Ever heard of Fun, Whitewater, and Predictable Success? Char Watson and Bethany discuss the first four stages of the Predictable Success Growth Model and How you can go through them and scale your business.

August 3, 2022

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Char Watson: Getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things.

Dr.Bethany Fishbein: Hey! Welcome back to the Power Hour Optometry podcast. I’m Bethany Fishbein CEO of the Power Practice and host of the podcast. So thank you for listening. So today is interesting. My guest is Char Watson and Char works in consulting in the Dental industry. She’s the founder of the Providers DOO Certification and the Director of Operations. She’s the host of the CEO Doctor podcast and she helps Dental practices grow. And I reached out to her because of some of the observations that we make in optometry. There’s always so much insight to be gained from other comparable professions. And we found in the past, dentistry, veterinary similar like healthcare practices that kind of run like we do, have a lot of great insights and a lot to offer. So I am looking forward to our conversation today. Char, thank you for taking the time and for doing what may end up being part one of a two-part podcast or may not we’ll see how it goes.

Char Watson: Thank you so much. I appreciate that.

Dr.Bethany Fishbein: If you don’t mind, will you share just your personal evolution and how you came from working in a Dental office to doing what you’re doing now?

Char Watson: Yeah, absolutely! So I’ve been in the healthcare space for about 15 years and then I kind of accidentally tripped into the Dental industry about 13 years ago. I was kind of in that transition phase, has got a job that’s out at the place we were living in, out of the city we were living in. And so I kind of needed to get a different position and couldn’t find a position where I was working. So long story short, I worked in the brick-and-mortar space for about 10 years. I moved my way up through the practice. The last five years, I was  Director of Operations for the brick-and-mortar space and I was helping him spearhead mergers and opening up additional locations. But then we were facing a family lifestyle change. Basically, my husband was getting deployed and so I was soon needing to be a single parent. And so I need to reduce my working hours so I can really focus in on home. So we kind of took that leap of faith and decided to go out on our own. So I’ve been doing that for about three years and I started out just doing Front Office Training and Development but I found that my heart just really wasn’t on fire. I wasn’t doing what I really loved to do, which was really coaching and mentoring these office managers to be Directors of Operations. And when I was going through that transition, I couldn’t find that level of mentorship and training and development. I couldn’t find anything online and I couldn’t find a mentor. And so through trial and error, I really learned how to be in this position, how to be the number two for the practice I was in. And so after about a year of running different office trainings, I decided to really go where my heart lied and I developed what’s called the Providers DOO. So it’s a Director of Operations Certification Program and it’s to develop office managers to help them transition into a Director of Operations, essentially being the number two for their providers. So that’s where I have gotten myself to today. And today we’re just really going to talk about the patterns and recognition that I found through my journey and also going through my clients’ journey and kind of codifying what I saw within these practices.

Dr.Bethany Fishbein: That sounds great! And I liked when we had talked previously and we were getting to know each other something that you had said at that time. You said, “I’m an observer of patterns.” Right? 

Char Watson: Yeah! 

Dr.Bethany Fishbein: And I feel like that’s what we do in consulting. We’re observers of patterns, sometimes good patterns and sometimes not-so-good patterns. So the pattern that we’re talking about here is really the stages or evolution that a business goes through or a business owner goes through from conception to the end. There’s so much parallels in what we’re doing. Talk about what you consider to be the first stage. 

Char Watson: Okay. 

Dr. Bethany Fishbein: Is that like, just thinking about it? Deciding to take the leap?

Char Watson: No, obviously that’s I mean I think that’s more just coming up with the idea. I would say the first stage identifies as Early Struggle but really all of us would think of it as Startups. So the Early Struggle stage obviously we’re looking to identify our market, be able to have an existential fight, to be able to find a sustainable market that is going to let us have a lifelong practice, right? Cash is typically our lifeline until we’re really sustained. So that gives us about two to five years where we’re really at that sustainable factor. But the fact is, in that Early Struggle there’s about an 80% mortality rate with those starting a business. And I don’t want that to scare anybody, but it really does take so much to get through that Early Struggle stage. And the interesting thing that I think is the founder’s evolution to that Business stage and adjust as an entrepreneur. Really and truly that’s really what it comes down to. And that’s basically it, someone who quits their 9 to 5 working 40 hours a week to do an 80-hour week job to get paid less, right? And so you have to have your heart so in what you have this big vision for. You have so much you have to work. There’s so much that you have to do. And really to succeed in this stage, you have to become really great at what you are doing. Right?  You don’t have to necessarily be a great leader, you don’t necessarily have to be a great manager, but you have to be able to be an all-star player for you to get through this stage. And at this stage too, we’re not really thinking about teams, we’re not really thinking in that terms either. And so unfortunately in this stage, if you get through this stage and get to the next stage we do tend to build a lot of habits or immediate reactions to get through challenges or to face opportunities because we just have to get through it. It’s such a hustle and grind mentality and force of nature to be able to get through this stage. But that will cause problems later on and we can talk about that later.  So essentially at this stage, the only strategy you have is to get through it, or else you are out of business. So obviously it’s getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things. When you’re in this stage, it’s so easy to just start a whole bunch of things. We’re so excited about all the things that we want to do and where we’re going and half of the time if not most of the time, those projects don’t get finished. And so it’s really hard to get that progress. So that’s the third of the three strategies. Is just to finish your pending projects to help you get that progress.

Dr.Bethany Fishbein: And when you see it in Dentistry, are most dentists who are deciding to start their own offices, are they fully leaving the job where they were? Or are they still working for someone else a couple of days a week just to have income while this is going on? What’s the typical pattern?

Char Watson: So you know, to be honest, I don’t see a lot of associates being with another location and then trying to start their own. There’s usually a conflict of interest there and it’ll be in their contracts as well. They cannot go off and start a business while still working for us sort of thing. But we will see associates stay with these organizations for about five years or so. So they can really get comfortable with what they’re doing. They have that coaching, that mentorship, they get to learn the systems and the processes of the practice, and then they fully go out on their own.

Dr.Bethany Fishbein: Gotcha. So they tend to kind of once they make that decision, they go all in. 

Char Watson: Yep.

Dr. Bethany Fishbein: It’s a little bit different. I mean some optometrists will do that but I think there’s a little bit less of that concern about competition. That a lot of them will still be working a day or two or three somewhere else and trying to do this other as you said, “80-hour a week job for no pay on their own.” So that adds in a layer of time. That makes it even tougher. 

Char Watson: Yeah.

Dr. Bethany Fishbein: It’s a tough stage but it’s an exciting stage for sure. 

Char Watson: Yeah, that’s amazing. 

