Podcast/Blog Posts

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Partnership Blues?
Pushing Reset.So, you chose to enter a partnership with a group and things are not going as planned.  This is an increasingly common water cooler discussion.  What can you do?  The answer of course is, “...it depends”.  It depends on what the actual issues are - i.e. philosophical differences,...  Read More
Smoke & Mirrors?
“Equity” is one of the most frequently discussed and least understood topics in the healthcare growth arena.   Have you heard the question, “What’s your equity story?”  When it comes to the answer, the old adage - “Everything before but and after because, is bullshit.” - most definitely applies....  Read More
Feeling The Squeeze?
A confluence of events finds doctors facing unprecedented financial pressures.  It really doesn’t matter if you are in private practice or part of a larger group.   The dental industry has experienced a permanent erosion of profit margins over the last decade or more.  Top line pressures from...  Read More
"Cool Story Bro."
So, you’ve received multiple offers from group buyers.   The Total Enterprise Values look positive and maybe even within a reasonable range.  One or two may even stand out as runaway winners on the first pass through. Then, the fine print. The component parts - cash at close, hold-backs, seller...  Read More
Dr. Benjamin Wachter : Dentistry Uncensored w/ Howard Farran #1710
In this episode, Howard Farran reconnects with longtime friend Dr. Ben Wachter, a Mesa, Arizona native and 2017 graduate of A.T. Still University whose career has been shaped by service, perseverance, and a passion for caring for the underserved. Ben opens up about the mentor who changed his life...  Read More
Puckered Up?
“When life gives you lemons, make lemonade.” - Elbert Hubbard, 1908 So, you elected to transition your dental practice(s) into a group (DSO, DPO, DMO, DXO).  The total enterprise value and rollover equity story were just too darn compelling to resist!  Besides, many of your colleagues and...  Read More
Dr. Jay Reznick : Dentistry Uncensored w/ Howard Farran #1705
In this episode, Howard Farran sits down with Dr. Jay Reznick, a Diplomate of the American Board of Oral and Maxillofacial Surgery and one of North America's earliest adopters of fully-guided, prosthetically-based implant surgery. Trained at Tufts, USC, and L.A. County-USC Medical Center, Dr....  Read More
Financial Distress, Insolvency & Bankruptcy
So, you decided to pursue an affiliation with a group and things are not going as planned?  Worse yet, it appears that the larger business is now struggling with leverage issues you were told “not to worry about” as you were going through your process.  Maybe it was even discussed when you were...  Read More
Built vs. Bought
You can function just fine without getting involved with a group (“DXO”) or private equity! If you are not interested in pursuing an affiliation with a group practice - read no further - this note is not designed for you.   If you are open to pursuing options with group practices there is one...  Read More
Sausage Making 101
Valuation Metrics to Consider Multiples Revenue or Collections  - As reported for tax purposes, does not capture any barter or “off the books” income - Doctor-to-Doctor transactions have historically been in the range of 80-100% of revenue - Group transactions typically exceed this range...  Read More
Second BiteTheory
Probably the most overhyped/oversold reason to join a group dental practice is the "second bite" or “equity story”.   Having done this for too long, I’ve been able to witness the evolution of deal structures and terms.  Trendy new acronyms to describe the same thing - the tortured mental...  Read More
Group Premiums - Reality or Yeti?
Group Premiums   A common topic of discussion revolves around how much more groups are willing to pay for a given practice versus an independent dentist - a/k/a the "Group Premium".   Group Premiums have nothing to do with fundamental value.   Group Premiums represent the incremental equity risk...  Read More
The Most Common Digital Red Flags in Dental Lawsuits
In litigation, these tiny anomalies can snowball into major credibility problems. THIRD IN A SERIES—PART 3 OF 5 Digital red flags often do not appear as the proverbial “smoking gun.” Red flags are usually found as small inconsistencies, such as a timestamp that doesn’t line up, a missing image, a...  Read More
Multiply What Exactly?
Most folks want to rush to The Great Multiple Discussion.  What factors should I apply to which income statement items to figure out the value of my practice?   Far fewer people spend time discussing what they’re actually multiplying - i.e. revenue, SDE, EBITDA, free cash flow, etc. Moreover,...  Read More
The Sucker’s Bet - Key Person Risk
What is Key Person Risk? Key Person Risk is the threat to a business’ stability, operations and financial performance arising from its over-reliance on a single individual or small group, such as a founder CEO or a key sales person.  If the key person leaves, becomes incapacitated, or dies, the...  Read More
Is Group Practice Equity Already The Next Tulip Bulb Craze?
Is Group Practice Equity Already The Next Tulip Bulb Craze? WTF was the Tulip Bulb Craze? The tulip bulb craze, historically known as Tulip Mania (or Tulipomania), was a period of intense financial speculation in the Netherlands during the Dutch Golden Age. Often cited as the first recorded...  Read More
What's Your Multiple Kenneth?
What’s Your Multiple Kenneth? Let’s give organized dentistry some credit, we’ve done a bang up job on educating the market about a variety of things when it comes to scaling businesses. One unfortunate byproduct is the ubiquitous watercooler discussion of, “What multiple do you pay?”   ...  Read More
Personal Guarantees In Affiliations
Personal Guarantees & Affiliations An increasingly common conversation topic is Personal Guarantees ("PGs") - specifically joint and several - in the context of group practice affiliations.   Yes, PGs from the new - now minority - shareholders. The bidder is likely to suggest that their...  Read More
Modeling School
Modeling School Ah, group dentistry.  As new groups spring up, existing groups nose dive.  The circle of life. You may hear the question, “Which model is right for you?”  TopCo, JV, Parent, Hybrid, SubDSO, DPO, LOL, DMO, AKA, WTF.  So many folks go to such great lengths to relabel themselves....  Read More
Deal Structuring:  Just what is “market” these days?
Ok, we’ve covered a lot in recent weeks - debt, equity, TopCo/JV, partnership considerations, etc.   So what about deal structuring?   Deal structuring lays out the components of a deal and how the parties intend to fund or finance them.  The most bandied about term is “cash-at-close” (“CAC”)  -...  Read More
New Partner Considerations
New Partner Considerations The purpose of this article is to provide an overview of the puts and takes of bringing a new partner into your practice or group. Valuation Considerations There has been a marked increase in independent dentists using groups for “stalking horse” valuations to boost...  Read More
A Valuation Without Context Is Worthless
When it comes to business valuation, everyone loves to rush to “the multiple” discussion - i.e. what multiple of revenue or unlevered free cash flow (EBITDA) is used to arrive at the Total Enterprise Value (“TEV”). While this approach can be directionally accurate and helpful for “swagging”...  Read More
“What’s Your Equity Story?”
The contemporary forms of group practices (DSO, DPO, DMO, ABC, DGO, LOL) are approaching their sixth decade of operations.  As the labels and models proliferate, an increasingly common conversation is: “So, what’s your equity story?” Fantastic question. I encourage anyone curious about...  Read More
How Electronic Dental Records Become Legal Evidence
A Forensic Breakdown SECOND IN A SERIES – PART 2 OF 5 Electronic dental records have surpassed the paper chart as primary medium for patient documentation. Back in the day, when a paper note was contested in court, handwriting experts and ink analysts were called in to assess whether the chart...  Read More
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