Episode 105 – Another Secret to Practice Growth with Dr. Dwight Peccora

“I think the most important thing is to passionately know your community and know there is a purpose to serve,” says special guest Dr. Dwight Peccora. Tune in for the second part of our conversation with Dr. Peccora where we dive into the balance of caring for the heart of your business in order to strategically control your growth by:

• Rallying a team to your culture
• Leveraging your community (and why it’s key to your growth)
• Creating visible processes and systems to reduce risks and increase efficiency

Bonus: Listen carefully for a unique tip to have front office staff hyper-focus on patients and delivering exceptional patient experiences.

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About Dr. Dwight Peccora

Dwight Peccora graduate from UT School of Dentistry in 2010 and partnered at the existing Fort Bend Dental in Missouri City, Texas (south west side of Houston, Texas). Dwight had a dream of developing a group practice that prioritized quality comprehensive care with all general and specialty care under one roof.

Over the Last 6 years, Dwight has developed one mega practice in Missouri City of 10,000 squarefeet (which includes a CE facility), with three other locations throughout the Houston, Texas area to bring about access to this level of care for the Greater Houston area.

His greatest joy of practicing this way is the chance to collaborate among a team of doctors to find new and progressive ways to serve his patients. He has taken the original Fort Bend Dental from $1.7 million to just surpassing $9 million among all locations as they onboard their 4th location this winter in the “hub and spoke model” of practices.

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EPISODE TRANSCRIPT

01:02
CHAD: Hey, everyone, Dr. Chad Johnson here. Thank you for joining us today as we continue our conversation with Dr. Dwight Peccora. And for the listeners, they just got done listening to the last episode. And here we are, and the next week talking about-

01:16
REGAN: Community. So we in Episode One, just heard Dwight talk about mastering multiple locations, empowering the team, delegating leaders within the team, keeping a minority shareholder, it came out really fast way and it’s a huge testament to success. Knowing where I sit, I’m like that is not easy to achieve. And especially having been in charge of our team, which is about the same size, I think you have how many team members 40 or so 40 to 45. Now 45. And to hold the culture hands down to you I bow down that is not easy to do. And you have multiple locations on top of it. So I’m really genuinely curious, Dwight, how do you involve your community? What unique things do you do to kind of share the love with your especially as you’re going into new communities? And how do you pull your team along with that? How do you get them on board?

02:16

DWIGHT: Yeah, I think one of the biggest things for us is we, we were blessed that we’re a strong brand in our community. That’s that’s a relatively beautiful thing that comes from feeding back and forth off of the community and what we’ve done for them all at the same time, I like to say that we may have a lot of options that come up to us, we have got doctors that may be struggling, especially after COVID. Hey, are you interested in buying this practice going back and forth.

And the vast majority of the time that the answer is no, because we have to see the alignment. And we like to say we are going to take on a practice that we cannot not take on meaning it is so evident. So obvious. Sure, we have some background calculations on where market geo fencing we should be to serve our community where there’s an area. And when we say underserved, it’s hard for me to say that in a world where there truly are truly underserved areas. For us, it’s a matter of areas that do not have access to comprehensive care.

 First off for the community, not just the fact that Oh, they’ve got all these specialists spread all over and they’re driving in and out. But more importantly, just having a dentist that they know that they can have access to that where the dentist and the team lives in the community that they live. And that that they’re a part of that and also building a space where we know that our team does live, we believe that we’ve been recruiting and developing, we tend to have a little percentage of access people on the team, because we prep ourselves for that next step.

 But the way we do take on other locations is is our leadership team, our hygiene, our admin from the front desk clinical, every portion of the of the practice goes to that office if we’re acquiring an office and they will swap out. So I’ll go and practice there. And I’ll see patients there and I’ll get to know it. And the hygienists will swap with that hygienist and that hygienist from that existing practice will come practice here at our headquarters location get to feed off of our culture.

