Dr. Lhota has added a second location and increased from $1.5 million to $8.5 million.
vision, team development, expansion, profitability, leadership
Negative net worth.
That’s what Dr. John Lhota realized he was facing at age 40. After graduating from dental school in 1985, he was saddled with a large amount of student loan debt. Both he and his wife, Emmy, who he met in dental school, had student loans. Their interest rates were between 16 and 20 percent. Struggling to even make the minimum loan payments, their loan indebtedness doubled when they were forced to put some loans on forbearance.
Additionally, Emmy was earning less because after finishing dental school, she didn’t take to it, so she chose to become a hygienist instead. Due to their loans, it was over a decade before Dr. Lhota could even think about starting or buying into a practice. In 1998, he was finally able to purchase a two-chair practice, Dental Park West (DPW), in New York City (NYC), which was essentially a set of charts, for $30,000.
Believing it would improve his financial situation, Dr. Lhota began investing his dental skills. “I took a lot of continuing ED courses to increase the repertoire of procedures I could do really well,” Dr. Lhota said. “I thought that would help me be more successful financially, which never came to be the case.” Four years later, he was still struggling.
In 2002, he discovered his net worth issue and realized that if he ever wanted to retire, he needed to work turning the practice into a viable business. “It made me extremely worried when I discovered I had a negative net worth,” Dr. Lhota said. “It provoked anxiety, which provoked me to take steps and take action to fix the situation. Fortunately, it occurred to me at age 40 and not at age 58!”
Approaching the situation as an education problem, he sought guidance. “One thing I’ve always been good at is going to school, so I looked at it as a learning project,” he said.
After trying a lot of different consultants, he eventually found one that helped, however, he found the approach to be “very cookie-cutter.” “The consultant I worked with before Dr. Meis helped me, but his formula was the same for every doctor,” Dr. Lhota said. “He didn't ask, ‘What do you want for yourself? Your life? Your family? The way you work?”
When he met Dr. John Meis and Wendy Briggs, he was intrigued. But after trying so many consultants and not getting the results he wanted, Dr. Lhota initially found it difficult to hand his trust over. “Having faith that this person knows what they're doing and that they have my best interest in mind was a big step for me,” Dr. Lhota said. “It took me a long time to pull that trigger. However, after considering it for a long time and having many conversations with Dr. Meis, he bolstered my confidence.”
It's been over a decade since Dr. Lhota started working with Dr. Meis, Wendy Briggs and The Team Training Institute.
In that time, Dr. Lhota has added a second location and increased from $1.5 million to $8.5 million at its peak (pre-COVID). At 61, Dr. Lhota no longer practices dentistry. The sole owner of DPW, Dr. Lhota’s profit is the same or more than the income he was getting when he was working in the practice full time. (At peak, his profit doubled his income.) He thoroughly enjoys his autonomy and freedom. “I’ve been able to take a month or two off because of a family matter or take a month off and rent a place by the water,” Dr. Lhota said. “I’m still available by Zoom or phone, but I can do almost anything that is required of me other than signing checks without going to the office.”
Here's how Dr. Lhota grew the practice by 466.67%:
Get Clear On YOUR Vision
Prior to joining The Team Training Institute (TTI), no other consultant had ever asked Dr. Lhota what he was looking to achieve. Instead, they only offered money-making advice. Dr. Lhota credits Dr. Meis for helping him get clarity about what he wanted, which then allowed TTI to guide him in the right direction.
“With Dr. Meis, I found it appealing that he started out by asking questions such as, ‘How would you like to get to the point of having financial independence? And how do you define these? How would you define success for yourself?’” Dr. Lhota explained. “The Team Training Institute is much more geared towards an individual approach to my wants and needs. It made me think a lot more about what I wanted as opposed to just solely trying to become successful enough that someday I could retire. I started out thinking I needed to make more income to get where I wanted to go. What Dr. Meis made clear, that I didn’t understand prior, was that you need to have a goal of what you want to accomplish and accomplishing that goal is how you reach your financial goals.”
