Scott Leune: So what would a dental practice look like if a hygienist owned the practice and had an associate dentist? Does that make sense for certain hygienists? Does that make sense for certain owner dentists to partner with a hygienist? How does a practice like this get funded? How many patients can a practice like this see? Can it be profitable? What might this look like? And that's exactly what we're going to talk about in today's episode. I've got Irene Janku. She is a hygienist, a speaker, an educator. She has her own podcast and she owns her own practice in Toronto. She is maybe one of the most experienced people I've spoken to in my career when it comes to this specific topic of a hygienist owned independent dental practice. And so tune in. This is going to be an awesome thing to listen to on the dental CEO podcast. All right, Irene. So again, thank you so much for joining us. If you can, could you take maybe a couple sentences to, I know we just did an intro for you, but if you could take a couple sentences just to kind of let everyone know who you are and what you're up to right now, and then we will dive into a bunch of questions.

Irene Janku: The elevator pitch. Thanks again for having me. This is great. I love talking about business and advocating for independent dental hygienists who do kind of crazy things. I had this vision once upon a time that I wanted to be a business owner, but I never envisioned it would be quite like this to work backwards. I own my own dental practice operating to the public, like a general office. Most people don't even know it's owned by a hygienist. They think it's owned by the full-time dentist that works there. I'm also a restorative dental hygienist, which affords me the opportunity to do general hygiene, but also fillings, cran and bridge, full large cases, teacher educator podcaster. And I like to create nerdy videos on Instagram and YouTube. So that's basically the 62nd pitch.

Scott Leune: Alright, well, we've got a lot going there. So I want to ask you a bunch of questions about the ownership of a practice as a hygienist, because that's the thing that stands out to me is the most unusual thing about your situation that a lot of listeners have never heard of or experienced before. So to back up a bit though, you are in Toronto, Canada, is that correct?

Irene Janku: Yeah, correct. Scott Leune: And so do the Canadian laws allow a hygienist or anyone to be the owner of the clinical entity of a dental practice, or is there an entity structure set up so that there's a business entity that you own? How does that work?

Irene Janku: This is a pretty common misconception. People seem to think that it's a Canadian thing where Canada is broken down into provinces just like the US has broken down into states. So there are states in the United States that allow dental hygienists to also be practice owners, far and few in between. Of course, Ontario being the province that I live in is very similar in that I live in a kind of unicorn province where my scope of practice allows me to do restorative and orthodontics and own a practice. So it exists and it's existed for decades both in Canada and in the us. It has nothing to do with Canadian laws, it's all based on province. So each province is operated by our version of a state board, which is called the college. I operate under the College of Dental Hygienists of Ontario. The dentists operate under the Royal College of Dentists of Ontario, the R-C-D-S-O.

So each of those independent entities have their own rules around how to operate or navigate a practice ownership quite like this. On the structural side, if we're talking contractual work, it's no different than if a non-dentist, were going to be a practice owner with a dentist, meaning like a chiropractor or a physiotherapist. It all depends on how the corporations are structured. The interesting thing about the province of Ontario is that the dentist can't be my employee. So the contract itself is kind of like a rental agreement where there's ATM inclusion and a structure around the use of my resources, the equipment, depreciating cost of the equipment, the resources around my hr, so using my receptionists and my hygienists and chair space sundries and that sort of thing. So it's not a fee split, it's not an employment contract. It's kind of a premise contract.

Scott Leune: That makes a lot of sense. And so just for clarification to our listeners in the United States, like Irene mentioned, every state has a different set of laws around this, and there are just a very small number of states that allow a hygienist to own a practice when we talk about the clinical entity that actually owns patient charts. However, in every state across the country, a hygienist or any non-dentist, I mean my 12-year-old son could potentially own in A DSO structure, the business entity that in essence is getting most of the valuation and most of the profit of any dental practice. So what's interesting is that a lot of people coming out of dental school or even practicing dentistry right now, we think, oh, I don't live in whatever, Arizona in my state. It's not legal for me as a hygienist to own a practice. But actually, yeah, it is.

It's just not owning the clinical entity with the clinical charts. It's owning all the other assets of the practice that is being rented to the clinical entity and therefore receiving most of the financial benefit of the dentistry. It sounds like in a way, there's some the commonalities with what you're doing. So you've got a facility, you've got a team, and you may do other services like billing or marketing or things like that with your team. And in essence, you are renting entity or this asset, this facility to private dentists to therefore practice dentistry in. Did I say that correctly?

