Why Dentistry Should Never Become a Commodity | with Steven Lynch, BOAC #58

0:00So today we are 10 sites with another five in exclusivity, very good and strong pipeline. So I'm hoping that we get to over 20 within the next, say, eight months. Patients that haven't been for 20 years that want a quick full-mount reconstruction never come back, not really of interest to us. We're more interested in conservative dentistry, returning client base and community-focused dental practices. Dentistry is not a commodity. It's about people. It's about the relationship with the practitioner, with the actual dental practice itself. And sometimes on high street, you get a very high turnover of staff.

0:30Whereas if you're out, just off the high street or in a regional town, the staff are more loyal, the patients are more loyal. We don't change the name. I'm buying the history of a practice of patients walking in the door. So I don't change the name. Don't rebrand. Don't put Total Dental Ireland and flashing lights on it. Nobody would know who Total Dental Ireland is. When you're 20 years as a co-founder of an accountancy firm, you're putting out a lot of people's fires. You see a lot of financial difficulties. Dents of separated earning, good at spending. What's the most important thing is that practice is delivering.

0:55Patience comes first. They've got good systems already. They've got good combines and rig. And what, you're going to fall out over a PMS? Yeah, I'd love to have it, but I'd much prefer to have a fully functioning, happy practice than disgruntled people. I think the days of the squeaky stairs, dead wolf practitioner, I think they're over.

1:16Hi, everybody. This is Jared. I'm one of the co-founders at Career in Healthcare. We are back for another episode of The Business of a Clinic. Today we're joined by Stephen, much further afield than the usual UK audience joining us from Ireland. Really excited to hear more of his story, an interesting one, combination of practice leadership and a past career outside of practice leadership. So that's always fun. Stephen, thank you so much for joining us, for making the trip down. We would love to maybe start with, I always say this, start with the two minute version of how you got to this chair.

1:48and then we'll do the sort of longer, more detours version of that afterwards. Two minutes is a very, very abridged story. Yeah, three minute first and then. Perfect. So I studied accounting and finance in Dublin City University. And thereafter, I went on to study chartered accountancy. But you have to have an apprenticeship. So I went through BDO in Dublin. And coming to the end of my articles, your three and a half year term, BDO said, look, there's a bit of potential in this guy. so we might send you to BDO Sydney on secondment. But little did they know that I actually had fallen in love with another member of staff from BDO and I said, I ain't going down there.

2:29So I ended up taking an interim financial controller position in a German bank, which turned out to be a long-term position because the person didn't come back from maternity leave. So I stayed there for four years, working really, really hard. And then the entrepreneurial spark inside me, basically on when I was having a pint with my brother-in-law he said he was importing a lot of this um two whitening product from America uh that nobody had the agency in the UK or Ireland or anywhere from Europe so I said god maybe we should look at getting that for the UK and Ireland so a couple of emails a couple of phone calls later on a plane with my brother-in-law to Chicago to midwinter dental show and met um Bill Dorfman who's the founder of Disco Dental and he said yeah you can have the agency so my father-in-law was just retiring from us he was in insurance and he sold his business and we're looking for something to do keeping busy i placed an advert in the bdj and the dental mags dentistry the irish dentist journal at the time and my god just quickly it exploded and i went home one day and i said you know what catherine i said i'm gonna just do this full time like what am i doing working for the german banks seven days a week you know on Excel spreadsheets.

3:45I can be packing boxes. So I did that for a few years, maybe two or three years, just because I telephoned one day and said, guys, we're coming direct into Europe. So, you know, here's your P45. See, all these distributorships are all gentlemen's agreements, okay? So that door closed, another one opened because once I was doing that, people knew I was an accountant, all the dentists that I'd built up the contacts in. And they said, would you like to do my accounts? And I said, no, no, no. At the time I was busy out. you know, and I went, you know what, after that happened, I went, you know what, I think there is a massive gap in the market for this.

4:21So I met a someone who was of similar mindset to myself, and he, his brother-in-law was a dentist too, and he was doing the accounts for his brother-in-law, and we put our minds together, met up for a coffee, and about a month later, we set up Medi-Account services, and it grew organically, and our client base was about 35 % of the dentists in Ireland. So I did that for 19, 20 years. And I guess my life, you know, full circle is when I was leaving the secondary school, I didn't know whether I wanted to study accountancy or dentistry. There were certainly one or two. Okay. And here I am now in the, doing the business of dentistry.

5:02Got it. Very full circle. Yeah. And the transition, sorry, just I understand you, So you ran your own accounting practice, effectively serving dentistry. You're not doing that now, of course. No, I... So just the jump to where you are now. Oh, sure. So again, very serendipitous. A former colleague who had met during my accountancy term in Ireland, he'd gone to the UK and little did I know what he was doing. I'd lost touch on him for a few years, but he rang me out of the blue one day and said, I'd like you to meet a guy called Ross Finnegan from Lonsdale. He's coming to Dublin and he just wants to have a chat about the Irish dental market.

5:46So I said, where are you now? And he said, well, I'll tell you, I'm co-founder of a dental group in the UK that's backed by Ross. Okay. But he just wants to have a chat to you about the Irish dental industry. So I went and met him. We got on really well. We talked for two or three hours. I just gave him, I was happy to have a coffee. I think I'm here today having a chat with you. uh just telling him about the industry and then maybe three weeks after that he called me again i said you want to meet up again and during that meeting he said look we're thinking of coming to to ireland i'd like you to leave it and i said ross look i've got a day job i've you know i'm seven days a week doing my account and leave you're all my dental clients and he says no it would mean you've coming in so again i went home chatted to my wife who's thankfully she's a good listener and she's head of advisory and BDO now.

