From Hygienist to CEO: Heidi Arndt talks About Her Experience Working with DSOs

DSOPro: Tell us about your background

I went to college to be a dental hygienist. When I graduated, I started working as a clinical hygienist at the Mayo Clinic in Rochester, Minnesota. The practice focused on periodontics, oral surgery, and prosthodontics. The primary patient base was local referrals and medically compromised Mayo patients who needed specialty treatment or implant maintenance. We were also involved in complex cases and some of the research being conducted at the time. Working at Mayo was a dream come true. The collaborative care was impressive. It was one of the best experiences of my life because of their group philosophy and how they look at patient care. 

Eventually, I decided to move to Minneapolis to be in a bigger metro area. I was hired by Park Dental, a large dental group, to be a mentor hygienist. They were affiliated with American Dental Partners out of Boston. I saw patients but I also mentored other hygienists on clinical care and productivity, among other things. Later, I moved to an affiliate of American Dental Partners in Wisconsin called Forward Dental where I was also a mentor hygienist. My focus was improving productivity by creating a mentoring program and supporting the clinical teams.

One day the CEO asked me, “Could you do this for all of our affiliates across the country?” They had 23 affiliated dental groups and employed around 1,000 hygienists at the time. So, I became their National Director of Dental Hygiene and traveled the country working with all their hygienists and doctors to create a strong standard of care. I loved it, but I saw other dental groups starting to evolve and grow, and I thought, “You know what? I can do this on my own.” I knew how to scale a program to multiple locations in different states and how to deliver strong results. So, in 2002, I started my consulting company, Enhanced Hygiene, with a focus on developing dental hygiene teams and increasing the productivity of hygienists through improved patient care initiatives. We focused solely on dental groups. 

It was great to consult with DSOs across the country. I also conducted CE programs and was a key opinion leader for several companies for about 8 years. It really put my name in the space as a hygiene expert. 

While I was running Enhanced Hygiene, I worked with several other industry experts to put on an annual conference called “Dental Group Evolution.” This conference was held every January and focused on evolving dental groups. I had speakers from different DSOs and other people whose missions I really stood behind. It was a ton of work, but I absolutely loved it. I saw the need for a broader reach of dental group support, so I started a sister company I called Enhanced Practice, which was focused on dental group development from doctor development to operations. Enhanced Practice was a great compliment to the work I was doing with Enhanced Hygiene.

My two businesses had me traveling a lot and my kids were growing up quickly and I felt the need to be home more. So, when someone offered to purchase my company, I sold it in 2019. I did not imagine how hard this transaction would be. It was like selling your baby. That was one of the toughest things I’ve ever done. Selling a business that you created and grew is very hard. Lots of lessons learned. 

The company that purchased Enhanced Hygiene was based in Austin, Texas, so we moved here and I continued to work with them for a few months. We love Austin so that was a silver lining in it all. A dental group called Strive Dental Management was purchased by a private equity group that offered me the position of VP of Clinical Operations. I began working with all the clinicians across their organization to build out a structure to support them and create strong clinical alignment. Strive had only five locations, but they were producing about $20 million in revenue.

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Within a short time, I moved into the COO role. My focus initially was to stabilize and grow the business, which we did very quickly. Then COVID hit. So of course, we were closed for several weeks, we had to lay off our staff, and it was a very stressful time. For me, the hidden blessing was being able to take a step back and retool the business. I knew that when we reopened it would be with a different feel and focus.

The summer of 2020, I was promoted to CEO of Strive Dental Management. My focus was to continue to grow the group and support our clinicians with providing best-in-class care. In July 2021, we sold Strive Dental Management to another DSO. It was so rewarding to lead and support a successful transaction. Having a successful transaction is a milestone for a lot of people and I’m glad I experienced it. 

After that, I had the opportunity to take some time off. In February 2022, I started Evolve Dental Advisors, which is focused on supporting the evolution of the dental industry by providing strategic clinical and operational guidance to emerging/midsize dental groups.

DSOPro: What was the secret to your success?

I’m a clinician, but I’m also an operator. So, I understand how to meet the intersection of clinical and operations. Creating alignment with your clinicians and operations/leadership team is crucial. I’m very passionate about ensuring that clinicians are in alignment not only with the philosophy of care, but with where the organization is going. When there is a disconnect with the clinicians, the practice is not successful. 

Dentistry is about the patients. Without patients, happy patients, we have nothing. Without clinicians, happy clinicians, we have nothing. So many people are focused on growth, growth, growth, buy this practice, buy that practice, but never really look at what we are doing to support and develop our clinicians.  

This philosophy goes back to my early years in dentistry when I realized the importance of having a mentoring program for doctors and the entire clinical team. At Strive, we brought in a lot of new graduates and the first day they walk in, you need to provide them with the support and guidance to understand how we attract patients, our guidelines for creating an ultimate patient experience, the technology we’re using, and how you communicate with your hygienist. Most new dentists have never worked with a hygienist before, and they don’t even know the value of a hygienist.

So those are the types of things that need to happen with new doctors, because otherwise they’re going to struggle and will not be successful. The entire mentoring process is very important.