Irene Janku: I mean, I don't have multiple dentists. I have one full-time general, part-time prosto, part-time oral surge. And so what you're talking about too, just to backstep, is the goodwill of the charts, which there are some loopholes around contractually, and that's through a custodian agreement. And again, I'm not speaking for the United States, only for the province of Ontario, and this is kind of why my practice is unique because Tooth Life Studio owns the charts, not Tooth Life Irene or Irene Janku or my professional corp or the dentist. So there are contractual ways for the ownership of the charts to still stay with the goodwill of practice without it needing to be the ownership of the dentist using a custodian agreement that is sequential. So there's always a commonality in the ownership of the charts. And this is a question that I get asked frequently. I'm a council member for the Canadian Dental Hygienist Association.

I'm on my first of three year terms as the independent practice, kind of like a kind of an internal consultant where hygienists will reach out and they'll call the college or the association and say, Hey, can I get some help? How do I keep my charts the most expensive thing? And there are ways around it that my lawyer and I developed four years ago, and before that the charts had to stick with the dentist regardless of who owned the brick and mortar. So yeah, different thing here. I don't know if that exists or if that's possible in the US

Scott Leune: It is. So what happens is the practice entity, let's just call it the business entity for this conversation, can assign or choose the custodian of the charts. It has to be a licensed dentist in that state, but it's any dentist the business entity chooses. It doesn't necessarily need to be the dentist that's actually doing the dentistry or the business entity can also change it. So if it is the dentist doing the dentistry, but they for whatever reason leave that location, the business entity can say, okay, I'm assigning these charts now to a different licensed dentist who's a custodian. Therefore protecting the patient base, connecting the patient base to that location and to the owner of that location as opposed to the associate dentist or the independent contractor dentist.

Irene Janku: And that's a pretty common kind of DSO model, why some organizations have their chief dental officer that may or may not be practicing at all, but that person is kind of the stable entity. That person may also be their RPO, which is a radiation protection officer, which is what we have here. Another question hygienists asked is, how do I take x-rays? And in Ontario, I'm not allowed to diagnose perio. I'm not allowed to give local anesthetic and I'm not allowed to prescribe radiographs, but I can own all of the equipment that is required to do all of the above. And it has to do with having that stable person in place in order for the premise itself to be licensed to do all of those things. And I can own the equipment, but I can't prescribe the bite wing.

Scott Leune: Yeah, I think there's just a lot of commonalities between a US DSO structure and what you're doing in essence

Irene Janku: By design.

Scott Leune: Yeah, yeah, of course. Yeah. And you own, so you're working in the entity as a hygienist, just like the dentist is working in the entity and so forth, but you're the owner of the asset. Now you mentioned restorative hygienists. What does that mean for the listeners who've never heard that term before? What does a restorative hygienist do?

Irene Janku: So Arizona graduates dental hygienists as restorative entities, meaning that they can do filling work, crown work, post prep work in the us you're more familiar with the designation of an efta, an expanded functions dental assistant or a therapist in certain states. They have a few more capabilities of more preparation type, scope of practice exemptions. So basically what I can do is I can take a post prep and take that to completion. So doc will pop in, drop a box, do a class two, whatever restoration, and then I'll finish it with my assistant. So we're moving from one op to the other, flip flopping back and forth, and the assistant is the stable person in the operatory. And while docs prepping in one room, I'm filling in another room and then we just keep switching back and forth. That's what my Wednesdays look like. Wednesdays are resto days. Mondays and Tuesdays are clinical hygiene days.

Scott Leune: Let me back up a bit and talk like the ownership of the location. So why did you do this? So why did you decide, you know what, I want to be the owner of the practice.

Irene Janku: So I've been practicing for 17 years. This coming June, I opened my practice in 2020. That wasn't the plan, but it happened for the better part of my career. I worked in a variety of different practice types. When I first graduated, I worked for a periodontist for four years. I worked in a bread and butter practice. I'm Romanian by origin, and the dentist was Romanian speaking. So most of the patients were Romanian fluent in the language and lots of communist dentistry that was done. For those that understand what that looks like, it's more carpentry work instead of treatment planning, like triage dentistry, pain, people waiting in the operatory waiting room for hours just to be seen. Not saying that that's a bad thing, there's a place for every form of dentistry. But I was essential because of my language. So I worked in a super systemized practice and also a not systemized practice all at the same time. One that had a really low overhead because of the type of dentistry that was being done, what she thought, and one that was surgical in nature and everything was really structured. And then from there I went and I worked in Petto and I kept trying to find my home, the place that I really enjoyed working, and it just never happened my entire career. I moved from specialties to specialty. I worked as a surgical hygienist in that perio practice to where I'm triaging tiny humans who are screaming. I worked in a very aesthetic cosmetic practice in Yorkville for at that time the version of Dr. APA for Toronto, still practicing but not quite doing the same kind of work. And then my last practice was this holistic practice that wasn't really holistic, but it marketed itself as holistic that had a lot of restorative hygienists. So I was one of two that were not restorative hygienists.

