Scott Leune: It has never been as expensive to build dental offices in the past as it is today, and is incredibly complicated. We've got budget considerations, we've got design, we've got city permitting, we've got contractors, we've got change orders, interior design. We've got to run the practice based on what we build. There's a bank that comes in play. I mean, there's so many things happening and there's been a lot of changes and there's actually the right way of doing it, the right way that has us building a beautiful practice that is efficient and has all the storage and all the rooms we need, and it is built and designed in a way that saves us a ton of money. That is, we're going to be reviewing today the newest way to build practices, and I've brought on the owner of one of the best design companies in the world for dentistry, lean dental design. That owner, Chris Raba, he is pulling back the curtain and we are going to go step by step from beginning to end on exactly how to do this, what to watch out for, who needs to be on the team, what is it like even the timeline, even the cost considerations. How do we deal with problems? We are going to go through all of it, the good, the bad, and the ugly on today's episode of the Dental CEO podcast. If you like what you're hearing on the dental CEO podcast, please take a few moments to leave us a review on your favorite podcast platform. All right, Chris. So again, thank you so much for joining us. I always get asked a ton of questions in our startup seminar about what it's like to build a practice today about managing the budget, about how to make things beautiful, about how to do it, what are some of the horror stories, what are successes, what should we expect? So I've been excited to do this interview with you because I feel like in dentistry we need an update because things have changed dramatically in the last few years. So before we dive in though, in case there's anyone that hasn't heard of you or your company, could you in a sentence or two describe in your own words who you are and what you do?

Chris Raba: Sure. So my name is Chris Raba and I'm the owner of Lean Dental Design. So we are a dental specific company. We focus on dental practices and part of our bread and butter. What we specialize in is efficiency, no waste, and producing a very beautiful practice for our clients.

Scott Leune: Awesome. Okay. So how about we start with what are the general steps? Let's say I'm either a startup dentist or I own a practice, but I'm going to move it to a new location. What are kind of the general steps in getting things designed? How does that timeline look?

Chris Raba: Sure, yeah. So the first part of the process and a part of the process that we like to be evolved with if we can, is the location process. When we have a client looking for a location, we like to be able to give some feedback on the spaces they're looking at to make sure that the space has the right proportions, make sure there's no challenges with the space. There may be columns or things like that we have to work around. So kind of step one of the process is assisting with the location, not the location itself, but the space they're looking at to be sure it checks all the boxes and there's no complications or challenges because of it.

Scott Leune: Okay. So a startup dentist has already pulled demographic reports and analyzed them and decided, okay, these are the three areas of town that need a startup practice and then has gone through the real estate side and found maybe the top three locations they're potentially negotiating with the landlord. And are you saying then at that point where they're at this kind of tail end of negotiation, they think they've kind of landed on the top location or two, that's when they bring you in. So you could give feedback on any sort of challenges or issues they need to know about upfront when it comes to the space. Is that correct?

Chris Raba: Exactly right. That's the best case scenario. Now, sometimes we have clients that come to us once they've picked a location, and the reason why that's not ideal is because we may be approached to put maybe a seven practice into the space that they've selected, and once they've selected it without our input, we may be telling 'em they can't do seven ops. So that's why it's ideal for us to be a part of the process before they commit to the location.

Scott Leune: So columns basically cause an inefficiency in design cause you to need extra space or any sort of issues with bringing power a certain place or maybe the door can't be moved because the facade of the building is not glass all the way down to the floor where you can just replace with the door. Things like that will impact how many ops you can put in, but how much space do we need? So if a dentist says, I want a seven op practice and I haven't chosen my location yet, about how much space do we need outside of these weird issues of excessive columns and things like that.

Chris Raba: So typically the format that we use is 330 square feet per op, but that's going to vary depending on the type of dentistry. A GP would definitely be three 30. A pediatric dentist is going to need a little bit more space because they have a larger reception area because the kids area, some dentists that are very lab heavy may have a larger lab, but from a base standpoint, three 30 is square foot's a pretty good formula to lay you how much square feet you need for five to seven ops.

Scott Leune: So if I'm a general dentist and I want a lean design, I don't want bloated hallways, bloated spaces, then seven ops times 330 is 2,310 usable square feet gives us kind of a baseline number, assuming we don't have a bunch of issues with columns and weird shapes and so forth.

Chris Raba: Right? Correct. And one thing you said that's super important for people to identify with is usable square footage. A lot of times people will come to us with the lease space and they'll say they have 2,500 square feet, that's the leaseable square footage. So on a 2,500 square foot space, that's the leaseable. When you look at the usable, it's usually about 150 to 200 square feet smaller because the leaseable is looking at the exterior walls and then half of the demising walls. So it's important when you looking at a space not to just focus on the leaseable, but also try to find out what the usable square footage is

Scott Leune: That leaseable means. Not only are we paying for the space we get to use for dental office, but we're also paying rent on the thickness of the exterior wall and on part of the thickness of demising walls with the walls that separate us from the neighbor. Right? Correct. So obviously we can't use that space, but that's what we pay rent on. So that's a very good point. When you talk to a real estate agent saying, Hey, it's 2,500 square feet square, that's going to be a different number though when you talk to your architect because the architect needs to know what the usable square footage is. Okay, so you've been involved, we found a location, it's got a couple columns, but it's the right space we can get our seven ops in. So now next, so how do we design this thing?

