Episode 35 – Inside an Investment Grade Practice with Dr. Nathan Kupperman

“I’m always looking for cutting-edge material. I want to be constantly reinspired and re-engaged.” ~Dr. Nathan Kupperman

If dentists were cars, Dr. Nate Kupperman would be a Ferrari. 

I talk to a lot of doctors.  While most of them have their own inspiring stories to share, I knew from the first time I met him that Dr. Kupperman was something special. Just a few moments into our first conversation I thought to myself “Oh my gosh, this is an amazing young doctor who is building an Investment Grade Practice with intent, thoughtfulness, and savvy business decisions. Other dentists need to hear this!”

What impressed me so much about Dr. Kupperman is how mature and insightful he is with his business thought process: he has an investors’ mindset and is in the business of dentistry for all the right reasons.

Today, Dr. Kupperman joins me to give you an inspirational glimpse into the thought processes and mentality he employs as he builds his own Investment Grade Practice, including how to:

• Train your mind to see opportunities
• Mind your culture and motivate the investor mindset in your team
• Grow responsibly 

Want to know if you have an Investment Grade Practice? Click here to use the completely free Investment Grade Practice calculator: What’s my IgP Freedom Number?

Want to have a conversation about your Investment Grade PracticeTM? Contact Brent at brent@productivedentist.com.
Never miss an episode! Subscribe to Investment Grade PracticesTM Podcast on iTunes & Spotify.

EPISODE TRANSCRIPT

Victoria Peterson
Today I am so delighted to be with the founder of the NAC Dental Group Dr. Nathan Kupperman from Tallahassee, Florida. Nathan, I’m gonna put you on the spot here and tell everyone that if the dentist could be a car, you know like there’s some that are Subarus, others that are Suburbans. You are the Ferrari of young dentists, and I’m so excited to have you here today.

Dr. Nathan Kupperman
Oh, thank you for the flattering words. Dr. Peterson, I appreciate that.

Victoria Peterson
Oh, you better call me Victoria.

Dr. Nathan Kupperman
Yes, ma’am. Yes, ma’am.

Victoria Peterson
So tell us about NAC Dental Group. What is this?

Dr. Nathan Kupperman
No, I tell my group so it is a private organization that I started myself about four years ago so we’re five locations, I guess private DSO located in the northwest of Florida. We currently have nine providers working with our organization so I’m really excited about the growth that we’ve seen over the timespan of our development.

Victoria Peterson
Wow, that’s amazing. Now you graduated, am I getting this right in 2015? From Nova? You got it. You got it, Victoria. Alright so that’s seven years so you worked a little bit as an associate and then you formed your own group, is that right?

Dr. Nathan Kupperman
I was an associate for a few years. I contacted about a dozen offices thereafter and then, during that contracting period of time, I came across like three offices where it was a big opportunity, and the doctor was retiring so I was able to acquire three, and then I had a fourth and then I merged another office during COVID and I bought a fifth during COVID so that’s kind of how things moved along.

Victoria Peterson
Me I love that strategy and love.

Dr. Nathan Kupperman
A little bit of strategy, a little bit of luck but I mean, I think I think once you can, after working at so many offices, I think it allowed me to be able to recognize the opportunity that was in front of me. I feel like if I had just worked at one office or something I don’t know if I would have necessarily jumped on I think I would have been a little bit more scared but you know, when you see a home run, you see a home run

Victoria Peterson
well, and you’ve trained your mind to see it and that’s one of the things I want to talk to you about today. We met you at the productivity workshop in Dallas, was it in September or February this year? And I’m so impressed with you not only for your clinical skills and your clinical ethics the way you treat people all that is so top shelf but you have an investor’s mindset you’re like a young Bruce Baird if we could put Bruce back in a time.

He’d be Nathan Copperman so is it something you developed? Is it something you’re born with? How is it that like you said, could just see the home runs you could see the value you can see when it’s a smart opportunity? How do you do that?

Dr. Nathan Kupperman
Yeah, so first of all, I just want to say hats off the PDA. That workshop was incredible. You know, you burst did a great job but I’m coming back to the investor’s mindset. That’s definitely something that was not just you know, inherited. That was something that was built over time because oddly enough, you know when I was contracting it all these different offices.

