SPGxTFAP - 2024 Recap

Welcome, welcome. I will not do my customary intro because this is a different episode, an episode of a different color, if you will. This is the 2024 end of the year recap episode, and this is not just for the SPG pod, but this is also for T-FAT for the full-large podcast. In honor of that, I'm wearing my T-FAP times SPG tank top. My co-host was given one of these, but it slipped his fingers. He left it somewhere. Who knows where it went, but with me is

Dr. Steven Voreholt. Steve, how's it going? Hey, good. I'm wearing my SPG hoodie since I'm on the SPG pod. It's a crossover. There you go. I don't know what happened to that, but I need to find it because that's a nice-looking sleeve of shirt you got on there. It's kind of like when soccer players or basketball players take off their jerseys at the end of the game, like you're wearing the SPG pod swag, I'm wearing the T-FAP swag. You can send me your pod worn jersey. I'll never wash it. I'll

just throw it in a frame. We'll cut it up and make a quilt out of it and it'll be sentimental. That's a great idea. Happy Boxing Day. Dude, happy Boxing Day. I was just about to say that we're recording on the day after Christmas. I think that there's an interesting reason for that because it's been a lot of family time, a lot of time, hold up doing family stuff. To me, this time of year is always an indication of careful what you wish for. Too much of a good thing can be a not so good thing.

Balance is important in ends. What I realized during this time of the year is that we find ourselves in rhythms that I think are more good than we realize, where you have the split of where we're going to exercise, we're going to work, we're going to be around family, and you find something resembling an equilibrium and you feel it when you work too much, like that balance gets off.

But then I think that that balance can also feel off and this feels weird to say, but when you're around family all the time for several days in a row, you start to get that nervous itch to get back to it. Have you experienced something similar? Yeah, and it's always tough in dentistry, especially as a business owner or in our case now, in a higher up position in a large business, is like, this is a pivotal time of year. The books are about to close. And we're taking the last,

how many weeks? What are we doing here? But it's good. No, it's a good reset. And it's interesting. I haven't had a lot of different Christmases since I've been moving around the country. And the weather here is, even though it's quite warm, it still feels like Christmas somehow. So it's kind of neat. But Arizona winters, when you guys live there for a while,

have you ever lived in Phoenix? I've been there so many times over the past few years, teaching courses and doing visits and whatnot, that I was there at Christmas a lot. And it's almost like some people overcompensate for the weather. You see so many Christmas decorations and lights, but then it doesn't feel the looks a little, looks a little gauche. But it gets bitter cold there in December and January until the sun's out and then

you're so it's an interesting thing. And I studied abroad in Australia and was there like leading up to Christmas at the end of one of the semesters and that was bizarre because it was actually summer and getting hotter and yet they're paying out lights and that felt just really awkward. But no, it's really flush in the opposite direction. I think so. It's the Coronolus Effector, Coriolus, or I don't know. Well, yeah, I think with you mentioned Santa Barbara

feeling different at Christmas time. And that cuts to the heart of what I wanted to talk to you about today, Steve, which is the year in review because you're at the point now where you've been at Santa Barbara Dinshes and implants for just over a year. Yeah. You're past your one-year anniversary, but and also with your time at SPG in your role as the senior VP of clinical affairs

that also completes your first calendar year in that role. And so I felt like it was appropriate time-wise as we're winding down 2024 as we're recapping the year as we're typing up our year in review for our doctor team. And we're planning exactly the order of which we're going to roll things out development wise and plan of attack wise for 2025. It'd be good to debrief on the year

because we've learned a lot. There have been certain themes that I've identified as being applicable to us, not only as we're figuring out what went well, what didn't go well, but most importantly, what are those themes that we can use to draw from when we're making decisions for the coming year? So I felt like you'd be a great sparring partner in that debate. And so to start things off, if you're thinking about, hey, what went well for 2024, what would you say

falls into that category of like, hey, this went great. Let's double down on that and do it again for 2025. Yeah. I think it's been really fun to see certain doctors start this year or late last year and kind of where they're at now. And it's while you're in it, like while we're like June, July, like it's just kind of like, I don't know, it's kind of like the weather changing, right? You

don't really notice it because it's so subtle. But if you like take a snapshot right now and look at, for instance, like Devin and Grand Rapids and look at Devin when he joined in like January, February, whatever that was, it's like, it's that's when you can really get the stark difference in how much they've grown as clinicians and also really in the confidence that you can see through the doctor chatter, through phone calls with someone like him. And there's