Chris Raba: So the next step for us is to come out to the space and do what we call a 360 asbuilt. So we're going to come out to the space, we're going to scan it, we're going to get as much detail as we can on the location because a lot of times landlords don't have accurate information on the space. They may have a what's called a shell set. So those are the original drawings for the building before they were built. A shell set may show certain proportions or certain areas of the building that don't actually exist or maybe they do exist. So we go out to the location, we do a scan, we verify the entire space, we check where the power's coming in, we check what the plumbing's coming in, we check if there's any existing rooftop units. So that would be the most important. Next step is to verify what's there, what's existing. So while we're designing the space, there's no surprises that come up during construction.

Scott Leune: And so that scan, it's like a 3D scan, so you get exact measurements of when you say as-built, that means as it is today, whatever the space looks like today, whether it's an open shell with nothing in it or whether it used to be a nail salon the way it looks today. Is that correct?

Chris Raba: That's correct. And we use a camera, it's called a Matterport camera, and it's a really a great tool. It creates literally a 3D model of the space. So we're able to be sitting inside the space while we're designing it.

Scott Leune: Perfect. And now comes the design process, and let's assume in this hypothetical scenario we're going to gut all the walls because we want to build it the right way from the beginning without compromise. How do you know what type of design I prefer or how do we start making decisions? How long does that take? What's that?

Chris Raba: So as part of the process, we have our clients fill out what we call an onboarding form, and it asks some general questions for the practice. So with that information, I use that as a guide as I'm laying out the practice to make sure that attentive to anything they want that maybe is not typical of their space. We have some clients, for example, that want to have maybe a special photo area or like I mentioned in the beginning, they may have a larger than normal lab. So we first gather the information on the space while we're also getting information from the client as to what their goals and dreams are for the practice itself. And I use that as a guide while I'm laying out the design of the space.

Scott Leune: And how long does that design process, what a dentist might call like a general floor plan?

Chris Raba: Sure. So once we get the 360 information, plus we get the information from the dentist as far as what their plans and dreams are for the space, it takes about a week to put together a schematic floor plan that we present to our client,

Scott Leune: And there's back and forth happening as well. So the client's looking at making comments and suggestions or things like that. And once the floor plan is set, while we could go to contractors with a floor plan, the problem with that is we don't get a real bid because a contractor needs a full set of architectural plans to give us actually a full accurate bid we can count on. So once the floor plan is done, we then need to move on to the full drawings. Could you describe that process?

Chris Raba: Yep. So once the floor plan has been approved by our client, we then release the floor plan to multiple groups. First we release the plan to our interior designer, so they're going to work directly with the client on the colors, the finishes, architectural features. So that's happening kind of in one column. Then we also release our plans to our consultants, which are going to be mechanical, electrical, and plumbing engineers. They're going to work on all the detailed drawings for the HVAC system, the electrical service coming into the building required for the space and all the plumbing. And then we also released the plans to the rest of our team to work on the architectural details. So all in all, you're looking at 60 to 70 pages of drawings that we're putting together once that floor plan gets approved to move forward.

Scott Leune: And so this is where a dentist starts picking the type of flooring we're going to use or the type of lighting, or at least where all of that is located or deciding do I want 10 foot high ceilings or 12 foot high ceilings? Is that correct?

Chris Raba: That's correct.

Scott Leune: And how would a dentist know, do I need more outlets in this room, or what kind of power do I need for my mechanical room? Those types of things. Especially because a dentist has never done this before. Typically, how does that happen?

Chris Raba: Sure, yeah. So what we do is that we walk 'em through a power design and show them what we recommend based on our experience, and then we'll adjust and change things kind of based on their feedback. For example, in an operatory, we typically have what we call a duplex outlet, which are two plugs. So we'll do a duplex outlet on the doctor's side and on the assistant side, well, some doctors may want what's called a quad, which is a four outlet situation. So we may do a quad, but for the most part, we give them a general recommendation based on our experience. We also bring in the equipment specialists they're working with to give us some feedback after the floor plan has been finalized. So they can also give us feedback on power. They can also give us maybe feedback on some spaces, maybe an imaging on the lab that are kind of responding to what they've selected. So at that point, we're not guessing at things. We're getting actual information from the equipment person they're going to work with and the equipment they're going to use in their space.

Scott Leune: Alright, so I call 'em dealers. They sell dental supplies, they sell dental equipment for multiple brands and so forth. So the dealers coming in and saying, okay, we've got this CBCT machine and it needs this kind of power, or we've got this laboratory equipment that's going up with 3D printer milling or the handpiece cleaners in the sterilization and all of those. I need an airline for the handpiece cleaner. I need this kind of power, this kind of space for all this equipment. So you start with the floor plan and that forms a foundation of where all the rooms are going to be and what size. And then you go into detail on what do we need for the equipment, what do we need for mechanical and electrical and plumbing and all the kind of engineering to build this thing? What do we need from the interior design perspective? And of course that's really fun. And when that's all said and done, you say there ends up being like 60 or 70 pages of drawings. Those drawings are needed. Correct me if I'm wrong, they're needed number one for the city to approve and say, yes, you're allowed to build this thing in this way, but they're also needed for all the contractors we're going to get bids from to see every single detail to give us the most accurate bid possible that we could hold 'em accountable to. Is that correct?