6:39But she said, look, these opportunities don't come around too often. Think long and hard about this. So I thought about it. We chatted about it. I went back to Ross and said, yeah, but I have to finish out the tax season because I don't want to leave my clients in the lurch. So extracted myself from MediCount. And then within a couple of weeks, we had our first clinic. And now it's how many? So today we are 10 sites. with another five in exclusivity and a very good and strong pipeline. So I'm hoping that we get to over 20 within the next, say, eight months. How long has that been now? Just over two years.

7:22How has that felt? It's been a roller coaster. Yeah. It's a whirlwind, but I really, really enjoy it. Yeah. I mean, as I said, I had a lot of, I suppose I had a head start having the contacts in the industry. And I guess the first five or six were easy. First degree con. Well, yeah, people that I knew would be, you know, looking to exit their businesses. And they are happy to go with the devil they knew than the one they don't, you know. So for me, it was, I mean, it's hard work. Don't get me wrong. And I guess Lonsdale are very good at supporting me. they're always encouraging me to take on a we built up a great central team um and um so much so that i've got a new mna manager coming on port now in september our central team now is 11 um and i guess we got a couple of key recruits in there we i my first appointment was a head of operations a clinical director um a chief people officer all of those things that would have been burdens them for owners beforehand.

8:28So I said, okay, we need to have a really good, strong central team, get the processes, systems right, and integrate those into the practice that we're going to acquire. And from what I understand, this is a, I'm going to say more traditional appreciating, of course, that's largely up for debate, but it's a traditional private equity acquisition structure in the sense that you're acquiring, taking operational ownership, and then working with the practices to grow. It's not a partner-led model, it's a more ownership-led model it's buy and build essentially yeah okay okay got it and and out of curiosity and then sort of curious to get into your those uh emotional strings that sort of pulled you toward it but when you think about day one with one clinic yes and whatever day it is now hundreds plus days 10 clinics seem to be maybe 20 clinics what is the what does the future hold is this is this 100 clinics across wherever is it 50 clinics is it tbd let's see how well we go what's the sort of end state here to be honest it's it's tbd okay okay um i mean we're well funded uh we're running a good ship um you know we we got great people on board you know that's yeah i suppose from from my side of things i tried to get the right people on the bus to to coin a phrase from that jim Collins Good to Great book, get the right people on the bus, get the right people doing the right jobs and get the bad people off it.

9:55And there's no reason why, you know, it's like I'm a father of four. The step from two to three was probably the biggest shock. So for me, having 10 clinics now, I would say going from maybe number seven to 10 was easy. One to five was hard. Do you know what I mean? So now you're sort of, yeah, exactly. When you have your central team and you have the process is right. I think the numbers are just numbers. Once you have the system and processes right, I think it's manageable. Yeah. Makes sense. So I'm always curious. So without going into the deep financials, at least at this stage, when you're thinking about the profile of a clinic that's interesting to you, I'd be curious to understand what that looks like, because I think a lot of group leaders that we speak to they will often reduce it to uh ibid on culture yeah um and i think even does probably easy easy it's easy for people to understand its number but what are the what are the less obvious components of a practice that you're trying to understand well you know without giving away too many trade secrets no please don't yeah um i don't really like or go for high street practices or commodity practices that might be seen as commodity dentistry I'm looking for quality returning patients you know so practices that really offer good quality work where patients are happy to come with their families or recommend that it's conservative dentistry or if we're doing more advanced that it's done by qualified practitioners that have the letters after the name to actually do those treatments so you know patients that haven't been for 20 years that want a quick full-time reconstruction and never come back, not really of interest to us.

11:45We're more interested in conservative dentistry, returning client base, and community-focused dental practices. Got it. That I think makes a lot of sense. And I guess that shows up also in the culture of the practice. It probably feels very community-based when you walk in. Well, 100%. So, for example, our latest acquisition, which was in May, is a third a generational practice. So established in 1916, great-grandfather of dentists operated as a dental practitioner and his brother operated as a doctor out of that same building where we're in today. And it's a beautiful building. And for him to actually entrust us, Total Dental Ireland, with that, I suppose, family heirloom, like to wear that jersey of that practice out, we're so proud that we were chosen amongst others to be able to just to continue on with that care for his patient base.

12:37You know, it's such an honor. Interesting. And I can see how that is a different thing than, to your point, well, high street healthcare more generally, which is a bit more transient. It is, but as I said, it's commodity. You know, dentistry is not a, that's one thing it's not. Dentistry is not a commodity. It's about people. It's about the relationship with the practitioner, with the actual dental practice itself. and sometimes in high street you get a very high turnover of staff whereas if you're just off the high street or in a regional town the staff are more loyal the patients are more loyal I find it's a better fit for us Makes sense, and that's 10 now so that mould has held across the town, okay interesting and I guess in terms of the you mentioned two things the first one was you're looking for returning patient population evidencing trust in the practice, longevity of the practice, etc.

13:33And you're looking for conservative dentistry. That's correct. I can very easily understand what returning patients sound like most of the work that we do at Coherent is about returning patients. So I can understand very clearly what that looks like. Not being from dentistry myself, when you think about conservative dentistry, how does that show up in the day-to-day? Sure. So a lot of it is about routine maintenance. So, you know, dental practice should be promoting maintenance and care to prevent, you know, massive treatments having to be undertaken. So we encourage people to go to the hygienist still off.