It’s just as important for hygienists, dental assistants, and the front office staff. That is something I believe most groups lack. My mission is helping to establish mentoring and training programs, to support clinicians so they can be their best. In today’s world, where we have so many issues with  retaining and recruiting staff, having these support mechanisms within the organization are crucial to the ultimate success of the dental group.

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DSOPro: Are there other gaps that still need to be filled to address those needs?

There are. Dental groups are growing at a record pace today. Many groups are building what some call a “duct tape DSO” just to add EBITDA (earnings before interest, taxes, depreciation, and amortization) as quick as possible. But if you look closely at them, it’s just a group of practices, not a “group practice.” They lack collaboration, systems, and consistency. They struggle with organic growth and consistent performance due to a lack of alignment.

It is difficult to establish consistent performance and quality in settings like this. It’s like walking into the Mayo Clinic in Scottsdale and having a completely different experience than I did in Rochester. It is important to have parameters in place to ensure consistent quality care (which fuels growth) and create the ultimate patient experience. In the end, it’s going to affect the value they have during a transaction. It’s going to affect their retention and recruitment efforts. This is something that these groups need to start looking at. 

DSOPro: What other types of new issues are DSOs facing?

A hot topic right now is technology integration. Technology helps the patient experience, and it helps providers. Here’s an example: a dental group decides to integrate a new technology such as Pearl AI, and it enables clinicians to make a better diagnosis and treatment plan for the patient. It also helps the patient see exactly what’s happening in their mouth. But if you buy technology and don’t train your team how to integrate it into the patient appointment, it will never get used. These types of technologies are coming at us very quickly now and we need to take advantage of them.

Another thing I often see is that clinicians are so worried about overtreating patients that they are undertreating them. That’s very prevalent. These tools like Pearl will help us identify things that maybe a clinician would have overlooked in the past. I’m excited about where we’re heading with technology and what an opportunity it is for dentistry. I’m hoping everybody embraces that, but also understands how to properly integrate it into their organization.

DSOPro: What other technologies are group practices considering adopting?

Another very important topic right now is patient financing. One of the main reasons patients do not accept dental treatment is the cost. To me, that’s an access issue. There used to be only a couple of options for patient financing. Now there are numerous options at terms patients can afford. They can easily apply using their phone and get instant approval. That will change the dynamic of accessing care. That’s a game changer and it’s a win for the patient.

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Staff may not be comfortable talking to patients about finances. I think that’s a training and cultural issue. In fact, originally my team didn’t even mention financing because it was an additional burden on them to try to get patients to apply for credit. And if they did, most of the time they were denied. It was very frustrating for staff, not to mention patients, to go through the hassle and not be approved. Now the team needs to embrace the process and understand how it benefits the patient. 

DSOPro: Would you like to talk about what it’s like being a woman at the C-level today? 

Honestly, I look at it a little bit differently. I feel I was put into executive roles for my expertise and leadership skills. They knew that they could count on me, and that I was the best-qualified person for the job. 

DSOPro: What advice do you have for women or men who would like to achieve what you have?

Work with mentors. There are so many people around you who can and will support you. Be confident and be bold. Be willing to take on opportunities that may seem scary or outside of your reach. I didn’t think I was ready to be a CEO, but the people around me knew I was and told me. They said, “Hey, everybody makes mistakes, don’t be afraid to do that. We all learn from those.” I think that’s the best advice ever. 

If I hadn’t started working in the dental group space early in my career, but just sat chairside in a solo practice, I may not have had these opportunities. I took on every challenge put in front of me and always had people supporting, guiding, and helping me. If they hadn’t done that, I would not be where I am today. I’m forever grateful to all my mentors, and also to the DSO space, because it really cultivated my career. It’s been wonderful!

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About Heidi Arndt

Heidi Arndt, RDH, graduated from the University of Minnesota with a Bachelor of Science in Dental Hygiene. She worked as a clinical dental hygienist at various dental groups, including Mayo Clinic in Rochester, Minnesota. During her clinical tenure with American Dental Partners, Heidi was promoted to the National Director of Dental Hygiene. In this role, she supported the dental hygienists within their affiliated dental groups, managing over $140 million in hygiene revenue annually, and led all dental hygiene development activities for more than 250 practices and 1,000 dental hygienists across the United States. 

In 2011, Heidi started Enhanced Hygiene, where she partnered with dental groups to train and develop their hygiene teams. In 2017, she launched a sister company – Enhanced Practice, and an internationally recognized conference – Dental Group Evolution, which focused on supporting the development and growth of dental groups and emerging DSOs. Heidi sold these companies in 2019.

Most recently, Heidi was the CEO for Strive Dental Management – a DSO located in Austin, Texas. Strive was a private equity-backed DSO with over $20 million in revenue. Under Heidi’s leadership, they experienced year-over-year growth, and she led them through a successful transaction and equity sale in July 2021.

Heidi has spent over 20 years working in a dental group/DSO setting and is passionate about supporting clinicians, owners, and investors to match clinical and business success. She is founder and CEO of Evolve Dental Advisors.