I was commuting a great deal and I think you’ll probably, you know, see that this is like a common subject but I feel like when you’re commuting, and you have all this time, you know, you start listening to podcasts and listening to audiobooks so I probably, you know, listened to maybe like 50, something audiobooks on just business on taxes on forming corporations on like loopholes of real estate,

on just a lot of otherworldly economic books, and then a lot of like, psychology leadership so it just, like, the list goes on and on and then obviously, you know, there are just podcasts like this, you know, I’m just constantly tuning in and looking out for new podcasts that are coming out looking for like the cutting edge, cutting edge material that’s out there.

Victoria Peterson
It sounds like you’re a Constant Learner,

Dr. Nathan Kupperman
constant constant. I mean, I feel like I get bored, I feel like I’m constantly I want to be like reinspired, reinvigorated, re-engaged constantly, weekly, at least, you know,

Victoria Peterson
I love that. I love that and you said that you have five locations and nine doctors so how do you identify or nurture or motivate that same type of learner mindset with your associates?

Dr. Nathan Kupperman

I think that really has to do with the onboarding process. I think that’s a critical part. I think before anybody even steps foot in your office, I think that there has to be a cultural alignment, that’s there. I think that’s really, really critical so I think, when I’m interviewing associates, you know, I’m thinking about potentially hiring them, I’m definitely vetting them, and seeing if they’re going to culturally be a good fit, you know, obviously, if they’re going to be ethical, just to see if they’re going to fit in with, with the other doctors.

It’s kind of funny, too, because a lot of times when I bring a doctor up, it’s like, we kind of throw him in the lion’s den, it’ll be five of us that’ll, you know, go out and, you know, grab some chicken wings and beers, and we’ll just sit down and talk and we’ll just see, you know, it’s like, is this guy philosophically there? Clinically, you know, Is he a good person is the outgoing so I think that’s a that’s been a really good thing that’s worked out for us.

Victoria Peterson
I love that. I worked for a dentist in Atlanta early in my career as a hygienist and she let the team be in charge of hiring new team members and always gave us her credit card gave us a two-hour lunch break when we had our final candidates and she required that we go to a restaurant, here are the requirements, you must be seated, and they must have cloth napkins so these weren’t nice restaurants that we went to, to see how did the person interact with us?

How comfortable were they in a higher service environment? Because this was a real high-end cosmetic practice? And more importantly, how did they treat the waitstaff and that would oftentimes, they’ll be great on paper, they had all the skills in this one gal. Remember? She was like, Oh, my napkins dirty. I need a new one. Send them away. Oh, I need to catch up. Oh, the salt and we’re like, why didn’t you ask for all these things at once and she goes, You know what I was I wait on people all day long and when I’m out in a restaurant like this, I want somebody to wait on me hands. They’re gonna you’re gonna earn their tip and we’re like, Hey, thanks for the heads up, baby. Next.

Dr. Nathan Kupperman 8:18
That is great, that is a great way to weed some people out that’s for sure.

Victoria Peterson
Right? So I love that you make it a three-dimensional process. It’s not just a one-on-one interview or an office interview. I’m gonna name that part of the episode chicken wings and beer. How to tell if you’ve got the right associate? That’s awesome. Do you also have an ebook?

Dr. Nathan Kupperman
Ebook? Yes. Yes, yes. It’s the titles. I know that I know nothing but it’s, it’s good it’s a good kind of a starter book. I think for the for like a new grad just graduating or students still in dental school so I kind of I share that ebook with people I’m going to potentially hire and then go first, the first sign is like if they read it, right and the second sign is like, just I get the feedback from them and I see and they’re kind of like in alignment, because I have a lot of psychology and leadership, things that I kind of cover in that book and I just want to see, you know what they think I want their feedback and I want them to kind of know who I am before they even meet me.

Victoria Peterson
So yeah and why the title? What is inside this book? I know, I know nothing.