14:10So at least twice a year. And our dentists, if someone does need a big procedure, we would have specialists not in every clinic, but in some of our clinics. And they're very well qualified to do the jobs that need doing. so we would encourage our associates to you know learn from the specialist dentists that we have within the group and if they can and it's it's it's i suppose convenient for the patient to utilize the the specialists we have within the group got it okay i understand so this is really about prehab rehab and everything in between yeah it's not just predominantly maintenance is you know if you've got a good maintenance program in a practice oral hygiene in that in the practice, the patients should be well set.

14:56I'm so curious, the work you would have done before the group, you would have seen and had exposure to a very large, 35 % of the dental market in Ireland. So you would have seen the financial side of the house for a huge number of practices. That's right. Which gives you unfair information, which is perhaps why you're very good at the job that you do. What have you sort of learned from seeing things done well and things done badly at scale that you're then taking forward into the group and you're saying actually I've seen that go wrong we're going to do it differently. Exactly. I would have advised countless dentists on practice sales or acquisitions over the years and I guess the opportunity for me was I've seen where others have failed is exactly what you're saying and where have they failed?

15:41They have failed in you know having meetings about meetings, not empowering people you know trying to take everything into a centralized center okay that doesn't really work in ireland you know you have to empower the practices so you can train people up so dentists are really really good at doing the dentistry you know maybe not all are graded in the business side of things and they would have they would traditionally wouldn't may not have been very good at delegating tasks so if you train the staff up their support team up allow them do the ordering you know we can, yes, you know, we can do all the payroll and the pay the bills and the admin side of things and introduce processes and systems that help, particularly in terms of the regulation and compliance, which is really, really onerous.

16:31So I've seen others maybe not do that so well. And that's what the opportunity was for me when I was, I suppose one of the trigger points for me to actually come and do this was, I know I can do this, you know, and that's why I went out and got the people that I knew who could do it. It's interesting you're using the word the dentistry of the clinic and the business of the clinic. Obviously the name of the show is the business of a clinic. So we agree that there is this almost bifurcation in practice leadership and some people naturally have one and figure out the other one. Usually that's the practitioner figuring out the business.

17:09It's very rarely that a business person comes in and suddenly discovers how to be a dentist because that doesn't really happen. That's one thing I don't do. I'm very good at leaving the dentistry to the dentist. Exactly. But I will empower, I will help them. Right. I will give them, I reinvest in the practices. I will, you know, if I see something, particularly in the age now where we're a lot of AI coming on board into dental practices, if I see something that I think is worthwhile, I will introduce that into our practices. You know, something like a virtual assistant to help with the phone answering.

17:44So, you know, if you walk into any dental practice or even in a medical practice, you want to have someone to greet you. You don't want to be greeted by somebody who's on the phone, you know, and saying, give me five minutes. So if you can have a virtual assistant that's able to, you're able to press a button while you know, when you know the people really coming in and the virtual assistant is able to answer that phone for two or three minutes, I mean, that's a great tool. like I walked up the road here where you are in Mayfair you've had a whole nice five star hotels where there's someone to open the door for you to meet and greet it's very welcoming when you get that that's the type of practice that I'm trying to get in terms of that when someone walks into our practice that they're met by someone who's actually there to actually physically meet and greet them say you know go through the mental questionnaire with them if it hasn't already been filled in but the essence of what I'm trying to do is make it very personal our practice is very personal um i'm very people-centric and patient-centric it's interesting the uh the thing you you touched on is virtual assistance so i guess a person and or a thing and or a hybrid handling some of that uh patient pressure i'll call it that patient operations particularly for those who are not physically on site yeah um now you're talking about a practice that has been around since 1916 That's correct.

19:07I can imagine that the patient database or practice that's been around since 1916 has a few rows on it. Yeah. More than many of the practices. We work with practices that are around for 20, 30 years. They might have 50 ,000 patients in the database somewhere. I'm struggling to imagine the size of the database. Obviously, not all of it's retained, but 1916, you have multiple, multiple decades compounding patient body. that's a lot of people to look after, particularly when many of those patients are not physically there. That's correct. So how do you think about at a group level, now you have 10, obviously they weren't all founded in 1916, but you have, let's say on average, 10 ,000 patients per practice.

19:48I'm making the number of 20 ,000 patients per practice. Yeah. How do you think about managing the, you're talking about being people-centric, relationship-driven. How do you think about managing and enabling those relationships for 200 ,000 patients? Yeah. Very good question so this is where you need to have your ai is really really good at this so when we when a patient comes in our door you'll say would you like to be contacted by by i suppose are any of our marketing initiatives or emails or whatsapps people are free to say no and on our systems we can actually then say okay do not you know computer does not count they contact these people it's it's physical person has to bring these people okay so we're unable to do that and ai allows you to do that but generally there's no reason why with our databases though people we can send out a grab and go do you want to be contacted by us do you mind getting our marketing initiatives do you mind getting recalls you know you get patient consent to contact you and you can't contact the patient without without the consent and i guess that's what your question is is is really asking is how How do you contact two thousand people in a database?

20:56How do you market your wares? Each patient of the practice will have ticked a box to say, do you want to be contacted virtually or by email or SMS? What's your preferred method of contact? Most people nowadays will say email or SMS or WhatsApp is totally fine. I'm very comfortable with that. And AI facilitates this because it allows us to say, you know, this month we're offering a widening for life program or we're doing promotion on whatever hygiene that we're doing or too, you know, a lot of it is we're trying to get the patient back in because they might have been lapsed or, you know. So we want to make sure that they're being looked after because if they don't look after themselves, you know, potentially they're looking at a big bill that nobody wants to have to, you know, pay in the future.

