1514 Bob Brooks of Practice Endeavors on COVID-19's Impact on Dental Practice Transitions : Dentistry Uncensored with Howard Farran
Bob Brooks is a CEPA (Certified Exit Planning Advisor) specializing in Dentistry, a CBI (Certified Business Intermediary) specializing in Dentistry, and an Ohio Licensed Real Estate Broker specializing in Dentistry. He is the owner of Practice Endeavors and has been serving dental practitioners since 2003.
VIDEO - DUwHF #1514 - Bob Brooks
AUDIO - DUwHF #1514 - Bob Brooks
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Please excuse any typos as this was digitally transcribed.
It is just a huge honor for me today to be podcast interviewing Bob Brooks CEPA CBI that stands for certified exit planning advisor and certified business intermediary of practice endeavors for brokerage and practice endeavors for real estate he is the great great nephew of Dr Willoughby Dayton miller PhD DDS md science and doctorate in science scd he was the first dental microbiologist ever right there in Ohio where he uh in fact he lives uh I’ll get back to that i should uh read all your other stuff um but um my gosh he is an Ohio licensed real estate broker specialized in serving dentists he continually works to meet the rigor standards of these organizations and completes many hours of continued education he is an instructor in the ibba's dental practice broker credentialing program he has served as program coordinator for the national practice valuation study group he is an active member and regular presenter with the Ohio business brokers association he has developed proprietary patent-pending tools to better service clients and assist them in fulfilling their dental practice goals his dental practitioners have benefited from bob's non-clinical ce presentations throughout Ohio he excels at what he does he enjoys seeing his clients with satisfying and possible incomes he's obviously a graduate of the Ohio state university with a bs in 79 and played first trumpet spending time with his wife rindy four adult children eight grandchildren enjoying river life in Florida and playing concerts throughout Ohio with the osu marching band alumni to Phil’s leisure time it is a great honor to bring bob brooks onto the program whose family tree has been serving dentistry since 1853 that is an amazing family tree you have their bob yeah well i probably don't look that old but that was uh when uncle Willoughby was born so uh as you said he was the first dental microbiologist and it's kind of been fun to have people general historians from around the world come visit our location here in Ohio to get a little dental history and information about uncle Willoughby Dayton miller he removed teeth from the queen of England uh used uh nitrous at that time which was unusual he was Kaiser Wilhelm’s personal dentist in Germany he was a golf champion in Austria Kaiser Wilhelm wanted him to renounce his American citizenship and become a German citizen and uh instead they uh so the diamonds uh they they took their wealth home by sewing diamonds into the seams of their garments and came home and and uh he bought the property where our office is now located and uh he was named dean of the dental school at university of Michigan but he got appendicitis and died of a burst appendix before he ever took that position and uh a statue of uncle wilby stands on the dental campus at Ohio state although he never went to school there and he never taught there so that's that's kind of interesting wow and that was a very special time when they were just uh coming on to the understanding that there was this microbiological world that they couldn't see with their eyes and talk about that and and that i mean this was the largest pivot of dentistry i mean when they realized there was something they couldn't see causing all this problems and he was the first microbiologist in dentistry right you google his name today he comes up number one yeah yeah i mean i mean that is just amazing i i um posted uh um some long articles on him on dental town history and some of them uh i want to take credit for this were on micro fish and i literally had to look at a micro fish and type um but i put all the words there because i couldn't find it on the internet and i knew my homies don't have enough time to do that but i spent preparing for your lecture i must have spent three hours typing out um what i could find of him on micro fish and it's just crazy and um i didn't realize how much Ohio and Pennsylvania had to do with the uh biological revolution that went on um around the world in dentistry yeah it's amazing and the the interesting thing is even though I’m related to dr miller uh uncle willowbeast uh as we refer to him that has nothing to do with how i got into this line of work that I’m in so it's uh it's an interesting aside but uh it gives me street cred as i like to say well it does i mean it's just it's just amazing and then his partner in crime was over in Philadelphia ned williams and uh i i mean i think ned williams and your uh great uncle i mean they they that was the biggest pivot in dentistry and um the the germ theory and all that stuff coming out and and uh wow those were interesting times i wonder um what we will look like a hundred years from now uh when young dentists and could you imagine in 21 in a hundred years from now how silly do you think i mean do you think you'll look at us right now thinking we were just like sophisticated cavemen cretins and didn't know all about this and that well you know it's interesting i think people who are alive um and tend to think that they're smarter than people who have gone before them and i think as we look at people in history there are some very intelligent people perhaps more intelligent than us that accomplish great things so it's interesting to have a different perspective sometimes well i want to um i want to jump right into the heart of the story and that is on my gosh um the reason i called you to come on the show i've lectured for and out for the Ohio convention everything i know you're a legend out there um but this pandemic is a legend i mean this this is a once in a century pandemic and what i notice on dental town is we started that in 99 and um it's had free classified ads one of the best parts of the website is robust and it's always had about 1 000 offices listed for sale where some dentists trying to sell us practice and about 4 000 ads to hire a young dentist or associate to help out the practice pandemic comes out boom instantly goes to 2 000 dental offices for sale with all these older dentists saying forget it man I’m not doing the ppe I’m not gonna get the air purify I’m just so done I’m just out of here I’m gonna sell it and then the 4 000 ads to come work for me as an associate has dropped to a thousand and the only people hiring are dsos and i think this pandemic has been the strongest marketing branding exercise for dsos because obviously so many dentists decided they were not going to face this pandemic by themselves and there was safety in herds and they my friends that own dsos their phone's been calling off the hook saying i went out buy my practice take me over how do you see it in Ohio and i really want to know because Ohio if you're from around the world i mean you know you got the northeast coast you got the california coast Ohio is just the the gold basket center of middle america what is it what does it look like to you out there in middle america um in the practice transition business are you seeing a bunch of old people calling you up say bob I’m so out of here sell my practice um what are you seeing well we've seen a little bit of everything and i thought that there would be more interest from late career practice owners that had low collections in wanting to sell their practices and we actually advertised for that to help them for a very low fee and do a patient record sale you know into existing practices that are making a full-time living because many practice owners late in their career they they've done what i call their their practices are what i call lifestyle practices you know they don't know what they're going to do with their time and they just keep hanging on their collections go down and their skill sets go down and whatever but there may be a lot of those that have gone out but i think many of them have unrealistic expectations they think well yeah i've only got two or three chairs and my collections are down to two or three hundred thousand a year maybe less than two hundred thousand a year and you know they'll be a young dentist that wants to buy this practice and come in here but quite frankly um you know dentists don't want to buy practices like that their best option is a patient records sale and many of them are reluctant to do that i think it's a great opportunity for existing practice owners who want to get a thousand percent return on their