Dr. Carlo Biasucci joins Dr. Jordan Soll to discuss the evolving landscape of dentistry in Canada, highlighting the decline in solo practitioners. Dr. Biasucci shares advice for dental practice owners to adapt to business challenges and the importance of focusing on leadership, systems, and marketing in order to run a successful modern dental practice.
Read the audio transcript below:
Dr. Jordan Soll:
Good morning, everyone. Welcome to Brush Up on Business presented by Oral Health Group, a special Brush Up podcast series focused on the business of dentistry. I’m Dr. Jordan Soll, Chairman of Oral Health’s Editorial Board, and today I’m joined with Dr. Carlo Biasucci.
Dr. Biasucci is a Canadian dentist, author, and practice consultant. He has founded Northern Dental Care in Sault Ste. Marie, Ontario, in January of 2009 with the guiding philosophy of “friends helping friends.” To further his training, he completed the core curriculum at Las Vegas Institute for Advanced Dental Studies and has taken advanced courses in conscious sedation, implant dentistry, and orthodontics. In addition to clinical work, Dr. Biasucci is also a speaker, business educator, and consultant to other dentists. He is the founder and CEO of Elite Practice, a training and growth solutions organization serving dentists in Canada and the United States. He has authored multiple books and more than two hundred articles covering dentistry and professional practice topics. Welcome Dr. Biasucci.
Dr. Carlo Biasucci:
Thanks for having me, Jordan.
Dr. Jordan Soll:
Before we jump in, I think in the essence of transparency, I would like to also say that I am a client, a full freight paying client of Elite Practice, and it’s just my being so impressed with the program that I invited Dr. Biasucci to do this video cast series with me.
Dr. Carlo Biasucci:
Awesome. And please call me Carlo.
Dr. Jordan Soll:
I will. Thank you.
Dr. Carlo Biasucci:
Yeah. Wonderful. Wonderful to be here.
Dr. Jordan Soll:
Okay. So, before I let you speak, I want to take a page out of your latest book, Beyond Clinical Excellence, which excellent book, and I want to set the tone for what is happening in dentistry today. And, you know, I kind of always say in my family, I’m ringing the bell on the Titanic, and I kind of feel when I read your book in the beginning, you’re doing the same thing. You’re trying to enlighten the dental profession and the dentists that really want to excel of what’s happening and the challenges ahead of them.
So, I just want to start off by saying, “Data from the American Dental Association shows a steady decline in the percentage of dentists who own their own practices. In 2005, approximately 66 percent of dentists were solo practitioners. By 2021, that number has now dropped to under 50 percent. Simultaneously, dental service organizations have doubled their market share with projections indicating they will control over 50 percent of the U.S. dental market within the next decade. These numbers aren’t just statistics; they reflect a seismic shift in the business of dentistry. With Canada, the shift of corporatization isn’t as aggressive, but Canada usually follows the U.S. statistics within a decade.”
I could read more, but as Carlo goes on to talk about, it’s also the shift in attitudes of the dental patient. So, Carlo, I’m going to ask you, please elaborate, tell us where the dangers are.
Dr. Carlo Biasucci:
So, with solo practice, and this is something that I discovered early on, there was a time, of course, when you could build it and they will come. I can open a practice and just the fact that I am there and I do good work, people will come to me. That has changed. And the loyalty of patients has changed. The competitiveness of the market has changed. Basically, it has shifted dramatically in the last twenty years. Even in the last ten years, you look at the market in dentistry, the landscape has changed. So, if I’m a solo practice, the typical practice that your average numbers are based on, one dentist and four or five employees, nothing wrong with that model. But in the competitive landscape that we have today though, well, what happens where I’m now up against, you know, all the dentists up and down the road from me now have twice the marketing budget, twice the budget to spend on training, twice the budget to spend on, you know, hiring the best people. Maybe twice the budget is an exaggeration, but they have it if they need it, and we’ve seen this.