The dentist operated with six restorative hygienists out of eight operatories. So all she did all day long was prep. She never finished a restoration. So I saw all of the good, these places that I worked in and all of the things that I loved. And I looked at the business ownership under a microscope. Dr. Bud, the periodontist always paid his team regardless of whether the schedule was full or not. He also made everyone take vacation at the same time. Dr. Dana used to help us kind of crowdsource for ce and she would take us to these big events. So I looked at all of these things and I wrote them all down of the places that I loved and then all of the things that I didn't love. And I said, if I can't find this, I need to make it. I need to be able to wake up in the morning. And that was my turning point is one day I woke up and I was like, I don't want to go to work today. And it, I was sick, so I fake called in sick to work, and I sat there thinking this was the first time in my, at that time, 15 years that I'd ever done that.

Scott Leune: So it sounds like you had a massive amount of different experiences compared to a typical hygienist and you were thoughtful enough to pay attention and even write down and get organized about what you wanted and didn't want. And that led you to saying, you know what? I'm going to build it myself because that's the kind of life I want to have. I want to have this quality dentistry. I want to have this scheduled the way I want to have it. I want to be able to take time off. I want this practice to represent the kind of career that I intended to have. Did I say that correctly?

Irene Janku: Yeah, absolutely.

Scott Leune: Okay. And then how do you get funding though for a practice?

Irene Janku: That was the struggle. I did a whole podcast episode on how I got funding, which I'll share the link with you if you want to share with your viewers. But interestingly enough, when you ask for money for a practice, they put you in the same category as a dentist. So I put together my own business plan. I figured out how to write a business plan, which they don't teach you in dental hygiene school. And I later learned they also don't teach you how to do that in dental school. So I took some courses online to figure out what do I need to put together this particular type of business plan that shifted. It shifted from an independent hygiene practice operating, doing dental hygiene to this. I want to do restorative, I want to do myofunctional therapist, I want an oral surgeon. I want want all of this.

I want A-C-B-C-T, I want all of the things. How do I get the money to do that, which is going to cost me about a million bucks? Wrote the business plan, went to the bank, got declined, and they're like, well, we don't see this. We've never seen this happen before. So our analysts just don't know how to quantify it. The numbers don't match. I'm basically doing an associate model in their mind right away, and I'm not the primary provider and I'm not even producing the most amount of money. So they're like, this is going to fail, it's not going to work. And I'm like, it will work with strong systems in place, a good location and a strong team. I can make it happen. So I got declined. I got declined, and finally I went to another bank and there was a person there that just Googled my name.

The guy that I met was like, this is different. I like different. I've been successful funding different things. And then looked up my name and advocated for me. He's like, she does all of these things. She's a speaker, she's traveling, she's lecturing, she's competent as a clinician, let's see if we can put some money behind her. It turned out that I needed to fork over 30% as a personal injection, which is much more than a dentist ever needs to do. So luckily I was able to save and I put down 30% as a personal injection and that's how I got the money.

Scott Leune: And this was a startup practice? Correct.

Irene Janku: Startup

Scott Leune: During COVID. At what point do you feel like in the startup journey did the practice become financially not necessarily be successful, but

Irene Janku: Right at the beginning? I've been profitable since day one and COVID actually helped me with that. And I know that everyone's saying the pandemic really businesses suffered, but it bought me time. I was also very smart and strategic with where I was spending money. So I quit my job, my full-time clinical job. I was still teaching at the time, my full-time clinical job about nine months before opening. I learned I didn't hire a designer for my practice. I learned how to use AutoCAD. I was very much involved in the entire build process, which I documented on the office. Instagram highlights. I built every system by hand and with help. So COVID helped me because I bought myself time and contractually, I worked with a really great real estate lawyer that before pandemic clauses existed in common legal lease agreements, we already drafted one in. So we had this natural disaster type clause in that allowed me to extend my fixturing period far after my permits had closed.