Dr. Bethany Fishbein: So then what happens?  You survive, right? And so is the milestone that you hit predictable profitability like you can cashflow things or? Like how do you know when you moved on to stage two?

Char Watson: Yeah, so stage two, we call it Fun. This is where you’re mining your profitable market. So this is essentially, you’re just selling, selling, selling. You’re flexing your sales muscles. You’re flexing your marketing muscles. So you’re not reliant on cash to get you through the next sell and to get you through the next sell. You’re out of that. So instead of being cash-focused, you become revenue-focused. So you’re not struggling just to make it paycheck to paycheck. You’re not trying to find your mark. You’re not trying to find your next patients. You’ve already found that market. So now, you’re just working on that loan hanging through. So this is the area that is really highly flexible. We’ll see a lot of the practices that kind of punch above their weight. They are you know. This is a really fun stage. I really do love it. But we’ll see practitioners are like, “Oh yes, we do do orthodontics even though we haven’t started it yet.” or “Oh yes,  we’re going to do implants here although I’ve never done it.” And it’s exciting. They’re super excited and they’re super enthusiastic. There’s just a wide means of flexibility that will get them into trouble later. But for this stage, you just want to say yes to everything. And that enthusiasm and that willingness, patients love it. They just soak that right up because then they’re like, “Oh, you see me. This is easy. I only have to go to this one provider for all these things.” They love it. So the problem is though is that this causes increased complexity because we’re saying yes to too many things. This is where we started to see projects start to fall off again. And the founder’s evolution, this is kind of where they hit a brick wall. So they kind of become the reluctant manager or the captain on the field per se. So they have a job to do just like everyone else but to win, they really have to make sure that everyone else is winning too. And that’s so different than the Early Struggle. In the Early Struggle, you’re just doing everything. You’re the all-star player like everybody works around you. For Fun, it shifts and now you’re having to look at your team like, “Oh hey! Are you doing good over there?”, “Do you know how to do your job?”, “Have I given you that support and clarity that you need to be successful?” But then they still have to perform just as much as the team too. There’s nothing. It’s not that they’re sitting down any less. It’s just that they’re moving it out and around them, right? They have to build a call to play and then be able to play that call. That’s one thing that I’ve kind of noticed a lot with practitioners. When they get to this Fun stage, this isn’t quite encapsulated like it should be. Meaning that they’ll make a call. They’ll say like, “We need to do this.”, “This is our strategy.”,  “This is our plan.” But then they’re doing something different than what they’re asking the team to do. They’re not seeing it as if it’s a whole team involvement including themselves. And that starts to cause that complexity and that’s where we started to see culture start to break down. And that’s where we started to see teams starting to break down, right? And so you have to be able to hold yourself accountable for what you’re asking the team to do and hold others accountable to be successful in this stage as well. Oh, sorry. Go ahead.

Dr.Bethany Fishbein: I mean as you’re describing that. My background is I opened the practice 21 years ago like. So as you’re talking about this, I’m thinking back to those days and being in these stages. And what you’re saying is just really hitting a little bit. Like it’s fun for the provider because “I can do this. I can do this. I can do this.” But everybody trying to support them is like hanging on to like a chain whipping around. Because it’s you know, “We’re going to do this thing.”, “Okay, we’re all going in that.”, and then, “Nope, we’re going over this way. And so I remembered those days and that enthusiasm. And that’s where sometimes the frustration with stuff starts to kick in because like you’re saying, “You need to, at that stage, start to know how to lead a team.” In dental education is there practice management? Like do they learn that anywhere along the way?

Char Watson: So you know to be honest, no.  We see a lot of office managers move up through the office just like I did. Like that really is normal to start as that receptionist or account manager, coordinator, or whatever and then move your way up to office manager. And you just kind of stumble into the role and more or less you just have different responsibilities but the actual training of how to be a manager isn’t there. The way that it or the strategy to it isn’t really supported correctly in this stage. So for most practices, it’s about command and control. So it’s the provider saying, “Hey! This is what we’re going to do team. Go do it.”  Just like you were describing. And so then everybody’s just trying to follow him around like lost puppies. But really at this stage, this is when I really suggest getting your number 2 actually because of that. You need to have that person that provides that yin to your yang. The person that can really step in where you have more of your weaknesses and more of your blind spots thus running the day-to-day. But also that person that can say, “No we can’t do this. We have to finish this priority.” or “We have to finish this imperative that we’re working on.” Right? They’re going to keep that balance and play or otherwise you have a visionary that is like running everywhere and has a whole bunch of sandboxes that nobody knows which sandbox to play in anymore. 

Dr.Bethany Fishbein: It’s totally true because that’s the voice of reason or like when we’re training, we call that thought partner.

Char Watson: Yeah. 

Dr. Bethany Fishbein:  To say no, that’s huge because the other thing that I see when we see providers in this stage is that it can get expensive. Because all of those things that they say, “Yeah, okay.” you know and you’re saying implants and orthodontia. In our world, it’s aesthetics, and myopia treatment, and you know just different specialty areas. But it’s, “Oh! You’re interested. Great! Yes, this is a direction we could go in. I’m gonna go buy this piece of equipment that lets us do that.” And all of a sudden $70,000 later, it’s like you don’t know yet if you can support it. So I feel that when we’re supporting owners in this stage and it’s hard. You don’t want to be the unfun one. Somebody’s super excited about something and they want to do it and you’re like, “Yeah, not today. No. No.” But that voice of reason is important.

Char Watson: Yeah. It is really important. And honestly, it happens in the dental industry too. We see a lot of these in solo practices. I mean most of the solo practices are hanging out on the  Fun stage.  I guess you should note too, that the Fun stage is only one of the two out of the seven stages that are sustainable. So the Fun stage is your growth stage and you can stay here as long as you want. But to you’re point, you have to keep up focus until we actually have a market here. Number one for us to invest in this tech, or this service, or this whatever. Is it minable, right? Like it’s like, “Does my market actually want it, or is it just this one patient that wants it?” So does that make sense? And then two, you have to reduce that complexity if you want to stay in that Fun stage and sustain this growth stage. You have to actually say no a lot more and that’s where that number two comes into play to help keep that balance. Otherwise, you push or the provider will push themselves into that third stage, which is the Whitewater stage. If you want to right we can jump into that. But that’s really that number two is really going to help you stay in that Fun stage as long as you want to. If you’re willing to say no a lot more.

Dr.Bethany Fishbein: Okay. There’s something to that. My thoughts are brewing here. So is the goal to move through all the stages? Or like, ideally, you just stay in the Fun stage and that’s your growth stage and you just keep growing, and growing, and growing forever?

