I used Google to look for latex glove manufacturers and found a company called Lifeguard, owned by an Indonesian family that had moved to the US but was manufacturing latex gloves in Indonesia. So, I ordered a large shipping container full of gloves. It was delivered to my friend and business partner’s house because we planned to use the garage for storage. We had no help or money to hire help, so it took us until 2:00 a.m. to unload the boxes, and the garage was stuffed to the roof.

Then, we just started going door to door to dental offices, giving them our pager numbers and business cards. We called the company Pandora Glove Company. That was the first iteration of what soon blossomed into a $15 million dental supply company.

It was tough. Once you hit a midline area, like $15 million a year in business, it becomes a big balancing act between money in the bank, enough inventory on the shelf, and balancing the accounts receivable. Like many others, my business faced economic challenges in the late 2000 recession. Running a dental supply company was expensive and sucked tons of cash flow because you would need two dollars to sell an extra dollar by the time you cover your accounts receivable float and adequate inventory levels. I started to see the writing on the wall. So, I decided to sell my company to Benco Dental. I saw a future for myself in joining them to open the Southern California market.

I did a decent amount of business my first year and won the Rookie of the Year award! I had the best experience in the world at Benco. I learned so much from the culture and about the organization from the late Pat Ryan. After working at Benco for about 3 years, my friend Dr. Shervin Molayem, a periodontist, gave me an idea. Shervin is one of the most extraordinary clinicians and visionaries I’ve ever had the pleasure of meeting. He’s the epitome of “fortune favors the bold” and has invested in many startups. He said, “I have an idea. Let’s start an agency for the traveling dental specialist.” So, I’ve been doing that for about 10 years now.

It was a great idea. Oral surgeons are dealing with things like IV sedation and a lot of other potential landmines. Why don’t they have an agent, like sports figures do? So, we created a model where we would essentially match-make specialists to help primarily GP restorative practices with their in-house specialty procedures one day or so a month. At the time, we charged the specialists a “middleman” fee of 5% to 10% of the total production.

Not long ago, we adopted a new model doing away with the middleman fee. Now, offices pay a nominal $250 a month to have us help them save time and find predictable matches with in-house specialists. We will also help with onboarding details—from setting up the contracts to arranging the percentage split and guiding them on insurance, billing, and credentialing requirements. There are a lot of details and arrangements that need to be made. Offices often tell us, “You saved us so much time and found us a fantastic specialist.” Remember that the specialists are 1099s and can disconnect anytime, so it is a matchmaking type of setup.

DSOPro: What is the most popular or requested of the specialties?

By far, endo. Most general dentists don’t want to spend an hour and a half trying to find a canal and possibly jeopardize being able to save the tooth because they’re not experts at it.

DSOPro: Do the specialists stay with an office for months, years, or permanently?

That varies, as does frequency. The ideal frequency to bring in an endodontist would be twice a month. They’re usually taking care of both symptomatic and non-symptomatic cases. If a patient is in pain, the GP may do a pulpotomy to relieve the pain and add a medicament inside the tooth. Then, they can schedule the patient to come back and see the endodontist within a couple of weeks. So ideally, you’d want a bi-weekly schedule if the office could support a two-day-per-month schedule. Most start with one day per month.

Another reason bringing endo in-house is so popular is that the GP knows the root canal has been done and when to schedule the restorative dentistry. If they don’t have assertive communication with the specialty referral-based endodontic practice, they’re often lucky if the patient gets the treatment done and then shows up for the crown restoration. It can be risky to send a patient to an unfamiliar office.

The conversion rates and production are higher when you have an endodontist in-house because the restorative dentist can also benefit from the root canal procedure fees. Let's face it: patients are more comfortable accepting treatment in the familiarity of an office they have been visiting for some time. Specialty fees are twice as high, especially for procedures on molars.

Most GPs refer molars and retreats to the endodontist. The smart ones combine the anterior root canal to fill up the days when they see the day is falling short. The number one reason endodontists stop returning is when they see cases and production dwindling and they’re not busy enough.

DSOPro: What about the other specialties? Do many of your clients use all of them?

They do. Most offices that contact us are new to arranging in-house specialties or need help finding a specialty type. An office’s resources limit its ability to have the outreach that an organization like ours does. Especially now, with Cloud Dentistry as our parent company, we’re able to reach many more candidates.

Each specialist has the availability to service about 15 offices, although there are only about 3,000 or so specialists of each specialty type around. I wouldn’t say there are that many who are willing to travel. In some parts of the country and some demographics, it’s frowned upon for more seasoned specialists to travel. Their family is saying, “You should be in private practice now. You should be spending more time with your family.” They’re not worried about making more money.