investment to offer two hundred dollars per chart for patients to walk in their door you know not just flat out buy a pay a certain amount up front but only for patients who walk in the door i think it's a fair return to the to the sellers and it's fair to the buyers and then it's up to the buyers to you know identify what work needs done with those patients and to encourage them to stay with the practice it's not the seller's responsibility so that's a good out but i haven't seen uh there has that may have occurred but i I’m not seeing it like i expected to uh there are practice owners that are not many of them below the age of 50 um that have had a good experience being home and it's like well I’ve got my debts paid off I’ve got plenty of money put away hey i kind of like this uh not working anymore so we've actually picked up some clients because of that and they're in no rush to sell but it's like hey we had to stay home during the shutdown this we could kind of get used to this and then there are other practitioners that have just been laboring under wearing n95 masks and just uh they're older and they've had great collections and wonderful practices and they're just wearing out they're just flat wearing out and you know their time horizon if they say they're gonna go another five years you know it's way shorter if they say they're gonna go two years that means two months i mean it's just it's really shortened up so you know we've had a significant amount of activity and as i stay in touch with my uh friends around the country brokers in Florida and Colorado and other places uh they're they're experiencing a lot of activity uh so they're just some dentists that uh don't wanna don't wanna keep going anymore what is the dso activity um look like in Ohio and how has it been impacted by the industry do you um has it been a large part of your business uh selling practices uh two dsos or talk dsos in Ohio okay well you may remember at pvsg a couple years ago you were or i guess maybe it was last year you helped us out in scottsdale and alex giannini spoke as well and i i have looked at some of the numbers with dsos and i remember talking to george radigan with the north American dental group back in august he said we've got 85 practices that we need to close before the first of the year and we can't take any more practices right now and of course covet put them in a bit of a stall so you've got this pent-up demand by dsos you've got the pinup demand from private buyers but also uh you know they can only process so many practices at a time and the practices we see in Ohio that go with dsos there a lot of times they're under the radar you don't even know that they they've sold uh you know it's still under the practice seller's name and there's no big announcement that you know midwest bought uh such such and such practice or whatever uh the clients that we serve are largely um private practitioners and most of them want to sell to private practitioners if some want to sell to dsos that's fine with us uh you know if somebody is you know mid career or not late career and they want to practice for many years at dia and they just are fed up with management bso may be a good uh option for them uh as you know if a dso buys a practice even if they pay 100 percent of collections and they hire the dentist to work for them another two years you've probably seen the model where they actually be better off continuing to work two years under their own uh banner uh because they get paid on the excess earnings of the practice to get paid on hygiene of course if they're an associate for the dso they don't so i won't go through that case study but i i think dso purchases have been backed up and slowed down by covid because they just can't run enough of them through but of course they're probably lining some up for first quarter q1 of next year wow um yeah that was so fun seeing you in scottsdale it's so amazing how the mind works because that that seems like a million years ago yeah yeah i mean it just it's just a crazy how long ago uh that was um you um you posted the other day on dental town my column was uh my howard speaks home for november was ownership isn't for everyone and you uh posted something i thought was very profound you said great topic and valuable insight one new factor involved with working for a dso is global non-compete provisions and associate contracts our company which assists in dental practice transitions recently experienced a deal that was 99.9 percent complete but the buyer's attorney discovered a non-compete in the equity portion of the buyer's dso employment contract based on the information i have it is my understanding that these non-compete restrictions prevented the associate from owning a practice in any state that this dso operates in and any state that they plan to enter for three years after employment with the dso the dso associate who previously worked for the practice owner who sold the dso had no idea that this restriction existed until this buyer tried to buy a practice it's logical to think that such a non-compete could easily be defeated in court but the buyer in this case did not want to be the guinea pig prospective dso associates may want to think twice about signing employment agreements with dsos that unreasonably restrict associates from future practice ownership my gosh that is a crazy story and I’ve seen that my for 30 years um what I’ve seen in arizona live and in the courtroom myself was a dentist um if the the judge can only um enforce the contract they basically the united states court law is that two people can agree to anything as long as it's not illegal and the courts will enforce it and they can enforce it or not but they can't change it so um for this one person who said um their contract said well if you work for me you can't practice in phoenix for uh five years and the lady thought come on phoenix it takes an hour to drive across town you're telling this guy he can't have a living i mean like I’m in the southernmost part of phoenix and it would take me an hour to drive to the most north so she just threw it out um and i saw in um um in a small uh but anyway so if you get too greedy the judge can just access and just say what do you mean you can't work in any state that you're i could just see her just saying throwing it out but it is a risk but um and then it's different for each town like in in new york city um a restricted covenant might be four blocks because every building is 40 stories tall and has 20 dentists in each one so you know so what what are you seeing on these being enforced um contracts well of course I’m not an I’m not an attorney but the distinction was that they couldn't own a practice in any state the dso was in our plan to go in not that they couldn't practice they in other words they could be an associate for someone else they just couldn't own a practice and i think that's the leg they're standing on is like we're not preventing you from practicing we're just preventing you from owning well you know that's uh that's still onerous and if somebody's wanting to step up and take it to court and defeat it that would be very beneficial to a lot of associate dentists who want to buy practices who work for dsos but it's going to take that first one and the deal that we uh had going on the uh the buyer had already turned in their resignation and then became unemployed because they couldn't buy the practice that they were just about ready to purchase uh because they didn't want to get into a legal dispute with their former employer and so i don't know where it goes uh it's going to be up to you know somebody that's willing to take on the legal fight and it seems like it should be reasonably defeated but who knows um do you what percent of your business is in Ohio almost a hundred percent okay so if if my homies are listening to you um you really um you're for hire to help them in Ohio but what if they're not in Ohio where how would they you recommend they find a broker that aspires to the things that you believe in well uh fortunately as a result of my pursuit of greater and greater education I’ve come into contact with you know over a hundred people who do what i do across the country and I’ve got some connections with some people whose opinion i have uh great respect for and i'd be happy to direct them to people who can help them you know i think it's important to get connected with the right people because some people unfortunately in every industry there are those who will take advantage of others and uh you know this goes on all the time um i think i mentioned uh in some of the mature i prepared for this session with hugh howard that you know sometimes attorneys you know they get they get paid more money if there's chaos and so they see they sow the seeds of chaos and make deals much more difficult sometimes blow them up you know they're they're