Char Watson: No, I’m glad you asked that question. No, because with Fun you have to have an expectation on your cap. It isn’t growth indefinitely that would be Scale. So growth, you have to have that cap on your expectations. You have to know you’re going to eventually reach that ceiling and you can’t keep pushing it further. Unless you’re willing to go and push to this next stage to get into Predictable Success. So Predictable Success is stage four. Right now the stage we’re talking about is stage two. So it’s that stage in between. Are you willing to go through what we call Whitewater? Because it’s very very difficult and it’s your growth transition phase to get you to that scalable phase.

Dr.Bethany Fishbein:  Gotcha. So let’s talk about Whitewater. 

Char Watson: Okay.

Dr.Bethany Fishbein: Because I know you know we want to be rock stars. So if you tell us we’ve got to get through, we want to get through it. What is it?

Char Watson: Well okay. Obviously, it belongs to anybody who wants to get to scale but growth really is. Fun is a good stage to stay in. So don’t feel like the Predictable Success or stage four is the only sustainable stage. You absolutely can stay in stage two as long as you want. Okay, so Whitewater is when the growing complexity inside an organization is starting to cause problems. So this is where we see mistakes and errors happening. The cost of rework is happening. Profitability is plummeting. There’s a loss of control, doubts, loss of confidence, loss of alignment and so there’s a lot of fighting or firefighting every day. Typically, at this stage, to be honest, I usually see it around three to four locations. And when I’m coming into the practices to help them get through Whitewater because so what I do is I develop emerging leaders. So I either meet them at the Fun stage and develop the office manager to be the number 2, to be the Director of Operations. Or I come in at this Whitewater stage and develop the Director of Operations and the processor and build that alignment for the Executive team.  So when I’m coming into this Whitewater stage, typically, there’s a non-executive team present. Typically there’s three to four locations and when you’re actually talking to those locations at that practice level, they are so disconnected from that DSM management from that executive level.  They don’t have any alignment from top to bottom.  They don’t know what their goals are. They don’t know why they’re there. They don’t have support. There’s no communication, right? And so then they silo themselves out just so that they can barely survive, but they’re not growing. And if you don’t acknowledge the problems in Whitewater and get through Whitewater, you can fall all the way back down to Early Struggle if you let it go long enough. But Whitewater is really great. You have to choose. Do you push forward and get to Predictable Success where you can scale? Or do you reduce the complexity and fall back down to just Fun where you just have to deal with the expectation on your growth capped?

Dr.Bethany Fishbein: So is that progression from one to three, or four, or five offices fairly normal in dentistry? Because we see some in optometry but it’s pretty unusual. And so typically, what we’re seeing is somebody starting with one office and growing that one office to sometimes ridiculous levels. Ridiculous in a good way. So you know you’re describing it and I’m hearing it but I don’t know that it has to be growth in multiple locations. I think like in one office it can be starting to departmentalize a little bit more to say, “Okay, now we’ve got. It’s busy. So we’ve got people who just do this.” And before everybody did everything and so.

Char Watson:  Right.

Dr. Bethany Fishbein: Sometimes they’re not talking to each other. Or there may be an Associate Optometrist and so now the owner and the associate do things differently, right? This can happen in one spot.

Char Watson: Oh yeah, for sure. You won’t see it though if it’s just a solo practitioner. They don’t typically move through these stages. They really do kind of stay around that Fun stage. If they’re trying to get a partner within that practice or associates within that practice then yes, that practice certainly can evolve through these stages. But if we’re just talking about a solo practitioner with no additional providers in the office, typically we won’t see them move through these stages. They typically just go from Early Struggle to Fun and then just hang out there.

Dr.Bethany Fishbein: Okay.

Char Watson: Yeah.

Dr.Bethany Fishbein: What are the keys to getting through the Whitewater?

Char Watson: So Whitewater,  I think to me, I kind of think it’s fun. So the reason why is because you’re looking at things in such a different perspective. So in Fun, we’re really focusing on systems and processes for the team underneath us. Okay, so we don’t have a lot of in-house services such as HR. Typically, we outsource that. We typically outsource that. So we outsource a lot more in Fun and keep it pretty minimal in-house. So those systems and processes are just focused on the team. For Whitewater, we’re actually developing the systems and processes for the executive team. That’s what makes it so different and so unique. So we have to completely shift the way that we’re approaching the practice. So in Whitewater, we’re really focusing on building the Predictable Success team. So that’s your visionary, your operator, and your processor. That additional third row. We have to move to making high-quality team-based decisions. So it’s not just that command and control structure, right? We have to move away from that. We’re making high-quality team-based decisions. And that’s a whole like. We could dive into Whitewater and all of this like on a whole other podcast because there’s a lot to go into it. And then what we call Growth Imperatives. And again, like all of these could be its own episode to really get through and like understand all of these different meanings. But those are the focuses for us to really get through Whitewater. Additionally, the founder also has to go through their own evolution to really help them get through Whitewater. They kind of move from being like the captain on the field to stepping off and being the coach on the sideline. And that transition is really hard for most providers because especially if you started your own practice and you moved through all these stages. You can’t be the one that’s calling the shot and then making the move in the field and then going back on the sidelines to coach and then jumping back in on the field and that’s what we see happen. And what that’s doing is that’s causing chaos and hurricanes all around. And you’re not empowering your leaders to step in fully because you’re still playing in the field. So this evolution, you have to take a step off of the field and coach from the sidelines. And that can be really hard. And so the focus here is to really choose if you’re going to be going up, going through to Predictable Success, or are you going to step out and let someone else step in as the visionary. That’s a choice you have to make. What are you willing to do at this point? Next is to leave but not to leave. We’ll see the practitioners get to this Whitewater stage and honestly, if you don’t notice it soon enough, you’ll get burnt out from the turbulence of this stage really fast. And so they tend to just step out. But the problem is this being absent isn’t being a leader and walking away isn’t delegating. You can’t just leave, you have to still lead. You still have to have a presence within your practice and really have to focus in on your leaders. So not just focusing on breaking them up and choices. The first choice is your Senior Executive team, so that’s a visionary, an operator, and a processor. You have to focus on that first choice. But the second choice, that’s your leadership team within the practice, that’s your office managers and your associates. You really have to focus in on those leaders and get them strong, get them empowered, let them make decisions, and have the independence to do it without you micromanaging or stepping into the field again and or stepping off the field and then coming back in. It’s just causing hurricanes everywhere. So don’t do that. And then finally you just really, the best suggestion I can say is to find a guide, find a coach to help you get through this stage because there’s a lot of blindspots here and a lot of unknowns. It’s hard to see what’s in front of you when you are so sick in the weeds of it.

Dr.Bethany Fishbein: Yes, that we know and that’s what we do. We find that. So talk about Predictable Success because that’s the goal, right? Is you get through this to Predictable Success? What does that mean in your language here?