Try to find a hygienist in today’s market. Well, we might all be paying a competitive salary, but I can get a $10,000 signing bonus with this practice because they’ve got the backing to do it. If that doesn’t work out and they end up having to do that again in three months, well, they can do it. If I’m a typical practice owner, now my margins are being shrunk and shrunk and shrunk. And so, I’m up against this wall, so to speak, of, you know, can I continue on the path that I’m on? And every dentist is starting to see this. Their profit margins are shrinking. They’re working just as hard if not harder. And why am I stuck on this treadmill of trading dollars for hours? And if I want to continue even where I was, even if to make the same income today as I made last year, I’ve got to work harder. And so, something is breaking within the, you know, the industry for the average dentist, and this is, I think, what we’re going to elaborate on today.
Dr. Jordan Soll:
Okay, I’m going go a little off queue for a moment. If there are no changes, if somebody doesn’t course correct, tell me how you see this looking five to ten years from now.
Dr. Carlo Biasucci:
So, the adaptable practices are the ones that will survive. The practices that think that everything is going to be the same and nothing’s ever going to change, I would just point you to Blockbuster. I mean, you know, eventually, the thing that you’re doing is going to be irrelevant, and you’re going to end up getting swallowed up by the competition. You know? Like, everyone understands how that worked out, right? I mean, no people are still going to keep coming to rent physical videos. Yeah. No. There’s a point where they’re not.
Dr. Jordan Soll:
So, you have to just, you know, Einstein’s famous quote, “Keep doing the same thing over and over again and expect a different outcome.”
Dr. Carlo Biasucci:
Exactly. Exactly right. So, the adaptability is the key for any business, but dental practice is no different. And truly dental practice is a business. I know that we are in a service, it’s a service business. Our primary goal is to treat patients, to treat them well, but it’s still a business at the of the day. I think every dentist gets that. You know, the key is, so what do I do to stay competitive? Because what we all typically do, so what I did when I first started, I took a thousand hours of CE in my first five years. I did a bunch of curriculums, and I had my AGD fellowship and all this stuff early on. Great, and you should do that. These things are important. Like, an excellent clinician and being highly ethical, these things are not negotiables, I think. But that does not mean you’re going to be successful as a practice owner. Again, my personal testimony, you will still struggle unless you get a few things right on the business side, and these are things that we are not taught in dental school.
Dr. Jordan Soll:
Alright. So, let me ask you: from when you graduated from dentistry, what were some of the biggest misconceptions you had about owning a dental practice?
Dr. Carlo Biasucci:
Yeah. There were a few. One of them being what we just talked about, and that, well, I’m good at what I do, therefore, people should come to me. Not so. They don’t know you exist. Okay. So how do I deal with that? And now I have employees. Well, I’ve never had employees before. What do I do with employees? How do I manage them well? How do I get them to do what I need them to do? And it’s the fact that I pay them enough to get them to do that thing.
So, you have this thought, everyone has this dream when they go to dental school about what dentistry is going to be like. You know, for me, it was like watching the dentist that I knew in the community, my own dentist. It seemed like it was a respected profession, they were good people, they were doing very well, it was a stable, you know, thing, let’s say. I thought okay, well that looks like a good road, so that is kind of the picture that I had going into dental school. Graduating from dental school, well, things were very different once you hit the pavement and actually start to figure out, wow, that’s interesting. So that cost that much? Oh, and then you realize how much overhead is and how much you have to actually do beyond the clinical, which is now I’m spending, you know, whatever hours clinically a week. And now I’m trying to run my practice, and I’m spending probably just as many hours in the beginning because I have no idea what I’m doing, and trying to figure all these things out the hard way.
There was no defined path, right? So, you’re just figuring stuff out. And these are the biggest challenges. We see this with startup practices. People will call us after they have committed to the space, design, started construction, and they’re like two months to opening, and we realize now we don’t know what we’re doing. It’s a little late, you know.
Dr. Jordan Soll:
I will tell you, I’ve been at this now…I graduated in ‘84, so I’m now just over 41 years out. We have someone full time sterilization. I have an office manager who is unbelievable, but does all my compliance stuff, all everything to stay in bounds with government agencies. I don’t imagine how anybody can start a practice from standing still just to be in compliant with everything.
Dr. Carlo Biasucci:
Yeah. Things have changed a lot. Now it is possible, right? So, I’ll give you another example. I did an interview kind of like this, maybe three, four months ago with one of our clients who did a start up, actually not far from here. Yes, in Oakville. His practice was extremely successful out of the gate, but he started working with us a year before he opened. And we figured out together the gaps.