And we’ll look at what’s going on and how they do what they need to do. We do the same thing with the front desk we do we do top to bottom, our even our lab team. So our Director of our lab, they’re on the leadership team, she’ll go out she’s a ceramist, right? She loves getting to go out there and she goes and she looks at the work and she sees what’s going on. We get a very in depth view of what’s going on what are going to need more resources to develop that practice and what areas we could be a blessing for. Right if that doctor is saying or if that doctor is not saying we’re just taking on a whole new office.

 I think that it’s about investing the time and knowing that these are not easy decisions, especially when you put so much onus on the team. If I just up and say hey, I want another location I’d throw it in. If they’re the ones on the team are the ones who make the decision whether we take on the practice or not, because they clearly see the vision of where we’re headed. And so we are, we’re very involved with the Chamber of Commerce, we’re very involved with all local groups. It’s not abnormal for us to be sitting at on the development boards or being involved in different things that allow us to see that.

 But I think the most important thing is to just passionately know your community and know that there’s some there’s a purpose to serve, right? At the same time, every portion has to win, you can’t run a business off of nothing. So you want to build a business model that says, hey, you know, what we can be there, we can be fruitful. And we can provide care at a level that they’re not currently receiving and not available to them, we also tend to kind of figure out what areas have zip codes that are really far away from some of our main locations. That’s actually why we built the return location, we had a huge number of patients driving an hour to an hour and a half from a certain portion of the county coming out to us. So we placed the Richmond location between us and them to make sure that they had better access to it and then push resources that way.

 So it’s the way many business in other industries grow and develop, we have this kind of like, I we need to eat practices just because they’re there. And regardless of what made it happen, it takes time it takes effort, you should actually focus on why you’re going to be successful. They’re not just because you’re going to push marketing and just force it in. But because you believe that you got a doctor there who believes in the community as a part of it, you know, that whole process.

 None of this, again, is easy, but it takes time. And we’re willing to say if that means we grow at a slower rate. And we’re not trying to jump to 20 practices or anything like that. We don’t work that way. We can at least keep an eye on the comprehensive and quality care and kind of build that culture right around the community. So that’s, that’s the hope. And that’s, that’s so far, it’s gone well, with things that have been hard,

 

06:50

CHAD: I don’t look at your practice thinking yeah, they just need to work on not growing at such a slow rate.

 06:59

DWIGHT: We did the truth is, is sometimes we have gotten to the point where I’ve like I’ve been comfortable with some of those rates of growth. We when we moved into this other location, we moved, and we were getting like 50 new patients. And now we’re getting like 180 new patients a month in this practice. And so just a lateral move to be more readily visible, readily available. Those are the things that you realize other industries do all the time, they say why would I put on the corner? Why would I be on the on, you know, right next to the Main Street? Why would you do all those things? The truth is, is other businesses know what they’re doing. If you want to make yourself readily visible to the community, do it, build a nice building, build nice access to the community you serve? So we’ve enjoyed that. 

07:45

CHAD: Yeah, Dwight, you’ll, it’s a side note, but like I had bought a four acre property on the corner of where growth was happening. And we got into it. I was on the school board. And it got into an issue with the City Council. They actually went to court against each other and it went all the way to the state Supreme Court.

08:06

REGAN: Oh, not heard this story. This? Yeah, see? 

08:09

CHAD: Oh, yeah. And, yeah, you pay me enough, I’ll name names, but uh, so the problem then came about, I was going to put my office on the corner up here. And they decided, and I don’t know if this is me being paranoid, or if this was just going to happen, but they put a median in the middle of the street to block incoming traffic into that property. And I swear, it’s because of where I landed on, you know, the political lines of it, I ended up just selling the property just because it wasn’t accessible so far as the way that when I first bought it, versus what it could have been versus what it turned out to be. And so I just, I totally dumped it, which is really too bad because I still like that corner. But if people weren’t able to access it, it, it just yeah, so it’s just too bad.

08:59

DWIGHT: Things matter. And that’s, that’s hard, too, because that is a that is our world. I mean, it is so counter polarized all over right now. And it’s, you don’t have as much control as you thought you might have as an entrepreneur. But that’s why sometimes you just gotta hold back and just kind of be like, oh, we’re gonna take things a little slower and be be confident in our steps, even though we know it’s going to be three steps forward and to back sometimes.

