Josh Gwinn and Eric Nuss continue their discussion on customizing DSO consulting and support, and the Optimize Business Academy.
DSOPro: What does an owner or team leader need to do to make people feel they have a purpose?
Eric: I think that the unfortunate reality is that people don’t always get the well-rounded experience necessary to lead effectively and influence others in a meaningful way in school. While it does happen sometimes, seldom do most dentists develop the business acumen to take their practice to its full potential. Dentists and practice owners may learn some managerial skills or hire people who have those skill sets. But then when you amalgamate it all together, when clinical leadership and business leadership converge, there’s often strife. Trying to get those two ends of the spectrum to connect in a meaningful way is certainly one big piece of the puzzle.
Josh: I tell my teams it’s about authenticity. Everyone knows the truth. When you’re snowing people, they know it. As a leader, if you try to put on this face of perfection or dominance or name your toxic trait, you create mistrust. There is nothing that will speed up your productivity and your ability to execute more than having a team who trusts you. Trust is earned through owning your mistakes, and doing what you say you will do.
I coach doctors to understand that it’s okay to be wrong, but it’s not okay to be wrong and blame other people. My team often hears from me “Go fast, make mistakes.” What we say internally is “get stuff done,” or “GSD.” We’re looking for the highest-level GSD players because I want to go 900 miles an hour to GSD. If it’s the wrong stuff, that’s my fault. I will take all the bullets because I’m the leader. I’m the one who said, “Okay.” Even if it was your idea, if I signed off, it’s my fault. If it’s the right stuff, you’re all legends, you’re heroes, you’re killing it. Go, go, go. Let me be the one who takes the shots.
My intention is to create trust and an almost ridiculous amount of confidence that there is nothing we can’t accomplish. They should know, “If we make a mistake, Josh’s got us.” My job is to put a bulletproof umbrella around the team, so they can execute inside of that safely with trust, passion, and purpose.
I teach executives that they must be humble enough to admit when they’re wrong because I’m calling it out. They’re paying me for that. They must be coachable and ready to learn. I can teach humility. I teach how to serve with honor when you’re working with your patients. These are things the military drilled into us—honor, courage, and commitment. Have the honor to be honest and to cure yourself. Have the courage to do hard things when it’s scary, and step up and say, “I was wrong” when you are. Be committed to the task. When you’re wrong, pivot and keep going.
I help them lean into their values, understand what they are, take ownership of them, and then build a team that supports their value set. We can work with anyone, but we can’t work at cross purposes to our own values. That never works. If you seem inauthentic, no one will trust you and it will all fall apart.
So, that’s where we start. The sooner you start to think of those things and to honor your values, the faster you will scale and accelerate.
When we begin consulting a group, we bring a project management system with us and assign a project manager to the consultant. They build a strategic plan with the doctors, and we follow up on accountability every week.
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DSOPro: Are you working with whole teams in a dental practice or a leader who will trickle the information down?
Josh: The quick answer is yes. But every engagement is customized to that dentist’s needs. There needs to be at least one leader in the practice or it’s almost impossible to be successful. That leader could be the dentist, practice manager, or a hygienist who has everyone’s ear and is willing to do the work. We do need that point person in a single practice. Another example is a 10-office group where we work with the entire leadership team every single week. I also do executive coaching for the owners every week. In 6 months, they have grown their business by almost 51% year over year in a very challenging environment. They understood the concept, they just needed to lock down their value set. When the owner did that, there was a deluge of confidence, and they grew. It’s phenomenal to see things like that happen.
The length of time the process takes varies depending upon the scope of the project and the willingness of the participants. The unfortunate truth is that the owners must want it and put in the work to execute it—without that as a starting point, nothing will change. Within 6 months, if we’re not getting the movement, or providing value, we will recommend they find a different engagement or join our Business Academy, which is much less intense. They can have a learning experience there with a cohort that provides some support and shares the lessons learned from running big DSOs.
To summarize our offerings, we can show you how to do it, we can walk alongside you with accountability and help you do it, or we can do it for you.
DSOPro: What changes do you see in the future for your company and the industry?
Eric: We’re just starting as a company, despite almost 100 years of experience among our leadership team in the DSO space. A lot of people want to give some numeric value to how long this DSO consolidation movement will continue. I don’t think you can put a number on it for the foreseeable future. When you look at the largest group practice in America, it holds less than 2% of the market share of all dental practices. There is consolidation happening, but nobody holds a significant double-digit market share.
The big will get bigger, but I also think that will give plenty of people time to marinate on whether it makes sense for them to participate in large groups or if they intend to stay regional and small, or even independent, and how that plays out. Dentistry has been somewhat insulated for a long time from some of the things that have happened in other verticals in healthcare.
Probably the biggest catalyst to moving the needle would be if and when big health systems start to incorporate dentistry into their full-service offerings. If a hospital system or some other large healthcare insurance system were to incorporate dental for insurance benefits and service offerings, we’d see big changes.
