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VIDEO - DUwHF #787 - Steve Bilt
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AUDIO - DUwHF #787 - Steve Bilt
Steve Bilt is the Chief Executive Officer at Smile Brands Inc. (SBI) and OneSmile, LLC. He co-founded Smile Brands in 1998 and OneSmile in 2015 and in 2016 combined the two businesses. Steve was integral in SBI’s three initial platform acquisitions and led the acquisitions of Monarch Dental Corporation in 2003 and Castle Dental Centers Inc. in 2004. In addition to these transactions, Steve oversaw the development and operationalization of 150 de novo practices at Smile Brands and each of OneSmile platform acquisitions. Steve also serves as Chairman of the Smiles for Everyone Foundation.
Smile Brands and OneSmile have 5,500 employees and affiliated providers in approximately 400 locations across the United States. The Smiles for Everyone Foundation has established international outposts serving six countries in South America, Asia and Africa and conducts ongoing events throughout the United States.
Howard Farran: It is just a huge honor for me today to be podcast interviewing Steve Bilt, the CEO of Smile Brands Inc., SBI, and OneSmile, LLC. He co-founded Smile Brands in 1998, and OneSmile in 2015, and in 2016, combined the two businesses. Steve was integral in Smile Brand, Inc's three initial platform acquisitions, and led the acquisitions of Monarch Dental Corp in 2003, and Castle Dental Centers in 2004.
In addition to these transactions, Steve oversaw the development and operationalization of 150 de novo practices at Smile Brands, and each one of OneSmile platform acquisitions. Steve also serves as Chairman of the Smiles for Everyone Foundation. Smile Brands and OneSmile have 5,500 employees and affiliated providers in approximately 400 locations across the United States.
The Smiles for Everyone Foundation has established international outposts serving six countries in South America, Asia, Africa, and conducts ongoing events throughout the United States. My gosh. All my homies listening to you right now, they find it so hard just to manage their own office, and then here's a guy like you managing 400 offices.
I think these are amazing podcasts, because it might be a young kid wanting to meet the CEO of the, because you guys are the only ones really providing jobs to all of our graduates, and I have to thank corporate dentistry for providing so many jobs for our colleagues when they get out of school, but then the other ones have started their own office, and my gosh, just think all they could learn about how to manage their own office from a guy who's managing 400. They probably want to know what the hell do you eat every morning? Is it Wheaties?
Steve Bilt: Well, yeah, it's interesting, Howard. I think the big challenge is, you know, someone who's thinking about running a dental office doesn't think about being their own dental assistant. They don't think about being their own office manager. They don't think about being their own receptionist. Then when they run multiple dental offices, you go from one to two, that's hard, because you've figured out the division of labor and how to run one dental office very successfully. You go to two and you tend to just work harder, run faster.
When people go to three, you know, you can't divide yourself that many times. When you get to 400, you know, I'm not doing everything. I mean, quite frankly, I'm not doing near everything. Some would say I do very little, if things are going well, right, because we have experts in every area. Just like you have a superstar receptionist or a superstar office manager, it makes perfect sense, we have superstars running multiple offices and superstars running regions, and superstars running cental business offices and call centers, and so it's really, my job tends to be more about organizational design and development than it does quote unquote "doing everything."
If I'm doing a really good job building our team and developing our organization so that we have experts in every area, then it's really no different than anyone else's job. That's just what I have to focus on, and that hopefully becomes an area of expertise. What weaves that all together becomes culture, and I'll talk a lot about that whenever you ask me almost anything about building a business.
Howard Farran: How long have you been in dentistry?
Steve Bilt: 1998 is when we started, May of 1998, so we're going to, next year we'll have a very exciting May of 2018 to celebrate a big anniversary for us.
Howard Farran: That'll be your 20 year anniversary.
Steve Bilt: Yep, 20 years in dentistry.
Howard Farran: What was, what percent of the U.S. dental market was corporate dentistry in 1998, and what is it now? What has it done in 20 years?
Steve Bilt: You know, it's always a little bit of an elusive estimate to make, but back then, we were estimating about one and a half, two percent, was what you'd call, you know, organized in the DSO world. Now, just members of the ADSO, right, the Association of Dental Support Organizations, represent about eight percent of the industry, and then there's lots of smaller, as you know, folks who have two, three, four, five, six offices. My guess is that same two percent back from '98 is probably pushing between 15 and 20 percent right now.
Howard Farran: In 20, so you thought it was two percent in '98, and you think it's what percent now?
Steve Bilt: It's probably pushing close to 20 now.
Howard Farran: 20 percent, oh, but you said now eight percent of the dentists are members of DSO.
Steve Bilt: Eight percent of the DSO, eight percent of the industry is represented by members of the ADSO, the Association of Dental Support Organizations, so the ADSO members are about eight percent, give or take, of the sector, and then my guess is about 2x that or better is a smaller DSO.
Howard Farran: Where's the ADSO located?
Steve Bilt: No, that's the Association of Dental Support Organizations, so it's the industry trade group for the DSOs.
Howard Farran: Right. Are they in Chicago too, like the ADA and, where are they located?
Steve Bilt: No, it's a small organization that's more volunteer-led, so it's, and some professionals, right, so across the industry, so it has an executive board made up of the leadership of the DSOs, and they have an executive director.
Howard Farran: In 20 years, it's basically gone from two percent of the market to 20 percent of the market. That's 2018, so let's go to 2038, 20 more years, so it's gone from two to 20. What do you think it'll go from in the next 20 years? You think it'll go from 20 percent to what?
Steve Bilt: It's a really good question where the logical end of that, that exponential growth rate is. There's one way to think about it, in my perspective, is there's always a place for what DSOs do, and the level of support they provide for dentists, and there's always going to be a place for private practice dentists, and I also think the industry is going to organize other ways, as technology advances, for private practices to continue to be more and more competitive. Your forum is a great place for them to share best practices.
There'll be ways to do purchasing less expensively. There'll be lots of tools and techniques to develop more competitively, and the smaller, I don't want to use the word boutique, but the private practice mentality is always going to be something that lots of consumers respond well to, so I think there's a place for everyone in the industry.
I think the biggest opportunity, as you know, is the percentage of the country that's not in regular care. That's the horrible part, right? You talk about it all the time. You know, add six and a half years to somebody's life treating perio disease, and then throw that up against the stat that 45% of the country saw a dentist last year. The opportunity is to create more ...
Howard Farran: What percent saw a dentist?
Steve Bilt: The ADA stats I saw 45% of the country saw a dentist last year.