great attorneys too so it's just important to get connected with the right people and i'd be happy to connect um anybody who has an interest i you know i got a email from a friend in the phoenix area two days ago with uh needed a referral for a broker in chicago so you know I’m happy to help out and stay connected with people around the country and how would they contact you for this information well by phone or by email my phone number is 740-924-6294 at 740-924-6294 or my email address is b brooks that's b is in bob b brooks at practice endeavors dot com b brooks practiceendeavors.com nice and um so do you um do you think this uh insane uh pandemic do you think because uh there's um uh all this talk about these vaccines do you think this is almost uh are we almost done uh i you know i was hearing them talking about their uh um you know they could be vaccinating 30 million americans a month starting next month uh what are you what is your thoughts on all that well of course i don't have any better idea of uh how soon the vaccine will be available than anybody else but i can tell you how it's affecting patients and how it's affecting practices i was on the phone this morning for i don't know hour hour and a half with a client in eastern Ohio about 30 minutes west of pittsburgh and their collections have been really really strong but they did indicate that some people in that practice have been afraid to come back just for hygiene appointments and but their their numbers are still really good and the demand's really good we saw on the restart we've got clients that their first month back in Ohio may 1st they could start back we had a practice listing that they did 143 of normal of average in may 118 in june 117 in july and that's been typical the practices that do a good job of managing uh information and uh encouraging their patients and letting them know they're safe encouraging their staff so all their hygienists didn't quit uh you know there was uh i think a lot of the hygienists uh stayed at home during the shutdown and they all got online and and and scared each other you know the sky is falling and uh that's uh uh you know that's been a challenge for some practices because some hygienists have retired and maybe some of them were more in the high-risk group and so maybe it made sense for them to do so but it's been a challenge and it also caused the late uh graduation of of hygienists to earn hygiene students to uh to be able to come into the market and serve as hygienists so it hasn't affected practice prices uh the only way i see that it has uh lowered practice sale prices would be if there is a seller who has to sell for some reason and when you have somebody who has to sell you know you're not going to get the highest price but my job as a dental practice broker is to build a market for each seller which means identify multiple buyers and then we have not seen a reduction in the sale price of practices as a result of all this i think people understand that there's light at the end of the tunnel and that we're eventually going to get through this and we're not going to be in this situation forever and so life goes on so um we hear so many um rules of thumb i mean i mean dennis have a rule of thumb for everything and um some of them think that um when you go to sell your practice it's gonna sell for one year's collection and um and i tell them that has to be insane what if you have two practices that collect a dollar a year and one makes one penny profit and one makes 25 cents profit how could two practices collecting a dollar be worth the same if one will make you a nickel a year and one will make you a quarter a year how do you answer that question when people call you over the phone and just say oh bob you've never been in my practice tell me what it's worth yeah well any good any good practice broker is going to uh they're not going to give a number so uh you know it takes a lot of analysis to do a good job to come up with an appropriate number so there are three ways to value a practice one's the income method one's the asset method and one is uh direct market data which is comparables okay so the income method the most common way people look at practice values and the way that most buyers and their advisors look at practice values is just to simply use a percentage of collections but that's a bad way to value a practice so you know the lender limit howard and has traditionally been around 80 of collections is what lenders will loan for practices so consequently that's been the upper limit of what most practices sell for i realize there are a few exceptions and we've been involved in some too i mean I’m in a deal right now it's at 96 so uh the uh that's been the norm but that's not what practices are really worth that is a rule of thumb just as you spoke of so there are two other uh income methods and you know the they go beyond the scope of this presentation today one is uh capitalization of excess earnings we find that to work about eighty percent of the time and uh i learned this uh among many other things from my friend larry chatterley ctc associates in denver he's done over 2100 deals also developed this as being the system that is being taught by the international business brokers association and dental practice brokerage and also roger hill with hill mcgill got involved in that and rogers had over 4 000 deals so uh there's a lot behind uh what we have there but the income method doesn't work all the time the asset method is not generally used and the comparables method or direct market data method is a good system but here's the challenge with that the challenge is that there's no reservoir of information of all the practice sales in the united states and nobody has got uh the tiger by the tail on that because there are over 100 variables that affect practice value for example is the practice closed i mean did the practitioner become disabled or pass away three months ago is it a chart sale is there an associate in the practice without a non-compete agreement and the list goes on and on and on you know are there two operatories or are there eight none of these things get reported what gets reported would be the sale price possibly the seller's discretionary earnings and the collections of the practice that's it so we can't use that data so what we like what i like to use personally is i like to use data from the pepperdine university business school and the ibba and some other organizations put together a market pulse report which is multiples of all businesses in america that have sold now dentistry is far more profitable and successful than general businesses you know 9 out of 10 restaurants fail you know you look at gas stations flower stores manufacturing businesses it doesn't seem like it would make sense to use those multiples but being very conservative as a buyer if you use multiples from that even using those multiples times sellers discretionary earnings which is kind of like net income you know you you take out all the expense for the four cell phones for the kids and the thirty thousand that's going to mom and the five thousand dollar ce trip to tahiti and you and you do all the normalization or what they call add backs um then we call it recasting frequently when all that's done the seller's discretion earnings if you use the multiples for general business that actually ends up being very good uh a very good multiple to use time sellers discretionary earnings to come up with practice values and and we rely on that quite a bit so um I’m very impressed by um your continuing education and your memberships and i mean you're like uh i mean the you can always sell a dentist who you want to work on you as someone you know who takes all kinds of continued education i met you at a broker's continuing education um you're a member of this like like the exit planning institute what do what is things like the exit planning and say what does that do for you as a dental broker well actually the main thing it does is it puts initials behind my name the most people don't don't know what a cepa is so you know they would have to do a little research to figure out what that is but i want people to understand even if they don't know what the initials mean that I’ve gone through the rigors of trying to be the best in my industry that i can possibly be and I’ve learned a lot from general business from the exit planning institute and from the international business brokers association that was not dental specific but what i can i can apply it toward the dental industry so it's been very very valuable especially international business brokers association to learn all these things from general business sales and general business brokerage that can be applied to dentistry i think that many dental practice brokers have too narrow of a focus and they are not reaching out in many places uh business brokerage is