EP 92: Grow And Have Fun? With Dr. O’Flaherty


Is growing your practice fun? If not, you’re doing it wrong.

Today’s episode is special because our guest is Dr. Ed O’Flaherty, based in Dublin, Ireland.

The traditional practice in Ireland has only one or two treatment rooms, maybe 6 at most. But Dr. O’Flaherty has 16 ops. So, he’s doing things very differently in an environment where growing a practice is more challenging than in North America.

In this conversation, you’ll learn:

  • How to grow your practice in a city or state that doesn’t support you
  • How to find where 80% of your patients come from (so you can scale with precision)
  • Why having extra ops is like having extra cash registers in a supermarket
  • How to get the highest yield per square foot when renovating or building a practice (hint: it does NOT need to be over the top)

Welcome to the Double Your Production podcast with the Team Training Institute, the one place designed for dentists and their staff who want to grow their practices by following in the footsteps of those that have done it, who in the trenches, who know exactly what you are going through, and now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs.

Dr. John Meis: Hey everybody. Welcome to this edition of the Double Your Production podcast. I'm Dr. John Meis here with Wendy Briggs and our guest, our international guest, Dr. Ed O'Flaherty. Welcome Dr. O'Flaherty, how you doing?

Dr. Ed O'Flaherty: Yeah, very good. Thank you very much. Looking forward to this.

Dr. John Meis: So tell us about your practice, where it is and a little bit about it.

Dr. Ed O'Flaherty: Sure. So the practice is based in Dublin, Ireland. We've been there since 2007 now, and we have a 7,000-square-foot facility. I think it's about 16 operatories or clinics in the building, and we have a range of specialties. We cover all the cosmetic, implant stuff and general dentistry.

Dr. John Meis: Fantastic. So large facility, multi-specialty, that's kind of uncommon in Ireland, I would think.

Dr. Ed O'Flaherty: Yes, it's true. I mean, they're generally smaller, probably more one or two man practices. Always has been, and it seems to be a persistent thing. I understand in the States, a lot of people are still small surgeries, but we will be quite unusual, but not exclusively us, that's for sure.

Dr. John Meis: Sure, yeah, yeah, very good. So Wendy, you've done some work with Dr.O'Flaherty's practices, so tell us a little bit about that.

Wendy Briggs: That's right. So we had our first Hygiene Explosion kickoff a couple of weeks ago, and we wanted to do it in person, but we're all still a little bit in the midst of the COVID pandemic and travel can be a little bit tricky getting in and off island. So we were able to do it virtually and it was a great day. They're already doing a lot of things very, very well. Dr. Ed mentioned that they followed us for a time. In fact, I think we had, we first had a discussion a number of years ago about working with him and his team. So finally we were able to kick it off and I'm actually really anxious to hear from Dr. O'Flaherty, what the impact has been, because it's only been just a few short weeks since we did that work with his hygiene team.

Dr. Ed O'Flaherty: Yeah, absolutely. Well, first of all, I've been delighted to follow you guys for quite a while and we've used some of your online materials and got some of that training over the last couple of years, which has been great, some really good videos out there and some really good podcasts. So thanks for that information at the same time, there's nothing like having the Wendy Briggs, train your staff one-on-one. We're really looking forward to having you face-to-face, which would be even better. But I think we were all very impressed with how good it was over a Zoom call, so thank you for your time, really energizing for me as a practice owner and for Tom, my business partner and for all the team, they really, really got on very, very well with us. I think what was really special is the way you showed the why, why it's so important that we offer these extra services to people to try and have the very best dental health that we can have. It's an amazing thing to offer and it's something everybody should be offering.

Wendy Briggs: Well, I love that. So have they hit the ground running, more services being provided on the daily at Seapoint?

Dr. Ed O'Flaherty: For sure. I haven't run the numbers, but I know anecdotally speaking to them that they're all watching out for opportunities to help people. I put myself in and my kids and my wife in, in January, and we're all going to see what ancillary services are offered. I hope I get fluoride treatment. I hope I get everything taken care of, to the very, very highest standard.

Dr. John Meis: Yeah.

Wendy Briggs: Well love that, I love that. In the courts of our, in the midst of our conversation, our training, there were a few question and Dr. John that came up, which is why I reached out to Dr. O'Flaherty and invited him to be a guest on our podcast, because we mentioned he's a little bit of unique practice style for Ireland, certainly our work in the UK, generally it's one or two treatment rooms in the entire practice over there. And that's, as he mentioned a model that's just persisted. There are a few rarer practices. The largest that I know of, that we've worked with in the UK has six chairs. So for you to have 16 really is unique. I think it's not as unique in the States as it is in the UK, but it's really kind of a unique thing. And Dr. Ed had some questions about location number two, Dr. John.