Char Watson: Predictable Success just means you can deliver quality in the face of complexity. It means you can scale to whatever level you want to get to without your quality dropping, without your team isolating themselves, and without developing these silos. It’s a continuum of getting through Whitewater. The key there though is developing a synergist. That’s the person that’s basically the love language for the organization. They are the ones that are focused on the culture. They have a high EQ. They have a high HQ. They are really in tune with their team members. They understand their strengths. They understand their weaknesses. Oftentimes, I’ll put that synergist person on say like an HR role as well because we need that person anyway. They really help to glue and solidify the culture that has been developed. Once you get to that Whitewater stage and Predictable Success, you really get to see the value of your culture and your organization. Whereas, I don’t feel like you can really see that when you’re in those earlier stages because you’re just busy working. You’re just flexing those sales muscles. You’re just working and producing but you’re not really like taking a step back to see just how valuable your culture is and what you’ve done here, right? You haven’t taken a step back to enjoy it yet. And when you get to Predictable Success, that’s when you get to.

Dr.Bethany Fishbein: So what’s usually the founder or the provider’s time spent in patient care? Like are they decreasing their time and patient care or are they increasing as they build that leadership team? What usually is happening here?

Char Watson: Yeah. No, I love it so much that you ask that question. So in Early Struggle, they’re obviously that single contributor. In Fun, typically they’re the single contributor but they’re kind of taking a step out. So typically, we’ll still see them working at least three to four days a week but usually, they can start carving out at least a day a week to really be the CEO and do the CEO things. In Whitewater though, we’re really going to ask you to take a step down out of clinical because we need that visionary. If you’re capped on your time and your energy because it’s being spent so much on patient care, it’s really hard for us to really get through that. So in Whitewater, can we go 50/50? You know? Can we get down to like two or two and a half days a week? That will make phenomenal progress. And then in Predictable Success, I feel like that they really have more of an option there. We’ll see some providers do one or two days a week and some that just step out altogether and they will become more like part of the board per se. So they’re still very much involved in the organization but they are not providing that clinical care.

Dr.Bethany Fishbein: What percent of dental providers go this multi-provider, multi-office route versus just building up a practice? I mean, I’m sure it’s changed over the last 20 or 30 years.

Char Watson: Yeah, it has changed, and honestly, I feel like the pandemic has really caused like a hard turn right for this kind of emerging DSO route. So it really kind of was about 30% of like DSOs versus 70% solo practitioners, but the pandemic, like I said, it scared everyone. And so I think we’re seeing a lot more retransition into this more DSO route. And so right now it’s about 50/50. I honestly won’t be surprised. So within the next few years, if we see more of an 80/20 or 20% is more of those solo practitioners and 80% is more in that Dental Service organizations. 

Dr.Bethany Fishbein: So will you just define it, Dental Service Organizations because I’m not sure that there’s a popular direct parallel in our industry.

Char Watson: Oh yeah, sure. So the Dental Service Organizations, they become partners with their practice, typically, or you can start your own. And there’s that and that can mean a whole different thing. If you want to start your own, basically what you’re doing is you’re bringing in other practices that’s typically a merger and you partner with them. So the DSO typically has like 49% ownership and the practice has 51%. The DSO Management provides services. Again, this can be something we can really dive into on another podcast. But they provide a certain level of services, depending on the model, either all the practices get the same exact services or they can pick and choose. So essentially, the Dental Service Organization is a support to the practices and provides the admin support. And the practitioners can take a step out of having to do basically a call to CEO needs and they partner with this company. Or the founders will just make their own DSO. They’ll just build their business towards that model.

Dr.Bethany Fishbein: So in these stages that you’re talking about, this is kind of the founders building their own. If there’s somebody else to do it, it lets you skip a lot of that Whitewater.

Char Watson: Yeah, for sure. I think it’s still worth saying. We’ll have to do another podcast because we don’t have enough time to talk about those declining stages. Just because on that note, when you have these big DSOs, these corporate-level organizations, they can get into these declining stages. So even though on the outside they seem really successful, it doesn’t seem like they’d be having any of these problems. There are certain problems that happen within those declining stages but we’ll get into that in another episode.

Dr.Bethany Fishbein: Yeah, I definitely would like to talk again. I mean, it’s a model that we’re talking about in optometry. There are people doing it very successfully outside the US. There are some things here that have made it a little bit complicated to do that way. And what’s happening because that’s not as viable an option is some of these practices are selling out entirely. I’m sure that’s got to be a thing in dentistry also. It’s just private equity companies buying 100% of the equity and now the founder goes to being an employee, right? 

Char Watson: Yeah. They either step in that way or they just step out altogether and retire.

Dr.Bethany Fishbein: Yeah. One of my philosophies that I talk about is that understanding how to build leadership and to have a team that can carry out the plays on the field so that the provider can be in the exam room if that’s where they want to be. Or be CEO and employ someone else in the exam room. But not be in that position where they’re, your analogy, like calling the play, running in on the field to do it, checking it out, coaching everyone else, jumping back out to think strategy, right? Apparently, a lot of people are in that but that leadership team in place makes a tremendous difference in the ability to make that happen. I would love to talk again. We promised seven stages. We hit four here. Will you give a quick like, here’s what the next three are, and then we can go into them in more detail another time.

Char Watson: Yeah, absolutely. So the next stage after Predictable Success is called Treadmill. This one you can get out off and you can move back to Predictable Success. The stage following that is called the Big Rut. Just to highlight that’s basically the organization is too big to fail. It’s really hard to scoop them back into Predictable Success. Often times you will see them fall all the way down to Death Rattle, which is the final stage and this is where the organization is sold or scrapped or merged or acquired with another organization.

Dr.Bethany Fishbein: Char thank you. This is interesting. It’s so interesting the similarities but also the differences. There are some things that you said that just hit right on and then some things that are like, “Yeah. Okay. We’ve got similar stages but different milestones that are creating them.” So it’s something that I will absolutely think about, and I hope we can talk more on about. Give the details on your podcast or if people are interested in hearing more from you. Where do they look?

Char Watson: My podcast is the CEO Doctor podcast and then if you want to get in touch with me, I’m on LinkedIn just under Char Watson, or my website is called the www.theprovidersdoo.com

Dr.Bethany Fishbein: Alright, Char. This is part one. Thank you so much for taking the time today. And I am absolutely looking forward to next our conversation.

Char Watson: Perfect. Thank you so much.

Dr.Bethany Fishbein: Thank you and for anyone out there listening who’s interested in knowing your blind spots, helping develop your team, and helping to stay in Fun or get to the stages of growth, please check us out online at www.powerpractice.com Thank you.

 

Read the Transcription

Char Watson: Getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things.