wild wild west no no ce is required and you know you've got all kinds of quality of service you know all across the board so one one reason I’m highly motivated i took one of those uh clifton strengths finders test you ever heard of that no yeah it's uh trying to think uh gallup bought them out anyways called clifton strength finder and there are 34 different traits and i took one in 2011 and the 34 traits learner came in number two i took it uh i think it was in 2018 and lerner came in number one i didn't want it to come in number one i wanted something you know more exciting to come in like strategist you know or something like that but i don't know i guess i always have had an appetite to learn more and more and be the very best in my industry that i can be and so that's why i jumped into uh attending practice evaluation study group and then got involved in helping put some programs together for that group the last couple years and why i became credentialed so i think that's the takeaway as you know is the person you're working with you know on the cutting edge of what's going on are they working hard to be better and i just seem to have a natural interest in wanting to do that so what is the um what is the uh demand now i mean if you go to mcdonald's you get a big mac friendly coke you go to a dentist you get a root canal filling in a crown um are most what are most of your calls are they older dentists like me at 58 uh thinking about selling their practice someday is it young kids um at a school that have had a job for three or four years um what is what does your day look like well uh i would say that we probably have about uh three to one or four to one buyer to seller ratio as far as contacts to our office four to one four to one buyer buyer to seller right there are more buyers like yesterday i was at a client's office and i showed him a list of 35 buyers i have for his practice I’m waiting for him to get me his profit lost monthly profit loss statements for 2020. we don't we don't want to you know start to market the practice until we have all the information and we we haven't even established listing price but there are a lot of buyers out there for practices and good locations even if they're not premium practices there are plenty of buyers in premium locations and that's mainly in the metropolitan areas and in the in the school cities there's a lot of saturation uh so you know there are a lot of buyers and conversely in the rural areas there are fewer buyers so um you know if we have but there's a lot of money to be made into rural cities serving patients we like to see um you know we've always paid a lot of attention to uh practitioner population ratios and for for general dentistry and for all the specialties but they're just so many more opportunities in rural communities that if some of these buyers would lighten up and not be dead set on staying where they are i think that they they could find a lot of fulfillment they could serve patients and they'd find these communities to be uh wonderful places well i mean it's all around the world i mean i just read an article this morning in india um all the rural population half of india gets 15 percent of the dentist and the other 85 percent of the dentists are all in the big cities i mean they come out of school um they've delayed their uh mating ritual where you know at the end of world war ii they were getting married at 16 17 18 they pushed that back a decade so they're coming out of school and they're now a doctor they're now single and you tell them to go go be as pretty as a peacock in a town of 1 000 and they laugh i mean a lot of the dso captains that have been on this show like rick workman of heartland says they're they're done with uh rule because when they lose a dentist on you know they said 10 years ago sometimes they'd wake up and 10 of their rural practices wouldn't even have a dentist working that day so they're done with rural so so when i hear dso people say oh we're going to be like walgreens and cvs we're going to take over all the dentistry it's like whoa whoa slow down spanky number one you won't get half of america in the rural because they're not even going there so now you're just down to the other half and the free enterprise owner operated dennis is a tough nut to compete against i don't even think they can get half of that market so I’m only predicting the dsos um who are sitting at 12 to 18 percent whether you're measuring by location number dentist or dental supplies i only see them getting a quarter of a market also because when they come out of school there's about six thousand a year and it takes them about five five years so that's six thousand in this year times five years that's thirty thousand dentists it takes them about five years to come out of school thinking oh i know it'll be great I’ll just go work for someone else I’ll get along i love taking orders and I’ll live happily ever after and then i quit that job because something's wrong because i didn't like half of it and it takes about five years before they finally hit rock bottom and the only reason they lose all their fear of the unknown of going into their own practice is because they have fear of the absolute known which is uh dentists lawyers physicians are not the type of people who love to take orders they're always the smartest person in the room they always think they're the conductor of the orchestra and uh it's just uh it's just it's just a process so we know rural is bad we know the millennials want the big cities until they change their mating habits and calls and all that stuff which isn't going to be anytime soon so so a lot of dentists listen to you right now are two things number one you're saying it's a seller's market because for every dentist selling you're saying there's four buyers in metropolitan markets there are more buyers than that that's just the ratio of calls we get every week which is a question you ask me but i would say for uh you know good solid practices with say four chairs uh minimum doing you know 700 000 plus annually in collections um with uh not a not a lot of especially work done in-house uh you know some of these buyers have more skill sets than the sellers so there's what i call production gap there they can these practices are more valuable to them if they can keep more work in house obviously these type of practices in metropolitan areas are in high demand and there will be you know 10 or more buyers for every practice like that now in the rural areas you know if we could get three buyers for one practice we'd be lucky uh those would be rural cities more than an hour from a metropolitan area ten buyers for every seller now you've been uh doing this for how long have you been in dentistry doing this well I’ve been doing this since 2003 and i may be the first person you've interviewed today that has a degree in dairy science and that's my background and uh grew up on a dairy farm and uh the farm that uncle willowbee purchased and uh came home took over 92 which means i went into debt to my parents and things were going great we got up to be in the top one percent of the nation in milk production and i received an international crop production award and i had also started another business and managed several hundred farm loan accounts for the federal government as an independent contractor and had a group of people working for me and i could see that when commodity prices went down that farmers would just borrow money uh and it would reduce their net worth and and uh we had a big investment uh in what we had and things were going great but i didn't think there was enough return on investment i had a few health problems and decided to pivot and change careers and i got into uh commercial real estate not knowing i would be going into dentistry was introduced to a couple dentists who needed new office locations after i got my real estate license and i helped them and then i got pigeonholed as a dental realty guy and i did that exclusively helping new startups relocations and satellite offices for a number of years and in the last uh 12 years or so i migrated over into practice brokerage and absorbed and went out and chased as much information as i could get to help me be good and what i do so uh that's uh that's my background and my history there well in your 20 years um how does the um seller's market buyers market how does how does it look today 2020 in a pandemic versus a year ago before the pandemic versus 20 years ago when you started well uh 20 years ago when i started there were still a lot of good startup locations for young deniston and metropolitan areas in Ohio and uh we developed some studies and some tools to help dennis decide where to go and the ones that follow our recommendations did really well we did about three to five times the national average in gross uh collections first year collections for