Now, he was not a brand-new dentist, but still, if I’m going to open from scratch, and I’ve never been a practice owner before, well, I need to understand leadership. I need to understand systems. I need to understand marketing. I need to understand who do I need to bring on to my team? What roles should we be filling, how can we juggle in the beginning when overhead is tight, when profits are tight? How do we make sure that we don’t open and we have no patients? Like, all of these things take time to figure out, to dial in, to sort out in advance so that when D-Day happens and we are open, there are actually people on the schedule.
Dr. Jordan Soll:
You hit the ground running. Interesting. Okay. It’s no secret, and I’m not telling tales out of school. So, let’s talk about your personal health crisis change, and that was the impetus for you to just look at life differently, your dental practice differently, and that was, looking back, was actually a good thing for you because it really helped you grow immensely. So just talk to us a little bit about what happened and how it affected you.
Dr. Carlo Biasucci:
Yeah. I call it the best and worst thing that happened to me. So in 2012, you know, our practice was good. It was conventionally successful, as I call it. You know, everyone looking in would say, this is a good practice. You’re doing well. You’re doing, you know, a couple million dollars a year. You have your dozen employees. You’re making good money. You know, from anyone else’s perspective, it was good, because this is where you should aspire to. It was that, you know, unfortunately, it was that saying that, you know, you spend all this time climbing a ladder only to realize you’re on the wrong building.
And at that point, I was like, okay. I get that we’re making money, and, yeah, I understand that the practice is successful, except I’m burned out and exhausted.
Dr. Jordan Soll:
That’s pretty young your career.
Dr. Carlo Biasucci:
Yeah, like, I’m expended here, and this was ten, thirteen years, thirteen years out of practice. Or out of, no, sorry, 2012, so it was seven years.
Dr. Jordan Soll:
Three years, well, 2009 I have that you started.
Dr. Carlo Biasucci:
Yeah, so I graduated in ’05, right. Yeah, so it’s, just a handful of years, seven years out of school. And I’m hitting the wall. So, we were on a vacation, my wife and I, because we were doing this kind of quarterly just to get out and decompress scuba diving in the Cayman Islands, which I love. So, first dive, I was like that was seemed fine. Everything was fine. Dive computer was fine. I was a textbook dive, came up, and I wasn’t quite right. By the end of that day, my wife says I sat on the couch and I stared at the wall in the condo for three hours. I don’t remember it.
So that night I went to the hospital and got checked in there, spent the rest of the next nine hours in a decompression chamber, in a hyperbaric chamber, basically trying to put a stop to the damage that was being done, so I had a severe decompression injury. Everyone that I talked to said, you are like the luckiest person that we know because you could have had bubbles, nitrogen bubbles is what happens, it comes up into the blood. If it had landed, you know, spinal column, you’d be paralyzed. If it landed here, you’d be dead. All these other things that are, like, just explain to me kind of how this what was happening. And then coming from a, you know, medical background, I like, understood what they were talking about, and I realized, this is, like, you know, there’s more to this. So, anyway, it took me, I don’t know, a good six months to get back on my feet, a year to be back to normal.
During that time, the thing that really stood out for me was in the beginning you’re not worried about what’s going to happen in my practice. I’m worried about survival, right? You get past that point and then it’s like, okay, yeah, the practice, how are we going to deal with that? There’s no plan. I mean, you have insurance for disability and so forth, but there’s no way you’re going to be able to maintain a practice without it tanking on you, right? So, we got through some of that and as we got into the months that followed, the thing that really stuck for me was okay, if I’m going to go back to this, it has to be different. If I don’t fix the practice to where I want it to be, I’m going to quit dentistry because it’s not the only thing I can do.
And so, I spent all that time that I was off studying and learning everything I could about business, not just dentistry but outside of it. In fact, it was entirely outside of dentistry. So I studied restaurants, I studied the hotel industry. I was in rooms, and you know the rooms I’m talking about, with business owners owning hundred-million-dollar companies, and my big question to them was, more at the lunch table than anything else, how do you run your team? How do you operate with 150,000 employees? I find twelve difficult. Like, what is the gap? And then you realize it’s actually not that they’re smarter than you. They’ve just got some things figured out that you haven’t yet.
