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August 2020--Dental entrepreneurs seeking to scale up their dental practice or group are paying attention to DECA Dental, one of the fastest-growing organic DSOs in the country. It currently has more than 90 practices and continues to expand.


Sulman Ahmed, DMD, started the group in 2008. In this interview with Patient Prism CEO Amol Nirgudkar, he explains the process – and the philosophy – that DECA Dental used to grow their DSO quickly and intelligently.


Keys to Scaling a DSO

Many companies talk about creating a great culture. At DECA Dental, every team member is responsible for executing it.

Dr. Ahmed shares these five tips for successfully scaling a DSO:

  1. Create a culture of clinical excellence
  2. Remember you’re in the people business
  3. Develop standardized processes
  4. Communicate a consistent message for teams and patients
  5. Hire people who are culturally-aligned, have integrity and are humble


Dr. Ahmed speaks at a lot of industry events, including commencement ceremonies at dental schools. Recently, he asked graduates who wanted to have more than one location, and almost 85% of the hands went up. It’s just one more sign that the industry is moving away from a private practice model and more toward a dental support organization model.


Choosing to Grow Your DSO through De Novo or M&A

DECA Dental built its dental group mostly by opening new practices, called de novos. Ninety percent of their practices are de novo and the other 10% was purchased through M&A.

“I wanted to create the Starbucks of dentistry,” said Dr. Ahmed. “We’re not in the dentistry business serving people. We’re in the people business, serving dentistry.”

In 2016, DECA Dental continued its rapid growth, opening 20 de novo practices and acquiring six established practices in three new markets. Executing a consistent playbook was integral to its success.

“You’ve got to standardize almost all your processes,” explained Dr. Ahmed. “It’s the type of retail space, the color on the walls. It’s the way the office smells. It’s what patients see or hear when they walk in. It’s how we answer the phones.”

Why did he choose to expand through de novos? Math.

“I looked at it and said I could buy a million dollar practice for a million dollars, or I could open three de novos for that. If I could ramp them up to a million dollars in under 18 months, then I’ve created three times the value and that value is going to keep growing.”


DSO Growth Through Leadership Alignment

As DECA Dental grew, it became more important than ever to ensure everybody in the company followed the same set of values, from the doctors to the operations managers to the dental assistants and every individual team member.

“If there’s a break in the chain, then I’m going to fail because my message will not reach everybody in the company,” said Dr. Ahmed. “The entire team needs to be aligned on the integrity of the process.”

That philosophy guides their decisions. They focus on quality so their team and their patients can trust the results. That’s allowed them to warranty all their dental work for the past 12 years

“You’ve got to have a team that monitors and mentors and does things really, really well,” said Dr. Ahmed. “There’s a heavy emphasis on clinical integrity and making sure everything is good, that there’s no over-diagnosing or underdiagnosing. You just want to do good work.”

The guiding principles at DECA Dental are integrity, humility, compassion, and empowerment. Team members are encouraged to share ideas that will improve the company, and to speak up if they see something that is not right.

“These are the values we’ve scaled,” said Dr. Ahmed, adding that the values don’t change during tough times. In practical terms, this meant making sure team members kept their medical benefits during the COVID shutdown.


Leading a DSO through the COVID Crisis

Dr. Sulman Ahmed was one of the first dental industry leaders to implement COVID safety precautions. DECA Dental started performing temperature checks and asking patients to wait in their cars instead of the waiting room at the end of February. It wasn’t popular at the time, but patients and the team appreciated the proactive measures once the extent of the health risk became clear a few weeks later.

Dr. Ahmed’s team created a series of educational materials to share with staff and patients about the measures they were taking to keep everyone safe. The videos detailed everything from the new check-in process, to the face shields and PPE, to the changes in treatment presentation.

It was that open communication, integrity and culture that helped DECA Dental stay open to take care of emergency dental patients during the COVID shutdown.

“We’re very proud that out of 150 providers, about 120 volunteered to come in during the shutdown to provide clinical care. We were able to help almost 3,000 patients with their dental emergencies and kept them out of the ER during that critical time.”

As the pandemic continued, there were two metrics that surprised Dr. Ahmed. First, DECA had more dentists applying for jobs with them than ever before. Second, they treated a high volume of both new and existing patients. Their June and July 2020 revenue numbers were back on track, and even a little better than expected, said Dr. Ahmed.


Applying the Lessons Learned from the Last Recession

Dr. Ahmed started DECA Dental in 2008 just as the economy plunged. While he admits he was naïve, he was excited about their vision and what they wanted to accomplish despite the tough economy.

When you’re creating a culture, the words you choose make a difference. At DECA, patients are called guests. They’re welcomed into the practice with the same warmth as if they were being welcomed into a home. They’re viewed as part of the dental practice’s family and it’s an honor to see them and to serve them.

“When you change out the word patient for guest, it changes how you think about them,” said Dr. Ahmed.

It was important to Dr. Ahmed and his team to make it easy for their guests to receive the dental care they needed.

“We’re going to be open six days and bring all the specialties under one roof. I think the passion just kept driving that,” he said. “We were just training doctors and helping to mentor them and make sure the quality of the work was good. We challenged our leaders to grow individually and then moved on from there.”

During the COVID crisis, Dr. Ahmed kept the focus on DECA Dental’s customers: the doctors and the staff.

“We’re big on making sure that our customers feel fully supported. That could be through having the right PPE, if it meant more training, if new procedures were needed, we’re very aware that it’s our job to get them comfortable. Because if we don’t, then we can’t do a good job taking care of the guests.”

It comes down to integrity and culture.

“Your staff is watching what you’re doing,” said Dr. Ahmed. “The dentists, the dental assistants, the hygienists, these people are really passionate about what they do. They don’t want to be at home. They want to be working and making a difference in people’s lives. And a lot of our guests have been coming to us for years. So those relationships matter, and in a world of uncertainty, we just wanted to provide a little bit of certainty.”

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