So I wasn't paying rent until I was able to pay rent. And then we negotiated some rent deferment and a bunch of different things, but I was able to start marketing the practice and I hit the ground running. I went to every single business up and down the street giving them my business card, introducing myself as a local business owner. So I made local business owners be my patients before people in the neighborhood. And then they were advocating for me. So there's a coffee shop across the street, I buy gift cards from them. I made friends with the couple who was also opening at the same time. So I just walked the streets and said hi to all the local business owners and they all became my patients. So on the day that I opened and the week that I opened, I had full schedules and we still have full schedules. We went from two ops to three ops to four ops from zero patients to 1600 patients in less than a year. And now we're at 2,600 patients active charts.

Scott Leune: Alright, so let me run down a few quick questions about the practice just so everyone can get their bearings. So how many

Irene Janku: Ops? Well fourth op is going in right now, so peak capacity at three ops, but we're overflowed. So we're overbooked for six months. So I suspect that we'll be fine on day of open, which will be in six weeks.

Scott Leune: And then the practice open in 2020. So it's five years older, so is that

Irene Janku: Right? July 31st.

Scott Leune: Okay. And then how many new patients per month in that first year? You mentioned 1600 patients in a year, so about 130 new patients a month or so. Does that sound? Yeah,

Irene Janku: Between 130 to 210 at peak now we're averaging between 40 to 50.

Scott Leune: And you said you're booked out quite a bit.

Irene Janku: Hygiene hygiene's booked out significantly. So OP four that's going in is going to be a split op between restorative and hygiene, mostly hygiene. We're also extending our hours, so that's another

Scott Leune: To increase capacity. And so when you show up to work, what jobs are filled? So how many front office people do you have and what do they do? How many dental assistants and so forth, what does that look like?

Irene Janku: Yeah, so we have a office manager slash treatment coordinator. We have a hygiene coordinator and we have one receptionist. The receptionist is our flow person. So when someone walks out, they take their patients to the receptionist for restorative stuff. And then for hygiene stuff, they go to hygiene coordinator. We have two full-time assistants and a total of four hygienists that are all working on kind of different days. We're open five days a week.

Scott Leune: Okay. And so let me be a little more specific on just a particular day,

Irene Janku: Pick a day.

Scott Leune: So on a Tuesday.

Irene Janku: Sure. Two hy,

Scott Leune: Two hygienists.

Irene Janku: Two hygienists, myself and another hygienist. Okay. We have full-time dentists, so one doc, two reception team members that are sitting at the front and then one office manager, treatment coordinator, and two assistants. Two assistants, yeah. Scott Leune: Excellent. Alright. And then

Irene Janku: We're currently open 36 hours a week. 36 hours a week. Perfect. And by next year we'll be hopefully open 60 ish hours a week.

Scott Leune: So do you see yourself pulling out of the clinical side more either to just focus on something else in life or to at another location someday? Or do you look at this practice as like, oh no, no, this is my lifestyle practice. I want to be clinically engaged and we are going to make sure that this practice gives me what I want?

Irene Janku: That's a great question and I get asked that quite often. I think I will always work clinically in some form of capacity, whether it's here or whether it's another location. My main goal is to optimize this practice before opening another one. And I think the next time around I might try and do it a little bit differently and acquire a practice over, do a startup just out of sheer curiosity. But no, I don't think I'll leave clinical hygiene or clinical dentistry until I'm ready to retire

Scott Leune: And another opening another location potentially or buying another location or at some point there might be an issue with being able to get funding if you don't have a bank that's backing you for that.

Irene Janku: I think at this point I wouldn't go to a bank again, private equity is much more feasible and I've built some really great connections, so I likely wouldn't go to a bank again and I probably wouldn't even need to put any of my own money in.

Scott Leune: Did you ever consider in the beginning partnering in some way with a dentist, having a dentist be the co-signer, be a minority stakeholder in the business so that you didn't have to put 30% down? Was that ever a conversation?

Irene Janku: I didn't have anyone I was close enough to and I didn't want to take that risk at that time. I have closer friends now that I would consider, but I wanted to do it myself.

Scott Leune: Yeah, and when you look back at this decision, I think there's this misconception that can happen on both sides of a coin. One misconception people have that have never owned their practice is it's going to be too much work and too much risk. And the other misconception though is the opposite. I'm going to love it. It's going to be so much better. I'm going to love coming to work every day. And you kind of have those two sides of the coin. How would you describe your experience in this practice compared to when you didn't own your practice? What about risk? What about money? What about joy? What about time? If we talk about the, actually I'm going to write that down right here. So risk, money, joy and time, how do you compare in those things?