another good example is Paige. She joined us, I think, in I think 2024, she took over to Koma. And she always had the confidence in the gusto, but it now it feels like there's a better foundation behind it. And you can just tell when she talks to you that like she's, you know, she's fully invested and comfortable. So confidence and comfortability are probably two things. We can fake confidence. You can't really fake the comfort level. So that's been cool to see because

it just proves that our process of bringing on new doctors works. You know, if they if they buckle down and do what they're supposed to and kind of go through the, you know, the rolls and the reps. So that's been really, really cool to see. Yeah, I agree. And that you touched on one of my themes that I want to get into. But first on

the confidence piece, I got to hang out with Devin and his team in Grand Rapids last week. That was my final SPG focus day of the year was was hanging out with Devin and Rob and the team up there. And the confidence starts from within, but it's bolstered and buoyed and held up by the team. But it's interesting because you can't, the team has to get the confidence in the doctor

organically. It's hard for your team to fake that. And that's why I think it's so important speaking of processes to get the team seeing, feeling, experiencing the meat of what we do as quickly as possible. Again, new doctor joins SPG. The time between when the doctor starts and when that doctor completes his or her first arch or arches of all one for and the patients leave with

those loaded temporary. That really shortcuts and is almost like a cheat code for developing that team confidence because in this model, crazy highs, extremely low lows, and the way that doctors stay level headed is with the confidence that the team develops around them. So that all of the

stress, all of the chaos isn't only on the doctor's shoulders. Have you seen that to be true both in your role personally, leading Santa Barbara Dinsers and implants, and then also leading our doctor core, just the critical nature of developing that team around you to seeing your praises and pull you up by the bootstraps in those challenging times? Yeah, I think I don't have much contact with other doctors office teams to know how they're evolving. But I can tell you without a doubt that

when you talk to a doctor who has a good team, it's a different kind of discussion. There's a lot less stress and anxiety there. And then my own personal team here in Santa Barbara, my assistant's been with me since we opened a year ago. I had a new assistant who joined, I think she was in May or April or something like that. And then her office manager has been with us since January, February. So the team has had a lot of time to kind of coalesce and become a

pretty stable unit, which has been really fun to see. And just seeing the especially the assistants, because I work with them, obviously, much more hands on, go from deer in the headlights to they're doing the entire records appointment and scanning and being comfortable inserting prosthetics and hey, so and so broke their prosthetic, I'm going to print it and they take it from

there kind of thing. So that's been really cool to see. And I can imagine if you're in an office where the biggest issue, any DSO has is turnover, but it's not just turnover at the top. Turnover at the top is of course extremely, you know, difficult to deal with certain times, but even turnover at the dental assistant level can then put a lot more stress and strain, because there's a certain amount of time you need to work with your assistant in this model

before they feel comfortable and confident to go back to those themes. But I'll say this, the there aren't that many things we do. So I told my assistant, I was like, we do like 10 things here. Like if we boil it down, we have like a consult, a records, a surgery, those are all, you know, three, then we have post up a different kind of post up. We have a delivery of a prototype, a delivery of a final, like I'm running out of ideas of what else we do, single implant impressions,

I don't know if it gets 10. So you can literally write out every, every potential appointment and have it in a pretty small book and just be like, here, here's what we do. Now the issue with that is I've tried to write that book, but every doctor does have their own kind of nuance to those things too. And so we don't want to ever pigeonhole doctors would be like, here's the playbook, because that's the thing about implant dentistry. When I was teaching, implant dentistry and still do,

everybody wants the playbook. They want the cookbook, they want to come in and act like it's a root canals, right, where you go file 10, then then 15, go back to 10, then whatever. That's not how implant dentistry works and how surgery works. And so it's, it's difficult to kind of so distinctly break down every step. I can try big outlines, big ideas, how I do it. But each office kind of

has to get to their own top 10 appointments. And once they do that, I mean, think about these DAs, the one I've worked with a long time, she's been a DA for 20 years, when she was in a GP practice, she had to know a lot more than she does now. So there's, you can tell they're less stressed. Like there's times we just don't have patients for a handful hours in the office, you know, they're just cleaning up. I mean, did that ever happen in a GP practice? So

we should be able to lean into these team members. And I think intuitively, they kind of understand that it's a pretty good gig. But they have to get comfortable with these 10 types of appointments they've probably never done to this point. So it is like a 10 brand new things. That's exactly what I'd written down as being theme number one, which is getting comfortable

with processes. Because when when you're young, you're upstart, you're getting rolling, you're finding yourself as a clinician or as a team, you're so people driven, you're so personnel driven, everything is so contingent upon each person's preferred way of operating. But the more that we can distill it down into a process, then you're a little less immune to turn over, you're a little less immune to someone calling out sick and another person coming in and putting on a different hat