Dr.Bethany Fishbein: Hey! Welcome back to the Power Hour Optometry podcast. I’m Bethany Fishbein CEO of the Power Practice and host of the podcast. So thank you for listening. So today is interesting. My guest is Char Watson and Char works in consulting in the Dental industry. She’s the founder of the Providers DOO Certification and the Director of Operations. She’s the host of the CEO Doctor podcast and she helps Dental practices grow. And I reached out to her because of some of the observations that we make in optometry. There’s always so much insight to be gained from other comparable professions. And we found in the past, dentistry, veterinary similar like healthcare practices that kind of run like we do, have a lot of great insights and a lot to offer. So I am looking forward to our conversation today. Char, thank you for taking the time and for doing what may end up being part one of a two-part podcast or may not we’ll see how it goes.

Char Watson: Thank you so much. I appreciate that.

Dr.Bethany Fishbein: If you don’t mind, will you share just your personal evolution and how you came from working in a Dental office to doing what you’re doing now?

Char Watson: Yeah, absolutely! So I’ve been in the healthcare space for about 15 years and then I kind of accidentally tripped into the Dental industry about 13 years ago. I was kind of in that transition phase, has got a job that’s out at the place we were living in, out of the city we were living in. And so I kind of needed to get a different position and couldn’t find a position where I was working. So long story short, I worked in the brick-and-mortar space for about 10 years. I moved my way up through the practice. The last five years, I was  Director of Operations for the brick-and-mortar space and I was helping him spearhead mergers and opening up additional locations. But then we were facing a family lifestyle change. Basically, my husband was getting deployed and so I was soon needing to be a single parent. And so I need to reduce my working hours so I can really focus in on home. So we kind of took that leap of faith and decided to go out on our own. So I’ve been doing that for about three years and I started out just doing Front Office Training and Development but I found that my heart just really wasn’t on fire. I wasn’t doing what I really loved to do, which was really coaching and mentoring these office managers to be Directors of Operations. And when I was going through that transition, I couldn’t find that level of mentorship and training and development. I couldn’t find anything online and I couldn’t find a mentor. And so through trial and error, I really learned how to be in this position, how to be the number two for the practice I was in. And so after about a year of running different office trainings, I decided to really go where my heart lied and I developed what’s called the Providers DOO. So it’s a Director of Operations Certification Program and it’s to develop office managers to help them transition into a Director of Operations, essentially being the number two for their providers. So that’s where I have gotten myself to today. And today we’re just really going to talk about the patterns and recognition that I found through my journey and also going through my clients’ journey and kind of codifying what I saw within these practices.

Dr.Bethany Fishbein: That sounds great! And I liked when we had talked previously and we were getting to know each other something that you had said at that time. You said, “I’m an observer of patterns.” Right? 

Char Watson: Yeah! 

Dr.Bethany Fishbein: And I feel like that’s what we do in consulting. We’re observers of patterns, sometimes good patterns and sometimes not-so-good patterns. So the pattern that we’re talking about here is really the stages or evolution that a business goes through or a business owner goes through from conception to the end. There’s so much parallels in what we’re doing. Talk about what you consider to be the first stage. 

Char Watson: Okay. 

Dr. Bethany Fishbein: Is that like, just thinking about it? Deciding to take the leap?

Char Watson: No, obviously that’s I mean I think that’s more just coming up with the idea. I would say the first stage identifies as Early Struggle but really all of us would think of it as Startups. So the Early Struggle stage obviously we’re looking to identify our market, be able to have an existential fight, to be able to find a sustainable market that is going to let us have a lifelong practice, right? Cash is typically our lifeline until we’re really sustained. So that gives us about two to five years where we’re really at that sustainable factor. But the fact is, in that Early Struggle there’s about an 80% mortality rate with those starting a business. And I don’t want that to scare anybody, but it really does take so much to get through that Early Struggle stage. And the interesting thing that I think is the founder’s evolution to that Business stage and adjust as an entrepreneur. Really and truly that’s really what it comes down to. And that’s basically it, someone who quits their 9 to 5 working 40 hours a week to do an 80-hour week job to get paid less, right? And so you have to have your heart so in what you have this big vision for. You have so much you have to work. There’s so much that you have to do. And really to succeed in this stage, you have to become really great at what you are doing. Right?  You don’t have to necessarily be a great leader, you don’t necessarily have to be a great manager, but you have to be able to be an all-star player for you to get through this stage. And at this stage too, we’re not really thinking about teams, we’re not really thinking in that terms either. And so unfortunately in this stage, if you get through this stage and get to the next stage we do tend to build a lot of habits or immediate reactions to get through challenges or to face opportunities because we just have to get through it. It’s such a hustle and grind mentality and force of nature to be able to get through this stage. But that will cause problems later on and we can talk about that later.  So essentially at this stage, the only strategy you have is to get through it, or else you are out of business. So obviously it’s getting better at what you do is number 1. Number 2 is to develop yourself. So at this stage, this is a really crucial time for you to really get mentorship on yourself, really develop that mindset, that ability to get to know your strengths and be able to acknowledge your weaknesses. Get to know your blindside. So the dark and light side of who you are as a person is because you’re going to have to be able to find those people that can fulfill the areas you can’t. And then third, is to finish things. When you’re in this stage, it’s so easy to just start a whole bunch of things. We’re so excited about all the things that we want to do and where we’re going and half of the time if not most of the time, those projects don’t get finished. And so it’s really hard to get that progress. So that’s the third of the three strategies. Is just to finish your pending projects to help you get that progress.

Dr.Bethany Fishbein: And when you see it in Dentistry, are most dentists who are deciding to start their own offices, are they fully leaving the job where they were? Or are they still working for someone else a couple of days a week just to have income while this is going on? What’s the typical pattern?

Char Watson: So you know, to be honest, I don’t see a lot of associates being with another location and then trying to start their own. There’s usually a conflict of interest there and it’ll be in their contracts as well. They cannot go off and start a business while still working for us sort of thing. But we will see associates stay with these organizations for about five years or so. So they can really get comfortable with what they’re doing. They have that coaching, that mentorship, they get to learn the systems and the processes of the practice, and then they fully go out on their own.

Dr.Bethany Fishbein: Gotcha. So they tend to kind of once they make that decision, they go all in. 

Char Watson: Yep.

Dr. Bethany Fishbein: It’s a little bit different. I mean some optometrists will do that but I think there’s a little bit less of that concern about competition. That a lot of them will still be working a day or two or three somewhere else and trying to do this other as you said, “80-hour a week job for no pay on their own.” So that adds in a layer of time. That makes it even tougher. 

Char Watson: Yeah.

Dr. Bethany Fishbein: It’s a tough stage but it’s an exciting stage for sure. 

Char Watson: Yeah, that’s amazing. 