09:23

CHAD: Right, right. Hey, another tangent. Then. Have you ever looked at outsourcing to Cordova? 

09:31

DWIGHT: So, um, there is some discussion about creating some support fact. So we’ve run out of some room. We’ve been in this in our headquarter location now for five months, six months, and we really increase the size but we’re already maxed out. We’ve been very blessed to have a lot of access to a lot of growth as of recent, even with COVID. And so one of the things that we wanted was to have full call centers and full supports for insurance carriers. occasion, things like that. So we have looked into some of those outsources even out of South America because there’s, there’s incredible groups of people that are just amazingly educated. They just want access to supportive enterprises options. And so they’ve, we’ve been reaching out as of recent to go down that direction and hopes that we can find some more support for ourselves as well. 

10:21

CHAD: Well, I think about my, my buddy that I’ve known since preschool that we work out together and stuff like that his sister is down in Lima, Peru, and he said, the average annual income there I think, was, I don’t remember it was something ridiculously low, you know, and, and then, of course, you know, the purchases, there aren’t all that expensive, either. But it was whatever he told me, I was just shocked. And he was just like, and I’ve got two of my sister’s friends down there that are looking for jobs, you know, in the, the field that he’s in, and, and, and that they can do it remotely.

 And he’s just like, man, how can I not, you know, and that’s what’s tough about American industry where you, like, you’d be in a text, and you hear this all the time where it’s like, you know, let’s keep American jobs and stuff like, and that’s great. I mean, I totally believe in that. But then there’s, you know, the nice side of globalism, to and, and the, just like JM Oliver, you know, looking at helping with, you know, Africa and stuff like that giving them legitimate jobs and not, not in the goal of stealing it away from Americans per se. But in in giving us the opportunity to have a have the personal relationship side dealt with in person that we can, you know, maximize what we can do best. And that they can take care of some of the stuff that you can do on telephone, so that way they can feed their family.

 11:45

DWIGHT: I think that’s very empowering. So all our locations outside of our headquarter location, are hyper focused on having patient facing team members only on purpose because all that other stuff. So even when you walk to the front desk here, there’s no phones at the front desk there. They’re hyper focus on only communicating to the people that are there.

 I think it’s critically important that if possible, and that’s one of the reasons we scale is that you they’re hyper focused on the people that are there that what’s going on, so somebody comes up, it’s not wait one second, I’m on the phone type scenario. It’s, hey, I’m here for you, what do you need, and then it allows the cycle to go long, and I agree with you that outsource option truly is is that not only are there people, the rest of the world that want to get incredible jobs and support American enterprises and companies.

 There are also incredible Americans who want to get to focus on growing their own personal professional lives. And sometimes they get stuck on a call center or get stuck doing this, and that they don’t get any of this patient interaction, they don’t get any of this development. And we tend to have, you know, a pipeline, you can come in as a sterile tech, and then and then support in the lab and then continue to do a hygiene support. And then slowly, but surely, you can become an assistant, how many of them have then gone to be a hygienist do all these other things. Some of them started front, and they’re answering phones, you know, in the call center and doing things but they have a growth opportunity.

 And I think that’s critically important for people to understand that. Usually outsource just creates opportunities for others. Many times, it’s jobs that other people we don’t always necessarily want to have. But it takes time to learn and grow. And if you didn’t get the opportunity to be raised in a household where there was readily available education and things like that, or get all the money be able to do, by the way, super expensive education. And you can be part of the reason why we’ve got a lot of people who aren’t able to do that education. So they need pipelines within small business, to be able to access other jobs. And sometimes we have them stuck answering 350 calls a day, you know, in our call center the way we manage it, guess what, there’s no training, development, no discussion, just get there, pick up the phone and do it. removing some of those tactical things gives them the chance to think more strategically about their professional and personal lives

 One of the ways that you and I can place dental implants even is because we have hygienists and we don’t have to clean people’s teeth. So that there’s Case in point where it’s just like we’ve in sourced or you know, whatever we’ve sourced the idea that I don’t need to do everything to be the dentist, I can hire a hygienist and then in some states like Iowa, not in Texas, I’m not rubbing it in, but you know, the, the hygienists can use laser or that they can anesthetize and stuff like that.