Provide Win-Win Learning Opportunities for Your Team
Dr. Lhota continues to focus on improving hygiene productivity with his team. In the 10+ years they’ve worked with The Team Training Institute, they’ve done Hygiene Explosion training multiple times. “In New York, it's not that uncommon that your team turns over a period of time,” Dr. Lhota said. “They are a little more transient in terms of the population of the patients, as well as the population of the team members.”
When Dr. Lhota started, Wendy Briggs was still one of the trainers that would come to the practice to do training. “I had a relationship and trust with her, so I asked her to be the one to come to our practice for the very first training,” he said. “Over the years, we’ve had trainings with Bert, and it’s always worked well. There are usually some people who’ve had the training before and some that haven’t. Every time we do it, the hygienists always express a lot of gratitude and appreciation for the learning opportunities. I find that whenever we have training with The Team Training Institute, people are enthused about it. I receive cards and emails from the people on the hygiene team thanking me for investing in them.”
Dr. Lhota didn’t offer fluoride treatments in the practice until they learned it in their first Hygiene Explosion training with The Team Training Institute. “Now we offer it as a preventive measure,” he said. “We didn't really appreciate the fact that just because insurance doesn't cover certain things didn't mean that people don't want it and weren't prepared to pay for it. A lot of the things insurance doesn't cover, it turns out, are the preventive services that patients have a great deal of interest in and place a great deal of value on. We tend to get good acceptance of it, and it's a service that people would like to be offered.”
Sealants are another thing his adult patients want even though insurance doesn’t typically cover them. “Insurance treats it as if people only care about preventing cavities when they are kids,” Dr. Lhota said.
Even though some of the staff have gone through The Team Training Institute’s hygiene training before, DPW finds there is tremendous value in repeating the training. In 2021, just one month following hygiene training with Coach Bert, DPW saw a 138.89% increase in sealants and a 54% increase in hygiene production.
They continue to work on case acceptance by building a consistent philosophy of treatment across all providers in the practice. “We are better at case acceptance than we were ten years ago and better than I was 20 years ago, but that’s an area we still could use some improvement,” Dr. Lhota said. “We’ve made progress on consistent philosophy of treatment and diagnostic assertiveness, but we need to work on this more so we don’t short-change the person in the chair at the end of a shift.”
Make the Most of What You Have
While he still operates out of the original two-chair office, after maxing out at $3.2 million, he added a second office, six blocks away with four additional chairs. The practice is designed so that patients can get all the dental services they need without going anywhere else. Open seven days a week and staffed for two shifts, they maximize their resources while giving their patients more scheduling options. Originally employing two other general dentists and a specialist, today Dr. Lhota employs five general dentists and three specialists, which include a periodontist, an endodontist, and an oral surgeon. “The first specialist I added was an endodontist because I didn’t like doing endo and was referring out a lot of it each year,” Dr. Lhota said. “Today, most services we can do in-house without having to refer out. We don’t have an orthodontist, but our dentists do Invisalign.”
Get Creative with Expansion
Dr. Lhota admits he was “pretty intimidated about expansion” but because he’d reached capacity and was operating seven days a week, there was no other choice than to look for a bigger location.
“It's a very competitive market in NYC and the landlords tend to be very astute, and I'm not good at dealing with landlords and contractors,” he said. However, while looking for a bigger space, he was able to find a location with four chairs that had already been built out into a dental practice. Dr. Lhota purchased it so he wouldn’t have to deal with construction. “There was a dentist who was retiring, so I just took over his lease and didn’t have to deal with contractors,” he said.
Grow Profit and Autonomy
Another challenge Dr. Lhota had to overcome was that he was in income mode, meaning the majority of his profits were being generated by his working full-time treating patients. “I was working in the business so much that it didn’t lend itself to me being able to work on the business,” he said. Once he made the shift to working ON the practice, his profits increased, eventually equaling and even exceeding his income from treating patients. Between 2016 and 2019, his profits doubled. Dr. Lhota continues to earn as much or more than what he earned treating patients, despite spending little time working.