Dr. Bethany Fishbein: So then what happens?  You survive, right? And so is the milestone that you hit predictable profitability like you can cashflow things or? Like how do you know when you moved on to stage two?

Char Watson: Yeah, so stage two, we call it Fun. This is where you’re mining your profitable market. So this is essentially, you’re just selling, selling, selling. You’re flexing your sales muscles. You’re flexing your marketing muscles. So you’re not reliant on cash to get you through the next sell and to get you through the next sell. You’re out of that. So instead of being cash-focused, you become revenue-focused. So you’re not struggling just to make it paycheck to paycheck. You’re not trying to find your mark. You’re not trying to find your next patients. You’ve already found that market. So now, you’re just working on that loan hanging through. So this is the area that is really highly flexible. We’ll see a lot of the practices that kind of punch above their weight. They are you know. This is a really fun stage. I really do love it. But we’ll see practitioners are like, “Oh yes, we do do orthodontics even though we haven’t started it yet.” or “Oh yes,  we’re going to do implants here although I’ve never done it.” And it’s exciting. They’re super excited and they’re super enthusiastic. There’s just a wide means of flexibility that will get them into trouble later. But for this stage, you just want to say yes to everything. And that enthusiasm and that willingness, patients love it. They just soak that right up because then they’re like, “Oh, you see me. This is easy. I only have to go to this one provider for all these things.” They love it. So the problem is though is that this causes increased complexity because we’re saying yes to too many things. This is where we started to see projects start to fall off again. And the founder’s evolution, this is kind of where they hit a brick wall. So they kind of become the reluctant manager or the captain on the field per se. So they have a job to do just like everyone else but to win, they really have to make sure that everyone else is winning too. And that’s so different than the Early Struggle. In the Early Struggle, you’re just doing everything. You’re the all-star player like everybody works around you. For Fun, it shifts and now you’re having to look at your team like, “Oh hey! Are you doing good over there?”, “Do you know how to do your job?”, “Have I given you that support and clarity that you need to be successful?” But then they still have to perform just as much as the team too. There’s nothing. It’s not that they’re sitting down any less. It’s just that they’re moving it out and around them, right? They have to build a call to play and then be able to play that call. That’s one thing that I’ve kind of noticed a lot with practitioners. When they get to this Fun stage, this isn’t quite encapsulated like it should be. Meaning that they’ll make a call. They’ll say like, “We need to do this.”, “This is our strategy.”,  “This is our plan.” But then they’re doing something different than what they’re asking the team to do. They’re not seeing it as if it’s a whole team involvement including themselves. And that starts to cause that complexity and that’s where we started to see culture start to break down. And that’s where we started to see teams starting to break down, right? And so you have to be able to hold yourself accountable for what you’re asking the team to do and hold others accountable to be successful in this stage as well. Oh, sorry. Go ahead.

Dr.Bethany Fishbein: I mean as you’re describing that. My background is I opened the practice 21 years ago like. So as you’re talking about this, I’m thinking back to those days and being in these stages. And what you’re saying is just really hitting a little bit. Like it’s fun for the provider because “I can do this. I can do this. I can do this.” But everybody trying to support them is like hanging on to like a chain whipping around. Because it’s you know, “We’re going to do this thing.”, “Okay, we’re all going in that.”, and then, “Nope, we’re going over this way. And so I remembered those days and that enthusiasm. And that’s where sometimes the frustration with stuff starts to kick in because like you’re saying, “You need to, at that stage, start to know how to lead a team.” In dental education is there practice management? Like do they learn that anywhere along the way?

Char Watson: So you know to be honest, no.  We see a lot of office managers move up through the office just like I did. Like that really is normal to start as that receptionist or account manager, coordinator, or whatever and then move your way up to office manager. And you just kind of stumble into the role and more or less you just have different responsibilities but the actual training of how to be a manager isn’t there. The way that it or the strategy to it isn’t really supported correctly in this stage. So for most practices, it’s about command and control. So it’s the provider saying, “Hey! This is what we’re going to do team. Go do it.”  Just like you were describing. And so then everybody’s just trying to follow him around like lost puppies. But really at this stage, this is when I really suggest getting your number 2 actually because of that. You need to have that person that provides that yin to your yang. The person that can really step in where you have more of your weaknesses and more of your blind spots thus running the day-to-day. But also that person that can say, “No we can’t do this. We have to finish this priority.” or “We have to finish this imperative that we’re working on.” Right? They’re going to keep that balance and play or otherwise you have a visionary that is like running everywhere and has a whole bunch of sandboxes that nobody knows which sandbox to play in anymore. 

Dr.Bethany Fishbein: It’s totally true because that’s the voice of reason or like when we’re training, we call that thought partner.

Char Watson: Yeah. 

Dr. Bethany Fishbein:  To say no, that’s huge because the other thing that I see when we see providers in this stage is that it can get expensive. Because all of those things that they say, “Yeah, okay.” you know and you’re saying implants and orthodontia. In our world, it’s aesthetics, and myopia treatment, and you know just different specialty areas. But it’s, “Oh! You’re interested. Great! Yes, this is a direction we could go in. I’m gonna go buy this piece of equipment that lets us do that.” And all of a sudden $70,000 later, it’s like you don’t know yet if you can support it. So I feel that when we’re supporting owners in this stage and it’s hard. You don’t want to be the unfun one. Somebody’s super excited about something and they want to do it and you’re like, “Yeah, not today. No. No.” But that voice of reason is important.

Char Watson: Yeah. It is really important. And honestly, it happens in the dental industry too. We see a lot of these in solo practices. I mean most of the solo practices are hanging out on the  Fun stage.  I guess you should note too, that the Fun stage is only one of the two out of the seven stages that are sustainable. So the Fun stage is your growth stage and you can stay here as long as you want. But to you’re point, you have to keep up focus until we actually have a market here. Number one for us to invest in this tech, or this service, or this whatever. Is it minable, right? Like it’s like, “Does my market actually want it, or is it just this one patient that wants it?” So does that make sense? And then two, you have to reduce that complexity if you want to stay in that Fun stage and sustain this growth stage. You have to actually say no a lot more and that’s where that number two comes into play to help keep that balance. Otherwise, you push or the provider will push themselves into that third stage, which is the Whitewater stage. If you want to right we can jump into that. But that’s really that number two is really going to help you stay in that Fun stage as long as you want to. If you’re willing to say no a lot more.

Dr.Bethany Fishbein: Okay. There’s something to that. My thoughts are brewing here. So is the goal to move through all the stages? Or like, ideally, you just stay in the Fun stage and that’s your growth stage and you just keep growing, and growing, and growing forever?