So, to me, looking back at this, this was the key push for me to realize, okay, well, if I’m going to continue down this path, I need to fix this because basically, this life is not what I want. I don’t want to be running, burning both ends, killing myself, trying to make whatever I think that this practice should look like. I want to be able to have free time. I want to have family, which we hadn’t at that time. So, to me, this was the push. This is what pushed me into wanting to understand business at another level altogether from what I thought I knew.
Dr. Jordan Soll:
Good. So, can you explain to me, and I think this I noticed this in one of your literatures, you had a beautiful visual of all the baseball hats. So, can you please explain the six roles that dentists often play simultaneously, whether they know it or not, and which role is most challenging to delegate?
Dr. Carlo Biasucci:
Yeah. Good point. So, this is on the cover of the leadership book, which was put out maybe a year ago, and so there’s actually five hats on that cover, but there are really six.
So, the dentist. If we just take step back for a moment, back to a quote unquote real business, which I hate to say because the dental practice should be a real business. But if we look at the way a traditional company would run, you’ve got your CEO who’s the quarterback, right? They’re running the show. They’re calling the play. But then the CEO has their C-suite. You have your financial person. You have your operations person. You have your marketing person. And you can go on and on and on. Like, you have your HR person, right, and they all work together to realize the vision of the CEO. Then you have the frontline workers who are making the widgets that are sold or the service that needs to be delivered.
In a dental practice, it’s very different. Well, it’s basically a very tiny version of that where the dentist just keeps swapping hats, and they’re trying to do all of that. So I’m running my tail off all day treating patients, and then I’m trying to switch between that to have a lunch meeting with my team for an HR issue, and then I’m dealing with my accountant between patients to deal with finances, and then I’ve got operational challenges I’m trying to figure out during my day or in the evenings, and then, well, marketing. Oh, who has time for marketing?
Dr. Jordan Soll:
And then what I also realized, they’re trying to do all these other jobs and yet they haven’t been properly trained in any of these other jobs.
Dr. Carlo Biasucci:
Yeah. Great point because in a typical business, the person you bring on as your CFO, is a person who knows what they’re doing.
Dr. Jordan Soll:
Yeah. They’re an accountant. They’ve got advanced degrees in finance. Absolutely.
Dr. Carlo Biasucci:
Yeah. And likewise in operations. This is someone who knows what they’re doing. This isn’t the first gig. They are experienced in that role. And likewise with HR, they’re not asking, you know, elementary questions. They know the rules, they know the law, they know what they can and can’t do, they know who they’re looking for, they don’t have to screen an employee and so forth. If I’m just dabbling in all of these things, I’m doing none of them well. It’s the, you know, jack of all trades, master of none, right? This is where you end up.
Yet, if you ask every dentist, they will tell you the same thing. If I could just treat patients, and the rest could go away, I’d be happy. Okay, well that’s great because that can be done, but that’s just not how we’re running. Most practices don’t run that way.
Dr. Jordan Soll:
Okay, again, so I’m going to go off script for a moment. Based on what you’re saying, is there still that dream to have your own practice, or are many of the young dentists today…you know what, I got a ton of debt from school, I’m just going to work for a big corp. Is there still that that passion to have your own ship?
Dr. Carlo Biasucci:
So, I was asked this question actually fairly recently by another party that asked me just for what would you say to a dentist who was, you know, looking at entrepreneurship versus being an associate? And it’s exactly the same answer I would give. So, entrepreneurs are cut from a different cloth. Straight up. Like, you’re either wired for it or you’re not. Now, you can learn, absolutely you can learn, but there’s a spark, right, with a person who can be a business owner. They have the ability or the maybe the desire to accept greater risk for greater return. They just they see it. Like, they understand I’m willing to risk a little if I can do asymmetrically better than punching my punch card and I make x. So, they’re cool with that. Another thing is that they are they’re generally driven to push themselves. They want to see what the edge looks like. They’re driven people. Those folks, building a practice is still going to be their dream, and we talk to them all the time.