21:50So it's so important for us to be able to communicate with our patients. And that's what I would say to that. Got it. Makes sense. I'm curious. So one to 10, now we're at 10. When you add to the group. Yeah. There's a process that we've now built. There's a pipeline. There's a deal process. Post deal. Yes. I imagine there's an order of priority things that you want to go through to begin thinking about transformation, enablement, P &L work, et cetera. Yeah. If you're comfortable to say, what is number one? Where do you go first in the practice? Assuming it is an issue sometimes. Well, but what's top of the list?

22:28Well, let's just say what we don't change. Let's go with what we don't change. What do we not change? We don't change the name. Okay. Okay. Because I'm buying the history of a practice of patients walking the door. So I don't change the name. Okay. Don't rebrand. Don't put Total Dental Ireland and flashing lights on it. Nobody would know who Total Dental Ireland is. Okay. So I keep the name. Okay. And then little by little, we would look and say, well, what needs to be changed here? We don't just make changes for the sake of making changes. OK, so first thing is we've developed our own internal web portal and compliance and reg because that is the area.

23:00That's the burden of ownership to dentists really would be afraid of. OK, is the compliance and regulation. And it is quite onerous. So we've developed our own little web portal. So it's like a dashboard of this daily class that needs to be done in a dental practice. there's weekly tests, there's monthlies, there's six monthlies, you know. So it gives us a dashboard and it's task driven. So we would train the, say, some practices don't have a practice manager. So before we'd have bought, we might ask the dentist, say, who out of all your staff do you think would be a suitable practice manager?

23:37Because we don't want to put an external person in there. I'd much rather internally engage somebody to be a practice manager. So we would ask the dentist and they would normally identify and they say, look, this person is maybe afraid to be called the practice manager. And they might like to be a joint kind of a manager with a nurse or an admin person to understand. And they're sharing the role. And that suits us down to a T because it means then we're able to say, OK, if we're looking at the nurses, they might be good at doing the ordering of the physical stock from the supply companies. and the admin person might be good at maybe just checking to make sure that some of the admin tasks that are compliance and reg orienteered that they're able to look after those tasks so there's an onboarding process where we're bringing them through that portal and and that's number one for us in terms of you know um making sure we get the compliance or reg right um and then just saying look i want you to run this practice as if it's your own okay the dentistry is done by the dentist But that dentist, he or she is no longer doing do this, do that, do that.

24:42They're just focusing on the clinical work. And surprisingly, they'll find that keepers, I'm doing more clinical work here. The results are a little bit better, financial results. But in the back, the headache stuff has been taken away from the dentist and it's been shared by the staff within. And so we would have regional managers that would help. and they visit the practice one day a week just to help handhold with the with the reg and compliance stuff and just the how everything the hr and everything just to make sure it's running smoothly so it's it's not dramatic change it's a very little by little and handle holding approach which we feel is the best thing to do because otherwise it becomes overwhelming you know makes sense and i guess you're you're going into a a part of the practice which objectively nobody really enjoys um so there are probably there's probably much less friction around making compliance and reg easier yeah i mean i mean it it has to be done do you know i mean it's healthcare you know we're changing we are affecting people's lives so we have to have compliance regulation certainly like the dentists have to have cpt continual uh professional development yeah um So we have to make sure that everyone's adhering to the standards that they're obliged to adhere to.

26:00And if you compress that risk, then you can start thinking about the growth initiative in the practice and all the fun stuff. That's correct. I mean, it's, you know, it's down from its bottom up. You know what I mean? Like we train the staff right, make sure they're happy in their work. Happy support team generally means a happy dentist. Okay. And it all flows. You know, you make it a success. Makes sense. When you, I guess your first clinic, your second clinic, the earlier ones in the journey, yes. Have you seen, have you noticed material change? I'm talking about profitability change. I'm talking about cultural ways of working, satisfaction.

26:41Are they intangible, the soft things? Have you seen that journey? The first practice that we acquired, it's no secret, it was O 'Connor Moore Dental Practice in Sleika, which is in the west of Ireland. It's probably one of the most well-run practices that I've ever come across. So I knew the staff, the owners of that had invested in their team, got the right training, had the right systems. There was very little, shall we say, that needed to be changed in that practice. The dentists were very good at delegating the duties to the practice manager and assistant manager at that time. and that's really the model I've said every practice should like this you know they'd more staff than a normal practice would need and I mean this is really good because the team is big there's annual leave so why don't you just have someone or a floating nurse that's able to cover all the annual leave just made a lot of sense so I suppose I learnt an awful lot from that practice and they were clients of mine as the accountancy for 15 years so I knew the practice no surprises so So, I mean, that was the model that I wanted to have in every practice.

27:47Got it. Okay, so there was sort of a blueprint early on. It says, okay, this is what excellent looks like. Exactly. We're going to take this forward into other sites. But, I mean, every practice we have has its own, a lot of strengths. Do you know? There's some practice that I buy and I went, God, I didn't know that. And it's like a surprise bonus, you know? There's staff there that have never been asked to do stuff. and then suddenly they're great at doing things, you know. Do you find that there is, you know, now you're starting to build almost a collective brain at the group level. The best, you know, this practice does all these things well, but actually they haven't really figured out this thing, but actually that third practice has really cracked that thing and so now we're passing that.

28:26Is there a lot? So there's an awful lot of sharing. So all of our practice managers met actually as recently as Monday and they just had a kind of a culture and a learning and training day and just sharing their ideas and what's working for them, what's not working for them. That's really good to pause in a room when you get like 10 practice managers in the same room as what's working. And the regionals are able to say, wow, you know, I mean, the regionals are learning from the other practices that they wouldn't be under their supervision. And it's just great meeting of minds on that. That's really nice.