startups uh you know health practices that we're doing you know usually 700 000 or more in gross collections their first year um some double that uh so uh you know i think we were helping helping them make some good choices but you know we filled up all those spots and so those opportunities don't exist anymore and um you know it on occasion that there's a new development in a metropolitan area maybe there's a new location that would work for a dentist but by and large the metropoli metropolitan areas are saturated with dentists so i would say it's driven more young dentists who want to own a practice undoubtedly driven more into wanting to purchase practices and increase the demand for practices for sale and i think kova just simply delayed everything you know there's maybe pent up demand by patients and individual dental practices to get back to the dentist if they weren't afraid of seeing of going to the office you know and and that's why some of our offices had such high collections in may and june when they first started back but i think there's pent up demand for practice buyers and sellers where there were some sellers that those practices normally would have gone to market but they couldn't go to market i think bank of america even stopped lending for practice acquisitions and there was just too much uncertainty so you have sellers that wanted to sell or were thinking about selling that it got held up so now that gets added to the normal you know number of practices that would normally be available for sale and then there was also pent-up demand by buyers buyers would have purchased practices back in march and uh in april and may but they just uh got cold feet and so uh you know that there there's as much or more traffic and practice transitions now as as there ever has been well in real estate like right now in Ohio what would you say for a residential home to compare what would be the most liquid home for sale would it be a three bedroom two bath would it be four bedroom three bath two car garage what do you think is the most liquid home for sale well i am a real estate broker but all my clients are dentists and i only do commercial real estate and i wouldn't be a very good person to ask that question i don't really know i don't follow that okay well so i was trying to make a comparison to what is the most liquid dental office for sell is it a three bedroom two bath two car garage is a four bedroom three bath three car garage is it four operatory seven hundred and fifty thousand a year one doctor what what dental office in the urban is the most liquid minimum four operatories um and uh i tell you practice buyers love buying real estate so if the real estate's available if it's freestanding space or if it's condominium space that's highly desirable you know we don't lack for desire we don't lack for demand so but the most marketable ones obviously like i said are in metropolitan areas all digital is you know a buyer can come in and they can buy new equipment they can buy technology and some of the sellers say well I’m not going to buy a digital pan because if the buyer wants to buy one they can buy one I’m you know I’m ready to sell i don't want to buy one and they can say that but quite frankly you know if if a practice is all digital uh especially if it's all paper uh paperless then you know that is a more desirable practice so i would say 700 000 enough really i think anything six thousand and up with six hundred thousand up would be good because if you stop and think about it howard you know if somebody's gonna buy a practice and it's a private practice purchase they wanna have enough income that they can pay the loan on the practice pay off their student debt put groceries on the table and and make it you know if you've got a practice and i suppose it could be sharply different in different parts of the country you know the cost in new york city are going to be way different than they are in in Ohio but if you at least in Ohio if if the practice is like collecting 600 000 or more the pie is just not big enough so so that's an issue and then you've got the whole thing about well uh if it's a largely fee-for-service practice and you're gonna have better patient retention if the seller stays on then the pie needs to be even bigger if you're gonna keep the the cellar on for a while to maximize patient retention you know you're talking uh you know 1 million and above at least 800 000 above for the the seller to stay on a little bit stay on a little while and get paid as an associate so that would be the sweet spot for practice deals in Ohio would be that uh four to seven operatory you know 700 000 to 1.2 million all digital that that would be it have at least four opportunities and up to seven operatories yes and um collecting at least 750 000 a year but up to how much a year oh you know whatever part of it depends on the current production of the buyer you know if they're cranking out a million dollars a year now obviously they can buy a million dollar practice so uh i talked to two dentists this morning uh one is is producing 200 000 a year as an associate bad okay we got another one producing uh a million dollars a year okay so they can buy different size practices it's going to be dictated by the lender you know the lender's going to have some say in that but but just a range 750 up to one one and a quarter that you know is probably what a lot of buyers could handle on their own you know it's going to be hard for a buyer to buy a practice without they could buy a practice larger than that has an associate you know you certainly go up to 2 million [Music] and that would be maybe a first-time buyer could buy a practice up to two million uh you know if they're a super high producer they could possibly and with no debt they could possibly do it on their own but you know those are going to be the rock stars well you said the most profound thing to me um when you mention the production gap because 32 years um in fact I’m uh um i I’ve been seeing this forever i mean a dentist will go buy a practice for 1.25 million because he thinks this dentist these full mouth cases are just you know basically just a bunch of uh crown and bridge and all that he can do it but he doesn't realize he can't present and sell a case that big i mean when we look at sells case I’ve been i just hound one number over and over and over for my uh for the last year and uh dentists don't um there it's it's a different culture they don't like the word selling they tell you they don't like the word selling they tell you they don't want to be a salesman it's like okay spanky you are going to believe whatever you tell yourself but the average new car price in america is thirty three thousand five hundred and sixty dollars according to kelly blue book in usa today and the average American will buy 13 new cars by 876. well i guarantee you 95 of all the dentists in america have never sold one case for the price of a new car which their patients will buy 13 of them and they'll buy 13 new cars in their lifetime in Ohio and the insurance companies delta dental and blue cross and blue shield aren't going to buy you your car and you buy it with your own money and they always offer financing only 10 of the cars are sold in cash 90 or finance usually for 60 months and my boys was like oh i i don't do that i don't i know you don't do that but when you go buy an office collecting a million 250 000 because that boy in there knows how to do it and and he works four days a week but friday is the big case day and uh my god they won't even do the anesthesia because uh they don't want them they they don't want the liability of all that they have an anesthesiologist come on they put them down and then the patients oh it says oh my god if you're going to put me to sleep do the whole case and they they don't say oh your case bob will be 33 000 they say bob we could actually completely redo your mouth you'd have a hollywood smile for just 480 a month for 60 months bob does that sound like something you you want to commit to today and bob's thinking 460 a month to have a movie star smile that's the same feeling he gets when he's bought 13 new cars and then you go buy this big dog practice and yes you can prep a crown and you can make a temporary and you got a good lab but you sure as hell can't present and sell and close and collect on a 33 000 case i know dentists who've done it every friday for three or four decades and they're in a medical dental building with eight other dentists who have never done it one time in their life so the production gap of not being humble enough to know what the hell you don't know everybody is always gonna tell you what you know i mean uh you know the minute you meet uh some people they're gonna let you know all the all the things they're the most proud of but dentists physicians lawyers they never tell you what they don't know another