Howard Farran: More than half didn't even go to the dentist.
Steve Bilt: Didn't even go to the dentist. You think about the opportunity for all of us. The opportunity for all of us is to raise that number. It's a critical, obviously, overall health issue. You think about DSOs opening up, hopefully, part of the market for other folks. You think about private practices doing that. You think of all of us working together to raise that bar. That's the real big opportunity.
It's not a scarcity mentality, fighting over a fixed pie, it's all about expanding that pie and creating more and more awareness, getting more and more people engaged in the category through lots of efficient models. I think of it kind of like, you know, you can go to industry you want, go to retail, go to restaurants, right? You don't think of retail as a single category. You don't go, "Who's a better retailer, Walmart or Nordstrom?" Right? You go, "What are you looking for?" Right?
Are you looking for something very value-driven? Are you looking for something very unique? Right? Then you think about the category based on the consumers that want to access it. That's how I think about dentistry. Dentistry hasn't created models so that everyone is accessing it. That's a huge opportunity for all of us, in my opinion.
Howard Farran: Also, within those industries, sometimes your Walmart shopper will go to Nordstrom's for a prom dress. Sometimes you go to Taco Bell because you only want to eat two quick tacos for a dollar, and sometimes you go to a sit-down Mexican restaurant for $7.00 for two tacos. I want to say one more thing that I like about corporate. Isn't the oldest corporate dental DSMO Affordable Dentures?
Steve Bilt: You know, it's an interesting question. I don't know how far back they go.
Howard Farran: I think they go ... Can you look up when was Affordable Dentures started?
Steve Bilt: Affordable goes way back, and then Western, out here in California, goes back ... I think they can trace their roots back about 100 years, actually.
Howard Farran: Yeah, they're both 100 years old, but one thing I want to point out to my homies is that what I loved about Affordable Dentures is dentistry has always had a problem of focusing on the middle class, the suburbs, and the rich. Affordable Dentures saw this total neglect for all these poor areas, and Western Dental in California, everybody wanted to go to Beverly Hills.
Western said, "Well, here's a lot of poor areas." I see Aspen doing that today, Aspen purposely focusing on underserved poor areas, so there's a lot of great business acumen. If someone, so how many corporate DSMOs are there? How many?
Steve Bilt: It's a great question. The ADSO is about 35 members. I think then it's how you classify it from there. There's, I have no doubt there's 100 of them out there, of varying sizes. My guess is it's probably a significantly higher number than that.
Howard Farran: You guys are the big boys. How many ... What would be the fewest number of locations for the smallest one of those ADSO members, those 35 members?
Steve Bilt: The ADSO members? Probably in the 15 to 20 range is probably the bottom of that ...
Howard Farran: 15 to 20? Okay.
Steve Bilt: Yeah, it's probably about that list, and then you get the, you know, a lot of folks in the smaller scale. Howard, you said something earlier I think is really interesting about these various competitors and how they went to market. It's exactly what I was talking about earlier, which is you have a need in the marketplace that isn't being met, and then a business organizes in a way to meet that need. The ones that are really successful in doing it get very focused on their business model.
You think about an Affordable Dentures, it's a beautiful business, and they've really honed their model to deliver their service very efficiently. Western did the same for years. Aspen does the same now, you know, Pacific, Heartland, Smile Brands, we do that. We try to stay very focused on what is our value proposition, and then get better and better at what we do, to be good. That's where private practitioners can be extremely successful.
They focus on that value proposition for their consumer, and they deliver a great service and a great [inaudible 00:11:18] so there'll always be a place for them as well. Again, it's all about this, do we have enough models out there to take that 45% and make it 75%, make it 85%? I mean, that's the opportunity, and then everybody's, you know, quote unquote, "too busy," which is a good problem.
Howard Farran: Even, you know, I cut my teeth, I learned my business. My dad owned Sonic Drive-in franchises, and he bought his first one when I was 10, and his ninth one when I was 20, and look at hamburgers. They just, something as simple as a hamburger, how many business models are there? In & Out, Sonic, Ar- I mean, just, I mean, there are so many. No one is ... It's always evolving, it's always changing. True or false? A lot of people say that in the DSMO ... Do you call them DSOs or DSMOs?
Steve Bilt: Just DSO, Dental Service Organizations.
Howard Farran: A lot of people say that they're, two thirds of the dentists are female, 65%.
Steve Bilt: It's not quite 65%. I think you could probably look at new dentists coming in, and you're probably pushing, you're definitely pushing over 50, but in terms of the overall base, you know, at least in our world, I don't know everybody else's exact base, but I'd say we're about 50/50.
Howard Farran: You guys are 50/50, and that's what's coming out of the dental schools, basically, 50/50. A lot of people are saying that millennials are different than baby boomers like me. I'm 54. A lot of people say, "Well, you know, your generation wanted to own your own shop, own your own business, and wear all those hats," because when you own your own business, it's a lifestyle. It doesn't stop at 5:00. I mean, sometimes, if I ever got a phone call at 5:00 in the morning, that meant one of my employees was calling in sick. I mean, it's a total lifestyle.
A lot of people are saying that the millennials, a lot of the millennials, don't want the lifestyle their father or their mother had. They want an 8:00 to 5:00 job. Other people say that's not true, they want to own their own building, but they have too much student loan debt. Do you think the millennials coming out have a different view on practice ownership than the baby boomers before them?
Steve Bilt: In my experience, that's been a little bit overrated, sort of the mindset shift, or the, you know, the next generation's the one that's going to take us to hell in a hand basket. I think that's been happening probably since we left the caves. It's always the next generation ...
Howard Farran: Right.
Steve Bilt: Doesn't have hard work, doesn't want to do all the ... You know, I haven't noticed that. We bring in young dentists, they're hardworking, they want to serve patients. Actually, in my experience, dentists were always ... One reason I've stayed in dentistry 20 years, I love dentists. They're very big-hearted, hardworking people who want to do the right thing and want to work hard. I haven't seen anything change in the mindset of people coming out of dental school. Just haven't.
You've seen some demographic changes, like you alluded to a moment ago, skewed more towards female, which is great, and you've seen a big change economically, in terms of, you know, people graduating 20 years ago with no debt, and people graduating now with half a million dollars in debt. That certainly changes how quickly you go into private practice. The other thing that's changed is there's more options for them. It used to be, go find an associateship or buy someone's practice. Now, there's lots of places to go work. I think it's just options that have created that.