for a given day. But what you were what you were identifying, Steve, was the notion that our our dishes that we're making are the same across practices. But the recipe to get there is going to differ. And if you're too prescriptive about the exact ingredients in the exact recipe, that's when doctors bristle, that's when they start to really feel confined, constrained,

beholden to a certain way of operating. And I would argue to your point unnecessarily so I spent probably an hour and a half or two hours on the very first SPG focus day with Sarasota. Going through every single type of appointment with their team, because they had a newer dental assistant at the time. And it was clear that people at the front were speaking a different language to the patients than people in the back were. They were referring to appointments by

different things. And it was causing confusion for the patients, because there were several instances of the patient coming and expecting their final teeth, because based upon what one set of people had referred to the appointment as, it was pretty obvious to the patient. Oh, I'm getting my teeth next time, even though that wasn't the intention. And so we spent time boiling down like these are the step for eat, like all on four for overdenture for traditional

denture. And then here's what the patient facing lingo would be for each step of the appointment. And we came up with, I believe it was trial smile, rather than wax try in, because a patient has no freaking clue what that means. Like to us, it's pretty intuitive, but it's all dental lingo. It's all a foreign language to these patients. So the more that we can use pretty elementary broken down normal speak, the clearer we can be. And the less likely there is

of a customer service, snafu, stemming from well intentioned communication. But no, you're right. I think titling the different dishes that we serve, so to speak is great. But then leaving it up to each discrete individual team to come up with their exact recipe for that, I think is the move. And we've gotten so much clearer on what are the menu items, what are the common combinations

of upper this lower that that we offer. And so yeah, I think 10 may be shooting high. And I think it may be more like six or seven that we've seen be the common codes that we do over and over again. Yeah, I think it's I was misremembering that we do dentures sometimes because I've been so focused on implants, but six or seven fixed appointments is probably the max. And it's

I like the way you talk. It's it's a it's akin to cooking and not baking. You know, we're baking is like you have to put exactly a teaspoon of salt and cooking is like, you know, you just drizzle that on to taste. And so there's a little bit of to taste when it comes to how the doctor does inside those appointments. But there's something I have noticed talking to patients about these steps and making sure there's clear where we're at, because you don't want to overload them on

the consult day and be like, here's the 10 appointments to get you to final. I usually keep it kind of short and explain that generally we're done by 16 weeks in my office, sometimes a little bit sooner. But what I have noticed is patients, I will say like, we'll talk about the search. Hey, your next visit with me is going to be records appointment. We're going to we're going to do a smile design,

we're going to do all the records we need to work at the lab and develop your perfect smile. We love you to be involved, bring photos, whatever. After that is the surgery. And at the end of the surgery, we take the teeth out, we play the implants and you leave with teeth that day. And I've had more patients recently say, those are temporary, though, right? Almost like they hope their temporary because I think with some of these other offices that tried to race to finish,

like 24 hour 72 hour finals or within a week giving them the final prosthetic. I think it's finally after a couple years, reaching those Facebook groups and those patient facing support groups where it's like, that's actually not a good thing. Because I've had patients be like, but I'm going to get like another set of teeth, right? And I'm like, yes, of course, that's the right way to do it. Because I've had patients literally be like,

because like your gums are going to shrink and it won't fit. It's like they're saying all the things I've been saying for three years on why you shouldn't do this. And I'm like, I'm so glad you brought that up because yes, you're right. Some offices do cut corners in that regard, but we

don't we do this this and this and we do prototypes and so on. So I'm starting to get just a little bit of a vibe check on the patient population that they actually aren't looking for the done in a week thing, which was so popular three weeks ago or three years ago, ish, because it sounded so great, right? Teeth in the day or whatever it is. So that was just kind of interesting thing when it comes to the appointments. You know, most patients are totally fine with the fact that

they're going to get some teeth that day. And they're going to we're going to let them heal and settle and then we'll make a more permanent final fitting set. That's an outstanding topic to cover on a future teeth app episode. So anyone listening, whether you're an SPG doc or someone who does full arch in another setting that's listening to this, I would love to hear, have you heard similar stuff from your patient pool that Steve is talking about because you're right. Three years ago,

this was a huge uphill battle. We were having to strategize. How do we market? How do we position ourselves? How do we train our teams to build value for that waiting time for the time for us to respect each individual patient's biology and know that there's going to be shrinkage and there's going to be reshaping that happens of the architecture of the gums and the bone that causes there to

need to be a final article that looks way different than what the temps do. And in the me, me, me, immediate gratification culture that we all live in, it's a it's a steep hill to climb to try to build value for waiting and being patient with the process. But man, if we can start to see the patients self educating, if that's part of like the expected level of education that people come in with, because you expect people to be self educated on the whole like, is fluoride bad for me?

