Joel Berg: We are here today with Dr. Al Burns of Seguin, Texas. Dr. Burns is a 2007 graduate of the University of Nebraska College of Dentistry. He then completed a pediatric dental residency at the Ohio State University and Nationwide Children's Hospital in June of 2009. He and his wife, Lisa moved their family across the country to Seguin, Texas and opened from scratch their first dental practice, Alligator Dental, six days after graduation.

Well, we knew he was a go-getter back then. Since then, Dr. Al and his wife, Lisa have worked tirelessly to build a successful dental practice. Today, they have three growing locations and a new practice opening in 2021 Alligator Dental employees, 40 plus fantastic staff and sees over 30,000 patient encounters annually.

In 12 years, Dr. Al and Lisa have designed and developed three facilities built in an in-house dental service organization and cultivated a team that delivers a fantastic patient experience. Dr. Al is a hands-on owner, but practices full-time and has an amazing administrative team that helps him run his organization.

In addition to his private practice, Dr. Al has been part-time faculty at the pediatric dental program at the university of Texas health science center at San Antonio. Also since 2009, he has taught pediatric practice management and numerous programs and spent time himself as a part-time associate doctor in his early years as his practice was growing.

In addition to hiring many of his own associates, he has mentored and counseled hundreds of residents in the transition to private practice with advice on contracts, evaluation, work opportunities. And just being a sounding board despite to the success of the practice. Dr. Al and Lisa's greatest accomplishment is making their life work as spouses and business partners and raising their seven children who are all presently teenagers.

Yes. That is correct. As scary as it sounds seven, present teenagers. So Dr. Burns, you are so relaxed when I met you and, and today with 7 teenagers and you've done so much and you were a big hit amongst our newly erupted team as a suggestion with your knowledge. So thank you so much for being here with us today.

Al Burns: I'm very pleased to be here. I appreciate the invite and the opportunity to talk today. 

Joel Berg: So tell us a little bit about your practice. I talked a little bit in the introduction and maybe about Seguin, Texas, and why you chose that place and what's it like there. 

Al Burns: Well, first off I loved, dizzy in small town, Texas. It's been a great fit for me and for my family. And I'm really pleased with the, well, just the tremendous success that we've had and the opportunity we’ve had to help so many families, kids, and our community. We really landed here out of pure, just luck or circumstance, if you will. When I was looking for a place to practice and decided I wanted to venture out on my own.

I started looking around and we kind of settled maybe on Texas and this, and went through the process of looking through numerous communities. Seguin was one of them and we ended up coming, visiting it in various other places. And we just knew immediately. This is where we were supposed to be.

Seguin is a community of only about 30,000 people, although it does serve a pretty large rural area and we've just been blessed from day one. To be here to serve the small town, Texas families, families from all ethnic backgrounds and especially the rural communities in our area. And I think the best part about practicing an area like this is people really like to connect.

People like to trust people like to have a relationship with their pediatric dentist and their other medical providers. And so I've really come to enjoy that. And seeing my family grow with the people in the community and feel like we really have a bond with our patients, get to know them, watch them grow up, you know, play on the little league team with them, all that kind of stuff.

It's been a really enriching experience for me and my family. And here we are today, we're excited to be able to share some, hopefully some insights to other people in their own adventure and their own career. And I will say this, I have learned most of everything by pretty much failing and having to restart and refigure things out. And I have made so many mistakes along the way, building my practice. And hopefully today I can help maybe alleviate some of those stresses or X mistakes that I've made. 

Joel Berg: I hear that from so many leaders that only through failure do you really learn. I want to talk a little bit about, actually a lot about your expertise on looking into associateships.

And this is what the committee who recommended you, who wanted to get you on the show about all the knowledge you have about associateships and you talked about you've been an associate. Uh, you've hired many associates. So could you please tell us in some detail about what are the big challenges that residents face? And I'm going to ask you afterwards about the owner side in finding a successful associateship. 

Al Burns: I, again, going back to my mistakes, I have had many associates come and work for me and, I've had most of them not work out, again, going back to my mistakes. I've made many lot of mistakes as an owner, how to bring in associate in how to help an associate thrive.