I haven't noticed a lower work ethic. I haven't noticed anything of the sort. Is there a push towards one to own? Maybe. I think you have more models and people look and say, you know, "I'd like to try something else." You look at like the physician models. There are so many, what percentage of physicians are quote unquote "employed" in another organization? It's a much bigger number.
Dentistry organizes in a way where you don't need to do that as much, because there's not as much outside coordination, if you will, between a hospital system and a payer and some of those things. Dentistry, it'll always have, I think, a more accessible private practice model than you might see in medicine, but I just think people like choice, and then they find what fits them well.
We have tons of, I mean, I sign anniversary cards every month here, I get a big stack of them, and I can tell you, I sign 20 and 30 year anniversary cards for dentists by the handful every month, because people settle in the model and they really love it, and it's right for them. Others, you know, have moved on and opened private practices, and they're very successful doing that.
Again, like I was saying earlier with the retail models or the food models, there's just always going to be, in a healthy market, there'll be lots of different choices for providers, and lots of different choices for patients. Again, I keep going back to that. If 45% of the country's in regular care, we've got to have our minds open to the fact that more models and more choices is going to be better for everyone.
I mean, the country overall, the country's overall health, if we really believe in dentistry, which I know I do, I know you do, and I know people that are taking the time to listen right now certainly do, then we've got to get that service to be more ubiquitous than it is today, and so, more models, more efficiency, does that.
Howard Farran: Business in three words is supply and demand. What is your core competency? What are you seeing that American patients want and need, and what is your focus? What are you guys trying to do?
Steve Bilt: Our biggest mission is to say dentists, sometimes the variety of your capabilities can be your biggest detriment or roadblock to success. Dentists are incredibly smart human beings and they're incredibly capable human beings. They can do lots of things, but that doesn't mean that lots of things are their highest and best use. I talk to people all the time, and say, you know, I understand a bit about dentistry. I understand a bit about the business of dentistry, but my ability to actually do dentistry is zero.
I can't do dentistry, so there's no way, no matter how much time I spend around dentistry, no matter how much time I spend talking to you about dentistry, I can't do it. You have these people with these gifts that were given by God, right, in their hands, to do these amazing things. Then they've taken that skill and they've been trained in it, honed, licensed to do it its highest and best use.
If a dentist is spending half of his or her time doing administrative work, there's someone who can do that, let's just say equally as well, who's spent more time doing it, say 25, 30 years learning the business of dentistry. They can support that dentist so that he or she can be spending his or her time using the hands, the miracle, to pass those miracles on to people. If you think about that, how do you go to market?
Well, there's a certain number of dentists in the country, and it's not a huge number, right? 120 some odd thousand probably practicing on a full time basis. If we can make or help make the ones that we work with more efficient, because they're spending more of their time working with patients, and less of their time doing anything administrative, meaning moving towards that highest and best use, that's our kind of core mission, if you will.
That is what we think dentists, how dentists can move towards their core purpose and their mission, creating more true miracles every day, and we see it in our organization every day. We have a phrase we use called celebrate everyday miracles, because there's some remarkable things that are happening around the organization every day. When our docs are encountering patients, and they're just doing what they do best, it's amazing the stuff that happens. We want more and more time skewed that direction.
That, I think, is the biggest thing. Then what does a patient want, which was the other part of your question. What a patient wants is, make it convenient for me. I want great service, I want it now, I want it to be convenient, I'd like it to be one-stop shop, right, so let's make it simple for me, and I want to hear the word yes from you. I want you to tell me yes. Yes you can get me in today. Yes, you can provide the service I want. Yes, you can provide good pricing. Yes, you can provide consumer financing.
Yes, you can get me to a specialist when I need a specialist. They want it to be convenient. Now, has that really changed that much over time? Probably not. What's changed is there's more options out there, so there's more opportunity for people to encounter that. What's also changed is people are spending way more money on healthcare than they used to out of their pocket, so it's a more taxed environment, so I think making it efficient, making it easy, getting them in, you know, that's what many patients want.
Howard Farran: I think it's because of less children. At the end of World War II, the average American mom had five and a half children, so only the kid in the most pain, or the girl with the most crowded teeth, got ortho, but as we switch to only two kids, now both kids can get ortho. You know, when you talk about convenience, dentistry in America is absolutely not convenient when 8% of hospital emergency room visits are odontogenic in origin. I mean, I think it's sad.
I live in Phoenix, 3.8 million metro, and on Sunday, it's better to break a leg than to get a toothache, because if you broke a leg, the ambulance will be there, they'll take you to the hospital, fully staffed on Christmas, Easter, and Hanukah, but why are emergency rooms, 8% of emergencies are odontogenic in origin, so the industry, you'd have to say, it's an F on convenient hours. I mean, how could you give it anything better than a F if 8% of emergency room visits are tooth related?
Steve Bilt: Well, but that kind of goes to that 45% issue. What percent of that 8% were emergent problems over time ...
Howard Farran: Oh, sure.
Steve Bilt: Meaning, if you were going to the dentist regularly, or at all, then it wouldn't have ended that way. That's probably the overwhelming majority of them, were these problems that are created over time, right? It's this access issue. Is it affordable? Is it convenient? Is there a model that welcomes everyone in, or does it feel like an inaccessible model? There's always a place, again, for a high end private practice, but there needs to be a place for everyday folks to come, as well.
Howard Farran: I just think it's bizarre that, in a hospital, they can remove a tumor out of my brain, they could give me a bypass, they could fix a broken leg, and then when it comes to my mouth, it's like it's a different species. I think that's the other bizarro part of the deal.
A lot of my homies are probably wondering, do you manage four ... Okay, when you say you manage 400 offices, does that mean that you own the office and their employees, or does that mean, or is it different for every state because of all the legalities?
Do some of these offices, do you just do the back office paperwork? Explain what you actually, technically do, and is it different in every state, in all the state laws and regulations?
Steve Bilt: It can be a little bit different, state by state, but there's some general truisms, if you will, broadly. There's lots of different types of DSO support type models, so you can have, it can vary. Generally speaking, if you think about the DSO model, the idea is to support the dentists, to free them from the administrative side of the business, so that they're focused on the patient care, and being [inaudible 00:23:05] their patient. What's true of a DSO is when you get into the diagnosis and treatment of dental disease, which is practicing dentistry, DSOs don't do it.
Not interested in doing it, wouldn't be good at doing it. That's what dentists are trained to do. The whole concept of the DSO model is to say, if a dentist could be 99% of his or her time doing that, meaning caring for their patients, then efficiency's been created in the market, and therefore value's been created in the market, therefore the DSO is helping to create value by freeing up the dentist to be truly focused on just the care. You know. You have a private practice, like you said, 5:00 in the morning, you get the call, someone's not coming in, you're dealing with it.