Dr. John Meis: Okay.

Wendy Briggs: So I thought this would be a really great conversation for us to have on the podcast, because I know we always say that if someone has really great questions about any topic, there's other dentists that probably have the same questions that could learn from the conversation. So that's one of the main reasons we invited him on is to hear his questions that he had about continuing to grow and expand their footprint over there in Dublin. And so I'll let him kind of take it away with some of those amazing questions.

Dr. Ed O'Flaherty: Great. So I guess my thought was, you guys have obviously seen loads and loads of practices around the United States and in Canada, and you've seen probably, and seen the numbers on optimal practice size. So I was wondering when we're going forward with a new location, what should we be aiming for? Is it as big as you can find? Is it 7,000-square-foot, 10,000-square-foot? How many operatories should you be aiming to plan for, for the optimal, for the very best, assuming the patient numbers are there to back it up?

Dr. John Meis: Yeah. And so are you planning it to be, again, a multi-specialty with GP type practice in the same model that you're running now?

Dr. Ed O'Flaherty: Yeah, exactly. Yeah, it's worked very well for us and I think there's an opportunity to do something similar elsewhere. Yeah.

Dr. John Meis: Yeah. Very good. And when you look at your space now, do you wish you had more or less?

Dr. Ed O'Flaherty: Definitely more, definitely more.

Dr. John Meis: So that tells you that your, that you can go bigger than-

Dr. Ed O'Flaherty: Yeah.

Dr. John Meis: ... how you are, assuming that, again, that you have the patient flow. And tell me about the patient flow, or if I call your office to get an appointment, when could I get one?

Dr. Ed O'Flaherty: Yeah, at the moment it's a couple of weeks, we're-

Dr. John Meis: Right, cool.

Dr. Ed O'Flaherty:... we're quite busy. Yeah, for sure.

Dr. John Meis: Yeah. Good. And so that's a pretty good place to be. You know much longer than that and now you've got increased cancels and bailed appointments, and so that's terrific. All right. So if you had more rooms, how many would you add? More treatment rooms, how many would you add?

Dr. Ed O'Flaherty: I guess I've been following a little bit of the dental economics, the dental ergonomics that Wendy mentioned, and they kind of make the analogy about having extra shopping tills in a supermarket. You have the extra capacity for when you need it, rather than-

Dr. John Meis: Yeah.

Dr. Ed O'Flaherty: ... having them full all the time. I think it's the same, McDonald's, they have enough space for the busy times, they have enough space just for, it's not always full or always busy, and they obviously do very well. So that made me think about the right number of surgeries and the right size of surgery, that we never really thought about before. It was always based on what the building, it was an old building we moved into, so we kind of had some natural barriers, so we made it kind of fit around those barriers.

Dr. John Meis: Yes.

Dr. Ed O'Flaherty: And we didn't plan out a certain design or a layout as we'd like to now.

Dr. John Meis: Yeah. Very good. And so what are the ways, I think you can answer that question is, just relative to your size now. So there's a way that you can create a heat map, and this can be done through a variety of online tools where you create a heat map to see where your patients are coming from.

Dr. Ed O'Flaherty: Okay.

Dr. John Meis: And what you want to identify is, what is the radius around your current location, that accounts for 80% of your patients? And that's the radius that you're going to have to work with in the next office. And can you find a radius that has a similar population?

Dr. Ed O'Flaherty: Yeah.

Dr. John Meis: So, I'm really thinking of a matter of scale. Because you have the multi-specialty, I'm guessing that they draw from farther than the GP side of the practice, is that correct?

Dr. Ed O'Flaherty: Yeah, for sure. We get people from all over Ireland for treatment at different stages.

Dr. John Meis: So maybe on the GP side, you're doing the heat map, maybe not so much on the specialty, if you can separate the patient base in that way. And so a heat map just is points on a map, right. And so where, where your patients are located, where they live. So that's one way to look at it. And so from, you're about a size that I have very good data for. So in looking at practices in the United States, in a group of 120 locations, we did a return on investment analysis.

Dr. Ed O'Flaherty: Okay.

Dr. John Meis: And we found that the return on investment was best at six, six treatment rooms per GP dentist. And so if there's one, six is good, there wasn't that much difference between 10, 11, and 12. And we didn't have enough above 12 in that group to make meaningful analysis of that.

Dr. Ed O'Flaherty: Okay.

Dr. John Meis: And none of those offices were multi-specialty.

Dr. Ed O'Flaherty: Okay.