Or am I going to get metal poisoning from my amalgams? Like you have that sort of stuff tends to fester in the online patient forums. But if we're getting some type of recognition of, hey, not all fixed is created equally. Right. The kind that has the two sets of teeth, the healing teeth

in the final teeth, those tend to be better, those tend to be a better ROI. Then that plays right into our hands not to mention all of the stuff that's happening in the background that I've heard through the rumor mill that's about to happen to some of these outfits that do the quick turnaround time or the same day or the next day. There's a lot of stuff in the hopper that I've heard about

that could be coming to pass that could be made public here soon about that philosophy. And so I'm very glad that SPG never really dipped our toe into the water on to that immediate gratification style because it just it sounds like there'd be hell to pay in a lot of different respects. There's so much I've had discussions with friends and colleagues who did that and have switched back because of the high amount of retread they'd have to do. And most of them are our PMMA wrapped bars.

And then you'll see some Facebook posts in those patient groups where it's like a broken acrylic hybrid like old school acrylic hybrid. And the patient's post is like the office is telling me it's $20,000 to get a new one. This is the one I left with that day. They said this was permanent. So I think it is the zeitgeist is starting to kind of roll a little bit, which is good because to your point, yeah, two years ago, you'd have to be like, no, trust me, you don't want the teeth

this week and you'd have to fight that battle. And it just looked like from the from someone who'd restored this many times, I've seen so many restorative nuances that required a lot of work to think that some people were doing this in 72 hours. I just knew it was not going to work. And it like they come out like a flash in the pan, right? And we know some companies that are just massive numbers. And it's it's almost like gobsmacking. And when you look at SPG, we are the largest

implant focused DSO for GPs at 36 offices. We're the largest by a pretty good margin of like almost 50% over something I can even think of. And there's a lot of like little regional ones that might do this. But then you've got the big ones that are like several, you know, maybe tens or even 100 offices doing crazy numbers. And I just think it's, you know, the time is maybe nigh for those to realize if you looked in the books, maybe it's not as as Rosie looks because

they have to redo some stuff. And we've heard from doctors who've worked there and how bad the culture has become too. But I would say it feels kind of like tortoise in the hair a little bit where if a year ago we looked at those and we had, man, we're never going to get to that level. It doesn't

even make sense. How are they marketing with these these numbers? And then you start to hear through the grapevine and through colleagues who have left those practices or any other different way through patient testimonials, for instance, though maybe the way we're doing it, which is the slow and steady and correct way, still very profitable. We don't have to like rush out, grab the bag of cash before the whole thing falls down. You know, that's what it feels like. That's what

some of those are doing. So that's exciting to know that we can be very profitable at a moderate pace, but it's comfortable and it's consistent and it's good for the patient, which in the end will be good for us. Yeah, I think that's the way to do it. And I'm very happy. No, I'm always trying to cut time off every time. I mean, I'm trying to get down to eight to 10 weeks if possible. I have some ideas, but that's, you know, our soft tissue healing architecture is pretty much done by four to six

weeks. So I, there's ways we can certainly get shorter than like six months, which some practices have to be at because of the analog processes. And we'll talk about that on another episode, probably, but doing it in the 72 hours is just never felt right. And now we're starting to finally see that come home to roost. And that's kind of feels good, honestly.

Well, it's it's redeeming. But the point that you're making, it sounds like is we want to be looking at ways to increase efficiency without veering into the realm of irresponsibility, because we want sustainable outcomes, we want predictable outcomes. And part of the magic of being able to offer this service with surgically minded, hungry GP dentists is being able to do it in a predictable way. And the predictable way is to let the body cook, let the body do its thing,

give the body the time that it needs to be able to integrate with the fixtures. And then you have a lot higher likelihood of success, because the the redo rates that you hear about in the broader world are kind of staggering and kind of scary when you compare those to the rates that we see requiring revision or rework in our company. And so that's that's the cherry on top for me.

But no, I just I'm very thankful that the market seems to be catching up with what our experience has been as that patience is a virtue when it comes to knowing that the the final outcome is well worth the wait. And we see so many patients turned into raving fans, even in spite of the the healing times, even in spite of the fact that it wasn't instant gratification, which is a feather in the cap of our ability to communicate the value of what we do.

