Group dentistry is constantly changing and evolving. There isn’t just one path to success. While private equity and the dental industry may be focused on large DSOs, smaller, but equally important emerging groups are quietly changing the landscape of dentistry.
All DSOs by definition provide non-clinical support services to affiliate dental practices, so they can in turn provide quality care to patients, while giving dentists autonomy and affording economies of scale. In order to eliminate redundancy, these common denominators are to be assumed for all groups below.
Here is Group Dentistry Now’s list of emerging dental groups to watch in 2019 (in alphabetical order):
Affinity Dental Management began in 2017 and was founded by an endodontist, Craig Saltzman. The platform has grown from a few endodontic locations into a multispecialty DSO with 26 locations in Massachusetts, Connecticut and Vermont.
Twenty-two of the practices are specialty practices: endo, ortho, and perio. They have found that specialty locations lend themselves well to centralization because of the limited number of services that they are providing in relation to a general dentist (GD) office.
Having specialty practices within their platform offers their general dentists an in-house support system and their patients comprehensive care. This internal network yields more thorough treatment plans and fosters a partner relationship among the providers. Their dentists all participate in study groups and CE together, thereby encouraging them to develop relationships that go beyond patient care. Approximately 80% of their doctors participate in Spear Study Groups.
When looking at affiliate practice opportunities, they spending a significant amount of time in the diligence process. They want to understand the culture and the operations of the dental office, as well as the patient experience, before they partner. This investment of time and collaboration with the affiliating owner allows them to have an aggressive growth plan and continue to build a top-notch patient experience, while also being sensitive and responsive to the culture and successful business that they are looking to affiliate with. Once they partner, a comprehensive 90-day affiliation plan with a dedicated support team is provided.
Experiencing very low turnover, with only one dentist out of 30 leaving since the DSO began two years ago, most of the original staff is still with them today. Experienced dental professionals and dentists (still practicing) are in key leadership roles, which allows them to understand not only the synergies that can be realized in their affiliations, but also to be sensitive to implementation so as not to disturb the office environment. With the goal to be the employer of choice, while also maintaining cultural diversity among practices, they strive through compliance and benefits to exceed expectations. They find the HR component to be continually evolving and growing with them.
One of their goals for 2019 is to put more emphasis on the patient experience. As much as they want to grow their practices with new patients, retaining current patients and monitoring their satisfaction is a high priority. Obtaining post-appointment patient satisfaction data, they are continually monitoring and making changes based on feedback, which is an integral piece of their marketing strategy. Affinity is also implementing an in-house dental plan which will provide their patients more options to finance treatments.
Using an affiliation strategy and non-branded model, their long-term growth plan for the next five years is to be the preeminent multi-specialty platform DSO in the Northeast.
Key executives in group:
Craig Saltzman, CEO
Eric Bettinger, CFO
Meredith McGonagle, VP Operations
Apex Dental Partners started in 2014 and currently has 15 locations in Dallas, Oklahoma City and Tulsa. The group, founded by Dr. Layla Lohmann, David Lohmann and Matt Hale, focuses on affiliating with top-quality doctors while upholding the values of private practice.
Viewing business as a vehicle through which they serve others, their mission is to use that vehicle to improve the lives of their patients, teammates and the communities they serve. They believe they have a unique approach to the patient experience which is central to everything they do as an organization. Dentistry is changing, and with more options available than ever before for patients, their philosophy is that they must get the patient experience right every single time. That goal requires an intense commitment to building long-term patient relationships and delivering continuity of care.
Apex believes doctor quality is their biggest differentiator. They set the bar exceptionally high for practices joining Apex, and, as a result, they believe Apex supports a very high-quality network of practices. It is that demonstrated commitment to quality care that attracts many of the doctors who have joined them.
Most dentists are attracted to Apex due to their commitment to upholding the values of private practice. Their biggest competition is more traditional practice transition options. However, when a doctor joins Apex, they are afforded flexibility, control of their future, and certainties for the staff and practice that are otherwise not available through a traditional sale.
They have a very geographically focused model in which they look to build significant practice density in a few markets, rather than supporting single practices in many different markets. They believe this concentration of their practice base ensures that they can deliver a uniquely high level of non-clinical support to their doctors and practices.