Dr. John Meis: So I think the best model that you have is what you have now, and if you think you could use more than what you have now, then you filled up what's there, you already know how to do that. Right?

Dr. Ed O'Flaherty: Sure.

Dr. John Meis: And how far away are you thinking?

Dr. Ed O'Flaherty: We're looking around about seven kilometers, for about four miles I suppose from the current location. Thing that it's kind of easy enough to, for us to get there. And also it's, just be some crossover for patients who can't be seen at the moment in their current facility can go to the other facility, which will help to make that a bit busier.

Dr. John Meis: Yep. It's helpful with team as well. If you have a team member out, you can-

Dr. Ed O'Flaherty: Sure.

Dr. John Meis: ... people will be flexible when it's not too far away. That sounds like a really good plan.

Dr. Ed O'Flaherty: Cool, good. That's good to hear.

Dr. John Meis: Yeah. It's exciting.

Dr. Ed O'Flaherty: Absolutely. Yeah, for sure. Cause it's been a while since we, we haven't added a location in a long time and it's the right time, I think.

Dr. John Meis: Yeah.

Dr. Ed O'Flaherty: For us.

Dr. John Meis: Yeah.

Wendy Briggs: Fantastic. Well, what other questions did you have about that? Do you have any other things that are kind of-

Dr. John Meis: Yeah.

Wendy Briggs: ... weighing on you or decisions that you're trying to make?

Dr. Ed O'Flaherty: Yeah. I was just wondering in terms of cosmetic dentistry, some of the gurus, they all have these beautiful surgeries, which are absolutely massive and all designed amazingly. And I wonder what difference that makes for a cosmetic dentistry. Obviously I appreciate, amazing reception makes a big difference, having that, wow when you arrive in the building, but I wonder what the operatory size or the operatory design, what effect that has, if any?

Dr. John Meis: Yeah. It's a really good question. Here in the States, you can, you will see sometimes cosmetic practices that have very few treatment rooms and they're very big and, I'm not sure that makes a bit of difference on case acceptance. Certainly doesn't make a bit of difference as far as doing the treatment. So I think what they're, and certainly chews up a lot more space, and so the yield per square foot is less. Right? And when you're building, if you already have it big deal, but if you're building that cost per square foot is very high and you want to have the highest yield from the square feet that you can. So I don't believe big, I think having a really nice looking entryway, as you said, and waiting room is, a reception area is certainly worth doing. It doesn't have to be over-the-top, but it needs to be very, very nice. But I think just having enough room to have the technology that you need, which really isn't any bigger than a standard op.

Dr. Ed O'Flaherty: Okay.

Dr. John Meis: And so if you follow Design Ergonomics, and so David Ahearn, that's the founder of that company, and I have been friends for over or 20 years, and they do a wonderful job of making facilities very, very nice, very, very functional, but also very efficient with the space that you have.

Dr. Ed O'Flaherty: Yeah. He's got some great videos online. It's great, really impressive.

Dr. John Meis: Yes he does. Yeah.

Dr. Ed O'Flaherty: Brilliant.

Wendy Briggs: And we had mentioned, your desire to visit a few practices in the States, and we've got a few in mind, some of which were designed by Design Ergonomics. So you'll be able to see in-

Dr. Ed O'Flaherty: Yeah, right.

Wendy Briggs: ... person, what that might look like. And I would suggest too, as well, I agree with Dr. John, if you were going all cosmetics and 100% cosmetic locations, you may need to be a little bit more conscious of what those cosmetic patients may be expecting. But I think there's no expectation of those patients about the size of the treatment room. More so it's about the technology and about the feel and the modern aspect of it. They don't want to go back into something that looks like it was built in the sixties.

Dr. Ed O'Flaherty: Sure.

Wendy Briggs: They want to make sure it's modern and clean, but you also have multi-specialty, so you're not only attracting those cosmetic patients. So function becomes just as important, if not more so than a practice that was solely going for those cosmetic cases.

Dr. Ed O'Flaherty: Yeah. Great. Absolutely. I have another question just in terms of using technology actually, it's, we use Trios, the 3Shape scanner. Do you have much experience of using that with all patients before they're seen in the clinic? Is that a kind of thing you're doing routinely now?

Dr. John Meis: So it's very common in practices who have the scanners, and I would guess the number of scanners being sold here is increasing. More and more practices are using them. More are putting away the impression material and using the scanners instead. There is some value, as you already know, about scanning patients regularly, because you can point out places of wear, and movement of teeth and things like that when things aren't stable. And so there is some value to that. And I think the practices that have scanners are doing it, are scanning patients regularly. We have some practices that are scanning every single time and some practices that do it every other, or every third.