In a DSO supported environment, that call routes somewhere else, and you just show up at time to open and start taking care of patients. That, at its heart, is what a DSO hopes to do. Then you can get into varying degrees of, you know, does the DSO have a call center? Are the calls going to the central location and being scheduled onto the schedule of the individual office, or is the phone ringing in the individual office?
You're going to have a dentist who's independent working for a dentist who's independent, providing that care to his or her patients, and then, all the things that surround the practice of dentistry that aren't the actual treatment and care of the patient and the patient interaction, the DSO, depending on the depth of their service, can take those services off their plate. In our case, we try to be as "turnkey," quote unquote, as you can around the support side functions.
You know, do we, we can build out an office, we can make an arrangement to get good pricing on the equipment, we can help get good pricing on supplies, we can have marketing materials, we can have an online presence, we can have call centers, central billing offices, operational support people out in the field, operational support people here at corporate.
We try to look at everything that isn't that, that doesn't involve the dentist being able to focus on his or her patient, and routinize that or, in some way standardize it, or just have people who can deal with it when it runs off the rails like you said, because you get the call at 5:00 AM.
Howard Farran: The dentist and the assistant and the hygienist are all doing the wet hands as usual, and you guys are just taking over the dry hands.
Steve Bilt: Correct. That's, yeah. Yeah.
Howard Farran: Do you guys, when you expand, do you do a lot of mergers and acquisitions buying existing practices, or do you prefer the de novos and start your own from scratch?
Steve Bilt: That's a great question. We've done both. The Smile Brands model, you mentioned two companies at the beginning, Smile Brands and OneSmile, which really operate together, but we have one model where we will go into an existing market and build new offices for existing groups that we work with.
We have another model where, I mentioned to you, you were kind of trying to get around how many DSOs are out there, and how big are they, and some of those kind of things. We have a model working with smaller, emergent DSOs, or just folks who happen to have four or five offices in a given market, who look at it and say, "Wow, you know, when you go from four or five to 20 or 25, a lot changes."
The ability, you know, the level of sophistication around your support services, the confidence you have to hand to hand bigger things off to other folks changes, so we have a joint venture model, if you will, where we will invest in a smaller dental group or DSO that has four, five, 10, 15, 20 locations, and invest in that business through our OneSmile venture, so invest in that business, and then build it up together, so take it from, say, four offices to 14, 15, 20, and then create a path for another liquidity event for the owner there that we think is a lower risk liquidity event.
It's interesting, Howard. People don't do well processing risk. You know, like, how risky is this move from four offices to 14 or 20? The answer is very risky. You have personal guarantees, you're taking a lot of money, you hit bank lending limits, you have to put a lot of capital out, so that becomes a very hard leap for most folks to make, so what we like to do, say like we can invest side by side with you in your business and make that leap together, so that you can have a lower risk path to that secondary liquidity with us.
That's what we're doing. We've done four deals like that. We're working on a few more. We're pretty excited about them.
Howard Farran: You're not publicly traded, though. Are you part of a venture capital firm, then, or ...?
Steve Bilt: We're private equity backed, so we have a ...
Howard Farran: Private equity.
Steve Bilt: Firm. In 1998, when we co-founded the business, we partnered with a private equity firm called Gryphon Investors out of San Francisco, then ...
Howard Farran: Is that Peter Griffin?
Steve Bilt: Gryphon, G-R-Y-P-H-O-N. Yeah.
Howard Farran: No, get it, Peter Griffin?
Steve Bilt: Yeah, no, a different ...
Howard Farran: Family Guy.
Steve Bilt: San Francisco. They just raised a new billion and half dollar fund that they're investing out of, so we're quite active in the marketplace trying to do additional deals. They partnered with me back in 1998 when we started the company, and then when we reacquired Smile Brands and put OneSmile and Smile Brands together in '16, I had partnered up with them again, so we're ...
Howard Farran: Tell my homies, what's the different between private equity and venture capitalists?
Steve Bilt: Venture capitalists generally invest pre-profitability. When you see, you know, the story of Google, or Snapchat, or Facebook, when they're getting people to invest before they have earnings, that's generally how you think about venture capitalists. A private equity firm invests based on multiples of earnings. They're going to do what's called leverage buyouts.
They're taking the earnings of the company and that's what they're using to lever the company and then put in additional equity. Think about it, the [inaudible 00:29:22] dividing line is pre-profitability, and then post-profitability, and then depending on the scale you're at, that will determine the private equity firm you would, type of private equity firm you'd go with.
Howard Farran: When you talk about one-stop shopping, which the consumer wants one-stop shopping, do you think it's a better idea, return on investment, to take a young dentist out of school and teach him complicated stuff like placing implants, or do you thinks it's faster, easier, higher quality, better, to have specialists rotate to the office, like periodontists and oral surgeons?
Steve Bilt: You know, that's a great question around the specialty model versus the GP doing more. I think, I was just talking about this the other day, it's changing. I think we're headed towards more of a tipping point where it's changing more. I actually think it's better for everybody, though, so I see, and you look at clear liners, which is obviously going to pull more general dentists into orthodontia, but what it does is it creates way more visibility to treating orthodontic, you know, either malocclusion or re-treatment of old orthodontia, so I think what happens is it's not really an either/or.
I think what happens is you pull more general dentists into the mix of doing orthodontic services in that case, which also has them see more complex cases which they won't do, which will feed more to the orthodontists, so you'll see much more orthodontic treatment, generally, for people. I think the same thing with implants. I think when a general dentist sees implants, because he knows he or she is capable of doing implants, I mean, it's a great, product, right?
It's way better than a three in a bridge, in terms of functionality and lifestyle and moving on, so I think what you'll see is the general dentist will be able to do implants, because he or she is trained, and therefore will see more implant opportunities. The general dentists will do more implants, and they'll also pass more implants that are more complex on to specialists. I don't think it's really an either/or.
In our case, in our networks, we do both, so we want to have the general dentist seeing and doing everything he or she is capable of doing, and we'll have specialties who are rotating around to the offices, specialists, who are rotating around to the offices, who are able to do the more complex things that require ...
Howard Farran: You are having the specialists rotate into the practices?
Steve Bilt: We always have, yes. We have all of them, orthodontics, oral surgery, endo, perio.
Howard Farran: What advice would you give if, you know, this is June, so everybody just graduated, you know, 6,000 kids just walked out of school.