Irene Janku: I'm a far more calculated and strategic person now than I was five years ago. There are things that happen when you own a practice that you can never imagine will happen. Employee died, my assistant committed suicide. Someone drops the iTero and doesn't say anything. You get a flood, you get a fire, you get a phone call in the middle of the night from someone in the building that 9 1 1 was called and there are firetrucks outside your practice. All of these things happened to me in the first three years of owning a practice. You learn that risk is worth it in the end. It's a long game, not a short game. You learn that joy is defined by what brings you joy and you don't know what that is until you physically write it down. You become a completely different person to the world on the outside and sometimes you lose yourself on the inside and it's your responsibility as a person to remind yourself of who you were before you owned that practice. So I didn't play tennis for a year and a half. I took my dogs for a walk. They had to not I to you have to bring yourself back because you can be consumed with stress because of how much risk there is and then that's something that you just don't get taught.

Scott Leune: Yeah, it's almost like when I think about it, the simple analogy, I've got five kids and when I think about before I had any kids, I knew it was going to be hard. I mean I knew we'd have some sleepless nights, of course I didn't actually know what that felt like and what it's like to have to become someone that gets through that and is still giving of all of yourself to everyone else. And in some ways birthing a practice can be like that, where it's going to be hard, but you don't quite understand what that means. I'm going to go down a list here and ask you, so on the money side, do you feel like you're better off now or were you better off working as a hygienist for other practices?

Irene Janku: Money is not my love language and interestingly enough, I am not motivated by money. So the bank account, I don't open it, I don't look at it. I have my meetings with my accountant and things look good and stocks are up and I'm like, that's great, as long as I can pay my credit card bill and buy the things that I want to buy. I've never been financially motivated and I think it's because I came from no money to the point where I still have this scarcity mindset. I look at our reports and my office manager's like, oh, we did 150 K last month, that's great. And I'm like, I don't know. Is it great? We need to do more. So financially, yeah, I'm better off, but I don't feel like I am. I still feel like, oh no, can I afford this?

Scott Leune: And that kind of mindset's actually what's probably going to make you financially better. So this whole kind of healthy paranoia of are we the best we can be? Are we doing everything we should be doing that just leads us to becoming better. The reason why I'm asking you this question is not necessarily about how you think or feel about these things, but for our listeners who've never even heard of this, they're probably asking themselves, well I mean what's it, I mean, do you make less money or more? What's it, do you spend more time on this or less time? What's it like? They're trying to put this into categories. So financially

Irene Janku: It works out like an associate model. For those that are wondering how this works out, it's not a fee split, but somehow it just ends up working to be pretty similar to having an associate. So if you were to assume on the restorative side, if I'm doing a filling, I'm making 70% of that filling where my associate is making 30% just because of the way that the fixed end variable costs work out. When I'm here with you recording a podcast, my office is open. I'm not clinically working, so I'm not making my hygiene quote wage, but I'm making a portion of what everyone else is billing. So it does end up being much more profitable. Most hygienists can't work as many days a week as my office is open. Just physically, especially after operating for 17 years, you're trying to work less so, and again, it's the long game. So even if it's what, $5,000, $6,000 more per month, it's not going to make me rich now, but hopefully it's building wealth for future.

Scott Leune: So I see this in a couple of different ways. One thing I notice is that there's some hygienists that are driven and they're also got very high standards. And having your own practice allows you to kind of flex both of those muscles where you get to be driven with doing something better for the patient, better for work environment, better financially. You get to see out in a passionate way the way you envision dental practice being right, private practice being and that is awesome. And along the way, even though we get all scarred up and beat up and have these horrible things that can happen, there's also all these wonderful things that happen and at the end of the day, financially speaking, maybe you've made more money and someday you'll sell this thing and you've got equity there as well and that changes your family's financial future also.

Then on the flip side, I think about this from a dentist perspective and a dentist who is either working for the practice as, let's just call them an associate or a dentist that owns a practice that might be contemplating should I be in a partnership with a hygienist, right? So for the dentist that's working in the practice, I think that there's probably a lot of clinical autonomy that they get to enjoy in your type of high standard private practice setup. Then in a huge chain of locations in A DSO where there's all these other people having opinions on the clinical side of dentistry, I'm guessing, I'm guessing if I were to work for you as a dentist, there would be things I would love compared to working for a corporate group. Lemme stop there for just a second. Is that true? Do you think that your dentist would say that?