Chris Raba: That's correct, that's correct. And so what we call those documents are construction documents. So once we've completed the construction documents, we do a review with our client to go over the entire project to make sure that everything's looking the way they expect it to look. There's also a part of the process that's important to know is that those plans have to typically be shared with the landlord. So we'll share those plans to the landlord, they review those plans. They may ask us to make some adjustments, but once they tell us we're good to go, we're going to release the plans simultaneously to bidding and to permitting so that we can be running those two things at the exact same time.

Scott Leune: So that will save a lot of time actually, because the bid process takes a certain amount of time and the permit process takes a certain amount of time. And you're saying having an architect on board, you're able to start the permitting process before you've even selected the contractor. Is that correct?

Chris Raba: That's correct. That's a very critical part of the process because when it comes to permitting, depending on where you are on the country, permitting could take several months. Some parts of the country permitting could take one to two months, which is great, but for the most part it's a little bit more than that. Certain parts of California, for example, could be five, possibly six months to get a permit. So we want to make sure that permitting is happening. And then at the same time, we're bidding it out to at least four or five contractors who have some dental experience.

Scott Leune: So when you get the first round of bids back from the contractors, they've been given 60 to 70 pages, they should know down to the inch how much material to order, and they should know what kind of subs they're going to need, how to put a schedule together. They have all the detail that they need to get a perfect bid created. So do these bids come back? Perfect. What's that?

Chris Raba: Yeah, so unfortunately the bids do not come back. Perfect. And that's not the fault of the general contractor. It's pretty much every bid we ever a bid process we do. There is something in the bid that's not correct. And so what we do is that once we get the bids in from the different bidders, we do a qualifying process where we go through the bids with the contractor. If we see something, for example, that's too high, we want to talk to them and find out why it's that high just to be sure that they understood it. If that's their number, great. But at the same time, if it's too low, we don't just take a number that's too low and run with it. We want to make sure that number is a good number. I'll give you an example. We had a project that we just bid out recently and we were going over the bids and one particular general contractor had $16,000 for millwork. Typically millwork is going to be around 60 to $70,000 on the low end. So we saw that number, and while it's a great number, we didn't want to get excited about it. And so we contacted the general contractor, asked if their bid was complete, they said it was, but we then pointed it out to them, that particular line item, and they didn't realize that they'd put the wrong number in. So the process of reviewing the bids is extremely critical as part of

Scott Leune: The bidding process.

Scott Leune: How much could the cost swing, whether it swings up or down, the contractor gets a bid and puts it together and sends it to you, but there's mistakes in the bid. And so once those mistakes are corrected, what kind of swing do you see in changes from correcting those mistakes?

Chris Raba: Right, so it could be a $40,000 swing either direction. It's really, really important to ask those questions. The reality is that if you hire a contractor that has not bid your project correctly and has underbid your project, what's going to happen is that during the construction process, while they're moving along smoothly, at some point they're going to realize that they've not capitalized their project correctly, which means that they're not going to have enough money to finish your project. So what usually happens is that they will stop construction while they have to take money from other projects to finish your project. Or they'll either stop the project and just be very honest that they underbid your project and now you get a change order to your project, which usually happens towards the end of the project at that point, which is very difficult to manage that increase in cost.

Scott Leune: Well, yeah. And that increase in cost is ultimately going to be buried by the dentist, but if we didn't know upfront, this is going to be something unexpected that blows the budget apart. Right? And so the contractors send their bids back off of the 60 or 70 pages construction documents. There's always updates and little mistakes tweaks that have to be made. And once you go through that auditing process to revise them, now you finally got clean accurate bids, which means we're going to have the cleanest construction schedule possible and we're going to have the cleanest budget possible. And so from there, a contractor's chosen, right?

Scott Leune: Correct.

Scott Leune: And then because the permitting process had already started, once the contractor's chosen, they're going to be lining up their subs, the ordering materials and so forth. What's it like with the bank? So when is the bank coming in and being involved working with funding either architecture or construction? How does that work?

Chris Raba: So typically a bank will put together the loan and basically approve our client for the full loan amount, and they'll give them an initial construction cost. So if the loan is like 900,000, they may say, of that 900,000, we're going to give you 450. That's just for construction. And then once we get the bids in from multiple contractors and we show the lender that the bids are coming in at a certain amount, they'll typically take money from other buckets we call it, and they'll put that money towards construction. So they'll go from four 50 maybe to five 50 for construction. And then once we know what the final construction amount is that the loan has available, we work very diligently with the contractor to negotiate the bid down to get within that number. And so once that number's been basically approved by the contractor that that's the bid amount, we share it with the lender. The lender typically will not release any money on the loan until they know for sure what the cost of construction is. So once the contractor issues a final bid, that bid goes to the lender. The lender then will release funds on the loan to go

Scott Leune: Forward. So it sounds like this is actually a very complicated process at this point because you started by getting incorrect bids right off of all the documents, and then you had to go correct them, audit them, get the contractors to revise everything. Then you get the bids in, and now you've got to say, okay, now the bids are correct, but we've got to budget issue. We've only got so much money to spend on construction, so now we're going to have to go back to the design and back to the contractors and potentially re-engineer some things to be more affordable to meet the budget boundaries. Is that correct?