If you have people that are like, Oh, obviously, my my bone needs time to accept these implants and my gums have to level out. And we want to make the teeth to where the the gums are exactly versus where we hope they are. And so the if the patients are picking that up, that means that we're we're doing a really good job, which which brings me to another theme. So we talked about the theme of having our processes dialed in, like the SPG way of operating the SPG way of creating a great

patient experience. I also want to talk about the improvements that we've made throughout 2024 on the doctor experience. I feel like if I could brag about one thing for 2024, that's one of our

big achievements in almost more ways than we have time to list. But if if a doctor joined SPG in 2024, I can very, very clearly and authentically say that we gave a much more consistent, excellent experience, then what we're able to give in years prior, as we were still learning, as we were still dialing in exactly what the roadmap looked like for a wonderful doctor experience.

And I also want to say thanks to you, Steve, for helping to architect that. But in 2024, tell us about what you saw evolve with the SPG doctor experience. Yeah, I can't believe some of the stuff that happened this year, that it's only been a year.

I mean, it feels it because so when I joined as a clinical director and was working to come up with these processes, it felt to me like, Oh, we'll have this thing done in two months, like this thing wrapped up in a bow and then find out that, Oh, I also have to work in a practice and do all the other things and stuff like that. And and you get a lot of helpful, constructive pushback from the founders, from other clinical directors, even from some doctors and even from some staff.

I tried to roll out something, for instance, that was a patient treatment plan generator. And I just kind of shoved it down everyone's throats one day, just kind of like emailed like, Hey, try this. This is pretty cool. And I like skipped a lot of different checkboxes and didn't like tell the RM team or that it was going to happen. And so pretty quickly shut that down. I think like 24 hours later, it was a really cool beta test because so many things broke.

It was basically like a specialized online form that it's supposed to be super streamlined. You pick a couple buttons, type some stuff in it, it generates this beautiful document that's super straightforward for the patient. And when I used it, it worked because I knew how it worked. And when you suddenly give it to 35 team members, they click buttons, you didn't know they could click, they put things you didn't know they could put and Excel spits out some, you know, air syntax,

and you're like, what's going on? And so we rolled that back, we did some beta testing, I think, I think like five or six offices are using it right now, and it seems to be working. Okay. And so learning to slow down because this is a big ship that's moving and you can't just, it's not a speed both, you can just rip the wheel to the left. I should have learned my lesson at that at implant pathway because that's also a massive ship to move. But I just always want to do things like

real, real quick. So it's crazy to think that's only been a year because we've gotten so much done. I would think that from the doctor's experience part, they've probably noticed a lot more tightness up at the top of the doctor chain when it comes to my leadership and then Aaron Miller's leadership of the mentors and the new mentor pool and who we've chosen for that. And we have some new ones coming next year that we're really excited about. So I think we've become more big boy company.

I think I made this comment at the SPG Central team was like, it feels like we're actually like a like a real corporation at this point. We kind of have like processes and people in place and there's like a chain of command. And so we've done the same on the clinical side where there are a lot of different resources for the doctors that aren't just kind of like everyone shotgunning up and asking for advice. There's there's different pod groups, there's different mentors, there's

hierarchies within that. And then most recently, the SPGU, which is our internal CE platform, has gotten the facelift and some new videos. I think that's going to be kind of a big focus next year too, as we start to bring on more and more doctors again. So hopefully, I mean, and I want to hear back from our doctors too, what their experience has been because mine from the top has just felt like it's been a lot more consistent and easy to navigate, I guess, for like to know

kind of the pulse of the doctor, doctor group. Whereas before there were kind of when it was just three clinical directors, it was it was way too much stuff coming to all those three people. And so now we have a lot more doctors who are willing and able to travel, remote in and look at cases. And yeah, one thing we have to be careful with is to not ever let that

ratio get too big again, so that the mentors are starting to feel overworked or overwhelmed. And so as we continue to grow, we're already kind of building in these layers ideas of what could our next thing below the clinical the regional mentor be, you know, could we have a new maybe a buddy system where a new doctor kind of attaches to a doctor who's been in the network for a year.