And I'm still perfecting that to this day. I would say probably the most common thing that I have found amongst associates is, you know, and why most of them don't last, certainly there's life changes that take place, or I've had associates leave because they've moved or got married or various other things, or just gone to the next step of life. But the truth is I think most associateships across the board fail simply just because of unhappiness. And really what I mean by unhappiness, I made failed expectations really on probably both sides of the relationship. I see most of the associates they want, well they want an, a good income.

They want mentorship. They want autonomy, a good work environment. They want to serve their patients. And the funny thing is that's really what the practice wants to. They want an income, they want a good work environment. They want their patients to be well taken care of, but there still seems to be a disconnect between those expectations and, what I've really kind of figured out is, it's hard to make that relationship work because there's not really adequate time to learn each other and set those expectations. And so my lecture that I've developed over time is really how to help an associate be able to, in a short time period, be able to evaluate a practice, know what to ask.

Really be able to know what they want and some of those basic things. So they can learn to make this somewhat of a marriage. I mean, you're going to be in this practice 2000 hours in a year, you know, more than you will maybe if your own spouse, but how to kind of from the get go figure out how you can evaluate them in a very short period of time and hopefully be able to make a big, a big decision in with as much information as you can.

Joel Berg: So you mentioned Dr. Burns a couple of, quite a few things there. One of them was, it's the expectations, but when somebody comes out of a program and you started your practice a few days after you graduated, but most people aren't going to do that. How can one quickly come to assess their own expectations. Their own wants and desires is part of the reason for failures that the associate doesn't know what they want. 

Al Burns: Absolutely. I think certainly coming out and going into practice, you grow and evolve yourself and knowing what you like and what you want, what your life needs, changes dramatically. And I really feel like most associates struggle, not necessarily because what happens.

It may be in the clinic, but what just happens in life sometimes. And so to speak to that, really what I'm trying to say is I think residents fail themselves by not really honing in on what they want. It's a, it's easy to say. Yes. I want us to six full practice. Yes. I would like to have this or that or practice this way.

But it's simple things like what area you want to live, what you want, the culture of the office you're in to be like, how much control or little control do you want? And asking yourself those hard questions is one of the very key principles is in being successful. Because if you don't know what you want, it's hard to know what to ask about.

And it is a tough challenge. And in fact, that's probably in my opinion, the hardest thing to really figure out is what you want. And I was fortunate myself that I kind of had maybe a sense for that when I started that I knew, and I started on my own and knew what I wanted my practice to be like. But that too is evolved in time.

Joel Berg: Right. So knowing what one wants is something that you've realized as an issue, as an owner and as an associate and some of the failures you said, so have you changed the way you interview candidates for associates? You have it based on asking them, what do you want? 

Al Burns: You know, the words you have to try to eat that out somehow, or hone in on what they  

want and absolutely for any of the owners that are listening, that is really key and trying to decipher that so much of times contract negotiations are based on money or, you know, how many hours a week you work or days a week or things like this, but I've had plenty of associateships or opportunities kind of fall through because it was just the area they didn't like, or their spouse didn't like the area or whatever, whatever it might be. And asking yourself those questions outside of just clinical practice. What really important to you is so, so important. And, you know, that happiness is often derived by things outside of the money.

So it's, it's so important to ask yourself those questions and what part of the advice I always give is making sure you have someone that can be your sounding board, someone that's your devil's advocate in life, who you can say, Hey, what do you think about this? And someone who knows you really well and not afraid to tell you that sounds like a dumb idea, or that doesn't sound like you, or having someone like that is really important to help develop that sense of what you want.

Joel Berg: You know, many of us have been in education, particularly have been involved with graduate programs. We get asked all the time to help, you know, find connections or to give recommendations to people. And what you're telling me today, Dr. Burns, is really helpful to all of us in the education community about how to prepare people.

So when they contact me and said, Hey, can you help me find a practice in Texas, you know, I can kind of help them hone in, on themselves and what do they want. So I think the more we can get this information out there, the better off we're all going to be. So I'm appreciative to hear this today. I want to talk a little bit about The COVID climate, you know, we're still in the middle of this pandemic. Hopefully we'll be emerging from it soon. However, it's changed things. And what new challenges will associates face now looking for jobs in the midst, or as we emerge from this COVID pandemic. 