Wendy Briggs: I was going to say, we are working with a lot of hygienists and a lot of doctors that say, gosh, I wish I could get my hygienist to scan. And the hygienist was saying, we don't have time to do that. But initially, once you commit to it and you make it your standard, they get faster. Right?

Dr. Ed O'Flaherty: Yeah.

Wendy Briggs: So I personally was a patient in a practice not too long ago and was scanned, by my daughter, who's the hygienist. And what is amazing about that is, you can scan everybody, but then you know there's feature where you can look at it as if it were an intraoral camera.

Dr. Ed O'Flaherty: Sure.

Wendy Briggs: So here you have, in a matter of minutes, an intraoral camera image of every single tooth that would've taken you far longer to capture if you were just going based off of the intraoral camera. So I think it's got some amazing features from a patient acceptance and from a patient wow standpoint, from that new patient experience impact. There's power there. So certainly if you have it, we'd love to see it used consistently. Like Dr. John said many of them will do it once a year with the hygiene visit. And that seems to be enough, but if you have a practice where you're focusing in on cosmetics and you really want those conversations to be prevalent every visit, then it may make sense to do it every visit.

Dr. Ed O'Flaherty: Sure. Okay. And are people doing that free of charge generally? Are they charging something for the scans or are they charging for, not maybe for the first one but charging for rescans, et cetera? What's your experience on that?

Dr. John Meis: It's all over the map here.

Dr. Ed O'Flaherty: Yeah.

Dr. John Meis: A lot of practices here, what they charge is driven by what insurance will pay.

Dr. Ed O'Flaherty: Yeah.

Dr. John Meis: Not that we're recommending that, but that is what many practices do. So many practices don't charge anything for the scans, but many do.

Dr. Ed O'Flaherty: Yeah. Okay. That's fair enough.

Dr. John Meis: Wendy teaches the three roles of hygiene, the preventive role, the periodontal therapist role and the treatment advocate role, and the scanners are really helpful in that third role, talking to patients about treatment, talking about what they, what treatment they may need, where they're unstable, where they're wearing, where they're chipping, what restorations are failing. It really helps with at that role. We all have to remember that that role was really not taught in hygiene school. So hygienists, at least here in the States, don't get any training in the treatment advocate role or on restorative dentistry in general. And so it's a role that is important to have someone, like TTI, just help your hygienists see that role. And so we have several offerings to help hygienists get onboard and understand the importance of that role.

Dr. Ed O'Flaherty: I'm looking forward to that training for sure. I was talking today, one of the hygienists and she's, some of the dentists try and do the sealants, and she's kind of identified them. And I was saying the more they're obviously recommending other treatments, the less the dentists will be doing the sealants. So-

Dr. John Meis: Yes.

Dr. Ed O'Flaherty: ... I'm looking forward to that training.

Dr. John Meis: Yes, yes.

Wendy Briggs: Absolutely. We want the dentist that doing the services that only the dentists can do. Right? If you're really talking about maximizing space and efficiency, that's the ideal. Of course, we're delighted that a tooth is being protected. Right?

Dr. Ed O'Flaherty: Yep, sure.

Wendy Briggs: So that's thing one, we're happy that that's happening. Thing two is, okay let's figure out the smartest people on the team to do that, to maximize everyone's productive capacity. Right? And sometimes it just takes time to build awareness on that, and again, for your hygiene team to have the confidence to say, "Hey, we're going to go ahead and take care of that while you're here today". That's one of the things that we worked on. Right?

Dr. Ed O'Flaherty: That's right.

Wendy Briggs: So it's exciting. As we continue to progress in the program, you'll have more and more resources available to you with those topics. And I'm excited to see where you go with this as a group and as an organization, because I look back at some of the practices you'll probably be visiting, and some of them it's been a longer journey, but some it's only been a short three or four years and they look nothing like they did when they first started. So it's been a really positive thing. It's one of the things Dr. John and I enjoy the most is watching the growth amongst the people that we work with. It's really fun.

Dr. Ed O'Flaherty: Absolutely. Growth is always fun. Yeah. That was great. I appreciate your time. It's really good. And I appreciate all the training you've done. It's been so, so worthwhile.

Dr. John Meis: Well, good. I'm glad it's been helpful, and I look forward to meeting you when you're over here in the States and you're welcome in my practices to take a look at what we're doing and-

Dr. Ed O'Flaherty: Thank you so much guys, much appreciate it.

Dr. John Meis: You're very welcome.

Dr. Ed O'Flaherty: Very good. Thank you so much. It was great having you. Thanks a lot. Take care.

Dr. John Meis: Take care. And that's it for this episode of the Double Your Production podcast. We'll see you next time.

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