Irene Janku: Yeah, it's interesting because when I first opened I had two dentists who were splitting the days. Dr. Mano who has now left me to open his own practice, apparently I made it look too easy after promising me for a year, I'm never going to open a practice. I want to work here. And in the end he went into a partnership with a couple of his colleagues. So he was working and my current full-time dentist was also working. She was working in another practice that had multiple associates and a principal dentist. And it turned out the principal dentist was kind of dictating scheduling, taking some of the bigger work, giving her the breadcrumbs. She had a hard time ordering the equipment that she wanted or the materials that she wanted. She never got her assistant who she really liked and there were some intricacies. So when Dr. Manoj offered to leave, I offered her the position. I said, do you want to be here full time or should I look for another associate? And she said, I'm going to stick out here. I'm a relatively new grad, she's like five years out and I still want this mentorship from this guy. And I'm like, how much mentorship are you really getting? I'm like, let me lean in on ce. Let me get a spear package. Let's do some study clubs. Let's go to courses together. How much mentorship is this guy actually giving you other than taking your classes and taking your cases? So I started interviewing and I was moments away from handing an agreement to a new doc and I get a phone call from her in tears. Is it too late? Is it too late? I go, what happened? She goes, he just canceled my entire day.

He took all of my patients and a $6,000 day, $7,000 day is a big day. She's like, I can't stay here. You're right. The only mentorship I'm getting is how to be a bad boss. So I'm like, all right. So I ripped up the other agreement. I'm like, you're in. And since then we've implemented some really great CE and she gets to be the principal dentist and I have to manage all our sterilizers down. I'm the one calling Patterson service. She gets to put on her cute and she's out for the day. You get to be the principal and also have less stress.

Scott Leune: Yeah, so that's the interesting thing about this model is that you guys work alongside of each other clinically. There's not this inherent kind of competition that could happen over the patient, whereas in a traditional dentist owned practice with an associate, there's this layer of competition that could be there. Now from the dentist perspective, I'm a dentist, I own a practice, hypothetically speaking, should I have my hygienist be an owner as well? That's a very interesting thing to think about because we're seeing a lot of difficulty in finding and retaining good hygienists in a practice that can also perform. When I say good, I mean they're clinically good and they're financially good. We kind of have to have both. We have to have great clinical care and we have to have the business be healthy financially. And so it's getting hard to find and retain those hygienists.

And it's an interesting thing that I don't know if a lot of private dentists have thought about, but you can definitely set up the structure, the entity structure so that a private practice can switch to a model where a non-dentist can be at least a partner in that existing location. Or maybe this is a dentist that wants to have location two and three, but they've been hesitating because they just don't feel like they've got someone to help them carry the burden entrepreneurially of overseeing location number two and three. I'm actually thinking about someone I coach right now that's got two locations and he wants six, but he's so hesitant to move forward because he already feels stretched thin. I bet there's dentists like him that have good ethical hygienists who are driven, who would love the opportunity to participate in the ownership of a practice and participate in the management of the practice to have some decision making as well. So I see that there's probably this middle ground too. You are the owner that's on one side or hygienists don't own any of it. That's on the other side. There might be a middle that makes sense for people as well. What are your thoughts as I say all of this out loud, what are your thoughts?

Irene Janku: Well, there is a middle. So the middle is putting hygienists on a percentage of their billings but not making them go home if there's a cancellation. So let's back up. The concern that hygienists have from what I hear and what I see is that our clinical practice and our clinical judgment relies on a dentist making decisions financially, systematically, structurally. So we're losing our autonomy to make decisions because somebody else decides when we order instruments and what fluoride varnish use and this evidence-based element of clinical practice is removed because obviously we need to maintain our overhead and keep overhead low and everyone's striving for this below 50% number. So that's the struggle. And then dental hygienists are leaving full-time practices to work as temp hygienists because they're thinking, well, I'm already working in a crappy environment. I might as well work as a temp except that I'm going to work in a crappy environment but make more money per hour and this is the shift.

This is what's been happening within the last few years and I've experienced it because I've worked as a temp because I wanted to see what that was like. So having a hygienist be your partner is great only if you're allowing them to make the decisions on what happens in the practice. So thinking strategically like, oh, well, I'm going to rope her in and she's going to have her sweat equity and financial equity on the line in order for me to be successful and to make sure that hygienist producing well only works if that person is able to actually be part of the creation of the systems. Guess who hasn't had any issues with finding a hygienist? Me guess who hasn't lost a hygienist aside from someone going back to school to become a dentist? Me, I've had the same people in my practice including myself because when we make decisions, we make decisions together regardless of me being the owner.

And we make this joke that on Monday, Tuesdays and Wednesdays, I just work there. I'm not your boss, I'm your colleague. I'm running instruments, I'm doing the Bowie Dick test in the morning, I'm doing my own lines, I'm wiping things down. Guess who else does stuff like that? Dr. Michelle, she'll help her team flip the room. She doesn't just recluse to her office, she doesn't have an office. Guess who also doesn't have an office? Me, I work in the same computers that everybody else does. I gave up my fancy office after a year in to put an op in and I was like, what am I doing? I'm sitting here watching tennis between patients like no, I'm part of this team. So yeah, it's a great idea, but is it going to make any difference if you're still making all the decisions?