If you met an endodontist, and he was coming to Phoenix, and he said, "I want to live in Phoenix. That's where my family is, and endo's crowded," would you say, "Go and buy a land and building and start your own endodontic practice like all the old guys did," or would you say, "You know what I'd do? I'd go find the five biggest offices in Phoenix and do a day a week each one of those. You won't have any real estate, no debt. You won't have to manage a, I mean, it's like a DSO, your own DSO. I'm just going to go in and work as a independent contractor."
What would you advise a specialist walking out of school today?
Steve Bilt: Yeah, walking out of school, I would say, "Go find multiple practices and rotate through." I think there could be a point in time downfield where you've now decided, "Okay, this is the exact corner of Main and Main I want to be on. I've got referral sources all around me, and I just want to have a fixed location," but I personally think you're way better off managing the risk. Remember I said earlier, you know, human beings, I don't think, are very good at processing risk.
You think about the risk of, you know, building out a practice, picking a single location, assuming you're going to get enough referral flow into that single location to be successful, and carrying that overhead. I think it's much cleaner and lower risk to go to multiple practices, do the day a week that you were alluding to, and then really just defer that decision to invest in a fixed location until there's more certainty.
Now, you may find there's no reason to ever do it, because the lifestyle works, the income flow works, and you're in great shape, and your risk is highly mitigated, or you may find, you know, two, three, five years down the field that you know where you want to be, you've got it figured out, and you do it.
Howard Farran: What do you think a dental office ideal overhead? What would you put for labor, lab supplies, marketing facility ... What's your benchmark? What's doable? Not what would be the unicorn scenario, but what should be achievable?
Steve Bilt: This is always, you've got to be careful, because sometimes the language can be different, right? We think of labor running about 50%.
Howard Farran: That includes a doctor, though.
Steve Bilt: That includes the doctor for his or her production time, so if you put, you know, the same rate you'd pay an associate to do the production in there, even if you're doing it yourself, put, burden yourself against that labor the same way you'd pay an associate relative to their production. I figure that as 50%. Then the remainder of the overhead is going to run in the 30% range, so you've got kind of 80% all in with a 20 kind of waiting at the bottom, if you will, for profit, but that's after all the production is paid.
Howard Farran: When you say 20% profit, is that EBITDA? Is that earnings before interest?
Steve Bilt: I think of that as EBITDA? Yeah, yeah.
Howard Farran: That's earnings before a lot of other expenses, earnings before interest, taxes, depreciation, amortization.
Steve Bilt: Correct, but after the doc has paid for the production time, so the owner would have income in that, above that line, if you will.
Howard Farran: Yeah, so break down that 30%. Would you say staff 20 of that 50%, is that half dentist half staff?
Steve Bilt: You know, little more than half dentist, and then, so call it 65 35, probably, in that way.
Howard Farran: 65% dentist?
Steve Bilt: Oh, the 50, I'm sorry, the 50 we're talking about.
Howard Farran: Right, 65% of the 50 for the dentist, and 35 percent of the 50 for the staff?
Steve Bilt: And hygiene.
Howard Farran: And hygiene. That 30%, could you break that down? Can you break out any numbers of the rent, advertising facility?
Steve Bilt: Yeah, we tend to be a retail driven model, so we like highly visible real estate, so we're running about 10% in that real estate component, and then the other 20 is broken down between labs and supplies and financing fees, you know, if you've got sort of a Care Credit type model, something like that, and then just miscellaneous would make up probably, yeah, the balance, the five percent-ish.
Howard Farran: You're managing 400 dentists or 400 locations?
Steve Bilt: Locations.
Howard Farran: Are you in the real estate business? I mean, would you, if you had it all your way, would you like to own the land and building of all those locations, or would you say, "I'm not in the real estate business. I'd prefer to just lease 400 locations?"
Steve Bilt: My background goes to being a finance executive, so, back, way back in the day, so the answer's a little nuanced. If you're us, because of the cost to capital relationship, it's better to lease the facility and then just support the business of dentistry, not going all in the real estate. That's because we're, the way we're capitalized. If I was a single practitioner who owned my business, and I had a location I owned, you could start to see real value in acquiring the piece of land and paying yourself rent.
Now, you're locking yourself in, so you want to make sure this is where I want to be, but as long as you know it's where you want to be, then there could be real value, because that real estate, over time, if you assume that real estate's going to appreciate over time. If you're in an area where you see real estate appreciation, then I think it makes sense. You've got to be a little careful with that, though. Then you get into folks who have larger DSOs, you know, and they want to build it over time, then they can build a nice real estate portfolio owning the offices they're in.
Howard Farran: You know ...
Steve Bilt: It's a little different in our structure.
Howard Farran: I own my land and building, but I don't even know why, because when I grew up, my dad was in Sonics, and in the same Catholic church was Dan and Beverly Carney, the founders of Pizza Hut, and he had 2,800 locations. Every time I would talk to Dan about the land and building, oh, he said he only would buy the land and building with some small dinky town of 5,000 and he had no options.
He said, "Man, if you're in Wichita, why," you know, he hated the real estate business. He just wanted to, he said, "I could make five times as much money in the pizza business. What the hell do I want to be in the real estate business for?" He was a stickler, that, focus your money on your business, and you're not in the real estate business. Back to that.
A big question a lot of these dentists have is, some of the expensive technologies, have you found a return on investment on, like CAD/CAM is a $100,000 plus decision. So is CBCT. So is, some of these lasers are 85 to $100,000. In your 400 offices, what percent did you make the investment of CAD/CAM, CBCT, lasers, or other high end technologies or oral scanning instead of impression taking?
Steve Bilt: Yep, so it's a great question, and we tend to find, you know, you don't want to be, in our experience, the first mover on those things, at that big of a scale. It's kind of a crawl, walk, run mentality. You see things that are clearly the future, right? Digital radiography, you're not going to be developing film in an office, so that's kind of a no-brainer to move forward with. When you get into digital impressions, for example, clearly the technology's ready, it's moving the right direction, so we're investing heavily in that area to move in that direction.
You get into in-office milling, I think there's a choice. Some folks have moved fully into it and embrace it heavily. In our experience, it hasn't been something we've wanted to go fully into, so we experiment with it, but we haven't seen it tip over where that's where we want to be fully invested. We try to look somewhat carefully at that, and just make sure that the technology is implementable.
Howard Farran: Well, it's a genius answer, because digital radiography, half the market, more than half of all the dentists adopted it. Like CAD/CAM, it's sitting around 10 or 15%.