A key success has been their phenomenal support team that provides world-class business expertise to their network of affiliated practices, which they credit as a tremendous asset in their rapid growth.
Educating doctors on the DSO model is their biggest challenge. It has come to be common knowledge that many young dentists have preconceived ideas about joining a group, and those ideas unfortunately often do not reflect Apex or many of the other great dental groups out there today.
Their growth strategy is through affiliation, and in 2019 they plan to continue growing in their existing markets as well as expanding their supported practice base into other Texas cities.
Apex’s long-term growth plan for the next five years is continued market expansion into cities where they believe the practice and patient demographics align with their model.
Key executives in group:
David Lohmann, CEO
Matt Hale, President & COO
Dr. Layla Lohmann, Clinical Director
Complete Specialty Solutions (CSS), founded by Omar Alvi, Santosh Patel, and Diane Harrison, started in March 2018 and serves over 60 offices in Houston and Dallas, Texas.
Led by a team of specialty clinical directors and experienced operational leaders, the group integrates traveling specialty services into solo, group and emerging DSO offices in Houston and Dallas. This unconventional group considers themselves to be a one-stop-shop.
This specialty DSO provides only board certified/eligible employed specialists, specialty RDAs, appropriate supplies and equipment, along with on-site operations support to successfully integrate specialty services. Offering complete turn-key support, their vision is to complement the growing dental industry by allowing patients to receive specialty care in a setting they feel most comfortable.
By offering specialty services within a familiar practice setting where a patient already feels comfortable, patient satisfaction has proven to naturally increase. Additionally, their digital platform which will release in 2019, will digitally communicate with patients to streamline quality of care.
They have a seasoned team of clinical directors, by specialty, partnered with an executive operations team that has over ten years of experience scaling operations in both the dental and medical industry. With their care through collaboration focus, the model is attractive to specialists due to the consolidation trend within the industry, which is increasing opportunities to work directly with the general dentist and improving access to care in communities.
Their active clinical directors and operations team are focused on streamlining specialty integration which allows dental practice owners to generate incremental revenue and maximize underutilized operatories, while increasing continuity of care. The group allows dentists to increase their overall practice valuation when the time is right to sell their respective office.
A key success for the group is that within 7 months they are on a $1.2MM revenue run rate with an average of 30% month-over-month growth. Receiving the support of Texas-based DSOs and suppliers to promote their services, has been an important component of their growth.
The biggest challenge for the startup is in building a brand within a fragmented industry. Many offices feel specialty integration will disrupt the focus on growing their dental practice, however, they want to provide specialty integration which complements the vision of the practice. The group strives to keep patients and profits in-house.
Through an affiliation strategy, the group plans to expand into Austin and San Antonio and provide specialty services for 150+ dental offices in 2019.
Long term growth plan for the next five years is to strategically expand into top 50 markets, and leverage a proprietary digital work flow to maximize efficiency, while focusing on patient safety and experience.
Key executives in group:
Dr. Kamran Shaikh, PLLC President & Clinical Director
Omar Alvi, CEO
Santosh Patel, President
Diane Harrison, COO
Concerned Dental Care (CDC) was founded in 1976 by Dr. Jay Fensterstock. They currently have ten locations in Long Island and Tri-Boroughs, with plans to add four more offices this year.
In 1977, Dr. Jay was one of New York’s pioneers in the union/capitation space; reaching out to companies and servicing their employees via service agreements.
In 1976 he began in a two operatory office in the Bronx, his first job out of dental school. Nine months later he purchased the office. He quickly grew to 12 operatories. During that time Dr. Jay understood the need for providing his patients with all the care they would need under one roof. CDC now specializes in taking typical GP offices and turning them into multi-specialty practices.
Dentist-owned and operated, without VC or PE, they truly understand the needs, abilities and capabilities of their dentists. Understanding that providers would like to be part of something larger than just the office from which they work, they provide dentists with an opportunity to become partners through their unique ‘pathway to partnership’ program. This program allows dentists to benefit from the success of the entire company, not just their office.