Char Watson: No, I’m glad you asked that question. No, because with Fun you have to have an expectation on your cap. It isn’t growth indefinitely that would be Scale. So growth, you have to have that cap on your expectations. You have to know you’re going to eventually reach that ceiling and you can’t keep pushing it further. Unless you’re willing to go and push to this next stage to get into Predictable Success. So Predictable Success is stage four. Right now the stage we’re talking about is stage two. So it’s that stage in between. Are you willing to go through what we call Whitewater? Because it’s very very difficult and it’s your growth transition phase to get you to that scalable phase.

Dr.Bethany Fishbein:  Gotcha. So let’s talk about Whitewater. 

Char Watson: Okay.

Dr.Bethany Fishbein: Because I know you know we want to be rock stars. So if you tell us we’ve got to get through, we want to get through it. What is it?

Char Watson: Well okay. Obviously, it belongs to anybody who wants to get to scale but growth really is. Fun is a good stage to stay in. So don’t feel like the Predictable Success or stage four is the only sustainable stage. You absolutely can stay in stage two as long as you want. Okay, so Whitewater is when the growing complexity inside an organization is starting to cause problems. So this is where we see mistakes and errors happening. The cost of rework is happening. Profitability is plummeting. There’s a loss of control, doubts, loss of confidence, loss of alignment and so there’s a lot of fighting or firefighting every day. Typically, at this stage, to be honest, I usually see it around three to four locations. And when I’m coming into the practices to help them get through Whitewater because so what I do is I develop emerging leaders. So I either meet them at the Fun stage and develop the office manager to be the number 2, to be the Director of Operations. Or I come in at this Whitewater stage and develop the Director of Operations and the processor and build that alignment for the Executive team.  So when I’m coming into this Whitewater stage, typically, there’s a non-executive team present. Typically there’s three to four locations and when you’re actually talking to those locations at that practice level, they are so disconnected from that DSM management from that executive level.  They don’t have any alignment from top to bottom.  They don’t know what their goals are. They don’t know why they’re there. They don’t have support. There’s no communication, right? And so then they silo themselves out just so that they can barely survive, but they’re not growing. And if you don’t acknowledge the problems in Whitewater and get through Whitewater, you can fall all the way back down to Early Struggle if you let it go long enough. But Whitewater is really great. You have to choose. Do you push forward and get to Predictable Success where you can scale? Or do you reduce the complexity and fall back down to just Fun where you just have to deal with the expectation on your growth capped?

Dr.Bethany Fishbein: So is that progression from one to three, or four, or five offices fairly normal in dentistry? Because we see some in optometry but it’s pretty unusual. And so typically, what we’re seeing is somebody starting with one office and growing that one office to sometimes ridiculous levels. Ridiculous in a good way. So you know you’re describing it and I’m hearing it but I don’t know that it has to be growth in multiple locations. I think like in one office it can be starting to departmentalize a little bit more to say, “Okay, now we’ve got. It’s busy. So we’ve got people who just do this.” And before everybody did everything and so.

Char Watson:  Right.

Dr. Bethany Fishbein: Sometimes they’re not talking to each other. Or there may be an Associate Optometrist and so now the owner and the associate do things differently, right? This can happen in one spot.

Char Watson: Oh yeah, for sure. You won’t see it though if it’s just a solo practitioner. They don’t typically move through these stages. They really do kind of stay around that Fun stage. If they’re trying to get a partner within that practice or associates within that practice then yes, that practice certainly can evolve through these stages. But if we’re just talking about a solo practitioner with no additional providers in the office, typically we won’t see them move through these stages. They typically just go from Early Struggle to Fun and then just hang out there.

Dr.Bethany Fishbein: Okay.

Char Watson: Yeah.

Dr.Bethany Fishbein: What are the keys to getting through the Whitewater?

Char Watson: So Whitewater,  I think to me, I kind of think it’s fun. So the reason why is because you’re looking at things in such a different perspective. So in Fun, we’re really focusing on systems and processes for the team underneath us. Okay, so we don’t have a lot of in-house services such as HR. Typically, we outsource that. We typically outsource that. So we outsource a lot more in Fun and keep it pretty minimal in-house. So those systems and processes are just focused on the team. For Whitewater, we’re actually developing the systems and processes for the executive team. That’s what makes it so different and so unique. So we have to completely shift the way that we’re approaching the practice. So in Whitewater, we’re really focusing on building the Predictable Success team. So that’s your visionary, your operator, and your processor. That additional third row. We have to move to making high-quality team-based decisions. So it’s not just that command and control structure, right? We have to move away from that. We’re making high-quality team-based decisions. And that’s a whole like. We could dive into Whitewater and all of this like on a whole other podcast because there’s a lot to go into it. And then what we call Growth Imperatives. And again, like all of these could be its own episode to really get through and like understand all of these different meanings. But those are the focuses for us to really get through Whitewater. Additionally, the founder also has to go through their own evolution to really help them get through Whitewater. They kind of move from being like the captain on the field to stepping off and being the coach on the sideline. And that transition is really hard for most providers because especially if you started your own practice and you moved through all these stages. You can’t be the one that’s calling the shot and then making the move in the field and then going back on the sidelines to coach and then jumping back in on the field and that’s what we see happen. And what that’s doing is that’s causing chaos and hurricanes all around. And you’re not empowering your leaders to step in fully because you’re still playing in the field. So this evolution, you have to take a step off of the field and coach from the sidelines. And that can be really hard. And so the focus here is to really choose if you’re going to be going up, going through to Predictable Success, or are you going to step out and let someone else step in as the visionary. That’s a choice you have to make. What are you willing to do at this point? Next is to leave but not to leave. We’ll see the practitioners get to this Whitewater stage and honestly, if you don’t notice it soon enough, you’ll get burnt out from the turbulence of this stage really fast. And so they tend to just step out. But the problem is this being absent isn’t being a leader and walking away isn’t delegating. You can’t just leave, you have to still lead. You still have to have a presence within your practice and really have to focus in on your leaders. So not just focusing on breaking them up and choices. The first choice is your Senior Executive team, so that’s a visionary, an operator, and a processor. You have to focus on that first choice. But the second choice, that’s your leadership team within the practice, that’s your office managers and your associates. You really have to focus in on those leaders and get them strong, get them empowered, let them make decisions, and have the independence to do it without you micromanaging or stepping into the field again and or stepping off the field and then coming back in. It’s just causing hurricanes everywhere. So don’t do that. And then finally you just really, the best suggestion I can say is to find a guide, find a coach to help you get through this stage because there’s a lot of blindspots here and a lot of unknowns. It’s hard to see what’s in front of you when you are so sick in the weeds of it.

Dr.Bethany Fishbein: Yes, that we know and that’s what we do. We find that. So talk about Predictable Success because that’s the goal, right? Is you get through this to Predictable Success? What does that mean in your language here?