This model is more attractive to the younger specialists. They come out of their specialty programs with massive amounts of debt and no chance of getting approved for a mortgage whatsoever. As traveling specialists, they can start generating five grand a day take home. Over the course of 22 days, that’s over a million dollars a year they’re earning traveling between offices.

In a private specialty practice, you have the cost of the overhead and the staff management piece to deal with. You have to beg all the restorative dentists to refer cases to you. You must build so much value into the relationship to convince GPs to keep referring. Those endodontists who are in established private practices were able to forge that bond, but scenarios of specialists building friendships with the referrer may be few and far between. That’s probably the right way of doing it. However, the young specialist with a lot of debt and the ability to travel can make three times more money with less headache. This is a total case of “less is more” with no desire for the prestige aspect of it because they’re not at that age yet. They just want to work.

Experience counts, I should add. They would love to have a mentor. It would be fantastic if they could line themselves up for two or three days a week to work for a mentor at a private specialty practice. The problem is those deals usually go sour. They basically spit on a handshake to buy into the practice without an agreement in writing. It was all done based on good faith. And there’s always the seller’s last-minute regret.

Often, a new grad contacts me and says, “I just picked up an associate-ship position.” It’s always the first and second years they’re out. Then they ask me, “Can I join something referral-private-practice-based?” They’re interested when I bring up a DSO as an option, depending on how busy a DSO can keep them.

DSOPro: What types of practices do you typically work with, DSOs, emerging groups, and solos?

The original model was primarily private practice. However, with the new model, we’re seeing much more demand from private practices and DSOs.

The new model allows DSOs to treat it like a “try before they buy” scenario if they are also looking for a full-time or partner doctor. We’re happy to arrange a customized buyout arrangement for DSOs, too. Geographically, Pair Dental is currently focused on California, Texas, and the Tri-State area—New York, Connecticut, and New Jersey—and in December growing in Illinois and soon in Colorado. In comparison, Cloud Dentistry has grown to many other markets for the staffing component.

We merged with Cloud Dentistry several months ago and are off to a great start. Specialists love this new model for many reasons, and dental offices find it very convenient to have this subscription-style concierge resource to help them find in-house specialists.

The ROI for the DSO or a private practice owner is great. When specialists are in-house, they typically produce $8,000 to $12,000 per production. Many clients are doing “specialty for the day” and dedicating a full day to specialty. The offices can take Friday off, and the owner dentists can spend time with their families or deal with administrative stuff.

DSOPro: How is compensation for traveling in-house specialists structured?

Specialists are paid through the app. Electronic payments are generated automatically. When a specialist approves the production report through the app, a payment debit is applied to the office’s account or credit card. Credit cards are charged an extra fee of 2%. The system we created, Cloud Quick Pay, is super seamless. I haven’t seen anything like it in the specialty world.

Specialists can also gain access to Cloud Dentistry’s massive pool of tens of thousands of hygienists and dental assistants available to work with them at their private practice or while they’re traveling. That is a big pain point for them—working with assistants who are not experienced or qualified to handle specialty procedures.

The DSO or dental office can quickly help the specialist find the right assistant and dispatch them through the platform. They can schedule assistants to come in for the specialty treatment day and pay the assistant through the app if they want to. 

DSOPro: Tell us more about the partnership between Pair Dental and Cloud Dentistry.

I met Trey Tepichin a couple of years ago while building Pair Dental. He was teaching macroeconomics at Harvard University and was a full-time attorney. His friend Reza Sanjar, a dentist from Houston, and he discussed starting a company to address dental staffing issues. I assisted with fundraising and business development needs. They asked me to help build the company, but I felt I was already way ahead of them with my own at the time. So, I decided to go in with them as an investor. I didn’t realize how big they were going to get!

We immediately recognized the immense potential of Cloud Dentistry’s engineering team and leadership and how their vision, combined with the goodwill Pair Dental had cultivated over the years within the specialty community, could drive a significant transformation in modernizing in-house specialty staffing. When Cloud Dentistry invited me to join their team full-time, it was an exciting opportunity to expand on what Pair Dental had built. While Pair Dental had successfully created thousands of relationships and provided 140 treatment days per month, we needed a scalable model and technology. The merge with Cloud Dentistry unlocked the potential to take our success to new heights and truly scale our impact on dentistry.

The collaboration between Cloud Dentistry and Pair Dental was a perfect marriage, combining innovative technology with deep, established relationships between Cloud Dentistry’s users and specialists from Pair Dental. This synergy allowed us to build an efficient platform for matching specialists with practices, breaking through previous limitations and enhancing accessibility. Together, Cloud Dentistry and Pair Dental are transforming how in-house specialists integrate into dental practices, offering a streamlined, scalable solution that benefits specialists and practices alike. This partnership is not just about growth; it’s about changing the future of in-house specialty staffing in dentistry.

More from the Newsletter