And so there's different layers of support that way it's not all coming to one or two or three people because burnout is a real issue in dentistry in general, but certainly in this form of dentistry. And so something we're cognizant of as well. Yeah, and the way that we are able to make those types of adjustments and to improve not only how we interface with our doctors, but also how we structure those support layers so that the people doing the supporting don't get

burned out to your point. It's all about feedback. It's all about asking the right questions and finding what's working what's not working. What would you suggest? What would you see is a better way to get to the same outcome. And we've actually was on a meeting right before the break. Discussing the results of the employee engagement survey, which which pulled people across the whole company on a variety of different topics. And that was really enlightening to see what are

the themes? What are the consistent pain points that people are experiencing? And then what can we do to address those and improve those? And so it's it's been through feedback that I think a lot of the improvements that we've been able to roll out in 2024 have come to be. So step one is being in a listening posture, which I always try to be. And I think that's important for all of us, whether we're patient facing, whether we're talking about leading our teams, you always want to have

an ear out for feedback, because not all of it is actionable. Not all of it is pertinent. Sometimes it's a squeaky wheel. But if you start to see themes, if you start to see common threads between those different sources of feedback, sometimes where there's smoke, there's fire. If a patient if you hear the same type of complaint or the same type of observation from a patient this week and next week and then the following week, maybe there's an issue with your approach.

Maybe there's an issue with how something's being explained. Maybe there's something that centrally we could be doing better to give you a better patient outcome. But feedback is the life blood of constant improvement, which is why that's one of our big core values. We want to make sure that we're always sharpening the saw as much as we can. And that's why we're in a really great position to go into 2025 swinging, because we've taken the time to listen and refine. And we're

going to keep staying in that posture going forward. And I want to speak to another theme of 2024, which was we wanted to slow down the external growth to promote internal growth. This was a year of looking inwardly and tightening up and getting better and spending time to really pour into our existing doctor team, our existing practice level teams, our central team. Because if you're doing the math, we opened 21 locations in 2023. We opened six in 2024. A lot of different reasons

for that. A lot of different strategic decisions that led to that. But it was a really good thing. It was a very timely shift, a very timely operating adjustment. And what I'm happy to say is one of the byproducts of that is that we needed to grow wide in order to justify the position in the market in order to be able to build out the central support infrastructure. Because it's the classic chicken or egg dilemma. Do you incrementally drip drip drip open practices over years and years

and years and years? Or do you sprint to get to something resembling scale? And then adorn that framework that you've built out with all the requisite musculature and detail? That's the path that we chose. And it wasn't without its trade-offs. It wasn't without its challenges. It wasn't without its collateral damage, which every company experiences along their path to growth and scale. But we chose that route of building horizontally, building outwardly building externally.

And then in 2024, we really focused on internal improvements to the tune of opening six locations. And I'm happy to say that, you know, of those six locations, they all have amazing things that we can brag on brag on them about. And the last one that opened just recently in November was Kansas City. And I can't remember a hotter start for a practice or for a doctor or for a team. And I'd like to think that a lot of that is due to obviously having an amazing doctor and an amazing team

there. Kiefer prepared like no one else. He had a long ramp to be able to be prepared. But there were also things that we did better and more intelligently that were informed by past this step, things that we learned the hard way, things that we learned through experience. And that's my vision for going forward into the future is all of our locations are going to pop off that quickly with that strong of a proof of concept. And so that was an example of learn from the past, use that to

weave your future approach into your new endeavors. And you should see improvements over time, just like that. But what was your experience, Steve, of coming into the company on the tail end of that busy year of opening new locations and then seeing the gear shift into fewer openings. It was interesting, I guess I got in right at the right time, because you added Santa Barbara, which was an unplanned open after we started talking in the last summer. And the biggest shift

was clearly Matt Ford's job. Because when I met him, he was like in a different city every two days and just doing crazy stuff like that. But he settled into a really strong like vendor relations guy to an internal processes and obviously like the knee-ident announcement and barksdale stuff has been just like huge. And so having him have the time to focus on those kind of internal things that you talked about versus every two days, I got to fly to different city, look at a piece of

real estate, whatever, is obviously paying off in spades. But I will say, yeah, it's been interesting to see the gear kind of shift into a lower gear, but it hasn't felt like we've slowed down either. It's just kind of like we're rolling downhill just in low gear to kind of keep it under control. And it's like every startup, like if you watch like the Uber, pseudo documentary and all those kind of things, it's all about getting to scale and getting the

market cap as soon as possible so that you can then if you survive, then you're set up. And that's what it really not everyone survives. But we know some other offices that I could think of one that was in Arizona and Denver that we have some colleagues who work at and they did the drip drip and they just never got past like 10. Like they just the money when the money all dried up in 2022, if you weren't already or 2023, like if you weren't already out there, you were just stagnant. And

then you have that you guys are talking about this on the SP pod. But like that that number of practices is like the is like the the worst, like you're in the no means that area of the ocean where there's was no wind and you just get stuck. I can't I've been reading a lot of stuff