Chris Raba: That's correct. And that's called value engineering. So we'll sit down with our clients and the contractor and go through every sheet of the drawings and look at areas that we can make maybe some subtle changes to help find some savings. The thing we do not want to compromise during that VE process is that we don't want to compromise the efficiency of the practice. We don't want to lose any operatories. We want to keep the general aesthetics as best we can so that the practice looks beautiful. But the VE process for us, because of the cost of construction today has become basically a standard part of the process. We've rarely, if ever have gotten a bid on a project and then just ran with that bid and built the practice.

Scott Leune: So this value engineering, one example of this is maybe we designed frameless glass walls, meaning floor to ceiling, huge piece of glass wall for the office manager's office for consultation room, which has a beautiful aesthetic, but the cost of that comes back. And it could be, what could it be? What could a frameless glass wall be for a consultation room? What might that?

Chris Raba: Yeah, so a frameless glass wall, just the door itself, which is typically three feet by seven feet, the door itself is close to $2,500 just for the door.

Scott Leune: And what would be a regular wooden door that has maybe a few little glass panels in it, what would that cost?

Chris Raba: So that could be half the cost of that. And then the glass itself, like the glass wall could be another three or $4,000. So we'll take that number and say, this is what we wanted, which is beautiful, but we also can do something more cost effective. We can do a framed window, we can reduce the amount of glass. We still all the transparency that we want, but that could cut the cost down significantly by doing that.

Scott Leune: So that process is one little example where I've got a frameless glass wall and a frameless glass door and all in I'm like at eight grand or whatever with that decision, I could still have glass, I could still have beauty, we could just do it a different way and we could save $5,000, right?

Scott Leune: Correct.

Scott Leune: And that is building value in re-engineering how we design that wall and that door. So that value engineering process. Okay. This actually takes us, we got to step back a bit and talk about the industry because the reason why you're having to do value engineering in part is because construction costs over the last five years have skyrocketed. Could you talk a little bit about that?

Chris Raba: Sure. Yep. So basically before COVID, the average cost of construction would increase between three to 4.5% a year. That was pretty typical from year to year. Since COVID construction costs have increased six to 9% a year. So that's a big difference in construction costs. And the reality too is that while we're all hoping and praying it's going to go back down, it isn't continuing to rise. And so while construction costs have increased based on typically materials, those numbers are not going down, the loans have not increased at the same rate. So a lot of our clients are getting a pretty standard known amount, and that number's not changing at the same speed. The cost of construction is changing. It's requiring us to spend a lot more time trying to really carefully negotiate these bids to get as much value as we can for our clients.

Scott Leune: Yeah, I've never seen it as important as it is today to go through all of the detailed steps to get the design right and the value engineering as perfect as possible with the strongest negotiations to get the constructions down to something manageable, construction costs down. And then of course, if we still have a cost issue on construction, we're going to have to make changes in what equipment we buy, right? To free up some money that the bank would allow us to maybe put on the construction side. And you're seeing that happen this kind of process nearly a hundred percent of the time, right? Is that what you said?

Chris Raba: That's correct. I'd say in all the jobs we did last year, I think we had one project where we got a bid from a contractor, we made some slight adjustments and we built everything almost exactly per plan. But the important part to know about that project is that it was a small space, and that's something right now with the cost of construction that is more important than ever before, is the size of the space has a huge impact on the total cost of the project. So if you get a space that's 14, 1500 square feet, there's a higher probability you're going to get everything you want in that space. If you're at 2,800, 3000 square feet, you're most likely not going to build the entire practice. We're probably going to do it in a phased approach.

Scott Leune: So kind of like the analogy, if I own a beautiful condo, a small condo with two bedrooms, I can afford to put marble floors everywhere. I could afford to have the golden light fixtures, and everything's just gorgeous because it's not a lot of space to build. But if I'm going to have a 3000 square foot house, I can't have 3000 square feet of marble floors. So what you're saying now is if we can have a smaller total size for the practice, we could probably afford to have everything we ever wanted in that practice within reason. But if we go with bigger size, we can't afford to construct that with today's costs. And so it doesn't mean we can't have a bigger size. But you just said sometimes you have the strategy that says if we have 3000 square feet, you'll design all 3000 square feet. What will that practice eventually look like? A nine op practice, whatever it might be, but maybe the dentist will build, construct and build just a five op practice that they can afford and leave the rest of the practice as a phase two for whenever they want to expand that. Did I say that correctly?

Chris Raba: That's correct. That's correct. And that process is also very important to understand as it relates to the general contractor. Now you have to pick a general contractor that is comfortable with that process and knows how to manage it. Because the reality is that once you build phase one, the best case scenario is to bring that same contractor out for phase two. So it's all part of the process to understand that and double check things as you go. So it's not something you find out too far down in the process.

Scott Leune: So it sounds like one of the biggest ways to save money is actually to save space, is to have a smaller space built. Can we fit what we want? Because one issue Dennis has faced in our careers is we feel sometimes like we're claustrophobic in these ops or we don't have enough storage space, there's not enough cabinets for me to put the junk in that I need. So we are kind of traumatized in the old way of design of never seeming to have enough storage and never seeming to feel like we have enough space, but we're saying right now, let's go smaller. So how do we bridge that issue? How do we have a leaner space so that we can save a ton of money on construction but not feel like it's claustrophobic or we've run out of storage?