The insurance companies that have both dental and medical components seem far more liberal with approvals and payments on things like periodontal disease care, whereas the independent dental insurance company doesn’t seem to reimburse for preventive treatments that impact overall health and wellness. When you talk about the systemic link between periodontal disease and overall health and that the healthcare system understands you need to take care of your mouth and the body will follow, that’s a big shift in the marketplace and it’s going to take some time to get there.
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Josh: For our company, part of the diversification of offerings is based on the idea that while we can’t be all things to all people, we can provide value to you based on your vision for your career. What we’re really after is keeping dentistry in the hands of dentists and enhancing the vision that you either have or that we co-create and you adopt. There are so many avenues for us to be successful with the academy and the consulting partnership.
Because of the debt markets right now, we’re seeing a blowback toward the “dinosaur DSOs,” if you will. Some of these have been in and out of bankruptcy and insolvency. I could see someone bringing in a massive amount of capital and consolidating all of those who have struggled to operate but have mass scale and create one mass scale organization in the next 5 years or so.
On the private side, up-and-coming entrepreneurial dentists understand they too can build their own small groups and have a seat at the table. There will be a need for the expertise to go from 1 to 3, 3 to 10, and 10 to private equity and beyond. We fill that niche nicely, having private equity and entrepreneurial backgrounds throughout the organization. We invested more than seven figures in our leadership team before purchasing our second practice. I always go back to “team, purpose, brand.” We have the team now. Our purpose is very clear. We want to provide support to dentists and help them build their vision and then brand Optimize as the place to get support or if you want to be in a partnership-management format. We do not buy 100% of practices. We do long-term partnerships and provide dentists with multiple avenues of investment opportunities, as well as our academy and consulting services. They can continue to grow and invest either alongside us or we’ll teach them avenues of investing outside of dentistry where they can continue to build and grow wealth.
An overlooked component that our academy is addressing is overall financial wellness: making sure the books are straight, the accounting is in place, you have life insurance, you have your forward-thinking net worth pegged so you can feel very comfortable being the leader you need to be to grow the business that supports that lifestyle.
Eric: I’m glad you brought up their financial health, Josh. Roughly 5% of doctors of retirement age can retire with enough money to preserve their lifestyle to the end of their lives. People’s savings or what they consider to be their nest egg are commonly underdeveloped compared to what they really need in place to realize their full retirement without running out of money. We have an affiliation with New York Life and want to provide additional financial education to all our clients as we go through this journey with them. It’s not just how much we can sell the practice for because that might not be enough. We must look at their entire portfolio of liabilities and assets and make sure they understand how decisions made early on will protect them and provide security in the long term.
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Eric: Our inaugural Optimize Academy started in August. Check our website for more information for this world-class, retreat-style education program that delivers like a micro-MBA without all the extra classes you will never use. Our next program is October 24-25 in Colorado Springs at the luxurious Flying Horse resort. Come for the content and stay for the community and experience of a lifetime!
Eric Nuss, Director of Financial and Business Education, is a seasoned entrepreneur with over 20 years of experience in the dental and healthcare industry, known for his transformative leadership and business acumen. With degrees from Wartburg College and the University of Iowa’s Tippie School of Business, he founded Sun Health, a Dental Partnership Organization that has notably disrupted dental management by enhancing practice culture and profitability. Previously, Eric significantly contributed to North American Dental Group and initiated a business service department at Henry Schein, which he grew from zero to $50 million in revenue in six years. He has also created and led the Dental Business Institute, educating over 350 students who significantly grew their practices. Currently, as the director of business and financial education, Eric is spearheading educational initiatives to cultivate leadership and business prowess among healthcare professionals.
Joshua Gwinn, CEO of Optimize Practice Alliance, has a proven track record of transforming organizations into high-performing entities by making strategic culture development a priority. His extensive leadership skills were sharpened during his tenure as an operations specialist in the United States Navy, where he emphasized accountability, compassion, and creative problem-solving. After the Navy, Josh applied his expertise to leadership roles in various national vision-affiliated brands and large dental organizations, including overseeing operations for over 250 dental practices across the country. Most recently, as CEO of Hero Practice Services, he led a pediatric-focused dental, vision, and orthodontic organization across seven states and over 70 locations. Josh’s leadership is defined by a commitment to core values such as accountability and honesty, driving his teams toward fearless achievement of their objectives.
Optimize Practice Alliance
Optimize Practice Alliance is a Business Academy, full-service consulting and dental partnership organization dedicated to helping dental entrepreneurs and their teams clarify and execute their own specific vision for growing and scaling, building or joining a platform, securing investment, and protecting their legacies.
Josh Gwinn and Eric Nuss on the Optimize platform, customizing DSO consulting and support, and the Optimize Business Academy.
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