Scott Leune: Well, yeah, if you make that assumption that a dentist is trying to rope someone in but not give them any sort of autonomy or decision making power,

Irene Janku: I've seen it happen.

Scott Leune: I've seen it happen. Yeah, that's definitely not what I intended to say when I talk about maybe there's this middle option. So this middle option in hearing your words sounds like a hygienist partnering with a dentist is a true partner financially speaking from when it comes to profits, day to day to equity someday in the company. Also control and decision making on the quality of the organization and the systems on the people that work there on the processes as well as on the patient care that hygienist is a true partner. And I think that middle, I'm sure it exists in tiny percentage somewhere, but I don't think that's something that people thought about or do. And I think that would be a really interesting thing to kind of dive into for those people, for those hygienists that aren't in a position to own yet.

Irene Janku: Yeah, vested interest options would also be something that I would explore. I mean I'm kind of exploring that now so that you're not giving up a ton of equity or even decision-making, but a small amount of equity to keep people engaged. People are handing out bonuses like it's candy, and then come January 1st you've collected your December bonus and then you're giving your two weeks notice. So not to give someone a golden handcuffs type of situation, but more of an incentive to stay. And even if they go, they're still somehow in it.

Scott Leune: Yeah, the listeners to this, we recorded a whole podcast episode on what she's describing right now called profits interest. So this is something that we like big believers in for the team to have a way to participate financially in the practice and in the profits to be aligned with that and also have a reason to stay longer if it makes sense. So that is a vesting of profits interest. Yeah, I think we're on the same page with that. We're running out of time right now, unfortunately. God and I really want to dive in. I could bet we could create part two at some point multiple episodes on this topic, but I want to thank you for kind of telling your story on our platform so that people can hear this who have never thought about this before, what you've done. You may not have been the first to have ever done it, but you're doing it sounds like you're doing it really well.

You're one of the first and you are likely helping create what might be a wave of a new practice model that hasn't been the norm yet. And so us hearing it from you is so important to understand not just what this is and kind of how you do it, but also your mindset why you do it. What led you here is so important for hygienist to here and it's so important for dentist to hear, and I want to thank you for being that open and honest about it and letting us learn your story. Before we sign off here, a couple of questions for you. First of all, you have a podcast, it's called The Truth or Dare, did I say that correctly? Or The Tooth or Dare Tooth or Dare the Tooth or Dare, I apologize. You have a podcast, fun. It's called The Tooth or Dare. And then your practice in Toronto is called Tooth Life Studio, is that correct?

Irene Janku: Correct.

Scott Leune: Perfect. And then people I'm sure can find you on social media. You're speaker, you're an educator, you share content. So everyone listening to this, I encourage you to go follow Irene and learn more about this story. Now, Irene, before we go, are there any kind of last words you want to say to our listeners about anything we've talked about? Anything else you want to mention?

Irene Janku: Yeah, just one thing. All of the things that I do in my practice are all systemized and workflow related, and I share all of those for free on my website, which I'm sure will be linked somewhere. None of it is new, but systemization is really important and very valuable in creating a great patient experience but also predictable outcomes. When you don't have calibration among multiple operatories, that's when you get the Irene only patients or this only patient. If you don't have this, then that system in place, that's when things fall apart. So the beauty of what we do is that I could be here and I know that perio, restorative, preventative maintenance is all being handled systematically because of our workflows. So you don't have to take mine. You can if you want to, but create your own. And I think that will empower dental hygienists. Once you start seeing success, you really don't want to see failures anymore. And interestingly enough, successful cases end up being the most profitable in hygiene and also in restorative. So make a system.

Scott Leune: To wrap this up, one thought I just want to kind of throw out there and maybe this becomes another episode, is when we think of how aligned hygienists are financially and clinically to a dental practice, on one extreme we've got a hygienist that gets a salary and they can't really make any decisions. On the other extreme, we've got Irene, she owns a practice and there's kind of a linear path between the two extremes. We go from on the lowest end we just get a salary to show up, we don't have any control, then we kind of go up and okay, now maybe we're paid on a commission basis, so if we are more productive we can earn more from there, it can go into a bonus plan and then from there it can go into a profit sharing a profits interest plan all the way up to then maybe a partnership in the ownership all the way to your Irene, and you own the whole thing.