Al Burns: That's a very good thing. And I've had to adapt so much of my lecture material. I feel like because of the pandemic, the world is very different from an associate standpoint than it was a year and a half ago. Really I think at that time it was kinda more of a buyer's market. Associates had a lot of opportunities. You could really kind of pick and choose more and people were looking for associates to bring in.

So it was a really great climate and really that has been turned on its head. Tthe latest ADA statistics kind of show that overall about, there's a 10 to 20% decrease in kind of available jobs and clinical work to be done right now at a minimum. And so really this flip it's really kind of now a sellers market. There's less jobs out there. And so the associates really have to compete more. The other kind of interesting thing is so many practices during the pandemic had to downsize and shrink, which a lot of times meant they let their associates go or suspended them or put them on the leave. And there's just less work to go around.

And owners had to step back in and do the work to keep their practices going. Because of that, I think a lot of owners have had to look what it's like to almost lose your practice and are willing to maybe take the risk of making sure to be more choosy the next time they bring people back. And that also makes it so that associates have less opportunities.

And the real natural thing to do for an associate is to get kind of desperate and then make a hasty decision with your next position. So, the norms have all changed. So many things that we could count on before are not that way anymore. And so it's harder to evaluate a practice as well.

So those are some of the challenges that are going to be faced by associates, kind of coming out. But I look at it as really for the, for the great associates, the people who are willing to work hard and stay committed to a practice, with good clinical skills and social skills. There is not a better opportunity because the playing field has been leveled in many ways.

And there are lots of great opportunities and the practices want to build and need to build. And so there's, it's all about your attitude and how you look at it. 

Joel Berg: Well, it just makes the principles of knowing oneself and what you want and what the owner wants even more important. So your advice becomes even more important.

We're talking about the challenges facing associates or people looking for an associateship and also on the owner's side. So Dr. Burns, I want to talk to you about the interview process. So you've identified you as an owner of identified someone to be a potential associate. They've identified you as a potential practice. What could a potential associate do to prepare for their interview to stand out? You just said it's a challenge right now to get a job. So what can they do to stand out? 

Al Burns: I've really distilled this down to three key principles when it comes to the interview process. And again, remember. The interview process is extremely compressed for the commitment that you're making. You know, you might shop for a car for months, but here for this interview, you've got kind of one chance to go in and not only make a good impression, but also figure out if this is the right place for you.

And there's a lot of pressure in that moment to make the right choice, ask the right questions. And so thinking about that and giving my lecture for a long time, now it really boils down to the three things to me. First off is you have to gain the skill of evaluation. How did he determine if an associate's ship or a job opportunity is right for you?

And what you're looking for, uh, number two is knowing what you want. Being able to ask questions that are points wide, and then third of all, just knowing how to stand out. Which really means having a better sense for what ownership or the practice is looking for. And so, we're just scratching the surface on what each of those things mean, but for example, the tricks of evaluation, what we kind of teach, or what I teach in my lectures.

How do you visit a practice when you walk in there? Just knowing things like how big is the space, how many chairs do they have? How many operatories they have, how many staff do they have and immediately being able to calculate out mathematically. Just knowing what that office is capacity is then being able to look at things like their schedule for the last week and knowing what percentage of that capacity they're at.

And you immediately also get a good idea and a ballpark range of how much income, how much production is having that office. And again, what that capacity is. Do they have capacity to grow? Do they have capacity to take you in and bring you into their situation? Then there's the things like how to talk to the staff, knowing what kind of questions to ask to define?

What kind of cultures there, what kind of training culture is there? What is the relationship between doctors and staff? Is that a healthy one? Um, and then seeing the patient interaction is really key and knowing what to identify as far as customer service, this is a place where you'll be happy, how. Not only how you can treat the staff, but how the practice treats its patients, how it deals with customer service issues.

And then, you know, maybe has finally how to look at their online presence, how to see a lot of things by just what people put out there on the internet about themselves and knowing the quality of the practice to a certain extent based upon that. So those are just some of the tricks of evaluation that I've taught for many years that are important to know.

And it sounds like the timing on the pipeline is important to understand like some, my experience is that some owners will bring on an associate early because they want to make sure they have them when they need them. But they're not quite ready to fill up the schedule. Sure. Others will wait. And then impose too much on the associate, especially right after training.