Chris Raba: So for us, it's just basically taking a smart design approach. So when it comes to the operatories themselves, we look at the first as what's the most critical parts of the op? And we don't bring in things that aren't critical if it's all possible. So when it comes to side cabinets, sinks, things like that in the operatory, we don't encourage our clients to have those things unless they truly need them. So our first part of the design process is to understand what they want and what they need, and we'll give them some direction based on our experience. But at the end of the day, if our client wants a side cabinet or wants to have a sink in their operatory, well then that's going to determine the size of the op, and that's going to be a domino effect everywhere else. Same thing when it comes to storage. While storage is important and we want to make sure we give our clients storage, we want to be careful not to just create multiple closets that just become an area where things go to die. So we want to have a very smart approach when it comes to storage. So open shelf storage is very important to do that so you can see what you have. We try not to have too many closed cabinets or closed spaces where things can't be observed and monitored so they can keep track of those things. So it kind of goes hand in hand with the design of the space and how the practice is also managed. We used

Scott Leune: To think an op needs to be a certain size, but that was the wrong thing to talk about. The size ist nearly as important as the usable space around the chair size. The usable space is what we use what we need. It's the space I have for my chair, for my carts, for my technology, for extra employees, for moms sitting in the corner, the usable space around the chair needs to be maybe increased from the traditional operatory design. And then if I have side cabinets, they'll go next to that. Or if I don't have side cabinets, then my wall can be next to that. And I think what I heard you say is we can determine that size first. How much usable space do we need? And then if we can try to minimize extra stuff in the room, we can have rooms that are efficiently designed that don't feel small, don't feel claustrophobic, that has a domino effect, a positive domino effect in saving space. And therefore the end result of this, the end result of smart design is we've got a space that feels right and it used less square feet. The end result of dumb design is we've got this larger space, but we're running out of storage. We feel claustrophobic, right? And so dentistry's been used to this. I guess I shouldn't call it dumb design, but that's kind of how I feel about it, right? This dumb design. Okay. So what about the interior design process that's happening concurrently with mechanical, electrical and plumbing and talking to equipment dealers? How long does the interior design process take?

Chris Raba: So the interior design process takes every bit of the time it takes us to complete the construction documents. So the construction document phase, which is the detailed part of the process, that could be three to four weeks. So it's your best advantage to use every bit of that time because you're looking at your colors, you're looking at your finishes. What we recommend to our clients when it comes to interior design is to put together something that you really want. Don't try to scale back when you're initially designing the space because you may potentially miss out on things that you could do that you don't know you can do. So our clients will work with the interior designer. We recommend that part of the process that you create a Pinterest board, this could be done while you're looking for locations, have a Pinterest board, throw in there any pictures, any colors, anything you may see. You may be out with your wife or your husband. You see something, you throw that image into your Pinterest board. And by creating this collection concepts and colors and materials you like, the interior designer has a really good idea as to how you want your practice to look. And then they'll put together a very detailed plan with the list of materials that once again, the contractor can price and also the contractor will use when they're constructing the space to make sure it looks the way it was designed.

Scott Leune: And this interior designer, I mean this is like a licensed interior designer that not only can they put this all together, but a lot of times what I've noticed is people have a vision, and even if they've done some designing and decorating in their houses in the past, they may not be aware of all the materials out there, all the ideas out there, all the kind of trends that have become popular. So the interior designer is going to bring this level of knowledge that is going to make the space even more beautiful and maybe even more cost effective. Part of the value engineering may also be not just do we make this a glass wall or framed glass wall, but maybe a different type of material that came from the interior designer suggestions. Is that correct?

Chris Raba: That's correct, that's correct. And we can't do that unless we had the details to get information from the general contractor on. So if we're calling out a certain type of wall covering, which is also called wallpaper, we'll first get that priced, get some feedback on the cost. If it's too high, we'll find something that's comparable, same look, similar style, but saves you some money.

Scott Leune: It seems like every step of the way, there's that part, let's save money by doing the right thing, but just in a smarter way, it seems like that's almost part of every conversation. How do we do the right thing, make it beautiful, not lose benefits, but save money. How does it work with the ongoing communication with a contractor? Let's say the plans are finalized, the contractor's been chosen, permits are issued, construction starts. Who's talking to the contractor? What is that like?

Chris Raba: Yep. So the first thing the contractor does as part of the process is they're going to give us a project schedule or a project timeline. And so that is kind of step one to look at the overall project. And there are some key points during construction that we zero in on that are very important to maybe double check on the work, have some dialogue to make sure things are being coordinated. You have to also remember, they're not just constructing the space by themself. They also have the equipment person who's involved in that process. It is involved in that process. And so we're basically looking at the overall project, looking at the team, making sure everybody's communicating. We also ask that the contractors we work with that they give us at a minimum a weekly update. And so those weekly updates consist of maybe some photos of the space, maybe video of the space.