Steve Bilt: Right. We're looking at it, when you go all the way to CAM, you know, we say, "We're not ready for that. It's a small penetration. There's a deep training curve."
The digital impressions, you know, we're starting to see that move to be closer to the center of the curve, so we're kind of more attracted to that, but again, I think it's, we like to be right in the middle of the curve in terms of that adoption pace, to make sure we understand it, to make sure the docs are fully trained on it, to make sure it's where we want to be, given the scale we're at.
Howard Farran: What if one of my homies is driving to work right now and says, "Steve, I just want to do dentistry. I love dentistry. I like surgery. I just want to pull root canals, and I'm really getting burned out and fried on the business, the marketing, the advertising. I hate it, I hate it, I hate it."
Are you an option for these dentists, I mean, if they ... What would they, how does that work? Do they go to, and what would they find if they went to your website, smilebrands.com? Is there a place to learn more about handing over the dry hand activities to you, so they can just focus on the wet hands?
Steve Bilt: Yeah, there is to a degree on there. It certainly gives them a feel for our culture in our business, and there's individual brand sites they can go through from there to see how the brands operate, and they can learn more about us. They can also just, it's pretty easy, you've got the smilebrands.com, you've got the steve.bilt, so, email@example.com.
What I'd probably do is take that and I can connect them with the right person to be more one on one in explaining what we do and how it might fit their particular set of circumstances, whether that meant they just said, "Look, I just want to find a location and come join you, or one of your groups," or, "I've got locations, and I'd like to think about putting those together with your group."
We do both of them, all the way from individuals who just come join, all the way to small groups that we, you know, put capital into and grow with them, so both of those are options, and we have a couple different paths that I can connect them to to have that conversation.
Howard Farran: Here's how you remember Steve Bilt's name. My favorite business author of all time is Jim Collins, and the first book I ever fell in love with in business, Built to Last, then he did Good to Great, then he did How the Mighty Fall, and now what's his last one? Good to Great, Become Greater, what was ... Anyway ...
Have you ever considered changing your last name from B-I-L-T Bilt to add a U, so that, and say you were named after the book Built to Last?
Steve Bilt: I'd love to be able to make that claim, but no. I try to say, you know, somewhere in Ellis Island, I think it got shortened from Vanderbilt or Biltmore, and I keep trying to ping those guys and see if I can get in on the inheritance, but so far no luck.
Howard Farran: Well, I have read by people that have PhDs in this area said 80% of the people that came through Ellis island could not read or write, so they would say your name, and somebody was phonetically sounding it out, so it was, you know, anybody's guess what your real last name is.
How many states are you in, and could this guy call you from Beaumont, Texas to Parsons, Kansas, or how many states are you in for an acquisition, if someone says, "I've already got an office. I've been in Parsons, Kansas for 20 years, Steve. I've got patients." How many states are you in?
Steve Bilt: We're in 17 right now, and then we're interested in, you know, all of them, so you know, it's just a matter of having the right fit. If it was, if we're not in the state and it was a single office, that's a hard kind of entry point to come in. If we're not in the state and there's four or five to partner with, then we could enter that way. If we're in the state then, you know, anything could possibly work.
Howard Farran: You started in Irvine. Are you mostly a Southwest play, like California, Arizona? Are you more Southwest, or what, where are you concentrated in the most?
Steve Bilt: We're coast to coast, so we go, we tend to refer to it as the smile belt around here, affectionately. If you started in Washington and drew a big smile across the country, coming from Washington down through Southern California, across through Texas ... We're very big in Texas, 125 or so facilities in Texas. Move through Texas all the way through Florida, and then smile up to the West Coast, and then dot a couple i's in the Ohio markets. You start to get into, roughly, what our map looks like.
Howard Farran: A lot of them are probably also wondering, do you run 400 locations with the same practice management software? I mean, is this like Dentrix off the shelf, Eaglesoft, I mean, or did you have to develop your own practice management system, or what do you run these offices off of?
Steve Bilt: Well, so we have a core on some few different platforms, including QSI as one of the platforms. We also wrote our own software program that is inside our company, called e-Smile, so that's inside our business, and then we have an overlay over the top of that, which then takes all of that and connects it to our call center, outbound calling, and software programs that we've written, or our central business office programs that we've written.
There's a number of programs that we've created over the top of whichever clinical information system that we happen to be working with, that it grabs the data and we're able to aggregate it and see it in a single view outside of that clinical information systems.
Howard Farran: The foundation was QSI?
Steve Bilt: QSI is where we started, and then we wrote one as well, and then through various acquisitions we have a number of other programs, all the ones you would know, that we integrate ourselves into.
Howard Farran: I'm trying to get this ... So let's say you bought a dental office and they were on Dentrix. Would they still be on Dentrix, or would you convert them to your deal?
Steve Bilt: Right now, they'd just still be on Dentrix, and then what we would do is we'd put our overlay over the top of it to pull information ...
Howard Farran: You've written bridges, so if they're on Dentrix or Eagle Soft, or Open Dental, you've written bridges to go in there and pull out that information for you to manage.
Steve Bilt: Pull that data into a central database, then the database is going to, all the other programs that we have over the top, it'll hit that database and pull the information, so that it's in there.
Howard Farran: To your knowledge, of the members of the American Dental Services Organization, do you know any of these 35 members that run all these offices that can do it with an off the shelf Dentrix or Eagle Soft, or has everyone had to go back and program their own practice management metrics to run it?
Steve Bilt: You can't really be purely off the shelf, so you have to have something to get that data out to create the management reports you need. The biggest challenge tends to be when you go to do the billing and collecting more centrally, to leverage that, most of these programs aren't written to do these things centrally, so you tend to run into some challenges there, and then also just the view you want to have to be able to provide the support for the offices that you want.
I don't think anyone just grabbed the program off the shelf and is able to use that to run, you know, to support multiple offices, or certainly not 20 or 30 offices, or 40.
Howard Farran: I know, and every time Dentrix or Eagle Soft ask my homies, like, "Well, what do you want us to program," they never ask for anything in NBA1. It's always like, "Well, can you change the font to fuchsia? And I want Helvetica." I mean, they just, they don't even know what they don't know. I mean, I used to get so mad at Shine, and so finally Stan Bergman sent this amazing person with an MBA to my office, we talked, and she said, "I don't think that the market agrees with what you're saying."
She did a survey, and they spent money to shut me up, and they did that survey, and sure enough, they were right. Not one of my homies agreed that they should know their costs or labor, or their supplies. I mean, they just, uh, whatever.