What makes Concerned Dental Care remarkable is its stamina and staying power. Today, in New York, there are not many DSOs who have been an integral part of the fabric of the Tri-Burroughs and Long Island for so long and so successfully. Over the years, many dental giants have come and gone. But Dr. Jay and CDC have remained a staple in the community and are in growth mode.
With over 80 years of combined DSO experience working with dentists and team members, the team wants to not only improve business practices but, more importantly, the standard of living for dentists and team members alike. Their name, reputation and future are highly dependent on their teams’ ability in making great dental care standard practice with every patient interaction.
Believing that their ability to provide accurate, comprehensive treatment plans and unparalleled hygiene care are the cornerstone to a great patient experience, they have heavily invested in their hygiene program and their technology.
Dentist retention is a key success as their dentists has been with the group for 10+ years on average, with many of the dentists celebrating 25+ years with the dental support organization.
The biggest lesson they have learned is when to pull the trigger and acquire the next group of offices and when to hold and push for same store growth. It is a delicate balance, and once perfected brings the greatest rewards.
They believe that the future of dentistry lies with the 5-25 location DSO. They have the greatest potential for growth via joint venture and PE/VC funding. Allowing small to midsize DSOs, with synergy in their visions, to come together to form larger, interdependent DSOs. Leveraging each DSO’s unique set of experiences to enhance the provider, employee and patient experience.
As they continue to grow, recruiting top talent not only clinically, but those with the right personality that will fit their culture, proves to be a challenge. Additionally, the dental insurance environment has not and is not catering to the needs of their patients. This in turns leaves the burden on the providers and the company to find innovative ways to make top quality dental care affordable. While they love making this happen daily, it would be beneficial to all to have a true partner in the insurance company.
Key executives in group:
Dr. Jay Fensterstock, CEO & President
Dr. Antoinette Siciliano, CDO
Ariel (Ari) Wiener, COO
Montage Dental Group was found in June 2016 by a dentist, Dr. Brian Carp, a dental school dropout, Ryan Cunningham, and a banker, Justin Deutsch.
Now, they have seven affiliated practices in Eastern Pennsylvania and New Jersey, 70 team members, and 9.4M in revenue.
Using the acronym TEAM (together everyone achieves more), the founders have built the group without utilizing a hierarchical governing system. In fact, staff are not referred to as employees, but team members. And listening to those team members has been key to their success.
Stressing a collaborative approach to problem solving, there are no hard lines or steadfast practices within the group. Ideas, systems, and processes are all streamlined and reconfigured by all levels within the organization for the best possible result. Finding that sometimes management’s vision is not the best or most-effective strategy, they rely heavily on the team members and patients’ input.
With an emphasis on collaboration, comradery and patient experience, they have created a culture where there is no finger pointing. ‘It’s not my job’ is something you will most likely never hear at this DSO. Setting the example, the owners pride themselves in their willingness to roll their sleeves up and get the job done, even answering phones and greeting patients.
They have also developed and implemented several patient experience initiatives. Tracking all phone calls, which are graded and then shared with team members, provides immediate and concrete feedback. Another is their ‘10 Point Smile’ program, which is to be used at every visit. It includes:
greeting the patient with 5 seconds of their arrival,
hygienist/assistant will take the patient back within 5 min of the patient’s appointment start time,
hygienist/assistant will reschedule the patient to return to the office within 7 months of the visit,
hygienist/assistant introduces the patient to the doctor within 5 second of the dentist entering the room.
The training and development department has begun a ‘mystery shopper’ program to ensure that the ‘10 Point Smile’ is being implemented. It will measure quality of service, compliance with the program and gather specific information about the patient experience.
Their goals for 2019 are adding three affiliate locations, while they continue to improve training programs and centralization services. These services, which will be part of their unique affiliate strategies, include insurance estimating and billing, accounts receivable management, supply procurement, EOB payment posting and marketing services.
Their mission is to create a company where its culture will attract and retain team members, while providing a growth-oriented career path for associate dentists and other team members. They strive to accomplish this mission by providing a profit sharing and ownership structure for dentists, and eventually providing an equity stake to all team members. There is a cash and growth component to the way dentists earn and contribute to the overall growth of the company. Dentists buy equity and earn equity. Focusing on their single location, the equity will be held at the parent company level.