And I think there's all of those can be done well and poorly. And so it's important to understand what makes sense for this hygienist, what makes sense for this practice. And that is something that people have not taught well, they haven't figured out the best practices round yet. And I think that that's a wonderful place for us to go here moving forward as we're coming to this kind of conflict where what's best for a lot of hygienists is not being done in dentistry and it's resulting in crazy behavior. I'm just going to accept that I don't like working in any practices because all the working environments are bad, so I'm just going to temp for more money. That's a kind of a crazy behavior, but we've accepted as a norm. So I think it's time for us to kind of dive in at least on a podcast here to on maybe future episodes on these different levels and what can that look like, maybe what should that look like? And Irene, I want to thank you for being the one to have kind of started this conversation with us. It's a really cool conversation.

Irene Janku: Oh, they're coming for me. They already come from me on Instagram, so I'm prepared.

Scott Leune: Yep, yep. Alright, well let's wrap this up. So Irene, again, we're going to link all of your contact info and everything on this and look up her practice Tooth Life Studio in Toronto, look up her podcast, the Tooth or Dare Irene Ku, thank you so much for joining me and recording this with me. I really hope we can follow this up with future episodes.

Irene Janku: Appreciate it. Thanks so much. Bye.

Scott Leune: So some quick thoughts here on my dental download on that interview I just had with Irene. I think it's important to say that no matter what we decide to do in dentistry or in business, we need to do it in an ethical way, treating people. And there was a moment in that interview where it was almost like assumed like something might be wrong, but there's a right way to do all these things. Of course, there's a wrong way to do all these things and we're only talking about the right way to do them. Now what's so interesting to me is a lot of us owner dentists or dental CEOs, we have great people and we would love for them to benefit financially. We would love for them to take on more of a leadership role to make decisions, to help us oversee the business, to take some of that load, that work off of our plate.

We would love that. And maybe setting ownership up, whether it's with a hygienist or a dental assistant or front office office manager, that might be an interesting thing for some of us to do. And having a partner doesn't mean we lose control, we lose money. It doesn't mean we have to have immense amount of risk. There's all kinds of ways to draw a partnership agreements that would be appropriate for this scenario. But it's an interesting thought. Are you someone that owns one location and wants five, but you struggle to know how you would even manage that Maybe going to this really good hygienist that works for you is a solution. Or maybe we can go even further. We could say, well, we are going to have partnerships with all of our clinicians and that's going to look in this specific way. It's just very, very interesting to me.

Some people listening to this are not dentists, they're not even dental CEOs and you're listening to this pocket. Maybe you're a dental hygienist, maybe you're an assistant or an office manager. You too can own a practice. What it means to own is going to be legally defined and it's going to be compliant, your laws, but you can own it. There are obstacles, like she mentioned, funding. How do you fund a practice when a bank doesn't want to lend a hygienist a million dollars to open a practice? How do you get that funded? How do you deal with the need to have a dentist or to have a custodian? The records scenario set up? I mean, there's definitely hurdles, there's hoops you have to jump through to be an owner, but it's all very possible. It's very doable. It's been done plenty of times having non-dentist owned practices.

So as you kind of think about what this episode meant to you, I'd like to have you walk away with just a few kind of categories of topics to think about. Number one is, should we use partnership as a way to recruit and retain top people? Or number two, do we want to have a partner scenario with a non-dentist to enable us to grow bigger or have more locations, for example? Or if you are a non-dentist, another topic you can think about is should you own a practice? Those are some pretty interesting things that no one's talking about really, and I think we should dive in deeper and remember, one of the last things I said is I said there's this linear kind of this spectrum of how we have financial alignment with a hygienist specifically, but with other employees as well. On one end of the spectrum, we've got, you just get an hourly wage, you've got no ownership, you've got no real decision making power, and you also don't have any risks or liability.

But then from there, we can go into commission-based structure. We can go into bonus or profit sharing structure to partnership, to full ownership. I think we need to define each one of those in the best way to do it and when it might make sense. I think that would be a really cool learning moment for us here on the podcast. And it might change how you look at your career. You look at the ownership of dentistry, what you want to do for the next five years. I want to thank you for tuning in to the dental CEO podcast as we talk about this controversial topic of ownership outside of a dentist being an owner. And I hope this was interesting to you. Please, of course, subscribe to our podcast, make this a weekly habit for you to listen to. We would love it if you'd post an online review. Those things help support this podcast and help us continue doing what we're doing and we hope that what we're doing is good for dentistry and good for you. Until next time on the Dental CEO podcast.