28:57Yeah. And I imagine also quite a big draw for the dental leaders themselves in that now there's a more clearly established peer network. Absolutely. Absolutely. And, you know, as an individual practice, people can tend to be very isolated. When you bring everyone together in the same room, and I had first-hand experience of that because in the end of March this year, I brought all of the dental practices together. We had a learning day where dentists and front of house team and the nursing team all came together, had it in Dublin. I think there was, you know, we had it on a Saturday, so people gave up their Saturdays.

29:33and 88 people came, which was really, really good for, you know, for us, for our first inaugural one. So we had a dental morning learning. We had a nurses. We had a dental hygienist learning. We had front of house learning. In the afternoon, everyone sat in and there was like an ethical sales expert was giving ethical sales tips. And that ran from two to six. And then we went for dinner and then we had a couple of drinks and stayed in the hotel. It was really, really good. And when you see that, I mean, endorphins and, you know, you just get an awful lot out of it. That's really nice. I want to go back for a minute.

30:08So you talked about a moment where you gave us a few examples of a moment where you went home and talked to your wife about the next chapter and the next chapter. To the extent that you're comfortable, I would be really curious to understand if I were a fly on the wall when you were discussing this opportunity, she said or you said these opportunities don't come around very often there's something special about this what what was that conversation like on a on a personal level how did you ultimately get to the place where you said okay this is what's next well when you're 20 years as a co-founder of an accountancy firm you're putting out a lot of people's fires okay you're you become friends with a lot of, you know, it's very, what would I say?

30:55It's very, like, you get to know your clients really, really well. And, you know, you can see it's financial, you see a lot of financial difficulties, you know, dentists are great at earning, good at spending, okay? Tax season comes around, and it's like, you know, sometimes you feel like the Grim Reaper, okay? It's not me, it's not me, George. you know what I mean it's just your life now to be aware there's a lot of burden okay and there's a lot of responsibility not to say that I don't have that responsibility now but you carry a lot of people's baggage and I'd seen I suppose other people and you know I'd seen other I suppose other groups get great opportunity and I you know as I said to you I would have advised a lot of sales and I go you know I could definitely do that and I'd probably do better.

31:56And I guess I suppose a few years previous to joining Lonsdale, I would have had an opportunity to go to another corporate. Didn't take it. It did particularly well. And I didn't have any regrets. So, you know, opportunities to do something that you're really, really passionate about and and that's why i didn't really take too much conversation now let's be honest once i knew you know i could agree terms and get on with the guys in lonsdale and i have to say they are really really good and as i said i i'm as accountable now as i was in my previous role so there's monthly board meetings but what i love about i suppose the board meetings is the profit doesn't come first on the agenda.

32:45First thing on the agenda is reg and compliance. Then it's people. Then it's the profitability. Then it's the pipeline. And then it's the policies that we've adopted in the, you know, if there's new policies or whatever. And that's my mud, you know. Interesting. It's the model you're describing, it sounds like, at least from a lending partner perspective if that's what we would call them, but the sort of source of capital, it sounds almost like group leadership by entrepreneurship in the sense that you're sort of operating what sounds to be relatively independently as an executive team and then there's an accountability partner for you.

33:28So, so long as they live empowered, they back me. Right, that's exactly it. They back me, they back me to put the management team together. That's what I've done. You know, I'd like to think we're, you know, our management team is is really, really strong. And in actual fact, we're quite unique in terms of outside of myself and my chief people officer. Everyone else in the central team has worked either as a dental nurse or a practice manager or a practice consultant. So our central team know what they're talking about. They're not just number crunchers or anything like that. It's they know how a dental practice should work.

34:05You know, and that's what's unique about us. and that's why I like working with Lonzo because they really have empowered me to go and do this. That's probably fun. When I come and say, look, we need to invest in, either looking at the pipeline and say, look, do you think it's good? Yeah, I do. Perfect. You know, numbers make sense. Let's go for it. You know, it's not, it's not as, they don't, like they do question me if they thought I wasn't right. Like they have experience already with today's dental in the UK. They're a couple of years ahead of me down the line. So they're no fools. they know if I'm doing a good job or not.

34:39Interesting. I find myself sort of being pulled back to, you mentioned pipeline, this idea that part of your business is growth of the group. The other part is efficiency in the group once integrated. And a lot of the folks who have come on and chatted with us who come from group leadership perspective say every group is ultimately in the integrations business. That's like a group of any kind, medical aesthetics, dentistry, MSK. It's an integration business wrapped in a fund. It's basically an integration business. And I'd be curious in your experience with the group so far, how big is the integration story for you?

35:31How much of the core business for you at a group level is about taking what is effectively an independent asset and trying to find ways to bend it into your processes without losing obviously the thing that makes it special the brand the dna the culture of the practice but how does integration show up and i guess the the knock-on question to that is you mentioned ai earlier you mentioned the idea of finding things that you think really move the needle and rolling it out to the group is the buying decision made at the practice level? Is the buying decision made at the group level? Is it made at both levels depending on what's being bought?

36:07Like how does that sort of co-decision making work between yourself or the executive and the practice leaders? So in terms of the buying decision, are we talking about the actual buying the practice? More so buying things for the practice when you're thinking about making decisions to improve? Oh yeah, so I would, we would assess or each practice on an individual basis. So some practice that we acquire, you know, might already have digital scanners. So digitalization is something that I wanted to introduce in 2026 to the practice that we already have. Because some practice when you acquire them would have been maybe a bit more traditional, not as advanced as maybe others.

36:45So you say, look, if you want to speed up your processes, why don't we introduce a simple thing like digitalization for a start? And that means instead of doing physical impressions on a patient, you're equipping the dentist with a scanner, which is a lot faster, a lot cleaner, a lot less, I should say, a lot more comfortable for the patient. In turn, there's no gagging with the, you know, prep material. And then it's faster turnaround if there's any lab work required because it's a scan sent to lab technician. Lab technician reviews it and says, yeah, it's a good scan. I can make whatever out of this.

