In the blue-collar town of Evanston, Wyoming, population 10,000, there are nine dentists. Dr. Nate Lester, whose family has lived in the community for four generations, operates Bear River Dental, named in honor of his grandpa. “My grandpa ran Bear River Lumber on the land where we’re located,” Dr. Lester said. “We rebuilt my grandfather’s buildings and modified them to create our practice.”

Most of Dr. Lester’s patients are ranchers, railroad, or oil field workers, or the peripheries that it takes to make a small town happen. Dr. Lester lives on a cattle ranch, having returned to the area after dental school. “We wanted our family to have an opportunity to be raised in a smaller ranching community, where they had to work hard to hopefully one day serve society a little better,” Dr. Lester said.

Fresh out of dental school, Dr. Lester purchased a practice from an older doctor who was experiencing health problems. The practice was only four years old with one doctor, one assistant, and two dental chairs. On July 1, 2005, Dr. Lester closed on the practice and walked in to let the previous owner know the sale had gone through. The older dentist was sitting chairside with a patient. “He rolled back, pulled his keys out of his pocket, took the key off his keys and dropped the key in my hand and said, ‘I’ll leave my address upfront where to send my checks,’” Dr. Lester recalled. Leaving a patient numb and ready to go, Dr. Lester took over and did the procedure, but didn’t know what to do next. I asked the assistant, ‘How do we get paid for this?’” Dr. Lester said. “She said, ‘I don’t know. He always did that.’ I looked at the guy and said, ‘You got a freebie on us today!’ That was our start. She knew very little, and I knew even less.”

Dr. Lester knew he needed help, so he began hiring people. Before long, they were outproducing what the previous doctor had done. “We hit $600,000 and thought we’d hit the payday,” Dr. Lester said. He added another chair and more staff but always had this feeling of, ‘You don’t know, what you don’t know.’” In 2007, after one of his hygienists was introduced to Wendy Briggs, he brought Wendy in to do the Diamond Hygiene training with his team. “Not an exaggeration, she more than doubled our production,” Dr. Lester said.

In 2009, Dr. Lester’s friend, Dr. Dave Prince, invited him to hear Dr. John Meis speak. “Dave and I got invited to be in a group with very, very successful practices,” Dr. Lester said. “I think they looked at Dave and me as a fun experiment to see if they could teach us to grow our practices. Coincidentally, this was about the same time Dr. John and Wendy found each other and formed The Team Training Institute.” In 2009, Dr. Lester became one of the first members of The Team Training Institute. He says, “Despite it being a small town, the reality is, it is competitive. We have good dentists in town and they’re good men. So, we had to find a way to separate ourselves a little bit and we feel like The Team Training Institute is something that helps us do that.”

Initially, the key thing he learned from Dr. John and Wendy was that he could expand his horizon. “The idea of ever producing a million dollars seemed foreign,” Dr. Lester said. “I kept listening and learning and asking the right questions about how do you expand your vision? How do you grow from here? As I started seeing what others were doing and listening to Dr. John’s successes, I knew we could do better than we were doing.”

Today Dr. Lester has a business partner, 11 operatories and his production is $5 million. He went from barely profitable to 32% profitability. Plus, he says he’s a better dentist with more freedom.

We sat down with Dr. Lester and asked him about the lessons he’s learned from The Team Training Institute over the past twelve years. The following are principles that have created the biggest impact:

#1: Trust Others to Help You

The first thing The Team Training Institute encouraged Dr. Lester to do is to improve his management team. He was resistant at first. “It was really hard to give up control of different aspects in the practice,” Dr. Lester said. “But Dr. John and Wendy helped me identify that it was one of the areas that was likely holding me back. When I realized having the ideal management team is going to create the ideal practice, I promoted my dental assistant Tracy to office manager. I knew she was the right fit and capable of it.”

Today, Dr. Lester has a team of 26 people, including the doctors. The management team comprises Tracy as the office manager, a team lead for the hygienists, and a team lead for the assistants.

“We run three assistants per doctor,” Tracy explained. “We have two upfront that do the receptionist job, an insurance specialist, a recall specialist, and a 2-2-2 coordinator. Dr. Lester’s sister does a lot of the behind-the-scenes stuff that holds this place together like payroll and Dr. Lester’s wife does our marketing.”

The key to a good management team was hiring a competent office manager and getting management trained quickly. Balancing training and dentistry was tricky, so he brought his entire management team to every Team Training Institute training. “I credit The Team Training Institute for really helping train and develop Tracy,” Dr. Lester said. “She’s had 10 years of doing this and now she’s as good as they come. TTI really helped us train our entire management team. We’re firm believers that to get the most out of The Team Training Institute, take as many of your team as you can. It’s hard to come home and sell an idea to everyone in that Tuesday morning staff meeting versus two days where you can talk and think outside of your practice, come up with sound ideas and be cohesive when you come home. I’ve watched other practices in TTI and the ones that really get it are the ones that bring their entire team in. They’re the ones that will do the best.”