We're constantly reviewing those communications to make sure that the progress that they're showing correlates with the schedule that they've shared with us because that schedule is going to move and adjust. That's one thing I do want to communicate. That schedule is not something set in stone. They may have something occurring on a certain week, that thing may move up a week or may move forward a week, but construction is kind of fluid in that way. And so we always try to tell our clients to understand that they're in a field, which obviously is very exact. Construction unfortunately is not like that. So not to get too worked up over the schedule if something shifts, because typically a good contractor is able to, if they lose a week, they typically can catch up that week somewhere along in the process. That only can be discovered by communicating. So we communicate with them by email, by phone. They're going to be contacting us during the process no matter how detailed the plans are with questions, maybe their framework doesn't understand the detail. Maybe we didn't make the note clear enough on something. So it really is a lot of dialogue and a lot of teamwork to complete a project.

Scott Leune: So what I hear is that you're almost like an auditor or almost like someone that brings accountability to the project and kind of oversight and organization. If a contractor got a schedule, but there's something amiss in the schedule, you're going to see it and work with contractor to address it. If the contractor loses a week because you're there getting updates and overseeing it, they're going to be pressured to make that up somewhere. Whereas if you didn't exist, they're going to do whatever's in their best interest because no one's holding 'em accountable. If the contractor has questions or there's confusion or they didn't understand something about the design, you're going to be there to fill in the details so that it's built properly. Do you ever find yourself having to kind of bark at the contractor, meaning the contractor is getting close to an area that's unacceptable for the project or for the dentist and you're kind of having to bark and say, Hey, that's not good. You need to address this. Do you find yourself in that position? It happens

Chris Raba: Sometimes, but to be honest, the way we avoid that scenario is that we communicate very clearly with the contractor that we are working together. Historically, the relationship between the architect and engineer and the contractor has been somewhat contentious, hasn't been that great. So because of my background in design and construction, I had a construction company. I've seen both sides of that reality. And so for us, we really approached the process with contractor and say, look, if you make a mistake, we're here to help you fix it. We're not here to point the finger and blame you for something. We want to help you fix the issue. At the end of the day, we both want the practice to be beautiful to the benefit of our client. So while it has to happen, sometimes it happens very rarely we avoid it by communicating that we're all working together and collaborating with the same goal in mind.

Scott Leune: And I imagine you've got the whole gamut of maturity levels and experience levels with contractors. So some crock tractors have, this is one of their earlier projects who have never done a dental office and they've always been used to kind of half-assing shit and not really following a schedule or budget much and just charging their clients change orders for things. And on the other end, you've got a really professional crew. And your job in part is to make sure that even the worst contractor is lifted up to an area of quality that is going to result in the project being a success, right?

Scott Leune: That's

Scott Leune: Correct. And the dental dealers talking to you or the contractor or to both, how does that work?

Chris Raba: So the dental dealer initially speaking to our client to select their equipment, then a dental dealer works directly with the general contractor, so they're going to work directly with them. They're going to communicate to them when they need to come out and do certain things. For example, during construction, once you have a clean space you're working in, you're going to do what's called trenching. You're going to cut the concrete. The dental vendor is very, very important to come out and look at the slab and make sure that they approve the location for all the air and vac and potentially nitrous that's going into the slab area as far as to make sure it's all correct, where it comes in, where it comes down, everything has to be exact. Their involvement with the contractor is very critical. When the communication is not good, meaning the general contractor does not speak to the equipment dealer, then there's potentially issues on delays and mistakes could occur. They could have been avoided.

Scott Leune: Yeah, they put the power for the chair at the wrong spot, and it's literally impossible to plug the chair in. That's cutting the concrete. They cut the concrete, they run the power line, they pour back the concrete. And if there wasn't good communication, now what we got to recut the concrete, we got to move the electrode report it, and that can add weeks of delay. It could add thousands of dollars of cost. And that's one little example, right? That's

Scott Leune: Correct.

Scott Leune: And what I also hear is it's almost like at every step what you say is it's really, really important that this happened. It's really important that it's really important that it's almost like every single thing is important because this is such a complex thing to do. You're dealing with multiple subcontractors, vendors, city issues. You've got dental equipment issues, you've got all the mechanical, electric plumbing happening at the same time. Everything's down to the half inch of accuracy. And of course you've got the designs of the dentist, you've got the rent timeline, the clock ticking down until rent is due. You've got the bank with issues. Everyone wants this to be beautiful, everyone wants to make money, everyone wants this to go well. And then you've got acts of God, you've got a flood, you've got a fire, you've got the city inspector has a heart attack and now there's a two month delay or all these things can happen. That takes me to this next question. Sometimes dentists gets suckered into, maybe I shouldn't say that word. Well, I already did it. They get suckered into being convinced by a contractor to do what's called a design build. Can you explain what a design build contractor is? And then maybe could you talk about why that might not be something good for a dentist?

Chris Raba: Right. So a design build concept with the contractor is that you're hiring a contractor. Before you've designed your space, you're basically going to the contractor and saying, I want to build a dental practice. And what they're typically going to do is say, okay, we can build it for this amount. They're going to give you a number, and that number is hopefully based on some experience, but it's typically just a number. And then from there, they're going to work with you to design your practice. The risks of that are first that you don't know what their experience is when it comes to design. You don't know what it's going to look like as far as the efficiency of the space, and you don't even know what it's going to look like when it comes to the finishes. So once you've committed to the design build concept, you are stuck with that particular general contractor from the start to the very, very completion. Now, I'm not saying that it's not impossible. There may be a situation where it does work out, but for the most part, it's a very, very risky step to take because you may basically marry someone that you can't work out things with. So you may at the end of the day not get the practice you expected, not get the space that you envisioned, and at that point, you're not a happy individual because you made that commitment versus looking at multiple options, how to go forward.