on Reddit about sailing lately just keeps popping up. But you're in the dull drums, right? Like you don't have you're not nimble enough and small enough to just like make it work because you need a central team but you can't afford a central team and so like you need to quickly get through those 10 to 20 offices I think in a specialty type DSO or else you're likely to just flounder and and just stall. So I'm really proud of you guys for doing that. I can't imagine the stress

that was and I remember we've told you've heard the stories. It's amazing but you made it and now you get to reap through awards by settling in and kind of making everything run smoothly. I mean, I will say this when we when I joined in one of my initial proposals because I wrote you guys a like a 10 page proposal of what I could bring to the company was how disjointed practices seemed

to each other. Not just in the in the exact clinical processes but in like how they did their appointments how they did this who talked to who and so that was a big part and I was excited to tackle that because that's kind of what I like to do is to have big projects that I can start to see big movements. And so I feel like that's pretty we're pretty dialed in now like every practice has similar team build out similar doctor culture, workflows and so on. So that's

been exciting. It'll continue in 2025 and the November opening of Kansas City is was like I was so pumped for because I wanted to see what happened and then collecting like, you know, five arches or six arches in the first week or something was just like, wow, like, and this is not like in the zero percent APR times, you know, so that's amazing. So if that's even half of a bell weather for what 2025 looks like then the sky's the limit and I'm excited for

Matt Ford to get back on the road again. Yeah, I know he's he's switching. He's kid can't sit still. No, but your point about getting more centralized and that can have a negative connotation. But when we were when we were younger in our development, we were very decentralized as exemplified by things being different at every location. The even something

as small as the the the codes that we use were different at each location. So getting the same codes getting the same prices, having things be more centralized in the sense of we have our defined way of operating and the way that I would describe what you're talking about a second ago regarding the the sprint to scale and then the necessary hump that you have to get over to not get stuck in no man's land. We had to prioritize we had to stare this in the face this trade off

because everything is a trade off. We wanted to prioritize market leadership instead of short-term profitability. And there's all kinds of, you know, you can be Monday morning Monday morning quarterback about that. But it got us to where we are to be positioned to have profitability because we we didn't prioritize it on the front end because we knew that we wanted to get to a certain level of scale to be able to build the company that we wanted for the long haul. So we made short-term

trade offs in service of where we are now. And we yeah, we survived we flew flew close to the sun at different points in 2023. And luckily 2024 was a much different year a year of being methodical in a year of tweaking where we needed to tweak without any without any type of real cataclysmic existential issues that that may have plagued prior year. So we're we're excited about what we accomplished in 2024. We're thrilled with an amazing year. We've had so many doctors perform

way better than they dreamed, especially given 2023 performance. And we just had a lot of strong contributions from across the company from the doctor team from the practice teams from the

central team. And I think that in closing, I just wanted to say thank you, Steve, for believing in SPG for for leading us, not only within our company, but also being such a wonderful mouthpiece for us externally, teaching and and and really enriching the listenership of the full arch podcast and and keeping that going because I think that the more that we can spread the gospel as it were to get people to see the light because I talked to so many people every single week that are

learning about the full arch space. And they have this notion of dentistry is dentistry is dentistry across the board, but there's so many different rabbit holes that you can go down. And I'm really excited about ours. I'm excited about our our little narrow niche of dentistry and

what we stand to offer to patients going forward. Yeah, same. Biggest, biggest impact focus GPTSO in the country, if you're on the fence, this is the one to join because it's we've made it through the dull drums, you've made it through the point where it's comfortably, you know, profitable and

there's no unsustainable going on anymore. And that's that's really exciting. I mean, everyone who's with the company now, congrats, because being with the company early on is better and better, but there's the next round of recruits for the next three or four years are also going to have a really big payoff to join this company. I think that's just going to be it's I can't imagine what one more year will look like let alone three or five. I mean, it's just going to be I can't

believe it's been one year. I can't believe it's it feels like it's been three years, at least. And how much is that? SPG time warp. That's that's what it is. That's what it feels like for sure. I loses all meaning. Yeah. So if you have young kids and you want to slow down life, join SPG because suddenly the years will go by very slow. So yeah, man, but it's been a pleasure. Like I still can't believe it's been one year, but it's been a blast and a lot of different

changes. And sometimes those of you listening just look back one year. I do this every once in a while, look back five years. I mean, I've done podcasts where I did a podcast with Alan Mead would have been seven years ago when I was in Ohio. And if you listen to that, I can't believe that was seven years. I mean, it's a different person, let alone the amount of experience you can have now. The one thing in Genestry is like, if you have a GP practice and you own it and you