thing is what are they referring out a year i mean is this guy referring seven molars a month to an endodontist at a thousand bucks a piece and you love molar um or does you know i mean you gotta match this stuff up and the number one genius i ever saw in my life was back in um i think it was 1990 in palm springs me and my buddy mike tatula we we've laughed about it for 30 years this young dennis friend of us and he didn't think he had enough money to buy a big practice he didn't think he could buy a million dollar practice so um he thought you know the he could only afford a really small cheap practice he found some 70 year old guy in palm springs that didn't do root canals he didn't do anything he just patched everything with amalgams and he had this little patching amalgam practice for 50 years and this guy buys it and every single day for the next for the rest of his life four peop four patients come in with some modbl amalgam patch job for 30 years crumbles apart and all he would do is give a block and do a single unit crown make it temporary he did four crowns a day monday through thursday his whole life i mean he just bought the perfect practice and so that's a case where he bought this little nobody nothing practice and it was a million dollar practice with no work no effort just no nothing so knowing what that dentist is producing collecting diagnosing referring and being humble enough to look at that skill set and say do you have this skill set can you do what this says that that's that's a big part of the deal yeah yeah so we call that the production gap and so we actually look at those numbers on a practice like for example we've got a listing right now it's in a it's in dublin Ohio where merffield golf course is jack necklace you know and uh it's a nice community and this dentist he has 29 clinical hours per week and he sends everything out need an extraction it's like oh let us make an appointment to go see dr so-and-so for you and he stays right on schedule he farms everything out so we take a listing of all the specialty procedures and have the dollar amounts of everything that he sent out and so then when buyers look at that practice they can get a good idea of the amount of work that they're going to be able to keep in-house and and be able to serve those patients and profit from from that work so the other thing you said another thing dennis i always want to know is like let go back to the house i mean obviously in phoenix if you have a three bedroom two bath or um four bedroom three bath three car garage i mean that that range three bedroom to four bedroom that's the range one of the reasons the nfl players have such high you know fifty percent of them lose all their money and go bankrupt get for every year they were in the nfl so they played the nfl four years it only takes them four years to lose all their money because when they get that big paycheck they go buy a 12 bedroom seven car garage with lamborghinis um you know and and they don't realize that when they blow a meniscus and have to sell that 10 bedroom home it's not liquid and people who can buy a 10 bedroom home they might not want your 10 bedroom home they might want to just build their own so it's not very liquid and real estate people will say italian arizona even though you're in a desert if you go put 30 grand into a swimming pool you're not going to get that 30 grand back out of your house it's not going to raise your selling price for the price the pool but you you said that digital was a liquid investment you you you mentioned digital do you wha if you're an older dentist listen to you right now by older i mean anyone who's an hour older than i am is old I’m not old but if you're an hour older than me you're damn old um what money can he invest in his practice that will he'll get his money back and a return on investment and make his practice more liquid versus that's just not going to do anything to affect the cell what what are the best things to invest in well you got to put the glasses on look through the lenses of um everything that generated the numbers for that practice is what that buyer's looking at and the technology that's in that practice now is what was used to generate those numbers so you have to keep that in mind you know when a buyer starts saying well they don't have digital rate you know they don't have digital pan well yeah this was generated without a digital pan okay so if you want to uh turn in insurance claims and be able to use that radiography in a different way you know that may improve that's going to improve your efficiency and all that but that's not what the numbers represent so i would say it's kind of on on a timeline so if somebody wants a practice owner wants to sell in the next year there's probably not a lot they can invest in um i had josh austin come in you know he's uh a dentist in texas and he spoke about some technology uh once and uh you know there are some low dollar ways you can get uh uh technology that you can say that you're you've got digital radiography maybe get into it for thirty thousand dollars without costing an arm and a leg so somebody wants to sell today or tomorrow you know an investment is probably not worthwhile but if you're going to be in practice for at least another year or two you know you really should be digital and you don't have to have uh you know i I’m not a person that's going to tell you if you should have the nomad unit or you need to have the bitewing arm in every operatory i mean that's more clinical that's not my wheelhouse of expertise but i can say if you can do some low dollar investment in digital radiography that would be well worth it now some practice owners think they know what they need to do to spruce up their their offices and they may be correct and they may not be correct we've got a seller in northwest Ohio that i think they put new carpet down in all the operatories and walk walk hallways administrative areas and you know i never recommend carpet i mean I’m not it's not up to me but i just i prefer not to see carpet in operatories so sometimes they do things that they think are helpful but they're not really helpful so it's uh it's like you said howard you know people don't know what they don't know and sometimes dentists they don't want you to know what they don't they're not willing to admit what they don't know and they're not an expert in everything but if they would you know seek out some qualified advisors that could help direct them i think they could save cost and whatever they do invest they can invest it more wisely well i gotta tell you the carpet story where it's just so ridiculous it's hard to believe but going back to it wasn't i got out of school 87 it wasn't 87 80 and it was 89 a buddy of mine bought an old guy out in phoenix and he uh called me up and he said hey um will you uh any chance you come over friday night and help me rip up this carpet in the dental office we're gonna tile it over uh over the weekend so i went down there with a couple of my babies i forgot how many i had time i know i had at least two or three because i can remember eric playing with it but we pulled up that carpet and we each had a couple babies running around and they were kicking the balls of mercury that would roll into the wall and split into it was like billard balls and this guy had this carpet forever and um i mean it was balls of mercury the size of dimes nickels and and we were actually shoveling these balls of mercury and of course back then i mean what did you do with it you don't sound like you took it to some intelligent place but i mean it was just it was just it was just another crazy time but after i saw that i can assure you there should never be carpet in anything that has to do with infection control and by the way dentistry is an embarrassment your your um your great great great uncle would be embarrassed today because i mean i had this happen to me where um i went to chandler memorial hospital uh with a surgeon and we you know we park in his uh uh his uh little sports car and he's got his asex shoes and we walk across the parking lot go in the elevator go up and he spends 15 ridiculous minutes washing his hand like it's some religious cold and then gloves up and he goes in to do surgery and he thinks he's all sterile and then you go across the street and a patient of mine got me an intel tour and intel god everyone goes in a room they take off all their clothes they get in a uniform they go in another room they're wearing uh looks like they're walking on the moon breathing through respirators the air is filtered at one part per billion and the quality sterilization infection controls zero zero tolerance to six sigma is when they're making a chip for your iphone and then you go across the street to the hospital where the one thing doctors never want to talk about is how many patients die in their system each year