With the biggest challenge being their rapid growth, they are constantly evaluating their teams, systems, and process. If they are going to continue their growth trajectory, they must focus on their systems and training programs.
Dr. Brian Carp, Director of Clinical Care
Ryan Cunningham, Director of Operations and Integrator
Justin Deutsch, Director of Finance and Visionary
Tomalty Dental Care, a single location practice which originally started in 1977, did not begin their expansion until August 2014. They currently have nine locations located throughout Southeastern Florida.
The DSO was started by brothers, Drs. Sean and Jordan Tomalty. Their group’s mission is to enhance the health and livelihood of the communities they serve by expanding their family tradition of providing the highest quality oral healthcare possible in an unmistakably caring and friendly environment.
Since they started out as a family practice, they are highly focused on the family-value aspect of dentistry. A core value of theirs is that they will treat every patient and staff member as though they are an extension of the Tomalty family. Despite having over 60 employees, in 2018 they did not have any staff turnover. Investing heavily in their staff, the administration team has training protocols and metrics for every position (from front desk to doctors).
In just over the four years that they have been in operation, they have had zero associate dentist turnover. They attribute this to their extreme doctor-focused culture. In fact, their group has become such a desirable place for associate dentists to work, they now have a waitlist of dentists.
Some dentists do not want to sell to a ‘corporate’ dental practice. Understanding that some dentists may prefer to maintain their practice’s family feel; they are attracted to Tomalty. Since the group’s roots are in family-run practice, their DSO’s philosophy is to maintain a practice’s family-feel with the modern/backend support of a small DSO.
With a strategy that is both DeNovo and affiliation, they have expanded via PPO and FFS only (no HMO or Medicaid) which has allowed them to maintain a high level of quality and customer service. They offer many unique patient experiences, such as 2:1 patient transfers and two TVs in each operatory. Believing there are customer service benefits to patients speaking with an actual staff member, they do not have a call center. This is a decision that they are determined to stick with. They have developed a robust KPI tracking software that tracks everything from waiting room times to crown case acceptance percentage and they are working on custom software to automate insurance processing.
A key success is their fast growth for their size, with nine locations over four years, high customer service as is noted by their 5-star online reviews and excellent online reputation, highly desirable retail locations, secured funding, and a fully developed middle-management team.
Their biggest business challenge is contending with the large DSOs to find the best DeNovo retail spaces. Many large groups already have leases in place in the best and newest Do Novo retail plazas.
Now that they have their middle management team fully structured and staffed and they have private financing secured, they plan to acquire four or more locations and open two DeNovo locations in 2019 for a total of 14-15 locations.
Their long-term growth plan for the next five years is open to work with private equity to help expand to the Central Florida market (Orlando) and the Atlanta market. They are also working hard to develop a platform to help scale the company quickly and responsibly. They have a plan of 20 locations by 2022, then scaling to 40 locations relatively quickly after that.
Sean Tomalty, DMD, CEO, Co-Founder & Co-President
Jordan Tomalty, DMD, CDO, Co-Founder & Co-President
Tranquility Dental Wellness Center started in 2013 and has three locations in the South Puget Sound area of Washington.In a very male-dominated space, the group, whose motto is “Experience Affordable Luxury,” was founded by a female dentist, Dr. Lori Noga.
They may be small, but their vision is to be an industry leader in both organizational culture and patient experience. Every individual on their team is self-governing, possesses strong leadership, and has a zest for continual learning. Their collective philosophy is that they have much greater impact on the world acting together, than they can acting alone.
The practice started as a single, five operatory DeNovo in August of 2012. In six short years, they have reached over $7M in production and continue to grow at a rapid rate. With a target of $25M in annual revenue by 2025, they plan to continue their growth goal of 25% per year. They are also 100% dentist owned, so they have no investment backing.
They attribute their explosive growth to choosing locations with rapid population growth. With the squeeze of insurance reimbursements and the rising costs to run and operate a dental group, they are still able to provide a very luxurious, high class patient experience in a spa-like environment, while participating in PPOs and offering in-house financing options.