37:24rather than sending something in the post that has a risk of going off or, you know, getting broken or lost or anything like that. So it's processes like that. So it's on an individual practice base. You know, some practice might be using AI note-taking. So you go into your dental chair and you're sitting back in the dentist that's talking to you. You know, God, this guy's great at talking to you. End of that consult, press the button. All the patient notes are already dictated. you know they're already up on the system um rather than actually having to physically type so some people are good at that it's all right so you're introducing things that as you said earlier on you're learning maybe what other practices have introduced you're bringing it into the other one do you know um virtual assistants some some practices have said to me i don't want to have virtual assistant my patient base may not like this i go okay fine can we ask them maybe when they're coming in with their mind fine so we can we can do that you know so you're not just throwing things down people's throats.

38:23You're not dictating this is what you have to do. You're saying, look, would you like this for your practice? Do you think it'd be good? So you're sitting down with the four or five dentists that might be working in that practice and say, this is what we're thinking you're doing. And then I'll say, yeah, you know, at the end of the day, they're all independent contractors, so you can't dictate. So you say, would you like to have this? And that's important for me that I'm giving the auction. I want to show that I'm reinvesting in the practice if they want it, you know. So that's important. And I guess other side of things is we give autonomy then to the practice as well.

38:57So say material ordering, you never take that away from practice because we are in central. We don't know what's, you know, what they want or what they don't do, you know. So we say, look, you take care of the ordering. We'll take care of paying the bills. You know, and yes, we can benchmark, I suppose, we can benchmark from practice to practice what the margins are so we know if they're ordering too much and all and you know so we can we can certainly see any red flags that might come about. It's interesting we work we work with a few groups and there are there are a few very different models that we've seen some of which I think mirror what you're describing which is the function of central of the executive is identify opportunities for margin control and growth and then find ways to introduce gradually.

39:47That is one school of thought. We have another group that we work with that does not embrace that school of thought. And the posture is very much, I'm going to pilot this collaboratively with one site or two sites. And if it works, this will be steamrolled into every other practice, bar none. Yeah, I couldn't adopt that. So for example, at the moment I'm embarking on putting in a cloud practice management software, PMS, where I have the proper fiber. The broadband is strong enough to do that. So I've got that in three of my sites now out of the 10. There is another cloud-based software which is in two of the sites, which is a different one.

40:31But the utopian word for me is to have them all on the same one. okay but i know it's not going to be possible because some of my practices say i'm really happy with this software and if you said to me that you were going to change it post acquisition i would not have sold the practice here so i go okay we're not going to do that i'm you know i'm i'm not going to dictate so really happy to say okay that's fine you're happy with the software you're happy I'm happy like what you know if it's unbroken why would you need to try and fix something interesting yeah yeah it's interesting I think on the PMS side it's it's uh I've again we've we've sort of seen groups do it both ways we've seen some say in order for us to unify reporting and to have group level visibility which is all very good in theory all right really really good theory yeah straight textbook theory but in practice if someone really doesn't want it what are you going to do cause acrimony you know you've got a really valuable asset what's the most important thing is that that practice is delivering the patience comes first they've got good systems already they've got good compliance and reg and what you're going to fall out over a pms i mean yeah i'd love to have it but i mean i'd much prefer to have a fully functioning happy practice than disgruntled people makes perfect sense yeah it may make perfect sense i i'm i'm uh i want to hit everyone's favorite topic ai yeah um you've mentioned it a few times uh i'm a novice no no i'm taking taken into consideration uh we were we all go down the technical road i i think um i i would be curious to to understand more by the way i i think the fact that you're thinking about bringing into practice and i already have makes you not a novice yeah if we if we don't we're going backwards right and well so already i think not a novice.

42:25And we were speaking with a gentleman actually named Lane earlier this week who runs Independence Dental in the US, 80 sites. This is his second group. The first one was up in Canada. And I would say he's on the other end of the spectrum in so much as he has built a sort of company and group level brain of data and everyone is querying the brain. So they are very mature in their AI adoption. And to your point earlier in the cycle, also the UK, it's naturally more conservative in its posture. I am very curious. So we, I mean, our business is ultimately AI driven, human monitored, and our posture has been, there are places where AI is really fit for purpose, particularly where there are tight constraints, boundaries, clear delivery points, and the risk profile of it going wrong.

43:14Ultimately, it is non-deterministic. The risk profile of it going wrong is only so big. How bad does it get? Not so bad. Okay, maybe it's okay. I'm curious to understand your view, without getting into the technicality, what is your decision-making process look like when you are assessing an opportunity to bring AI into the group? What are you looking for in terms of this much upside, this little downside? What's your sort of matrix, Excel thinking process to make that decision? I think anything that improves life for the, you know, A, we're patient centric. OK, so if it makes the patient journey a better journey, absolutely 100 percent.

43:58If it if it de-risks dentistry because, you know, it is dentistry. It's not it's not easy. OK, mistakes can be made. So if it de-risks things for dentists, absolutely. So if it gives a second opinion on something. So the second opinion imaging software, for example. so AI can look at that and say you know what there's a crack there you might you mightn't see it but someone might miss it but again it's a safeguard we're piloting piloting a patient consent at the minute which is digital patient consent so in two of our practices so that means that 48 hours before a treatment sent an email it's a video of what procedure they're going to have okay and then they put down that I consent to this so consent is you know if anything that takes the burden or the risk out of dentistry, I'm more than happy to have that, okay?

