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Scaling a pediatric dentistry DSO

Sept. 25, 2024
William A. Peña offers his insight on staff and business management through his personal experience starting a dental practice.

Over a decade ago, my wife, Richelle, and I decided to go into business together. Richelle is a pharmacist who worked for the Target corporation in California for several years. While there, she attended their business school and learned about management, hiring, interviewing, and interpreting financial statements, quickly scaling the ranks and becoming involved in several mergers and acquisitions. During this time, I was in the pediatric dentistry postgraduate residency program at the University of California, San Francisco (UCSF).

How a work environment affects office morale

After moving back home, I sought an associate position with a pediatric dentist who accepted children's Medicaid at his practice. With appointments in such high demand and a schedule booked months in advance, the office was managed poorly and the team lacked genuine enthusiasm for their crucial work. Because of this, the atmosphere was devoid of happiness-and patient reviews were abysmal. After just one year, I left and started my own practice.

At my office, I was adamant about taking a different approach with my team. I vowed to be a servant leader, focusing on the growth and well-being of my staff and patients. I wanted my team to feel appreciated, empowered, and important. People are the most important aspect of any business, and team members spend most of their day working away from their families, so why not make working in my practice feel truly special?

A mission to inspire

My vision was to offer my services as a dental specialist to children in the community who had been shunned and neglected. I wanted to provide quality dental care in a beautiful modern setting, curating a positive experience for all pediatric patients-regardless of insurance or medical conditions.

During my time as a pediatric dental resident in California (and later working in a private practice in Florida), I noticed a lack of private practices catering to patients with Medicaid or special needs. These patients often came to a university clinic or private practices like my first office because the reimbursement rates were too low, the compliance requirements were too high, and people thought university clinics were best suited for special-needs patients because they had access to a hospital operating room.

However, I was determined to create a successful business with a positive, altruistic purpose. I also wanted to start my own practice from scratch-commonly referred to in the industry as the de-novo approach-rather than acquire one from a retiring dentist.

Creating my practice from scratch

Although I had a strong work ethic and resolve, I lacked business management experience. I had been an associate for only a year prior-and before that I'd worked in my dad's warehouse building kitchen cabinets as a teenager. I also never was able to take practice management courses in school or postgraduate residency programs, which hindered my ability to be a small business owner. Ultimately, I needed someone with real-world business experience who could work alongside me to help me realize my vision.

This is where Richelle entered the picture. While our office was being built, she grew disenchanted with her own corporate setting and was looking for a career change. When I suggested working together and building a business centered on children's dental care, she jumped at the opportunity.

Now, I can focus on my strengths-patient care and leading the clinical team-while Richelle handles marketing, building strategic relationships in the community, and setting up our front office.

Although we almost lost everything during our first three months in business, we built a loyal patient base through tenacity, hard work, networking, aggressive marketing, and providing exceptional care and service to every patient. We not only survived but flourished; before the end of our first year, we crossed the coveted $1M revenue mark and hired our first associate.

Emboldened by our success, we decided to open two more offices three years later, but in order to be an effective operations leader, I had to learn the intricacies and nuances of the business. I needed to understand things like supply chain management, standard operating procedures, and the company's cash flow. While I educated myself, I relied heavily on Richelle, my business and leadership books, and my faith.

It took some time for me to fully learn the operational side of the business, but eventually I was able to effectively liaise with my financial director, attorney, and numerous vendors.

Lessons learned through experience

We eventually scaled it to seven locations, but after nearly a decade, Richelle and I decided to sell our business to a larger, specialty-focused DSO that could bolster business growth in 2021. Building six large offices from scratch in a saturated market took a toll on us; it was time to hand off our business to a larger operator who could build upon our infrastructure and continue opening offices that shared our original vision.

Since selling, we have not only continued working for the company that bought our business but have also taught students and small business owners how to manage a practice properly via online courses and consulting.

Without my wife's expertise, I'm not sure if I would have been able to succeed as a dental entrepreneur. For those who don't have a life partner with a business background, I recommend reading business books or taking a practice management course. Managing a business, seeing patients, and providing quality care can be daunting. But it doesn't have to be this way. We have proven strategies and solutions to commonly encountered pain points in business that we want to share with other practices and dentists.

We're thrilled that our new mission includes helping others achieve the happiness and fulfillment they deserve. As we say in our consulting business, "Don't take advice from people who have never been where you are going."

About the Author

William A. Peña, DMD, MS, MBA

William A. Peña, DMD, MS, MBA, is a board-certified pediatric dentist and cofounder and former CEO of American Pediatric Dental Group. Dr. Peña holds a masters in business administration from Nova Southeastern University and a masters in craniofacial sciences from the University of California, San Francisco. In 2023, he and his wife, Richelle, cofounded RPW Consultants. This online consulting firm aims to support other entrepreneurs through virtual training programs and private consulting sessions. Dr. Peña currently serves as the senior director of his former company and continues treating patients at his clinic. He coauthored the book, The Power Couple: Navigating the Roller Coaster of Business with Your Soulmate While Raising a Family. 

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