Dr. Nathan Kupperman
It’s just a philosophical, quote. Aristotle, and it just lets you know that you know, like, when you graduate, it’s like, you don’t know. You don’t know what you don’t know, essentially and it’s just a way of like disarming the new grads so they come into the office and they’re humble and they’re open-minded and they’re ready to learn because I think if they, if they come in with that mindset,

it’s going to make it so much easier for the mentoring Doc’s to elevate them so quickly because it’s like new grads that come in they want to use this instrument, that instrument and they want to do things their way and then they’re not as quite as productive but then if they come in with an open mind, it’s amazing how rapidly we can elevate them and get them just like fired up and really doing great dentistry quickly.

Victoria Peterson
Yeah, do you mind sharing how long it takes you to get an associate up to speed, and in terms of productivity, what does up to speed look like in your group?

Dr. Nathan Kupperman
So, it kind of varies. I mean, there’s just there are some clinicians that are clinically both gifted, you know, I’ve seen clinicians skyrocket within the first three to four months and I’ve seen other clinicians that have kind of, they’ve lagged in the eight to nine month period so I would, I would think, too, like, you would want your doctors producing around at least, at least the bare minimum 60 a month, but uh, you know, you’d like to see him at that 80 to 100 month, a month of production wise so I feel like that’s kind of the development.

Another thing too is like, their, their speed on procedures so, you know, obviously, new grads are going to take them three hours to do a molar Endo and then as they can progress, I mean, you can do a molar endo in 45 minutes to an hour so those are kind of, like clinical determinants, I think, yeah.

Victoria Peterson
And how many hours are they working,

Dr. Nathan Kupperman
um, I really tried to help my doctors only work a maximum of four days a week and, and I have, I have part-time jobs too, that work, you know, two to three days a week and it’s funny too because I feel like the part-time Doc’s are the ones that have been with the organization for like, eight years, because they kind of has like that flexibility but I feel like four days a week is, is maximum, because I just, I just don’t want to burn my dogs out. I want them to have like that, that, that work-life balance, I think that’s really, really critical.

Victoria Peterson
That’s so key. I mean, every time you speak everything you bring up, it’s just a nugget of culture. Right? It’s

Dr. Nathan Kupperman
all about culture, all about culture. I’m not, I’m not trying to, you know, I’m not trying to, you know, create slavery and like, be whipping people to work. That’s just not, that’s not my style. I just want everyone I want I want people to come and show up to work and be excited to be there and be refreshed, like every week they come in so Well, I

Victoria Peterson
tell you what, I just did some quick math here and a four-day week. It is on papers like 128 130 hours a month, but when you throw in holidays and vacation, it’s about 114 so your associates are doing 526 to 877 an hour. Yeah, that’s more than twice, three times five times the average associate, the average associate does what 275 300 An hour?

Dr. Nathan Kupperman
I think that’s what they think that’s what they said in the course. Yeah.

Victoria Peterson
So you are Ferrari but I bet it’s not about speed. I heard you say it takes a while to get your speed up. Is it about speed is about efficiency? Is it about precision so that you’re not redoing your work? What’s the combination? Well,

Dr. Nathan Kupperman
there’s like I say, it’s like First, you go slow, then you go right, then you go fancy, right? So you’d mean, it just takes time to build up but it’s so easy to do things fast and do things poorly but it really takes time to slowly build up your skills and slowly build up that confidence but I think one thing too, that’s really, really critical, is kind of like the diagnostic aspect, it’s tough for newer doctors to diagnose and do comprehensive treatment planning.

Because sometimes, you know, they have a, they have a hammer and everything looks like a nail so sometimes you have to kind of back them up a little bit and say look at the comprehensive full mouth picture. I’m like, there’s, there’s a huge case here and the patient wants this like we can’t focus on just like one cavity or one truth that needs to be extracted. When you’re at war mouth doctors, we need to look at the entire picture so I think from a diagnostic perspective, if you can give the doctor that diagnosis, and he’s confident in that, I feel like that’s, that’s got to be like 60% of the battle, you know, clinically so that’s just kind of my thoughts.

Victoria Peterson
You know what you sound like such a great mentor.