Char Watson: Predictable Success just means you can deliver quality in the face of complexity. It means you can scale to whatever level you want to get to without your quality dropping, without your team isolating themselves, and without developing these silos. It’s a continuum of getting through Whitewater. The key there though is developing a synergist. That’s the person that’s basically the love language for the organization. They are the ones that are focused on the culture. They have a high EQ. They have a high HQ. They are really in tune with their team members. They understand their strengths. They understand their weaknesses. Oftentimes, I’ll put that synergist person on say like an HR role as well because we need that person anyway. They really help to glue and solidify the culture that has been developed. Once you get to that Whitewater stage and Predictable Success, you really get to see the value of your culture and your organization. Whereas, I don’t feel like you can really see that when you’re in those earlier stages because you’re just busy working. You’re just flexing those sales muscles. You’re just working and producing but you’re not really like taking a step back to see just how valuable your culture is and what you’ve done here, right? You haven’t taken a step back to enjoy it yet. And when you get to Predictable Success, that’s when you get to.

Dr.Bethany Fishbein: So what’s usually the founder or the provider’s time spent in patient care? Like are they decreasing their time and patient care or are they increasing as they build that leadership team? What usually is happening here?

Char Watson: Yeah. No, I love it so much that you ask that question. So in Early Struggle, they’re obviously that single contributor. In Fun, typically they’re the single contributor but they’re kind of taking a step out. So typically, we’ll still see them working at least three to four days a week but usually, they can start carving out at least a day a week to really be the CEO and do the CEO things. In Whitewater though, we’re really going to ask you to take a step down out of clinical because we need that visionary. If you’re capped on your time and your energy because it’s being spent so much on patient care, it’s really hard for us to really get through that. So in Whitewater, can we go 50/50? You know? Can we get down to like two or two and a half days a week? That will make phenomenal progress. And then in Predictable Success, I feel like that they really have more of an option there. We’ll see some providers do one or two days a week and some that just step out altogether and they will become more like part of the board per se. So they’re still very much involved in the organization but they are not providing that clinical care.

Dr.Bethany Fishbein: What percent of dental providers go this multi-provider, multi-office route versus just building up a practice? I mean, I’m sure it’s changed over the last 20 or 30 years.

Char Watson: Yeah, it has changed, and honestly, I feel like the pandemic has really caused like a hard turn right for this kind of emerging DSO route. So it really kind of was about 30% of like DSOs versus 70% solo practitioners, but the pandemic, like I said, it scared everyone. And so I think we’re seeing a lot more retransition into this more DSO route. And so right now it’s about 50/50. I honestly won’t be surprised. So within the next few years, if we see more of an 80/20 or 20% is more of those solo practitioners and 80% is more in that Dental Service organizations. 

Dr.Bethany Fishbein: So will you just define it, Dental Service Organizations because I’m not sure that there’s a popular direct parallel in our industry.

Char Watson: Oh yeah, sure. So the Dental Service Organizations, they become partners with their practice, typically, or you can start your own. And there’s that and that can mean a whole different thing. If you want to start your own, basically what you’re doing is you’re bringing in other practices that’s typically a merger and you partner with them. So the DSO typically has like 49% ownership and the practice has 51%. The DSO Management provides services. Again, this can be something we can really dive into on another podcast. But they provide a certain level of services, depending on the model, either all the practices get the same exact services or they can pick and choose. So essentially, the Dental Service Organization is a support to the practices and provides the admin support. And the practitioners can take a step out of having to do basically a call to CEO needs and they partner with this company. Or the founders will just make their own DSO. They’ll just build their business towards that model.

Dr.Bethany Fishbein: So in these stages that you’re talking about, this is kind of the founders building their own. If there’s somebody else to do it, it lets you skip a lot of that Whitewater.

Char Watson: Yeah, for sure. I think it’s still worth saying. We’ll have to do another podcast because we don’t have enough time to talk about those declining stages. Just because on that note, when you have these big DSOs, these corporate-level organizations, they can get into these declining stages. So even though on the outside they seem really successful, it doesn’t seem like they’d be having any of these problems. There are certain problems that happen within those declining stages but we’ll get into that in another episode.

Dr.Bethany Fishbein: Yeah, I definitely would like to talk again. I mean, it’s a model that we’re talking about in optometry. There are people doing it very successfully outside the US. There are some things here that have made it a little bit complicated to do that way. And what’s happening because that’s not as viable an option is some of these practices are selling out entirely. I’m sure that’s got to be a thing in dentistry also. It’s just private equity companies buying 100% of the equity and now the founder goes to being an employee, right? 

Char Watson: Yeah. They either step in that way or they just step out altogether and retire.

Dr.Bethany Fishbein: Yeah. One of my philosophies that I talk about is that understanding how to build leadership and to have a team that can carry out the plays on the field so that the provider can be in the exam room if that’s where they want to be. Or be CEO and employ someone else in the exam room. But not be in that position where they’re, your analogy, like calling the play, running in on the field to do it, checking it out, coaching everyone else, jumping back out to think strategy, right? Apparently, a lot of people are in that but that leadership team in place makes a tremendous difference in the ability to make that happen. I would love to talk again. We promised seven stages. We hit four here. Will you give a quick like, here’s what the next three are, and then we can go into them in more detail another time.

Char Watson: Yeah, absolutely. So the next stage after Predictable Success is called Treadmill. This one you can get out off and you can move back to Predictable Success. The stage following that is called the Big Rut. Just to highlight that’s basically the organization is too big to fail. It’s really hard to scoop them back into Predictable Success. Often times you will see them fall all the way down to Death Rattle, which is the final stage and this is where the organization is sold or scrapped or merged or acquired with another organization.

Dr.Bethany Fishbein: Char thank you. This is interesting. It’s so interesting the similarities but also the differences. There are some things that you said that just hit right on and then some things that are like, “Yeah. Okay. We’ve got similar stages but different milestones that are creating them.” So it’s something that I will absolutely think about, and I hope we can talk more on about. Give the details on your podcast or if people are interested in hearing more from you. Where do they look?

Char Watson: My podcast is the CEO Doctor podcast and then if you want to get in touch with me, I’m on LinkedIn just under Char Watson, or my website is called the www.theprovidersdoo.com

Dr.Bethany Fishbein: Alright, Char. This is part one. Thank you so much for taking the time today. And I am absolutely looking forward to next our conversation.

Char Watson: Perfect. Thank you so much.

Dr.Bethany Fishbein: Thank you and for anyone out there listening who’s interested in knowing your blind spots, helping develop your team, and helping to stay in Fun or get to the stages of growth, please check us out online at www.powerpractice.com Thank you.