And there are those, however, that really just, I just want to work three days a week, I don’t want any stress, I don’t want to deal with staff, etcetera, etcetera. They’re great associates, and the industry needs both.
Dr. Jordan Soll:
Okay. Alright. Along the same topic, just a little bit of a variation, so why do you believe that the traditional solo practice model is no longer sustainable in today’s dental landscape? I know we touched on it a bit in the beginning, but I just would like you to elaborate.
Dr. Carlo Biasucci:
Yeah. So, I won’t say it’s unsustainable, but I will say it is struggling, and the reason being is kind of what I discussed earlier, what we talked about earlier. You noted there is this uncertainty that always is there. If I get sick, what happens? If anything happens to me for that matter, what happens? So, if I’m the typical dentist, me and my four team members, five team members, great, that’s fine, but recognize what it is. You own a job, and that’s okay. It’s not a judgment against the person who’s doing that, it’s just that this is where you are and you’ve got to know that. This is not a business, this is a job, and if you don’t show up, you don’t get paid. Straight up. Yeah, hygiene may see patients. That’s cool. But your overhead is going to eat all that up and then some. Fine, just know what it is, right?
So, again, we could take that a level up because there are people in our program that will tell you…I can think of one off the top of my head who has been with us for maybe five years now, for the last year and a half has been off-on health issues, personal issues, etc., and his practice is still running and he’s still taking a paycheck. And he is a dentist, they have an associate now, and they have hygiene running, but with the model and the systems and the team that they have, is profitable in his absence. That is not most practices, though it can be built.
Dr. Jordan Soll:
That’s the goal.
Dr. Carlo Biasucci:
That’s right. That’s exactly the goal. The goal is not to have seventeen operatories and 12,000 patients and all that stuff that we did in our practice. The goal is, what does it look like for you in the ideal case? And for most dentists, I just want assurance. I just want peace of mind. Something happens to me, then what happens?
Dr. Jordan Soll:
Okay. And just before we wrap up, I’d like you really to elaborate because as we go through this video cast series, we’re going to talk more about Elite Practice. So, how did the concept of Elite Practice emerge from your own experience, and what sets it apart from the standard practice models?
Dr. Carlo Biasucci:
So, our program emerged from our practice, which is, I think, what sets it apart right there is because there’s, again, there’s no shortage of great ideas, right? Everyone understands the basics of how I run a company or how should I be running my practice. The key is in actually making it happen. So, in our practice, we got to a point where we were growing and growing and growing. Eventually, got to, as I mentioned, seventeen chairs and 12,000 patients and 40+ staff members, team members.
Okay, so now with 40+ team members, there is always a group of seven or eight people who are off on mat leave, who are coming and going in some capacity or another, and there is turnover. And turnover, you go one of two ways, right? If you think of your favourite restaurant, you go there because the same people: consistency. They know you, they know your table, they know what you like to eat, they know your order, right? If I show up to that restaurant now and those people are gone and it’s all brand new people, they have, like, one, maybe two chances to not blow it before I leave as a customer. The absence of consistency is what destroys companies.
If this is the thing that we were having happen, right? So, we have turnover, it’s going to happen. Everybody has turnover. But what happens when a new person comes in? First of all, how do I find the right person? Who am I looking for? Then when they come in, how do I make sure that the experience that my regular customer is used to getting, they will get no matter who they see as a hygienist, as an example. Or who they check-in with or check out with at the front desk, or who they see as an associate dentist. If the consistency is there, it changes everything. So, we built this entire training process exactly to solve our problem.
And then it became something that was scalable. Other dentists started asking how are you doing what you’re doing. We started sharing and it became a thing that was, well, okay, you know what, this is actually affordable, let’s test it. And eventually out of that, ten years ago now, grew Elite Practice.
Dr. Jordan Soll:
Okay. Thank you very much. I want to thank everybody for listening today. Be sure to subscribe to Brush Up’s email alerts, on Spotify and YouTube, to be notified every time we post a new episode. And please remember to keep brushing up! Thank you, Dr. Biasucci.
Dr. Carlo Biasucci:
Thanks, Jordan. Appreciate it.