did and I did, then it can feel very linear. You know, like, yeah, I've been here seven years. We've seen some, you know, just steady growth. When you do what you and I have actually done, which is like leave that space and go build something else, whether it's an education or in this, it's just a different kind of experience. It's like a bunch of little leapfrogs,

you know, from from one hot pan to another. Sometimes it feels like, but eventually, you know, that you land somewhere and all of those other big jumps you've made are starting to kind of compound a little bit. And it feels like that for me, like, maybe just look at my experience on like a resume in 10 years since graduating general school, every little piece of something I've done relates so perfectly to the position

I'm in now. Like you, some people might be like, how do you get to where you're at, Steven? It's like, I don't know, 10 years of random shit, like that just kind of happens to filter down to this. So it's yeah, it's not something that you can just jump in. So I'm stoked that a position was made available that that hit those, you know, highlights for my career. It's been really fun. Yeah, it's it's interesting because I've done a similar exercise recently to because

I was talking to one of my dental school classmates. We have our tenure reunion coming up and I was bouncing ideas off of him to figure out how we want to play on this thing and get everyone together. And man, it's it's kind of like you said earlier about the analogy of the sailboat and how quickly

you can change directions with a sailboat compared to a battleship. And all of us are kind of like our own battleships where you take one little degree of a turn one direction and then follow that trajectory for 10 years, you end up in a completely different place than you would have if that one degree would have been true of the opposite direction. And yeah, it's it's it's very crazy when you think about all of the little decisions that the culminated in

SPG being where it is us all being where we are. And with with 2024 winding to a close, I just want to say thank you to to our doctors for believing in us for for putting their faith in us. And your your point about there never being a better time to be joining the company aligning with the company growing with the company 2025 is going to be our best year ever in every conceivable metric whether we're talking about experience we're talking about performance.

We've we've been building this thing since the initial idea phase in 2020 to actually opening locations in 2021 all the way until now 2025 is the year that we've been building towards. And it's time to to really have our coming out party to have people around the industry take notice of us in ways that hasn't happened yet. And the the PR will be will be crazy. It'll be it'll

be cool to see the splash that we continue to make. And this will be something where as we grow and as we welcome more people into the fold, people that have been around since 2023 2022, we're going to say, Oh my gosh, I was in the the early adopter bleeding edge minority when I joined this company and I and I believed and at the time it seemed to those of us that started, it seemed obvious. And then it'll seem more and more obvious and more and more clear and hindsight. And people will

forget that a year ago, two years ago, three years ago, it was something different. It was something that had not been proven out yet. And then once the proof is in the pudding, then it'll be easy to say, Oh, well, that was an obvious bet. When in reality, we were doing something pretty different early on when we formed this thing. Yeah, I mean, there's the largest

implant focused GP DSO. And we have 35 doctors and 10,000 doctors graduate every year. It's a small group and it's less than 1% by far, especially the ones who have have excelled in this realm are very, very special clinicians. So but yeah, thank you. And thank you for you and the founders and the leadership that you guys have put into this and the unbelievable amount of blood, sweat and tears and probably stomach ulcers that have got us to this point. So excited for 2025. And let's

we can jump back on here and talk about 2025 next. And T FAP listeners look forward to that. And I know this is a lot of an SPG kind of focused podcast. I think a lot of the T FAP listeners appreciate the inside baseball stuff. And certainly we'll talk about, you know, relevant clinical

things as well, like we did in this one. But for the doctors of SPG, yeah, I hope, I hope this and the openness that the founders have shown throughout this whole process of what you guys have been through to make it to get us here has been really cool to be a part of. Yeah, definitely. We always strive for transparency and for T FAP listeners that are mining this

episode for lessons. Think about some of the things that we touched on, which is you sometimes have to make a big audacious swing at the ball to get anywhere and to take that leap and to do the to do the unproven thing or to veer into uncharted waters. I think that's applicable to all of us is sometimes you have to take that risk. And sometimes you have to just go where your heart is and build the airplane as you're already in the air. Because for anything cool that you're going

to do in this life, there is no roadmap for exactly what you're trying to do. So you have to build that map. You have to chart that course. You have to be your own cartographer. And that's what I'll lead you leave you with here today. So for the listeners of the SPG pod, thank you so much for the T FAP community. Thank you for listening. Be sure to listen to the SPG pod as well. And then we'll be back next week for the 2025 preview. Thank you so much.