Scott Leune: Yeah. So in my words here, a design build is where without a design, you pick a contractor and the contractor says, I can design and build you a practice for this amount of money. And then you sign on the contract, you're done, you've married, you literally married without dating anyone, right? You picked someone to marry based on their hinge profile, their dental contracting hinge profile. And so now you're in, and now you don't know. Can they design well? You don't know. Can they design in a way to save you money? They're actually not trying to necessarily save you money because that money goes to them and you don't know can they design something beautiful? You don't know if they understand the dental needs of the equipment, the dental needs of the operations of that kind of thing. You really don't know anything. And along the way, they're almost incentivized to try to have change orders. No one's bidding against them for anything. You don't know if the cost of construction, they're going to quote you based on what you're getting is reasonable. And so you might end up getting a really crappy set of finishes, really compromised materials to fit within that number they originally lured you in with. And you might have a bloated design and not have all the stores, not have all the ops you need. And so I think what we've been talking about with you is almost the opposite of that. Let's go figure out exactly what kind of contractor we want to marry and exactly what life we want them to build us. And then let's go date a bunch of contractors and have them contractually commit to being that. And then we pick a contractor and it almost de-risks the entire process. A design build has no bidding process, whereas get an architect to design something.

We get the best design, we get the best interior decorating, and then pick a contractor. We know exactly well, it's a bid process, so we get the best money, the best bids on exactly what we're trying to build. The reason why people choose design builds from my experience is the contractor will say, you won't have to pay an architect. We'll just do it. It's free. They say, although nothing's free, but they say, okay, it's free. And then someone told them, oh, that's a great contractor. They did my office. And so based on that one recommendation, they're marrying them. It's like me telling your son, Hey, that's a great girl. Go marry her. And he's like, oh, okay. And then marries him, right? Without dating. Right. Is there anything else you'd like to say on this subject, or did we cover it?

Chris Raba: No, but I will add this. Working with the design build contractor, we actually have lots of contractors that do our projects. They are design build contractors, but we've hired them through the bidding process. So they have experience with design, but they're may be really strong at construction. And I'm proud to say that those experiences have been positive and that they've told us working with us was very smooth because they appreciated the detail so that they were able to just build the project. From a construction standpoint, when I had a construction company and I was doing maybe a design build process, it's easier to do it from a construction standpoint because you kind of know what you're going to do because typically plans aren't detailed. So by us giving the contractor detailed plans, whether they be design build or just a regular general contractor, the process is going to go very smooth from the standpoint that they're going to understand the project.

But I do want to touch on one point, and that's smooth construction is not a smooth process for the most part. And we try to prepare our clients for that and kind of tell them that things are not going to always go perfectly according to plan. And that's why they need to have an open mind and understand that construction requires a lot of pivoting, a lot of pivoting and a lot of reacting to things in a reasonable way and solving problems and moving forward. I have not had a single project in my career by doing this for 20 plus years. That's gone perfectly according to plan. Like you said, there's a lot of moving parts and the team you're working with is super critical to make sure that those issues when they do arise are

Scott Leune: Appropriately. That's a great point you made

Scott Leune: About the design build. So a design build contractor doesn't have to do the design. They might suggest that as an option, but they could just do the build, right? So if I'm the dentist and I've been told, Hey, this design build contractor's great, but I want to go through a healthy process of getting everything designed perfectly from an architect and having a bid process with lots of contractors. I can still ask that contractor to bid on something I had designed and they still might be my awesome contractor. That helps me. And that's what you described. It sounds to me like from what you've said where this is a very delicate kind of balance. Building a practice, you've got the budget issues and the construction cost issues. You've got the desire to have something beautiful and to have something that gets all the things in that we need, all the rooms we need in storage, we need, and you've also got a lot of uncontrollable things with the city or with materials or shipping times. There's a lot of things we can't control that can bring risk. And we're putting that all into this construction project that never goes perfectly. So having a strong team upfront will give us the best design, it'll give us the lowest cost, it will have the most accountability to the process. And maybe most importantly, as things go wrong or unexpected, we have the smartest minds on that issue to solve and pivot immediately. Did I summarize that correctly?

Chris Raba: That's perfectly summarized.

Scott Leune: Yeah. Okay. And so we're just about out of time, but Chris, I really appreciate you letting us pull back the curtain and talk about these details. What's shocking to me is that even though this is the best practice on how to build a dental office, so often dentists go get a free floor plan from a dealer, which always looks like complete shit, bloated, expensive, and just a sheet of paper floor plan. It'll take that free floor plan and go marry a contractor based on a bid number they get that has no accuracy whatsoever. It's just an estimate. And then they'll go through the process and they will have these nightmare moments throughout the process of change order because they marry the contractor without a detailed set of plans. And I don't know how we, in dentistry, it's embarrassing. We in dentistry made this a standard way to build a dental office, a bullshit one page four plan, a contractor that we can't hold accountable to a number or a budget, and then we just become a victim of the process with no one on our team to bring accountability. Have you ever, before we wrap this up, have you ever had to take on a client that started the process that way, that kind of had a poor design done by someone else, was about to dive in with the wrong contractor? Or is there any kind of horror story you have that relates to what I just said?