Dr. Nathan Kupperman
And I have nothing as soon as like I was I was a great, great mentor in the beginning and I have another kind of like Clinical Officer. That’s, that’s with us. He’s been with us for about four years now and like I mentor him, and then he and I together mentor another doctor, and then now like all of us are kind of mentoring at once so that’s how we’re able to kind of expand our clinic or clinicians much more quickly because it’s like I have more of a support team now.

You know we have our monthly Doctor meetings. We have a good clinical Whatsapp group that we’re constantly going over cases you know, especially if you’re like, you know, you’re in a situation and you have a question, Am I still pretty much on speed dial for my Docs, you know, if they’re, they’re in a clinical situation in the office, I’m picking it up and I’m talking to them or they’re you know, sending me Pano panoramic X rays almost every day. We’re going through cases so I think that’s, that’s a critical part. You know, that’s a really big, big part of group dentistry.

Victoria Peterson
What I love about you is you are enthusiastic about some of the things that solo doctors dread

Dr. Nathan Kupperman 14:59
What are you What do you think? So what do you think solo doctors dread Victoria?

Victoria Peterson
mentoring young doctors? Can’t you just come in and do it? There’s a mindset of solo doctors that really when you break through it, and you start thinking about an investment grade practice, you know if you don’t get over yourself, and you just want to do things your way, and I’m an old dog, and I don’t want somebody coming in here and interfering with it and all of that. Sometimes you miss the mark, and your practice becomes unsellable.

I think that’s why, you know, the statistic of 95% of dentists can’t retire and maintain their lifestyle is so real and I love what an example of you’re like, What do you mean, you don’t want to like we go grab chicken wings and beer and we talk cases and we got to WhatsApp and it seems like you’ve got a system that makes it easy and enjoyable, and not compliance is driven. Or, you know, this dread, I’ve got to talk to them about what’s wrong, you really created a culture of collaboration.

Dr. Nathan Kupperman
In the feedback loop, you have to have a feedback loop. It’s like refining, it’s like we’re finding it’s like autophagy, your cells are constantly refining, like your organization is constantly refining and improving and getting better and there’s always obvious, there’s going to be painful phases, right? It’s a painful phase in dentistry, but it’s like that pain you break through and then you become better so yeah,

Victoria Peterson
well, what’s the future, of the neck group?

Dr. Nathan Kupperman
I just My philosophy is I’m trying to grow deeper, not wider. I don’t want to be a mile, a mile wide, and an inch deep. I want to be as deep as possible so I’m just trying to get my systems in place and get you to know, good management in place and have high-quality doctors high-quality dentistry because it’s kind of funny like I was on a podcast, actually, with Howard Serrano, dentistry uncensored and he just said, like, that’s like your, your keys, like, you have to really have a solid base, you know, like, you know, the five practice group that you have and he said, once you’re solid, you have all your systems is like, then that’s when you can be replicable so if I, if we can get to a point where we can replicate and expand more, that’s great but I’m going to do it responsibly. I’m not going to just buy up a million offices and try to exit sell out.

I just want to keep a maintained long-term legacy organization, kind of like I would say, like, I kind of want to be like the Publix of dentistry. I don’t know if you’re aware of Publix, but they’re like a, like a privately owned grocery store and like, all the employees are always just like, so happy to work there and they’ve just expanded responsibly over the years and they’re just a great company so that’s kind of like what my vision is.

Victoria Peterson
That’s so refreshing because you’re in it for the right reasons and I enjoy spending time with you and I’m like, I just want to spend more time with you. Yeah, well, we

Dr. Nathan Kupperman
talked about it at the happy hour, too. You know, you said that you met some like, you were lecturing at some workshop, and there was some kid in the audience who’s like, yeah, I just want to buy like three claps or three practices, you know, make them more valuable, and then sell it,

Victoria Peterson,
we’re gonna, I’m gonna flip practices like you flip a house? Like,

Dr. Nathan Kupperman
it’s like, yes. Don’t flip. It’s like people, you know, it’s patients and staff. It’s humans. You know, it’s not something you’re just trading like Pokemon cards.