Steve Bilt: All the DSOs would agree with you.
Howard Farran: I know, and that's one of the reasons ...
Steve Bilt: That's what we've had to invest so much money in developing over the top of it.
Howard Farran: You know, it's like, talking to dentists, it reminds me of my two oldest sisters. They're Catholic nuns. You could talk to them for 40 days and 40 nights and not change their opinion on anything. I mean, a dentist, they just want to do dentistry. Back to the lab and supplies. Did you think it was earth shattering that out of nowhere, last year, at the Greater New York, Amazon had a big booth there?
I mean, everybody, you'd heard rumors about this for three or four years, but I mean, they were at the Greater New York meeting. What do you think that signals? I mean, they wouldn't go there unless Jeff Bezos had dentistry on his bullseye target somewhere.
Steve Bilt: Yeah. I mean, I've got to believe that they've looked at, you know, it's a huge category, and I've got to believe they've looked at it and said, "There's ..." Well, I think they're studying it, quite frankly. Is there, you know, some places you can bifurcate this category to buy commodity products for a really good price? I think it's a good thing for private practice dentists to look at that and say, and probably all the dentists should look at that and say, you know, their history is they come in, costs come down.
That should be attractive, right, because you've got global visibility that'll be created for the smaller guy, because the technology's certainly there with the way Amazon works. Now, I think buying all the things that dentists buy creates a level of complexity. There's more to it than just, you know, the most commoditized products, obviously.
There's complex things in there, so I think it'll be an evolution, probably, but I would never underestimate them, obviously. They've been pretty successful doing what they do and putting their attention to it, I think, will certainly change things over time, for sure.
Howard Farran: I think, but it looks like that industry's in pain. I mean, Patterson, their stock has been hammered, basically, and they just let their CEO go. Do you think that's partly related to Amazon or the increasing competition, or do you think there's been a fundamental shakeup of the dental supply business model, that Amazon's at the Greater New York, and not long after, you know, Patterson's sales are going down and ...?
Steve Bilt: You know ...
Howard Farran: Do you think those two events are related somehow?
Steve Bilt: I don't think those two are directly related. I think it's a multi-faceted question. You say, "Wow, how would I feel if I was running a dental supply company and Amazon was talking about coming in?" There'd be a little sweat on my brow, I'm sure.
Howard Farran: Oh my gosh.
Steve Bilt: That would be for sure. I think, you know, Patterson is a great company, and they've made a lot of moves to start to see the DSO trend. Any time any business goes through significant or even, you know, tectonic kind of shifts, where you say, "Wow, I've got to now serve a much broader market," that's a high degree of difficulty dive.
I don't know the particulars of what went on inside Patterson, but I think anytime you try to make that big of a shift, you know, I just put something out the other day, an article I wrote on LinkedIn the other day, where I said, you know, is it more important to prepare your business for the discontinuous change of the future, or to make the incremental change that you need to make to continue to be more competitive serving your customers today. I put an or in the middle for a reason, but the answer to that question is yes. You have to do both. It's really hard.
It's the hardest thing you do, is like, how do I keep serving my customers and getting better incrementally with all the things they want, and then how do I deal with what's going to be this discontinuous change? It's really tough, and you've got to do both. When you're in leadership and you try to navigate that, it's hard. You try to navigate that as a public company, it's that much harder. You know, I mean, I think Patterson's a great company. I think Shine's a great company. I think they've done a great job serving our industry in total.
I think they have, to varying degrees, specialized in understanding DSOs over the years, Shine more so historically, Patterson more so recently. Patterson, I think, is just dealing with that transition. Again, I think it's a great company, great culture, and I think it'll be great over time, for sure.
Howard Farran: Yeah. I thought the man who took a public [inaudible 00:53:17] was one of the greatest men who ever served in dentistry. Whenever I go visit my sister in a cloistered [inaudible 00:53:24] monastery in Lake Elmo, I have to do something for four hours and one minute, so I usually go by and sit in Pete's office for four hours and one minute to make it a tax vent, or I'd go sit with the scientists at 3M, but that Pete Forsched, he was the most intelligent, logical, just the, I mean, God, he was just an amazing legend. I sure miss that guy.
Steve Bilt: He left behind a huge footprint that company, they honor. They really, you know, they do honor that there, so they did think a lot of him.
Howard Farran: Also, you know, but they always say that, you know, there are known knowns. There are things that you know. There are known unknowns, things that you don't know. Then there are unknown knowns, and then there's unknown unknowns. I always like to point out the things that all the corporates are doing that my homies don't do. One of the things they all do is they have a call center, and I know that every dentist in America, because I lecture to them every week, they can't tell you how many incoming calls they had last month.
They can't tell you how many of them went to voicemail. They can't tell you how many of them came in after hours. They can't even tell you how many of the people that left a voicemail, if anybody even listened to the voicemail, but I'll tell you one thing. Guys like you understand incoming calls, and you have your call center, and I bet you have people that only focus on those numbers. What do you think, what, tell us about your call center, because these dentists are like, "What the hell's the call ..." why do you have a call center?
Steve Bilt: Well, the most fundamental reason, which goes to what you're talking about, is we spend money to make the phone ring, so if you're going to spend money to make the phone ring, you ought to pretty darn serious about what you're getting out of it. That's the first thing is, you know, we know how much does it cost ...
Howard Farran: I'll stop you there. It doesn't matter, because if the crown doesn't fit, it's always the lab's fault. The dentist never thinks it's his horrible impression. If I spent money at a marketing agency and I don't get any new patients, it's not my fault. The marketing didn't work. They don't even, yeah, so, they don't know what they don't know.
Steve Bilt: Well, and that's the challenge, right? It's like, you know, think about it. You're spending money, you're not spending money for the new patient. You're spending the money for the opportunity to gain a new patient, and I think you said it really well. It's a mental model. How's your mental model set? I paid marketing go get me a new patient. If that's your mental model, you're going to be very inefficient. If your mental model is, no, I paid marketing, whatever it is, marketing dollars, to get the phone to ring, to get an opportunity to get a new patient.
Now I better be really serious about each step of that process, then you should be looking at four or five or six steps of that process, not just the one you alluded to, which is, did I get the new patient? Start with, did I get someone to at least engage with me? Click, call, whatever it is, and then how did I do through that chain, in performance, then you're starting to move towards a shot of efficiency, so that, yeah. We do study that closely. What does it cost to make the phone ring? What does it cost to get someone to click on an ad? What happens once that phone rings?