They’ve found their most productive meetings are always after The Team Training Institute meetings. To get the most from their time together, they discuss what they learned and express what they can do better or differently. Collectively they decide on what to implement and limit it to three items to avoid overwhelming the staff. “We’ve been till one in the morning on those meetings trying to narrow down and make sure we’re all on the same page on what we going to do, but they’re very effective,” Dr. Lester said. “It’s fun to go play, but this is the time that thoughts come to you that can’t really come when you’re in practice by yourself. We decide by the end of the last night what we want to bring home to our practice. There’s so much information shared, and ideas given during the Team Training Institute meetings that if you don’t sit down and really vet those out together, you’re missing key pieces that can help you.”

#2: Make Sure You Have Enough Capacity

When Dr. Lester moved out of his start-up building and into the building he bought from his grandpa he doubled in size, going from three chairs to six. But he instantly discovered there was a problem. A meeting with Dr. John confirmed his concerns. “I said, ‘I think we may have done this wrong,’” Dr. Lester said. “Dr. John said, ‘I think you’re already out of capacity.’” Dr. Lester went home and knocked out a whole wall, adding five more chairs to the building he’d just finished.

Now that Dr. Lester had lots of capacity, he needed to figure out where to get more patients quickly. Again, he turned to The Team Training Institute. “Dr. John said, ‘Make an offer to an older dentist in town,’” Dr. Lester said. “I got home on Saturday from the meeting with Dr. John and on Sunday I was standing on an older dentist’s doorstep. I knocked on the door and said, ‘I’d like to buy your practice.’” After buying the practice, he initially thought he would keep the two practices separate, but in a small town, he found everyone wanted to be in the new building, so he merged the two practices.

#3: Get Patients in the Door and Retain Them with a Positive Experience

The doctors credit The Team Training Institute for helping them to develop a “great hygiene department.” “That gets people to come in and keeps them coming in,” Dr. Owens said. “Which feeds the doctor’s schedule and keeps everybody’s production rolling.”

They do their best to keep patients happy by creating a positive patient experience, so they aren’t losing more patients than they are getting. One way they do this is by making sure people don’t feel like their being run through the mill. Dr. Lester’s advice: “Don’t make exams too short. Slow down and create a personal touch for patients.” By constantly focusing on what those touches are and ways they can provide a unique experience, patients know they truly care.

#4: Broaden Your Skills

Over the years, Dr. Lester and Dr. Owens have expanded their knowledge base so they can provide most of the services patients need including implants, basic orthodontics, and sleep apnea. Whatever services they can’t provide, they bring in a specialist. “We keep as much in-house as we can,” Dr. Lester said. “Every week we have a specialist here from Utah, either an endodontist, orthodontist, or an oral surgeon.” Another way they’ve broadened their services was by buying into a surgical center. “In Wyoming, it’s difficult to do sedation in your private practice,” Dr. Lester said. “We allow a nurse anesthetist to do that in a safe environment and then I will go in and do the dentistry.”

#5: Invest in Technology

While they don’t go into debt or buy every new piece of production technology that comes out, they do invest regularly, which has made them one of the most advanced dental practices. “We’re not afraid to spend money to make money,” Dr. Lester said. “We do our best to recognize a need and then go and get technology, but we’re careful with how and when we add it because we keep our debt little to none in the practice.”

Dr. Lester credits The Team Training Institute for helping him to determine which classes, technology, and opportunities are the best investment. “The Team Training Institute has taught us how to objectively evaluate ROI so that we don’t buy emotionally, but rather analyze the value,” Dr. Lester said. “So, if I’m going to go spend money on a CEREC, is the real ROI what the salesperson is telling me, or am I just getting a line from the salesperson because he’s trying to sell me something? Dr. John and Wendy also taught us in evaluating things, that once you recognize that there’s ROI, every single day that you don’t have that equipment or knowledge, you’re losing money.

#6: Create Systems to Deliver Consistent Care

The Team Training Institute’s (TTI) hygiene system allows them to provide consistent care to every patient—while also providing tiger proofing. “None of the hygienists got their degree from the same place,” Dr. Lester said. “So, it’s easy to have them running like cats in a bunch of different directions. With the TTI system, everyone is working towards the same goal so it doesn’t matter who the patients see. This provides tiger-proofing because we know if a hygienist is gone, the patient is going to be taken care of the same way.”

Dr. Lester credits Team Training Institute for keeping his team on track in following systems too. “Team Training Institute has provided exceptionally good training for the recall system, and they offer fantastic help on making sure that we’re following that system,” Dr. Lester said. “Every once in a while, we’ll recognize there’s something not working with recall, so we’ll reevaluate the system. Often, it’s not the system, it’s somebody that’s working the system.”