that has nothing to do with their disease and they're not transparent about it and the cdc has tried to get them to be more transparent but estimates that two to three hundred thousand americans die each year when they go to their hospitals and the fact that um when grandma's in the hospital that her children and grandchildren you know i mean think about it phoenix arizona 3.8 million people everybody dying of some god-awful diseases all in one building and you decide to take your three kids to go visit someone dying in that room are you completely out of your flipping mind and then these kids the rest are like they have mrsa they have this and that polyphasia by the time you're on five different prescriptions you dropped out all the time that that was that's my biggest fear of free healthcare when i hear canadians saying oh our healthcare is free dude it's a machine that eats 300 000 people alive would you like me to give your grandchildren free tickets to go to a carnival that kills 300 000 people a year i mean hopefully this coven 19 thing will wake people up hopefully they'll just ban anyone visiting a hospital unless you're sick and dying and actually have to be in there and then when you read American literature i mean all the smart people a century ago all said i don't care how sick you are don't go to the sanitarium because i mean they didn't know the microbiology theory before you know your great-great-great-grandfather and people would deliver a baby then go amputate a foot and and they looked at the mortality rate of having your baby in the hospital versus at home and everyone that could read or think independently knew to stay the hell out of way there and a century later it's not even that much better it's still a disgusting uh cesspool of infection uh they don't even try and that's why when they were talking about closing down dental offices and for this pandemic I’m like dude we dealt with hiv 30 years ago and we're a league ahead of so many places including many wings of a hospital i mean you just sit there in a hospital thinking god i would never allow this in my dental office just opening drawers and cabinets with their gloves on and all this crazy stuff um so young kids they um i don't know what's different about millennials but they're they're um they're different i mean they're um they're having less they get married a decade later they have half the number of kids um they don't work for one company for life like my mom's brother in my backyard here you know he got a job at mobile oil when he was 16 and he retired there as 65. they don't do that i mean all over wall street the millennials only work one to two years and then they change jobs even among fang stocks where they're throwing the most money at them stock options everything they've got um facebook apple netflix google uber they they just throw everything at him and they only stay one or two years and um that's what i see with associate ships and it seems like they have in it takes them five years of having five to seven horrible jobs before they finally uh say screw it I’m gonna work for myself is that how you see it or do you not see it that way i do see it that way and i think there's a reason for it when i used to present to dental students a decade ago i would ask them how soon do you expect to own a practice and the consensus was the majority was about two years and over the last several years when i asked the same question the response is five years and i think um that corporate dentistry has gone into a lot of schools and basically shared with students that you know they're going to have so much student debt it would be wise for them to take an associate's position with their company and they can't afford to own a practice and that's not just me guessing that's been repeated over and over by many dental students to me now you know i i was working on a practice today and after a buyer purchases this practice and makes the practice loan the seller's discretionary earnings pre-tax is going to be 468 000 a year okay so can you afford to uh you need to work for corporate dentistry because you can't afford to uh to uh to own a practice you're going to make 120 150 maybe 180 000 i realize there are a few that make more than that but but you can better afford to make your student payments making 150 000 a year or 450 000 a year which is it so you know it but but all this has kind of put fright in them uh some fear and uh so they've just simply delayed and there are there are dentists that are practicing right now that uh it was an older practice owner locally a couple years ago that was actually wanting to buy another practice and he and another dentist were uh talking and they they asked each other how much tuition was when they first started dental school and this one dentist who wanted to buy buy this practice that we had listed it was a thousand dollars for the whole year dental school was a thousand dollars for the whole year and by the time he graduated and Ohio state was on quarters and it was a thousand dollars a quarter and now you know what the debt level for students is so things have changed a lot because part of it's real part of its perceived concern but i do see them working in other practices once they learned the practice management aspect of things and they end up doing some of the administrative work that their employer that maybe they don't even get paid for it's like why am i doing this uh getting paid this much i could be doing it for myself making far more and when you um you're in like practice valuation groups and i i always find it interesting how different dentistry is than other um than other types of uh products like like com tell my uh homies the difference between like selling a medical practice if they would have been a physician instead of a dentist it's a different beast isn't it right you know so much of medical is controlled by hospitals now that they're just there's not the opportunity you know i think a lot of uh bright minds have gone into dentistry that might have otherwise gone into medical because the income and the liability in medical is uh you know lower income and greater liability and so maybe that's why they chose to go into dentistry into medical so we've uh you know I’ve assisted some medical practices in real estate but i haven't i haven't sold medical practices so I’m I’m certainly no expert in that but i do see that uh that obvious choice that some uh students are making to to choose dentistry over medicine for those reasons and what it um so banking um it all comes down to uh the the bankers and uh my gosh i actually liked it better in the old day because in the old day the seller carried the paper so you'd agree that you're going to buy this practice on a dollar they always charge 10 interest for seven years but that dentist was involved and he was incentivized because he wanted you to be successful to pay the nuts the mortgage each month so if you had a problem or an upset patient he had skin in the game but now you're just selling to a stranger and you're just going to take the money and run um do you um do you think that's a better system or did you like it better in the old day you know when you get down to it money is about little green pieces of paper with pictures of dead presents on it so it doesn't really make any difference where it comes from uh and you're going to owe somebody so for the sellers it's a good deal if they can get their money and get out of it but here's the dirty little secret i i shouldn't call it dirty it is i mean it is something that people don't talk about too much and that is i think that dental practice lenders and i get along great with them i mean i i was a moderator for a group of the top lenders here in the country uh a little while ago the ibba the international business brokers association hosted it and i moderated it and i get along great with these folks but they understand that just because a lender will loan x amount for practice doesn't mean that's what the practice is worth so there are three sources of money to pay for practice you've mentioned one of them seller financing the other one is take money out of your bank account and the third is uh you know from a lender i think that lenders are financing probably typically you know around 80 percent of what practices are worth and that's what a lot of them sell for because uh it's a hundred percent seller financing if uh practice is really sold for what they were were worth we'd see a lot more sales in the hundred percent range and there would be a little seller financing involved with it because lenders don't want to take that level of risk you know you stop and think about level of risk if there's an sba loan small business administration loan for anything let's say it's for real estate if you're going through an sba lender then they're going to the lender's going to finance 90 of the