So I think all that stuff is, you just said, you can kind of have a conversation about that and just make sure it aligns. It's all about alignment and expectations. And that gets into the finances. Of course. So what are the owners looking for? You know, obviously. Right. You could imagine, you know, uh, the quality of the individual, the capabilities clinically, but what are you looking for in an associate and, and how can they make themselves indispensable to respond to that, to the owner?

You bet the candidates and a great question. The standpoint, because you first have to stand out and then when you get the job you want to become, as you said, indispensable, and what that means, you want to become such an asset to the practice, truthfully, that they can't live without you. Right. That's how you develop leverage for yourself.

That's how you can get increases in pay. That's how you fast-track into partnership and various things like that and being indispensable. And I would, there's a few just key characteristics. But these, these associate partners or associate practice relationships that I feel like is really key. And when I, when I interview now and we kind of get past these, this area going to work for you, is this a right climate for you?

I really kind of look at what is this person's level of commitment to the practice? Are they going to be able to weather the tough times and when things aren't necessarily going right? Do they have the ability to communicate their concerns and worries when they're at a minor level before they grow into a large level?

So great communication, being willing to talk to your managers or to your doctor owner, whoever it is, is really, really important and developing a relationship of communication is really key. And then of course really what value to bring to the practice at all boils down to me to what experience you give your patients?

Do they leave energized and happy and excited and confident? Do you build trust with people? And that is a skill that takes some time to develop, but the ability to be able to. To build trust with your patients, then in turns builds a practice. It makes people want the desire to come back again and see you again and request you and things like that.

And if you build, learn to build trust with your patients in that way, you will grow a practice in a lot of great ways. And often the people who can build trust with their patients also learn how to build trust with staff and appropriate ways to make sure that, you know, the team grows as well. And not just the doctor.

Joel Berg: Yeah. And this last thing you're talking about, Dr. Burns is regarding the culture of the practice. And as you said at the beginning and your desires to go to Seguin, Texas, you know, building a culture there is a little different than it would be in New York city or Chicago. So it's, I mean, there's still a culture that's important, but it's understanding what's important for that environment.

And I think you've given us a great flavor for that. So my final question for you today is, I'm coming out of my training. I'm looking for an associateship. How do I start? You know, I'm not even sure if I know what I want. I'm not a hundred percent sure. I mean, there are some people who get into trouble because I'm absolutely sure I want to be in downtown LA. And I have to be this and I have to be that. And that's the little thing that's a little restrictive. So what's your advice on starting the job search furnace as an associate after you finished your sort of soul searching and kind of defining what you want, maybe even ranking from one to 10, what matters most to least, so to speak, you have to have some flexibility.

Al Burns: I really think what's going to sell in the, in the pediatric dental environment for the next few years, especially post COVID is again, going to be, relationships people very much now I think value human interaction and I really think finding the right job for you is going to require some work. It's not just going to be a quick email or a convenient, you know, phone call.

It's going to be kind of pounding the pavement a little bit and being willing to talk to people, call people up, extending yourself, asking about opportunities and showing that you have the, the social skills to have human interaction. I know that would speak a lot to me. For someone to be able to have, you know, that forwardness or leadership skills, if you will, to talk to me and say, Hey, I'm looking for a job.

This is it's someone who's got eager and eagerness and drive. And so there's lots of ways out there. They'll find jobs, all kinds of, different advertisements, but there's nothing wrong with just reaching out and contacting some people in an area that you like putting yourself out there as well.

So I would say the mistake is not necessarily finding the opportunity, but it's how you handle it and making a good first impression, and being willing to talk to people, you know, face to face and share some of yourself. 

Joel Berg: Well, Dr. Burns, thank you so much for being with us today. You've learned a lot along the way in a relatively short period of time, and you've got 7 teenaged kids. I don't know how you do it, but you've done it well in all aspects. So thank you. Thanks for being with us today and thanks for joining us on newly erupted. 

Al Burns: Thank you very much. I appreciate the opportunity to be here today and share some thoughts and always happy to help anyone who's looking for some guidance can reach out to me to be happy to talk with them? 

Joel Berg: That's great. Thank you so much.