Josh Gwinn and Eric Nuss on the Optimize platform, customizing DSO consulting and support, and the Optimize Business Academy.
DSOPro: Tell us about your backgrounds, your companies, and how you are collaborating now.
Eric: I have a 24-year history in the dental field. I started out in sales with a manufacturer, then became a regional manager for Henry Schein in Iowa, Nebraska, and South Dakota. We tripled the business in 6 years. I was promoted into a corporate office at Henry Schein to build a business unit called Business Solutions. That really was the heartbeat of the organization. We sold all the non-tangible services, from HR and support to marketing. We built a consulting agency inside the company called 360 Pricing Development and had over 200 clients working with that organization. I also built a business education platform called Dental Business Institute and 350 or so practice owners came through that program. It was an awesome endeavor.
I left the company when it was merging that business unit with Henry Schein One and joined the North American Dental Group as the director of business development. I acquired practices and sold equity to our associate doctors. I left in 2019 to start my own DSO, building a 12-location DSO in Colorado and New Mexico, which went really well in the beginning and not so well at the end. Next, I started a consulting education business while simultaneously getting to know Josh and Optimize. For me, it was a choice of, “Do I want to be by myself in an independent capacity or would I feel more confident, comfortable, and supported in a team environment?”
I decided I would feel better in the latter situation. I’ve always been a team sport guy and Josh and the company are amazing. They have provided a ton of resources, fortitude, and long-term vision. It was totally aligned with where I wanted to go to help dental business owners get more of what they want and less of what they don’t. Not to sound super cheesy, but it is a match made in heaven.
Josh: I joined the U.S. Navy after high school. When I left the military 6 years later, I worked as a vision technician in an optometry practice. After about 3 weeks, they promoted me to practice manager. It was a large optical chain that is now the third largest in the world. I spent 6 years in their system managing 35 locations. I became a director of operations, opening de novos on the East Coast, and moving around a lot. I jumped over to dentistry in 2012. My first role was as a VP of Ops for Great Expressions.
I ended up with 65 locations in the Michigan/Ohio area, and then moved over to InterDent on the West Coast where eventually I was running all 200 locations as an operations leader. After that, I moved to Hero Practice Services based in Denver. Hero was a big turnaround. When I got there, we had $6 million of EBITDA that had been cut in half in about 11 months. The company had also experienced about 70% provider turnover in the previous 12 months. So, I put on scrubs and went to work, literally cleaning rooms, taking out the trash, and doing anything that would help the teams. I believe one of the hallmarks of my career and leadership is that I’ll do any job no matter what it is. Teams tend to resonate with that.
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We parlayed that into a culture that was all about the boss. I always ask, “Who’s the real boss? Who do you really serve?” It’s not the leadership, it’s not me, it’s not the doctors. We all get caught up in our egos when the truth is the real boss is the patient. At Hero, we were providing pediatric dentistry, vision, and orthodontics. We went from about 40 practices to around 70 and grew the revenue from roughly $60 million to about $140 in a 28-month period. We gained about 2.5% of the national Medicaid market and we were able to really expand that business until Covid began in early 2020.
Post-Covid, I exited the business. Just before the pandemic, I met Dr. Jack Bayramyan. He owned six Kids Dental Place practices in Los Angeles County, which we brought into the Hero family. When I exited Hero as the CEO, Dr. Jack reached out and said, “Hey, I’ve got this idea for Optimize Practice Alliance.” The idea was to form an alliance with him as the clinical entrepreneur who had built six locations doing $20 million, and me who has a background in large-scale multi-unit DSOs. Although it has and will continue to morph, the original plan was for Optimize to have two business arms.
We would have consulting as the startup to get cashflow moving, and we’d also do practice management. We would do acquisitions, integrate those practices onto a management platform, and then build out a full education component, bringing in speakers from around the country to do event-based education pieces. We bought our first three practices and started putting everything on the map.
Eric and I sat down 10-11 months ago to discuss Optimize’s vision. From a cultural and “people first” standpoint—the way we want to start with “the boss” and work back to each other—we were in perfect alignment. The way I think about community and company-building is team first, then mission, and then brand. By combining our philosophies, I knew we would be able to add more value for our “bosses.”
DSOPro: So, what are you going to do together? Eric, does your company still exist?
Eric: My small consulting company was just getting started, so it has folded into Optimize. Those clients will be taken care of by our collective team. The education concept that I originated is now being redeveloped and integrated more collaboratively, incorporating a lot of the concepts from our Chief Dental Officer, Dr. Jack’s book, Extraction, in combination with our collective experience in owning, operating, transacting, and supporting dental group practices at large.