loan if it's a conventional lender they're going to finance 80 percent in other words they're not going to finance 100 lenders don't generally finance 100 of what a practice is worth lenders don't establish the value for practices they just see if the number that the buyer and the seller agree on will cash flow their cash flow lenders so right now um um that's the other question i I’m sorry we've gone over an hour and i still got so many questions for you um I’ll try to wrap it up pretty quick but um the dentist one of the first things they always ask is um well if I’m gonna buy this thing and I’m 25 i don't want to pay rent till I’m 65 i want to own the real estate and then you get into the question where are you in the real estate business or even the dental business maybe renting next to a busy grocery store for 40 years is better than going three blocks down the street off the four-lane intersection and owning the land and building of this little uh house i mean how do you coach and plus the the thing that's um that we both have in common is um people are very emotional about dentistry and pain and all that stuff and people are very emotional about finances they never want to talk money or finance and all this stuff like that but i think when they want to own their land and building of their practice it's a very emotional reason more than it is a financial logical reason how do you advise them on that complicated thing well of course if a buyer is going to purchase a practice uh you know the practice uh the office could be owned by the practice seller or not owned by the practice seller and if that property is leased and the lease is reasonable we don't uh the kpi key performance indicator for uh real estate costs is three to or excuse me five to seven percent of collections you know if that's in in that range uh or lower then they're good to go you know if you're gonna if if you're gonna make a good living from this practice and it's a great investment even if it's leased property you can smile all the way to the bank you don't have to own that property conversely if you look at what a practic what a real estate loan would cost you versus a lease payment if you have the option to lease or purchase i can see why somebody would want to purchase the real estate because their their real estate cost might actually be lower per month than what the rent would be and they would control their own fate and they would establish some equity in the property so that makes sense as well now on a lease of course the lease has to be assigned the assignor is the practice seller and the assignee would be the practice buyer so this the signer is not the landlord landlords don't assign leases uh the practice sellers assign the leases and the landlords have to approve it so i would highly recommend that when the practice documents are signed in the real estate uh paperwork is put together the lease assignment that the asset purchase agreement for the practice say that the sale is contingent upon the lease of the dental office and go ahead and get that asset purchase agreement signed don't leave it unsigned just because that contingency hasn't been met put that in as a contingency and then on the real estate assignment uh the lease assignment you put in there that the lease assignment is contingent upon the practice sale that way you can get that document signed because as you go to closing on a practice you won't have everything signed you don't want to have paperwork that's unsigned because they say well we're not going to sign a lease assignment until the practice sells you don't want to do it that way use it as a contingency in the paperwork and get everything signed ahead of time man i could listen to you for 40 days and 40 nights I’m just sitting there trying to think of uh what uh would be a smart question to ask you that my homies want to know and i uh I’m kind of running out of um what do you um we talked about insurance i know there's a lot of emotional stuff going on right now because the insurance companies didn't pay for ppe so now a bunch of dentists say I’m gonna drop I’m gonna drop insurance it's like okay well if you want to see a lot more or something try to get the government to subsidize it the employer to subsidize it don't ever tax it or regulate it and if you want to see something you want to see a lot less of something raise the prices tax it regulate it but my gosh um dennis just don't get it like I’ll say to dennis say well what's your favorite procedure that you just love to do and they'll say a crown and I’ll say okay what's your crown feet and they'll say a thousand and I’ll say okay well what are you gonna do with the feet next year i think I’m gonna raise it oh oh so you hate crowns because if you raise the price price is the most elastic effect on demand that's why you might have noticed they sell less porsches and ferraris than chryslers uh and plymouth and um my gosh um price is so emotional to them um and then the other thing with the young dentists they're the the a lot of the dentists are they're so obsessed on the price of the practice and then i say well what is the interest rate on the loan and how and they don't even know and I’m like well dude the interest rate on the loan on a 10-year 15-year loan could swing the total cost of this loan by hundreds of thousands of dollars so again they're emotionally locked in on the practice price because they don't know the total cost of the of the asset transfer with interest i mean it's just an emotional subject i mean um it's just tough but is there anything that you thought we should talk about today that i didn't bring up on insurance i would say that uh it's important for a buyer to know if they're going to be able to uh take on some of the insurances that the seller has for example in Ohio no buyers can now no buyers can pick up delta premier well delta premier has a higher reimbursement rate on a lot of procedures so you know buyers might want to discount the collections of the practice a little bit if they're you know comparing what what they could expect compared to what the the seller was producing also buyers should be aware that the it's important for them to get credentialed right away if they're going to buy a practice because a lot of times it takes longer than they expect even if they got the same insurance where they're an associate in another dental office in the area they think oh it'll be nothing for me to get credentialed don't it's a whole new ball game if you're going to be an owner so they need to get after it and as far as what you said howard about being price obsessed you know it is uh more buyers the majority buyers come back to me you know when it comes to price and and and I’ll tell you right now we sell most of practice we have listed at list price which you know i think is very reasonable because when i come up with a valuation uh we don't call them valuations we call most probable selling price it should be the same for the buyer the seller you know we don't inflate it because we're working for the seller we want good numbers to substantiate that price and so you know they'll come back and they'll say well i think it's too high or my advisors same thing you said they don't even know what the interest rate is they have no basis so if a buyer is going to contest a price they need to do their homework they need to have numbers to back it up you just you know they're not out buying a 20 000 car you know they you just can't talk about the blue sky you've got to have some uh foundation for what you're claiming and the amount of money if a practice sells for 50 000 more 50 000 less you know over the life of that practice they're going to be making millions and are they going to blow up a deal or are they going to let their cpa or their attorney blow up a deal that it could be the most wonderful opportunity for them uh just over a small amount of money so they do tend to be price obsessed and i think they need to to back off well they uh it is an emotional topic and i thought it was just amazing having you come on and talk some calm common sense common sense isn't very common but I’ve known you for a long time and you are an amazing man and thank you so much for coming on the show and sharing your thoughts and you said people could get a hold of you um by your email and your phone number uh so it's uh bob brooks so it's b brooks at practice endeavors.com and just go to practiceendeavors.com and it's right there but um bob thank you so much that uh for all that you've done for dentistry and continue to do you're one of dentistry's thousand points of light and i really appreciate all you've done for dentistry and for coming on the show today well thanks howard and thanks so much for what you've done and for what you're doing all right you have a good day okay you too bye-bye
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