 And so and so this whole debate to dentists are saying man Do we want do we want an expanded function assistant to be able to do you know, level one and level two and level three, whatever, you know, all the stuff that or do we want to mid level provider of hygiene, dentists kind of stuff, and at first, the turf war side goes, I don’t like that and it’s like, Yeah, but guys, if you can like We’ve already done that plenty. And I don’t think it’s necessarily a problem to, you know, evaluate it and say we don’t have to do it the way we did 100 years ago. Why are you scraping teeth?

 Yeah, no, I totally I absolutely agree. And unfortunately, and I think you and I are very similar in this sense. And I will state it, as I stated, if you’ve got good if you build a team that you’re willing to support and care for, and you believe that they, regardless where they go in life, they should leave you better than they came, then you would never be on that other side of just holding back. Right? And meaning those are usually doctors I’ll call out our industry, or our just our whole profession very easily is the fact because I’m very outspoken about this is that usually it’s when we don’t want to grow anymore. We keep others from growing.

 And so if we allow others to grow, it gives us the opportunity to grow ourselves. And a little bit of time that I’m not doing a cleaning or doing anesthetizing hygiene or whatever it is, gives me a chance to take care of patients who need it. And unfortunately, there are a lot of practices Hey, you know, I can’t get in I can’t get in. There’s this problem that a lot of its bottlenecking based on pride or, hey, I’m done learning I can make a good living this way. Really, the truth is, is there are others who can also make a good living based on being a part of your team just allow access to care in that model, and we won’t have government involvement in all types of things and access to care problems if we allow our teams to grow and provide access and provide care for those who need it.

 16:30

REGAN: I mean, I’m really blessed I we get to talk to dentists that are really passionate about learning. They’re passionate about constantly growing, you did say something Dwight, that stood out to me in the previous episode, and you talked about, you said everyone on the team needs a coach individually. And I have I’ve heard that in different sentiments, but not as a directly. And I know what PDA we always believe a healthy business leads to healthy team, which leads to healthy patients with which ultimately is, you know, a healthy community. So when I hear you talking about all the different kind of octopus tentacles that you have in the business in the community in the multiple locations, I mean, I picture you working like 100 hours a week, at least. So how do you take care of your health? I have two kings of efficiency, I can tell without telling you that I have to two men with very efficient mindsets. How do you do it?

 17:30

DWIGHT: So my core I’m a systems and processes type of guy, I passionately believe so I if if you have anybody else out here who knows me at all, they’re like, Oh, yeah, that’s the Google Drive guy who like has live Google charts on absolutely everything. I haven’t system and, and different. Honestly, this comes from a lot of other industries outside of dentistry, right. And a lot of people be, you know, they’re just skirting by and trying to do the best they can.

 But I do believe in or organizing systems and processes and holding lateral pressure. And so what I mean by lateral pressure are things that, you know, if you learn from guys like Alex Scharffen, when we’ve talked about another group, they, the biggest thing is to create an environment where there’s a very visible process to how we do what we do every day to grow and scale each department each person and go from there.

 And so we we build, we have what’s tends to be called a waterfall of our annual plan, it goes down to quarterly as it goes down and monthly. And it goes down to a sense of weeklies and we create this weekly commitment process where I have, I used to have like 20 meetings a week, like every dentist who thinks they need to have one with every department and every new thing that comes up and every piece of drama. And when we built a leadership team, like the one I’ve discussed in the past with liaisons for each individual department in each location, we will all get on one call on Monday morning, to start our day from eight to nine. And everybody’s in different locations on the zoom call.

 It’s not a ton of people, it’s just those communicators, those liaisons to their own departments. And they each have commitments from the previous week of things that are going on. And we check them off.