“I will periodically get offers to purchase the practice, and the practice has a good deal of value now,” Dr. Lhota said. “But when I think it through and think about the demands on me personally versus the income from the practice versus a one-time payout, it doesn’t make much sense to give it up. There’s not very much required of me to have that income. It makes more sense to do what is needed and glean the profits from the practice. I’m 61 now and I could be doing this if I was 70 or 80. To have those profits for another significant number of years outpaces the returns of just selling the practice for a good price.”
Grow Your Team
To make the shift to working on the practice, he had to let go of doing everything himself. He credits handing over responsibilities as one of the major keys to his success. “Delegate things to team members and trust them to do things right,” Dr. Lhota said.
While Dr. Lhota had a couple of administrators on his team and likes to promote from within, he didn’t feel he had anyone who aspired to get into management, so he hired a manager for the practice to run the day-to-day operations. “I felt it was key to the growth of the practice to have people who aspired to elevate their position as the opportunity presented itself as the practice grew.”
Today, Tatiana Gammichia, President of DPW, manages the entire practice. Tatiana started working part time at DPW in 2010 while she attended hygiene school. After completing school, she was promoted to the doctor team lead in 2013. “It evolved,” Tatiana explained. “After that, I became one of three directors, and we did flat leadership. When the pandemic happened, Dr. Lhota decided to promote me.”
Normally, DPW would have a team of 50 employees, which includes a hygiene team lead, a doctor team lead, an admin team lead, an assistant team lead and a patient services center team lead. Still trying to rebuild after the pandemic, they are currently only 85% staffed. “We don’t have team leadership roles filled for all of those right now, which makes the leaders spread a little thin,” he said. “COVID was extremely challenging in NYC. People moved away, and people that have second homes that are not in New York are living in those homes, so we are not back to being fully staffed. Where we are lacking most in terms of team members is in the leadership team.”
Prior to COVID-19, DPW was running like a well-oiled machine, so they took time off from working with TTI. Due to slow recovery and an emphasis on getting new employees up to speed, they brought The Team Training Institute back at the end of 2022.
Tatiana is working with TTI coaches to train new employees and new leaders on their systems. “I know with the help of The Team Training Institute we’re going to see improvements,” Tatiana said. “We’ve only been back with them for two months, but we’re training new leaders and we’ve put those systems back in place again. We’re repeating what worked before with a whole new team. I’m excited about that and believe we are going to be back on track to where we were, if not doing more than $8.5 million.”
A Leadership Team is a MUST
“You need to have a management team,” Dr. Lhota said. “You need to have somebody that's in charge. The assistance people don't just organize themselves. I don't think I had the understanding or the realization that I needed to have somebody that was in charge of the doctors. There needs to be someone getting feedback from the doctors, giving feedback to the doctors, and meeting with the doctors on a regular basis.”
“The same thing goes for each department. The hygiene department, the assistants, the administrators, the financial team, and the patient service team all need somebody that’s in charge. I didn’t understand that was necessary, and the fact that one person can really only handle leading so many other people, and that number, maybe like five to ten people, is important to understand too. We are now at the point where the leaders need to be able to work ON the practice and not just in the practice.”
Systems Ensure a Consistent Patient Experience
While staffing has been challenging, the good news is the systems Dr. Lhota put in place from working with TTI prior to COVID meant the practice was prepared. Systems allowed him to onboard new employees while continuing to provide a consistent patient experience.
“I think one of the most important steps is having systems for everything that gets done as opposed to an individual that's in charge of doing something right because the individuals will change,” Dr. Lhota said. “But as long as you have systems and the systems are documented, there’s a system for everything. There's a system for hiring for every position. There's a system for training and onboarding for every position. And frankly, we have so many systems that I don't even know what they are.”
Dr. Lhota even has a system for troubleshooting a problem, which has made the process of handling complaints much more palatable.