Chris Raba: Yeah, unfortunately, we have had that experience. We've had a client that we met after they invested a great deal of time creating a floor plan with a general contractor. We happen to have the opportunity to review that floor plan and immediately found issues with the floor plan, not just on the overall design. There may be code issues that will not work. And the important thing about code to understand is that it's not built according to code. You may not get a permit, or if you do get a permit and they don't catch the code issue, the issue is still there. And so in that situation, we have to have a very honest conversation with the client and basically tell them that they've wasted a great deal of time, but the benefit is that they have not constructed it yet. And so we go through that entire process that I outlined for you, create them a beautiful practice, and we'll still bid it out to that same contractor like you mentioned, because the contractor is, they're specialists when it comes to construction. Just like I would not try to sell equipment, that's not something that I do. And so every person that's part of the team, that's a specialist, it's important to let that particular person contribute what they're best trained to contribute. So when it does happen, it's not great because they've wasted that time and money. But the big picture wise, it turns out to be a positive experience for 'em. So on the

Scott Leune: Team, we need a real estate agent, we need an attorney. We need an architect. We likely need a CPA to help us start tracking all these expenses. We're going to have a loan, so we're going to have a representative from the bank. We're going to have a representative from the dental dealer side on the equipment. We're also going to have as part of the architect, the interior design team and the engineers and so forth that are needed on the team. And we've got a dental consultant or startup coach that's helping oversee and guide the dentist into making some of these business decisions. Is there anyone else I left out or is that the whole team?

Chris Raba: That's the whole team. And each one of those people that you mentioned are super important. Their experience can make a huge impact. If the lease is not negotiated correctly, then they're going to be paying rent before they open. If the consultant, they're working with doesn't understand when marketing should begin as far as when they open, they're going to open with no patients. I mean, we see it all based on the ability and capability of the people that they're working with.

Scott Leune: Yeah. Okay. Well, Chris, again, thank you so much. Are there any last words you want to say before we wrap this up?

Chris Raba: Just want to mention that when you're looking at our project, you look at the whole process itself. And so we advise our clients to, when they're making a timeline to kind of reverse engineer the timeline. Construction typically takes 120 days to construct. It takes potentially two to three months to get a permit. It takes two to three months to complete plans. And so you need to look at the big picture when you're starting the process and not just started thinking you're going to open up an office in four to six months. It could take eight to 10 months, start to finish. And so it's important to know the process and important to work with the right people. It's important to have an open mind to situations that come up and be able to react to those situations in the right way. And at the end of the day, keep a positive outlook and know that everyone's working into your best interest to give you a beautiful practice.

Scott Leune: And on that timeline, before it takes a while to find the location or after it takes a while to install the equipment and to train the team and get whatever the credit card processing terminal working. And then there's a soft open. And so there's this very important timeline and you guys have helped build some of the most successful startups in the country because they're my clients and you guys were their architecture firm. And these practices, of course, they're beautiful, but one reason why they're so successful is they were able to build this beautiful practice on a budget that gives 'em a lot of power to then have the money left over. They need to build the growth of the actual practice when it opens. And so this is a domino effect. If we aren't thoughtful and responsible with how we build and design this thing to save enough money, we end up being undercapitalized when we open it and now we have a hard time growing it and becoming wealthy and having everything we intended to have. So the decisions in the design process impact how many new patients we're going to get in month six after being open. Because it's all connected. It all comes from one budget. It's super important that this team is strong. Alright. Chris, how can people get ahold of you if they would like you to kind review their situation or consider hiring you guys?

Chris Raba: Sure. So they can email us at info@leandentaldesign.com. Once they email that address their contact information, someone from our team will contact them, set up a time to visit, talk about their project. I will also be involved in that process, maybe to review a plan they're looking at that someone else gave them or a space they're considering. And then from there we kind of share with them how we can assist them designing and building their practice.

Scott Leune: And you as the owner of Lean Dental Design, so lean dental design.com, you as the owner, what percent of the projects that you guys do, are you yourself personally as the owner of the company intimately involved with overseeing that project?

Chris Raba: Yep. So I design a hundred percent of the projects. So anything that comes to us, I do the floor plan and then I share it with my team to complete the detailed drawings. So every project we get, I'm touching that project from the very beginning until it's completed.

Scott Leune: Yeah, that's a huge value that you add because there's a lot of, we know how it is in today's business world. There's a lot of businesses where the founder, the talented person, the one with all the experience isn't the one doing the work anymore, right? It's some junior person. So in your company, you are still as the owner, you are the one doing all of that important work for every single client, which I would imagine means you can only take on so many clients per month, per year. Is that correct? Right.

Scott Leune: That's correct.

Scott Leune: Okay, excellent. So lean dental design.com. Chris Raba, owner of the company, really want to thank you for joining us. I have never heard anyone in dentistry on a podcast go through this amount of detail. So I hope this was super valuable for our listeners or people watching this. Now's the golden age of doing a startup. Now's the golden age of expanding practices. The only downside are the things we talked about with construction costs. Now's the time to do it. There's huge tax advantages. It's just a massive opportunity. But man, we got to do it right. So Chris, thank you again for joining us and everyone listening to this. This was the Dental CEO podcast. Until next time.