First of all, did we answer it? What's our ring no answer percentage? Right? Well, it went to voicemail. What did we follow up on? How many of those people became patients? Once they become a patient, which ones schedule, which ones don't? What did we say on the phone that led the patients to say, "I'll think about coming in," and then not come in, versus what we said on the phone to get people to actually come in and try out the practice?
There's a lot to that, but again, I think it's breaking it down to smaller component parts, not just that endgame you mentioned, which was, you know, did you become a new patient? How much did you spend? Right? It's more did you create an opportunity, and what did I do with it as an operator?
Howard Farran: There's a couple of new companies. One of them is on these incoming calls realizing that about half, you know, there's 168 hours in a week. The average dentist's only open 32 hours a week. That's only 19% of the week, and that half the incoming calls are coming in when you're not even open. This good old boy from Louisiana started a online schedule. Are you adding the ability for consumers to schedule their own appointment on your website?
Steve Bilt: We have right now the ability for them to request it, and then we match them up with the request. We are in beta right now with a technology we call Open Book, which allows them direct access to the schedule across not just one but multiple offices, to help select their appointment. We do have a beta test going right now of that exact technology. Right now, they can request it and we book them and then confirm back and get them moving on everything, so it's convenient. We're going to take it one step further and let them actually directly into the schedule.
Howard Farran: You plan on making that. You plan on letting them actually schedule their own appointment down the road?
Steve Bilt: Yeah. I think what, you have to look at, you know, are you making it convenient as you possibly can for a patient? We think the way we do it now is marginally convenient, because they request it, we match them up, make sure we meet their needs, take their insurance, do those kind of things, but we think we could make it one step more convenient for them through this, what we call project Open Book, which is technology we have to really expose it more ...
Howard Farran: Project Open Book? You opened a can of worms. You said, do we take your insurance? What is your insurance policy? Do you take every PPO, Medicaid, Medicare? How do you evaluate whether or not you'll take an insurance or not?
Steve Bilt: We try to be in the middle of the curve, so try to make sure everyone can get access to a dentist, so we take virtually all insurance, probably as wide a choice as anybody out there in the marketplace. We take virtually all insurance, Medicaid at these select locations, so we do that in a couple of states, so we're not a big Medicaid practice.
We're about 6% governmental overall, out of the whole system, so it's pretty small, but in given markets, we take more of it, depending on the need set around the individual office, so we're looking kind of around the individual office, what people need, but virtually all PPO, virtually all DHMO, and then we have very robust discount plans that we offer, or discount plans that we take.
Then we have our own internal financing vehicle as well, through what we call Smile Brands Finance, so we'll come even behind Care Credit and literally make sure every patient qualifies for some level of credit with us, so we really try to make it as accessible, as ubiquitous as we can.
Howard Farran: What percent of your patients finance their dentistry?
Steve Bilt: Finance it? Well, about half of what patients get, in total, is paid for by patients, and about half of that is paid for through financing, so call it 25%, 20, 25% would be financed at some level.
Howard Farran: Probably 50% of revenue is insurance, 25% patient out of pocket, 25% finance?
Steve Bilt: That's pretty fair, yeah.
Howard Farran: Is your own in-office discount plan, or in-office membership program, is that seem to be growing and becoming more significant, or is it more flat?
Steve Bilt: It's starting to grow. We're seeing a bigger need there. People are open to it. It's actually a really good value for folks. That's actually a nice growth area.
Howard Farran: Well, I want to tell you this. I still have not been able to get one dental insurance CPO to come on the show. I even waived my speaking fee and spoke to their annual meeting, and I get it, because if you, they won't tell you this, but if you go to the bar and drink with them until 3:00 in the morning, this is what they'll say. They'll say, you know, "We give this dental office $100,000 a year for the last 20 years. I only hear from this dentist twice a year, and it's because I didn't cover something, and he writes me then."
Sometimes they even have letters in their briefcase, or print out emails, and so the dentists have been so mean to the insurance companies, it's like they won't even network. There's none on Dentaltown. I mean, they're registered members. I know every member that's registered. They, if I do a trace on, you know, a [inaudible 01:01:58] on your email address with Delta Dental, whatever, but, so dentists have burned that ... It's almost like the Israelis and the Palestinians. I mean, they have been feuding forever, and they're not going to talk.
I really, when corporate dentistry took off, a lot of the corporates were getting badmouthed by dentists, a lot of them on Dentaltown, and I just thought it was so cool that you come on the show, that Rick Workman comes on the show, Steve Thorn, because you guys aren't bad guys. You're serving Americans. You're employing dentists, dentists that sell you their practice. They didn't have to. There was a mutual trade.
I mean, I just think it's amazing, and I've had so much feedback that it was so nice for just dentists to be able to put a face behind a company, to sit there and say, "Oh, that's who Heartland is," or, "That's who Pacific is," and, "Oh, that's who the Smile Brands is, Steve Bilt." I wish you would tell your other CEOs that we're all in this together. I call it the remote control. At the end of the day, the only thing ... You know the remote control, no one knows how to work the remote control because every department comes and gets their buds on.
They come from TV and cable and VCR, and next thing you know, you've got 85 buttons on there, and Einstein and Newton couldn't work the VCR, and it's the same thing in dentistry. There's all these silos, but the only reason I went to school was for the patient, and we're all serving the patient, whether you're dental insurance, a dentist, a specialist, whoever. I mean, we're only did eight years of college to help our patients, and I think you're helping a lot of patients.
Tell your other CEOs of those DSOs that we all are in this together, and invite them to come on the show, and thank you so much for talking to my homies today, Steve. I think you're an amazing guy, and I thought this was extremely informative, and every dentist on Earth could learn a lot from someone managing 400 offices. You sure taught everyone a lot. Thanks so much for coming on the show.
Steve Bilt: It was my pleasure, Howard. Thanks so much for having us. You couldn't have said it better. I mean, we're all in this together. Again, you know, if 45% of Americans got dental care and we all get in this together, and that number goes up, then we've had successful careers. We've done something to impact people. We've left that footprint or that dent in the universe, as Steve Jobs would say, if we can move that number together, and that's really what we would love to see happen. That's what I know, you know, my compatriots in this business would love to see.
I know, like you said, that's why all your townies went to dental school, is to do this, right, is to serve folks. If we can expand that marketplace, get that incredible miracle that they are capable of delivering to more people, then hallelujah. That's why I'm in it. Gets me out of bed.
Howard Farran: No one ever went to dental school to read a balance sheet and make payroll. I mean, end of story. Thanks again. Have a rocking hot day.