44:48So I'll invest in that because, you know, we want to protect the business, we want to protect the patient, we want to protect our dentists and everyone involved in the group, okay? So happy to invest in that. Not just going to have AI for the sake of it, okay? But again, if I go back to my virtual assistant, which is something that I'm really, really keen on, you know, anything that enables me to be more patient-centric when they come in the door and be physically able to say hello, chat to that patient. Anything that improves the workflows, anything like that, I am totally, totally all for. Can I double-click on that last one for a minute?

45:28The virtual assistant one, the one that interacts with the patient. I think a lot of risk compression, I understand, especially the way you described it, is second opinion. It's an interesting way of looking at it as opposed to first opinion. First opinion, you have expertise in-house, but second opinion is risk compression. That's correct. I can see how that, I think I can understand not only in dentistry, but out of dentistry, when you bring AI in as the verification layer to the human, you get huge value, question mark on whether or not the inverse is true. If you have AI being the primary decision maker in something clinical and the human being the verifier, that's, that'll never.

46:10We're not the everywhere. No. We're not there yet. And if I was to say that, it would be an insult to my dentist. Okay. Okay. Okay. Got it. Okay. Let's keep it at second opinion. Second opinion. Okay. Makes sense. That's interesting framing. Second opinion. AI is good for second opinion. Okay. That makes sense. Otherwise, there's no second opinion. That's correct. So better than, right. Okay. So the comparison point is second opinion from AI or second opinion from no one. AI won't be able to do the dentistry. Right. Will never be able to do the dentistry. Okay. Got it. So now, I agree with you personally.

46:38I think others would as well. Well, maybe when you and I are both dead, that was, but for now it happens. On the patient side, so many of our customers, many of our customers, when we have a first conversation with them, one of the things we ask is, have you tried an AI receptionist? And some will say, no, I haven't tried it. Okay, great, fine. Many will say yes. I say, okay, well, why are you talking to us? Because we don't do AI reception. We do human reception enabled with AI for recall, cancellation, fault, et cetera, et cetera. And many of them will say, you know, we love the promise. We'd love the idea.

47:14But what we found is that the AI delivered work at a scale, scaled vertically effectively, could keep going. But the verification tax, because it wasn't suitably accurate 100 % of the time, 90 % of the time, whatever it was, created this sort of downstream. You know, you save minutes here, you pay them back over there. And I'm curious as to what your experience has been or your outlook has been in terms of how do you deal with what I think the industry would call verification tax. When you save five minutes here, you pay 20 minutes here. That's not necessarily good. How do you think about that?

47:54It's not getting or maybe it is getting there. I don't know. But how do you sort of calibrate around that? Well, it's still in its embryonic phase, I suppose, for me. Okay. Right. So you can limit what you want AI to do with these virtual assistants. You can say, look, I only want call answering. I only want booking. You can say, well, actually, I don't want you to actually grab, go outbound. Personally, if just cancellations on a day, I don't mind outbound. You know, I'd rather try and fill the diary space than not. certainly inbound over out of hours, weekends. So you can actually limit what you want AI to do in this sort of what you're talking about there.

48:41So I would certainly put limits as opposed to rely 100 % on, because we're still learning. And we're still going to say, well, what's good for our business? My mother's 84, and I said, Mum, would you mind talking to a robot? No, as long as I know that my appointment's going to be made. as long as I can hear them. Yes, so I don't mind. Right, right, right. So you can determine what you want your AI reception to do. And what's important for me is that we don't drop calls, you know. It's important for me that I'm not manually on the phone confirming appointments while someone else is actually trying to ring in and book an appointment.

49:23So I think that's the strongest part of AI for me at the moment. Got it. It's to make sure we're not losing calls. The sort of gaps in between. Okay, I understand. So it sounds like you're thinking about it not necessarily as replacement as much as it is augmentation. Facilitation, augmentation. Okay, interesting. I referenced him before, I'll name him again, but we were having this conversation with this gentleman, Lane, and one of the things that he flagged that we've also seen here with some of our clinics is that when AI proactively identifies itself as AI and says to a patient... They hang up.

49:55Hi, who's there? They hang up. They hang up. And you sort of intersect that with, you know, you said regulation, obviously, it's a different kind of regulation, but the BUAI Act is now coming into view and it's requiring that anything that's touching then consumer in AI capacity does identify itself. It'll be interesting to see, you know, what happens. How will that play out? To your point of infancy embryonic, very much this. Yeah, that's right. Look, for me, it's more of a help than a hindrance to AI at the moment. and as I said to you, if we're not using it, we're going backwards and, you know, I really, I just can't emphasize enough that I really want my front of house to actually be there for the patient when they're physically in the building.

50:39I don't want them on the phone saying, wait five minutes, sir. You know, I want them, I want the patient to feel special. I completely agree. I I used to run clinic and we had a very similar view that you get one hour of magic. Yeah. And that has to last 365 days or it has to be good enough that in 180 days or 365 days, that that moment is powerful enough that they're going to come back and do that again. That's correct. Yeah. Which I think makes a lot of sense. And I imagine also in Ireland, obviously not Irish, but the way you're describing the dental practices that you look for, your expectation is that those patients are coming back.

51:17Oh, yeah. Yeah. They are coming back. Interesting. If we look forward, the journey from 10 to 20, 20 to 30, 30 to 40, whatever it is, what do you think will be the next big change for you as you effectively grow 100 % in size? What is the next big change for you? Yeah. I mean, it's definitely systems and processes, which are always working and always striving for improvement. And as I said early on in this chat, I said, it's like having a kid, you know, I don't think there's any difference between 20 and 30, 30, 40. Okay. Yes, you'll have bigger teams. You have a bigger network of people to meet on a daily, weekly basis.