Josh: Our company will focus on three things. Practice management, which is the full-on Optimize platform where we are the backend service organization. This portion is similar to other partnership-focused DSOs. We also have in-practice and group-level consulting. We do everything from creating a DSO and selling it to private equity, and then building out the backend for that company, to working with single-practice owners to maximize earning potential and exit valuation for their practice, and everything in between.
The third is the Optimize Business Academy, led by Eric and in keeping with his original vision of people meeting on a quarterly basis with like-minded individuals during an inspirational event. We’re planning experience-focused events so dentists and owners can leave with a mindset shift, additional tools to incorporate into their daily practice, and with a whole community supporting them behind the scenes. They will push each other on days when they need a little extra oomph but will also provide the value of best practices that flow in and out of each sphere of influence we build. Those three things are the heart and soul of how we interact with the dental community.
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DSOPro: What are some of the most important things you’re seeing that your clients need to learn and implement?
Eric: What they tell us is often a little different from what really needs to happen. That is, they think they need more new patients, which has been consistent for decades in terms of the perceived needs of a practice owner. Owners also usually think they need more loyal employees. There is an inflationary effect now with overhead, be it labor, supply, or lab costs that have gone up while reimbursements have remained pretty steady and, in some cases, have declined.
Profitability pressure is not a new thing, but I think we’re feeling it more now than ever. The solution, which will sound a bit cliche because it’s been said many times, is addressing culture, addressing how to create a winning team that is thriving in the workplace, loving their jobs, and can’t wait to get to the office versus those who are just punching a clock.
Josh: From my experience, being part of the Association of Dental Support Organizations (ADSO) board for 5 years, I didn’t hear a lot of talk about culture until right around the start of Covid. That’s when people started to realize there is a need for “purpose” built into all humans. Every human is searching for and in need of purpose in their lives. Instead, when our egos get in the way, we pretend they’re lucky we gave them a job.
After being in the U.S. Navy, I built my leadership from the ground up, starting as the vision tech who became CEO within a decade and held every job in between. I was commoditized repeatedly. People pretended I didn’t even have the sense to want a purpose, and that I was lucky to be there. Usually what I find in “old school” leadership situations is people pretending their teammates don’t have lives outside of work, and they’re lucky to be there. When that happens you just burn through people. No one’s sticking around for that anymore. So, we’re helping dentists to understand what makes them credible as leaders. It’s not because they can do great All-on-X work. It could be who they are as a community leader or how they’re helping others, investing in their own leadership development, getting rid of the self-doubt, taking the ego out of it, always providing support and accountability for their teammates, and trying to build the best humans around them, which is vastly different from trying to get the most out of everybody.
When that happens, we generally see a 20% to 40% lift in effort, which equates to revenue over time. People are willing to make additional effort when they know they’re in a place where they have purpose. At Hero, our purpose was to take care of the bosses who were only 5 years old. If you can’t get behind that, well, not everybody’s meant to be at Hero. My job as the leader of that organization was to, A, take care of the boss myself and help every kid I had a chance to help. Then B, if it meant taking the trash out so the teams could take care of the boss or get the best deals on supplies, that’s what I did.
Having the mindset to always do the right thing for the boss enables everything else to flow back to the investors, who are the least of this. Providing purpose for the dental assistants who live in the communities that we support is helping them help their own friends and families. Providing an incredible place for them to work is the real work. They gave me all they had when they knew I gave them all I had.
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DSOPro: What else can you tell us about Optimize Practice Alliance?
Josh: To our knowledge, we are the only group consulting in the federally qualified health centers (FQHCs) space right now on scale. We’re building out dentistry modules inside FQHCs. A little-known fact is that an FQHC can’t qualify for federal grants and matching funds without offering dentistry. So, we have helped establish dentistry inside FQHCs as well as tune the dentistry up to make it a profitable center for them.
Lastly, I’ll say that I believe we have put together a program that can help solve and support almost anything a dentist comes up against daily, so if you read this far and you think you might benefit from our services…reach out! Join the Alliance!
Eric: Our inaugural Optimize Academy starts in August. Check out 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. Come for the content and stay for the community and experience of a lifetime!
Part 2 of this article will appear in the August Happenings edition of DSOPro.
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 continue their discussion on customizing DSO consulting and support, and the Optimize Business Academy.
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