Victoria Peterson
Yeah, I think a lot of people have in the early days, I don’t see as much of a going on now. Maybe it’s a ramp and I just don’t see it but the concept of you could go in and paint the walls and upgrade the appliances and you know, double your money. I just don’t see that.

I think private equity has gotten pretty savvy. I think banks are asking better questions, and I just really admire your approach and, of course, you know, we’d love those things that aligned, but you’re building a lifestyle for today and an asset for tomorrow and that’s investment grade, you know, yeah.

Dr. Nathan Kupperman
And I’m big, I’m big, too. I don’t like to buy retail. I like to buy value add offices so I want to buy offices that aren’t offering all the services that they could be or they’re not doing the marketing or they’re, you know, they’re not, they’re not reaching their full potential. You don’t want to buy an office at full potential, because that’s very, very expensive. So

Victoria Peterson
exactly so you’re, you’re representing the buyer persona of value add. There are other buyers that say, I don’t care that you’re doing 5 million and you’re big and you’re expensive because your cash flow is so great and I can optimize a cash flow. It really is.

You represent a great buyer in the market and I’m seeing responsibility in lots of different strata place places, right so that’s so cool. All right, you have a new podcast out that focuses on this small group privately held small group mindset. Do you want to tell us a little bit about the group practice mutual podcast?

Dr. Nathan Kupperman
Yeah, so the group practice mutual podcasts are just kind of an idea that I came up with. Just I noticed that there’s a lot of podcasts out there that talk about you know, solo practicing, you know, I have a PDA that kind of focuses on the solar provider increasing their hourly production and things like that.

There’s also, you know, a lot of like practice analytics, so offices, you know, by doing a startup doing so, I feel like there are a million podcasts out there about that, but there really isn’t a space right now where it’s just like, you know, smaller group owners that are going through like, their, their growth phase or there you know, that that three to four location or I mean, you know, this week I interviewed Pierre Kelly, he’s got he’s up 13 locations, but I’m just, I’m trying to just build a network of small like group owners and kind of like, in a sense, like, create a mastermind almost like you had mentioned, but obviously, you know, using the podcast to spread the word of like good systems and, and good strategies that like all of us are using, so

Victoria Peterson
that’s amazing. How do people find this podcast?

Dr. Nathan Kupperman
I’m on Spotify, actually, so we’re like in our baby phase and I’ve just launched it on Spotify because I feel like that’s a pretty popular platform so hopefully it will be on Apple iTunes soon.

Victoria Peterson
Oh, that’s awesome so look for a group practice mutual on Spotify. I feel so honored that we’re on the ground for this.

Dr. Nathan Kupperman
Yeah, you’re literally launching it for me. This is the first real exposure that this podcast is that so thank you I appreciate it.

Victoria Peterson
Okay, when you’re a big guy you got to remember me Alright, so if people want to connect with you and learn more about what you’re doing what’s the best way for them to do that Nathan?

Dr. Nathan Kupperman
info at NAC dental group.com and I’m very responsive so you know whoever reaches out to me I always responded I just like love networking love meeting other professionals in the industry so that’s kind of what I’m really passionate about because ultimately I just continue just to learn and expand my mindset and expand my vision.

Victoria Peterson
I love it so that’s info at in as a Nancy and as an Adam K as in copper by Knack dental group.com I love it. Nathan, you have been amazing. To interview I’ve taken literally I hope I haven’t been too loud here. But I’ve taken about two pages of notes on this podcast and I can’t wait to break it down for everyone.

Dr. Nathan Kupperman
Awesome. Fantastic. Well, I’m glad that we can get this done today because we’ve been talking about it for a little while. I know you’re out in Idaho on vacation so I’m glad glad you’re back and I’m glad we got this done.

Victoria Peterson
All right. Thank you so much. Thank you so much.

Narrator
Thank you for tuning in to this episode of the Investment Grade Practices podcast. If you find value in this episode, help us spread the word by passing it along to a dental friend subscribe and give us a Like on iTunes or Spotify. Learn more about building your Investment Grade Practice at productivedentist.com Today