52:06But the challenge, I suppose, is making sure that my practices keep community focused, patient centric. that the patients come on first, that we never turn into commodity dentists. I would hate Total Dental Ireland to be considered as a commodity dental group, that it's really patient-focused and community-focused. Got it. So it's other things that don't change or focus on processes and system, focus on patient, community, et cetera. Yeah. Is there a...

52:40I don't want to use the word disruption, but is there a sort of expectation that, given what's changing in the supplier market, technology perspective, supplies perspective, etc., is there an expectation that there will be a sort of clear transition moment for the group where the next big thing happens? Yeah, and I suppose that's why you go to annual conference, You know, you go to conferences every month to see what the next big thing is coming on board. And that's why you chat with your dentists once a month to say, look, have you considered this? That's why we have a clinical director who's a sounding board.

53:23And, you know, we don't introduce things just because they're there. They have to be scientifically backed up. It has to be evidence-based to, you know, for us to implement anything or to even to recommend and say, you know, let's we think we should introduce this. So we're all ears. We're all eyes. you know maybe teeth will develop something that will help grow teeth you know we have to be on top of that we have to be there anything that's evident and scientifically backed up we have to be there and if it's advantageous to our patients we have to be there to be encourage our dentist to use it we encourage our dentist to upskill and develop and go to training so So, I mean, we're ready for it and certainly willing to change.

54:14But still, that e-cuff of patient-centric, people-focused, that'll always be there. That's the backbone of what you're doing is going to change. Yes. It sounds like, I mean, obviously your background, you were very sort of dentistry-adjacent for a very long time. So the transition into the sector may not have been shocking in the way that it would be for a newcomer. on a personal level i guess you've also been you know in in a ceo seat or equivalent before what's the the one thing you would have done differently in it looking back on the year two years whatever it might be what's the the wake up in the morning say oh if only i've done that that was a bit that way that was not heaven well look i think if you look back all the time yeah I'm not going to be able to move forward.

55:05Okay. I mean, I'm only two years into it, less than two years into it. I don't have many regrets. Do I regret buying any practice? No. Am I looking forward to the challenge? What's next? Absolutely. So at the moment, touch wood, I'm happy to say that I don't have any major regrets. you know and if i've made mistakes along the way certainly hasn't come back to bite me yet two years in two years got it okay that's it it's nice to hear because i think uh especially like the backward looking forward looking because i can imagine obsessing over the the thing that could have been a little bit different if i say if i'm bitten for a practice and let's say i oh god if i'd gone up another half a turn or something you know i could have got it but ultimately you You know, when I'm talking to a vendor, you know, we'll have a chat and we'll say, well, you know, why do you want to sell?

56:05Can you afford to retire? You know, if you want to, you know, if you want to go in three or four years, are you happy to work longer? You know, you know, sometimes I go, God, if I had said, you know, maybe I'll give you another bit of money, I would have got that practice and went some, you know. So those are the sort of regrets I have. But, you know, if it's, I suppose if it's, if it's not for me, you know, it's not for me um and the chemistry has to be right so so typically i would say i've you know if you don't get a practice say within first week there's a there's a lot of do and do you know bereave you practice bereavement uh but you gotta learn to move on there's plenty of fishing to see interesting do you think that that the group goes outside of ireland or is ireland core market, core focus, this is the near term?

56:57No, it'll be Ireland. It'll be Ireland. Today's Dental are in the UK, so that's their territory. But for me, it's social Dental Ireland. Right, okay. Yeah. Okay, got it. Interesting. A final question for me and affritching the time you've given us. I think that there are a lot of, in the UK, we have seen through our work, through the ecosystem, a huge growth in consolidation. We're seeing this, I think the industry is more mature. It's been consolidating, if not consolidated already. We're seeing this in medical aesthetics, dermatology. We're seeing this in MSK. I think people have growing conviction that private sector healthcare will be a natural complement already is to the NHS, even though the NHS has a big monkey in the room.

57:46There's still a lot of work to do here. I'm curious if you imagine the future, assuming that consolidation continues to pace or to keep a pace with the market, what do you think the shape of the patient experience will look like as competition rises, more practices come to the market? you're saying, you know, we don't want dentistry to be a commodity, or rather you don't want your group to become a commodity dental practice. But with the proliferation of supply, naturally you get good actors, bad actors, high quality, low quality thing, the bar goes up. For the customer of healthcare, for the patient of healthcare, what do you think that looks like for them?

58:28What is that experience going to be like for them? And how does that match with what you want or doesn't match with you want. So from my side of the thing, from Total Dental Ireland, we only make improvements to practices. So I think from a patient's perspective, it's only going to see an improvement in the quality and then they're going to be safer environments. It's going to be more modern. Certainly the appearance of the practices will look top notch. You know, I think the days of the squeaky stairs dental practitioner, I think they're over. I think single-handed dentists I think you know there's more consolidation in terms of their joining practices or merging with other practices I think you know so I think the larger scale practices are going to be where you can get everything in house so I think it's going to be a better environment it's going to be better for the patient because instead of going from one dentist in you know one area to having to go to a specialist in another area if everything can be done under one roof I think it's only an improvement for the patient So I see it as an advantage for the patient and I see it particularly it's an opportunity for the consolidators to be able to offer this.

59:39Sort of full service. Yeah, absolutely. Yeah. Interesting. Stephen, thank you so much for those listening. This is Total Mental Ireland, 10 now, soon to be 20, probably soon to be 30. We really appreciate the time. Thank you so much for coming. Total pleasure. Thank you very much. Absolutely.