Core values are represented by the acronym ADAPTS: accountability, dedication, abundance mentality, positivity, team player, and servant leadership. These values provide a cornerstone to their organization and are paramount to providing a framework in which they operate. They utilize these core values in their hiring process, in their review processes, and in all decision making. While they understand that not every person can be 100% in alignment 100% of the time, they allow every team member to ‘bring their whole self to work’ every day, without judgment, but instead with compassion and understanding.
Dr. Noga is passionate about self-managing, accountable teams. Every team member is to act as a servant leader within the organization and to be a steward to each other’s develop, growth, and success. There is no tolerance for a ‘command and control’ atmosphere. Their team members have mutual respect and recognize when another may be struggling and will step in and help train, coach, mentor these individuals to get them to a level where they can be successful. Every individual knows this is the responsibility of every team member. All team members encourage and lift each other up.
Every team member is responsible for 2-3 metrics that correlate directly to their job functions. Each team member is responsible for reporting these metrics and assisting in finding solutions to course correct when they are off goal. The group has determined that when each team member has control over part of the organization’s success, all team members work in the same direction, resulting in greater achievements.
Their biggest challenges are:
finding great, committed doctors and team members, especially when unemployment rates are so low,
fighting the stigma that patients associate with ‘corporate’ dentistry,
staying ahead of the rapidly changing social media and marketing challenges,
cost control when insurances are squeezing reimbursements down and cost of supplies, equipment, and facility keep rising, and
implementing the best platform for doctor partnership.
A key to their success is their human connections. It is evident on every level that they understand that relationships are what drive them forward. Everyone takes the time to get to know each other at the human level. In fact, this is one of the most common observations they hear from patients, or anyone who comes in from the outside. Team members feel safe to talk openly about their lives and aspirations outside of their position with the DSO.
Key executives in group:
Lori Noga, DMD – Founder & Visionary
Colby Cockrell, DMD – Clinical Director
Ashley Righton – Integrator
Tiffany Bibeau – Director of Centralized Services
In 2014 a pediatric dentist, Dr. Scott Goldman, and an orthodontist, Dr. Louis Whitesman, combined their four offices to form WhiteGold Dental Partners, believing that collaboration of care under one roof facilitates better clinical outcomes.
The group, which has now grown to 28 DeNovo and affiliated practices in Chicagoland and NW Indiana, has been renamed United Dental Partners (UDP).
UDP has large multi-specialty dental centers with dental specialists in pediatric dentistry, orthodontics, oral surgery and general dentistry working within the same four-walls. They have 82 doctors in the organization with half of them being dental specialists. There are very few procedures that cannot be completed by a doctor within their network. This allows for superior collaboration between professionals and ultimately better patient outcomes. Their offices are set up to meet the unique demands of dental specialists and their average office has 12 operatories and is 4,000 sq. ft., much bigger than the typical practice.
Investing heavily in innovative technology, all their offices are outfitted with state-of-the-art digital radiography, photography, and many have cone beam CT and/or CAD/CAM technology.
While their dental center roster currently spans across Illinois and NW Indiana, their influence stretches beyond that. They have a unique doctor mentorship program where dentists and specialists across the country have access to other specialists via their exclusive network portal. This affords them opportunities to discuss cases as a group to learn from one another.
The biggest challenge they face involves collaboration between dental insurance companies and their doctors to ensure they provide the best in patient care. Over the years reimbursement rates have remained flat and costs to do business and invest in technology continue to increase. This is probably the number one reason DSOs exist in the first place – to leverage fixed costs to ensure doctors can focus on dentistry and leave the business to the “other” professionals.
A key success for their group has been staff retention, many have been with them since their inception. They have created a team-oriented environment where they believe the best idea wins, irrespective of where it was originated.
Looking ahead five years, they would like to expand throughout the Midwest and reach the 100 mark, while becoming the #1 specialty DSO practice. One of their biggest drivers of this growth is them knowing that the organization is reaching people every day and making a tremendously beneficial impact on their lives.
Key executives in group:
Scott Goldman, DDS & CEO
Louis Whitesman, DDS, President & Chief Orthodontic Officer
Brendan Gibney, VP of Operations
Kim Rosenlund, VP of Marketing
Iman Zayed, Director of Marketing