 And at the very top, it has a percentage that calculates how much they’ve been able to get done in the last week and they talk about the things that they have left to do. And if there’s still left to do, we move them on to this current week. And we work on this and we have seen that somebody struggling meeting under 80% of their commitments are tackled, whether it’s a high dentist who’s establishing new contact for toothbrushes or different things like that. It really comes down to that all being documented. And moving right along.

 Ironically, I document this so strategically and in and focus that we had a banker come in and they were asking we’re looking at some investments For a new building things that agree and they said, Well, we saw that you grew one office 33% last year, and then the big office grew at 22%. We want to understand why. And I just, I grabbed that document on Google. And I sent it to them for the whole last two years, you know, and they’re going through week. And I was like, and they’re like, What is this, I was like, that’s everything we did every single week for every person who’s a leader in the company, and what they got done, and they attach everything, you know, what got completed, was like, every single week for the last year, like, they’re like, Okay, I think we can partner up and invest. Because it’s obvious.

 If you’ve got a process in the system, you can clearly see when your team is going to start struggling, they show early signs of not being able to complete tasks, being able to get things done, or when they’re struggling with their team, all of a sudden, their tasks go away, and they’re hyper focused on I’ve got to spend some time with my team, I’m struggling, we’re struggling, we’re not communicating well, or there’s a patient problem that keeps coming up recurringly. And there’s something that’s falling through the cracks. They’re communicating, they’re building it.

 So I went from having all those meetings to having one hour a week, focusing on that I do a partnership meeting once a month, to keep my partners abreast of kind of what’s going on in different things to that degree. But other than that, it’s actually not terribly complicated when you allow your team to lead.

 21:15

CHAD: So what operating system do you use? I mean, it sounds like it’s modified. But I mean, are you EOS or like 40 x like, or have you been? Like, do you even know what that is like? And you’ve just made your own? I mean, like how does.

 21:30

DWIGHT: So I’ve, I’ve just taken Google documents, regular Google documents on Google Drive, and I’ve taken it to the enth degree, and I’ve customized it, all the KPIs are structured there, because it’s a live document, and my whole team has access to it. And we just manage it that way.

 The truth is, is if it’s good, good enough for Google to run their operations, it is good enough for my dental practice. And if I sat here and showed you all this stuff, you’d probably be like, how did you do all this science? The truth is, I don’t I built the templates, I put in all the formulas, you categorize everything in a way that allows people to kind of be prepared. And if they just put a yes, I did this in the box, and they attach their attachment of the completed document, it shows, Hey, I got that done. And you just kind of move right along.

 It is the method by which I think Alec Scharffen would call that a cadence, right? The beginning, the next, this is our cadence, we stay routine. And obviously COVID through it all off. But we came right back when continued, we did what we needed to do. And so I think I think that’s the beauty of it is there was a process to that, that matter of how we did things. And systems and processes keep you going. They really, really do.

 22:37

CHAD: You’re gonna get emails requesting access to that, you know that right?

 22:42

DWIGHT: Absolutely happy to help out in any possible way. I do think that that’s, that’s why I’ve gotten to where I’ve gotten is people have shared their knowledge and never made me reinvent the wheel. And so I’m happy to share whatever we’ve done.

 22:54

REGAN: This has been my favorite, I say that almost every episode has been my favorite.

 23:00

CHAD: You’ve shared so much with us, Dwight, thank you. 

23:04

DWIGHT: That I will tell you this year has taught us a lot. And I’m I’m more thankful than ever, to maybe this is a good timing for the talk. Because we we’ve all been able to reflect a lot on our boundaries and our quality of life and how we’ve gotten to slow down. And I think that’s great for our society is to slow down a little bit, especially as entrepreneurs, we can’t turn it off. Right, it’s really, really difficult.

And that that’s, that’s one of the hardest things. And I think the pandemic actually helped us a lot in that sense. As hard as it was for the whole world. We have to focus on some of that positivity. And I think that being able to turn it off just a little bit or at least slow down a little. I think it we’re going to get a better result, you may not get the quality quantity that society wanted before the number of practices and the number of all the craziness that happened, but we’ll get better quality out of all of it. So yeah, thanks.