he started. The problem is that doctors don't realize other options are available because they're not showcased, and margins are astronomically high. Sales reps say "we'll knock 10% off this $100 widget" and you think you got the bargain of the century, while a DSO office down the street is paying 40-60% less—and the company is still making money selling at that price. Now DPP offers over 80+ vendors giving members discounts, with the suggestion to go through what you're using and price compare. On average, members see 10-60% savings depending on how aggressive they want to get. After COVID changed the industry forever with staff costs and supply costs going up while doctors haven't made the shift to adjust, even a 5% change in overhead drops so much profit to the bottom line. Thinking long-term about retirement, practice brokers often have to deliver bad news: "You're producing $1-1.8M but your overhead's 80%—the guy down the street doing $1M with 60% overhead gets more value when you sell." It's not what you're producing that matters—it's how much you spend. When John made a couple simple changes in his office, he reduced his overhead by 20% just like that, and it immediately hit the bottom line. That 20% means you can hire staff, give raises, provide 401k and benefits they've been asking for, buy that new CBCT with cash (but don't pay retail). You can give yourself a raise or retire early if you want—so much becomes possible when you're not worrying about paying bills every month. This is what DSOs do: they buy practices producing a lot, then strip out costs (supplies, credit card processing, payroll), getting the same services but cutting expenses, lowering overhead, and making investors super happy because the profit was there all along—it was just hidden. That's why DSOs and private equity are having such impact in the industry. John wishes dental schools provided something like an MBA because while we go to school for four years to be dentists, the lion's share of dentists graduate and open small businesses with no idea how to run one. Dentistry is unique because "we're successful despite ourselves"—you could run a successful $1M practice with 80% overhead and still take home a paycheck, but that same practice with 60% overhead means a much bigger paycheck. Most doctors don't know how to get from 80% to 60%, and that's all business practices, systems, and tracking what you spend. DPP has coaches available for members (hired separately), and John believes having a practice consultant do evaluations is a super important component—it doesn't have to be forever, but it's key. Michael Jordan had a coach, Tiger Woods has a driving coach—athletes at the top of their game have coaches, so why shouldn't dentists? His golden nugget: sit down with your accountant (hopefully a good one) and look at industry average figures. Where is your practice versus where should it be? What simple changes can help you grow? You don't have to do one more dime in dentistry to be more profitable—you could do the same amount tomorrow and beyond and still be profitable with a few key changes. Look at your numbers, identify what's out of line, figure out how to change it. If someone's not going over these numbers with you, maybe they're not the right person in your corner. You need people supporting you, not just watching you go day by day—your financial advisor to plan for retirement, your accountant to handle taxes and position your business where it should be compared to successful practices. Take time, look at your numbers, understand what's going on.