The Team Training Institute also gave ideas on how to develop their own in-office training systems. From those ideas, Dr. Lester developed Prizm Training System. “We use the systems that we’ve picked up from Team Training Institute and others that have come through the program,” Dr. Lester said. “We listened, learned, and developed this into our own training.”

#7: Tiger-Proof the Practice

“Hire an associate on a trial basis and offer ownership opportunity.” Dr. Lester added an associate after Dr. John identified the need. “One of Dr. John’s gifts is evaluating blockages in your practice,” Dr. Lester said. “We were capacity blocked and me being alone was inhibiting our growth.” A health scare where Dr. Lester had to shut down his office for nine weeks made hiring an associate to tiger- proof his practice an even higher priority. “I was alone at the time,” Dr. Lester recalled. “And that’s a bad place to be. If your hands aren’t here doing the work, then you’re in trouble and that’s scary.”

Three of the key principles Dr. Lester learned from The Team Training Institute are: 1) Offer a one-year trial period to evaluate the associate’s skills and see if it’s somebody who is teachable; 2) Identify good people you can trust and can work with as quickly as possible; 3) Give them the opportunity to become an owner in the practice. The first associate Dr. Lester hired was not offered ownership because, while he was a great, trustworthy guy, he was challenging to teach. “I learned from Dr. John that as you grow, find somebody that can be taught and wants to learn,” Dr. Lester said. “My first associate, no matter how soft I would present it when trying to teach him, instead of accepting the advice and help, he took it as an attack and the defense wall would go up. I knew long term that wasn’t going to work for me.”

The second associate he hired, Dr. Luke Lester Owens, ended up becoming a partner. He was told upfront that there would be an opportunity to buy in down the road after he successfully completed the trial period. “By inviting an associate to become an owner, they then act like owners and the staff sees them as owners,” Dr. Lester said. “And I know that there’s a plan in place if anything happens to me. It’s also nice to go for a week’s vacation and know that things are going to run the same whether I’m here working or not.”

For Dr. Owens, who was hired right out of dental school, knowing upfront that he would have the opportunity to become an owner down the line was an incentive to accept the job. Plus, having a trial period provided the transition period he needed to feel confident in being ready for ownership. “I don’t know if I would have come if I thought the only option was that I’d be an associate forever,” Dr. Owens said. “I was right out of school, so it was nice having a trial period starting out to just focus on learning dentistry and getting quicker. After I was confident that I knew what I was doing, ownership seemed like the natural progression.”

#8: Understand Salary and Profits

Prior to The Team Training Institute, Dr. Lester admits he had no idea if he was profitable or not. When he started diving into his balance sheets, he experienced an eye-opening lesson about salary and profits when he discovered that he’d worked for free for two out of the five years he’d been practicing.

“I still remember the night that I sat in Guatemala in a hot tub and cried to some of my friends,” Dr. Lester said. “I’d been working my guts out and the harder I’d work and the more I’d produce somehow the numbers were suggesting I was taking home less and less.”

Discovering he was doing something wrong, Dr. Lester showed Dr. John how much he was producing and how much he was taking home. “Dr. John asked, ‘Are you paying yourself first?’” Dr. Lester said. “I was paying everybody, including the associates, and everything else first and then I would take whatever was left at the end of the month to cover our bills. I’d leave the rest in to grow the practice, so for a long time, I took home even less than the associate did. A big moment I picked up from The Team Training Institute was to pay myself first and understand profitability.”

When Dr. Lester started to pay himself and reconcile his month-end differently, he discovered he wasn’t very profitable, so he turned his attention to increasing profitability. “Understanding profitability helped us an awful lot,” Dr. Lester said. “We discovered we can increase our production, or decrease expenses to become more profitable. Sometimes it was finding that balance and bringing both into alignment. Suddenly, I started making money, and we became more and more profitable. Last month, we were 32% profitable, and that’s after making sure the doctors are paid first.”

While initially, The Team Training Institute helped Dr. Lester recognize he didn’t have to know how to do everything, he credits being fully invested in the training and community as the secret to his massive success.

“There are a lot of sound principles that we never would have come across without The Team Training Institute,” Dr. Lester said. “It’s important to continually go, participate and hear new ideas that come from all the other practices. Over the years, I’ve seen a lot of practices come and go, but the ones that come and stay around, they’re the ones that really take off and do well. We’ve gone from $600,000 production to tracking close to $5 million by year’s end in physical production with two docs and four hygienists. I provide better dentistry and am more profitable, which in turn means more freedom for me and my family. Now that I’ve turned over things to management and have a trusted partner, we’re more tiger proof and our autonomy and freedom are greater. This has made me free to focus on being the best dentist I can be. We did that by just following sound principles of The Team Training Institute and owe so much to Dr. John, Wendy and The Team Training Institute family.”

Dr. Nate Lester has also been featured on The Team Training Institute's podcast. Click below to listen to his episode:

Ep 28: How to More Than Double Your Production with Dr. Nate Lester