“Problems are revealing about what we’re lacking in a system,” he said. “Is it revealing somebody not knowing what the system was or not adhering to what the system should have been? Or do we need to develop a new system? Or do we need to coach on what the existing system is? I’ve found that when patients have a problem, they don’t want to throw a team member under the bus because they don’t want to get anyone in trouble. I always tell them that what they are telling me is valuable feedback for my practice and for all of our patients. I treat it as feedback, not disciplinary action. Then, when I have that conversation with a patient whose expectations we didn't meet, it allows that to become a more productive conversation. Patients seem to have a good deal of appreciation for it, and they tend to be very open and want to contribute to a problem-solving process that way. It also tends to smooth it over and make it go better.”
Tiger Proof the Practice
While Dr. Lhota learned about tiger proofing from Dr. Meis, he always thought he should have solutions in place in case something happened to him or one of his team members.
By hiring more doctors and staff to create redundancy, he was able to reduce the number of days he worked. Seven years ago, he reduced his schedule to four days. Then he reduced to working between two to two and a half days per week. Eventually, he was only working one-half day per week. “In 2020, I stopped seeing patients when we were shut down for COVID-19,” Dr. Lhota said. “I tried coming back after that, but I was having trouble with my visual acuity, so I stopped at that point.”
Today, Dr. Lhota serves as a mentor to the other doctors, takes emergency phone calls, and handles certain problems or patient complaints about their experience when a team leader is unable to resolve the situation to the patient’s satisfaction. Nearly everything he does can be done remotely while his practice continues to thrive and provide him income. “My involvement is limited at this point, so the amount of time I have to put into the practice is significantly reduced,” Dr. Lhota said.
As he no longer practices dentistry, he succeeded in setting up the practice to run without him treating patients. He's also set up two alternatives to run the practice if he becomes incapacitated in any way, including death, so even then, his family could still be living off the profits of the practice.
“We have a solution for things, such as if I'm not there anymore, or I'm not available or incapacitated, or I get hit by a bus or something. There’s an alternate solution for me,” he explained. “We have a solution for team leaders and we periodically will have to rely on those because people will come and go, or people will go on maternity leave or something of that nature.”
Dr. Lhota credits The Team Training Institute for making him aware of what was important and guiding him with solutions that not only helped him grow but also prepared him for situations, including the pandemic. “I worry less,” Dr. Lhota said. “Had I not gotten involved with them, I would have a less predictable systematic approach towards reaching goals. There are certain key things that I wouldn't have done because it wouldn't have occurred to me to do them, like setting up a leadership team. Right now, I would need to be putting more time into revamping everything by not having the foresight to have systematized things, by not having the foresight to put plans in place in the event someone leaves or something happens or if I have to go away to take care of a family matter for a month or two. The fact that those things have been thought ahead, and plans are in place for them ahead of time takes a lot of stress off the situation when those eventualities come to fruition.”
In reflecting on what he’s learned after working with The Team Training Institute for over a decade, Dr. Lhota says he’s realized you can’t take your eye off the ball when it comes to providing a great customer experience. “I mistakenly thought what mattered most was doing good, honest diagnosis and good treatment and the way to do that better would be to get better skills at diagnostics and treatment,” Dr. Lhota said. “What I was taught through the process of The Team Training Institute was that this thinking—that I was getting really good at these things is assumed by the whole public. They assume that all dentists are going to give you a good diagnosis. Our consumers make their assessment of HOW you make them feel. We need to focus on this and continually focus on this because there will always be turns.”
“I’ve discovered that the implementation of the systems and getting them solidified in place provides the optimum experience. But then there will always be a certain percentage of your team that leaves… associate doctors who decide to start their own practice, assistants, or hygienists who move away. New employees require a whole new push that needs to happen to reinforce the training and systems. This push gets the patient experience where you always want it to be—so this needs to remain a constant focus. In my experience, I've worked with a lot of dental practice consultants, and I have changed over the years. I've worked with a bunch that didn't help me get many results. Then I met Dr. Meis and Wendy and TTI and I don't feel like I’m ever going to work anywhere other than with them for the rest of my career.”