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Jake Puhl, CEO of the Dentist Entrepreneur Organization (DEO), discusses when DSOs typically hire professionals with executive expertise.


As DSOs scale, at what point do they start hiring an executive team?

At the DEO, we observe a lot of group practice owners as they grow a DSO, and we’ve seen hiring done at different points in the organization’s growth and in different ways. I like to hold off on using the term “executive.” To me, the questions is: “When do you start bringing in professionals who have the right skills sets and experience to manage and lead specific parts of your support organization?” And the reason why I stress “professionals” is that executive titles are not what matters. It’s the professional skills and experience that matter. You're looking for very skilled people, who have done what you're trying to accomplish and have a track record.

Effective call-coaching with Patient Prism. Schedule a demo ›As you grow, you are constantly looking for the next professional you need. We find that once a group reaches 50 employees, owners think about bringing in some experienced people. This definitely happens when there are over 75 employees. That’s the trend we’ve seen.


Which professional roles do DSOs tend to hire first?

A discussion our DEO members frequently have is whether they should hire an HR professional, an accounting professional, or an operational expert first. Among DEO members, we have seen DSOs hire an HR expert when they reach 40 to 50 employees, and we’ve seen DSOs grow beyond 100 employees before they hire an HR expert. The professional you hire first depends on your biggest need. Are you struggling operationally?

If you are fighting fires every day because you have no systems, but you have decent people and a decent culture, you might start with someone who is operational, even if you have need for an HR person and a financial person. If your operations are decent and people generally have time and you're not putting out fires, then you might be looking to hire someone for the HR role. I have never heard anyone say that they think they hired the HR person too early.


Your financial expert doesn’t need to be full time.

Hiring a financial person can provide you multiple benefits:

  • Save percentage points on supplies.
  • Improve your billing cycle.
  • Identify a few leaking holes in your bucket.
  • Set up your accounting to track the numbers that are important to investors.

Even if you are hiring a fractional person, there is a ROI from having someone monitoring your numbers and being accountable for your finances. You don’t need to call them a CFO. You can give them the title of controller or chief accountant, but it is someone whose name is on the line for optimally managing your finances. Groups usually start with a bookkeeper and then hire a financial controller, maybe part time, and then with growth, hire a full-time controller they might title as the CFO.

There are a lot of accounting firms that help with accounting. They have gained competency working with DSOs. There are many controllers out there who serve multiple businesses and can be hired as a fractional employee.


Getting the right executives involved before you need them creates faster growth.

My tactical recommendation for everyone is to create an organization chart of the employees they have now and routinely examine it. When you double in size or grow, envision what your organization chart should look like. Outline that future org chart and start hiring for that future as you hire to meet your immediate needs. For example, don’t cover an expanding accounting workload by hiring a family member who doesn’t have the expertise for your future growth. Go ahead and hire a professional to lead your growth.

Often, group owners worry about increasing their overhead, but there is a benefit to hiring people who can make an impact on your growth. Start looking early for someone is going to make the biggest differences the quickest. When you hire professionals, they pay for themselves.


More Resources

The Patient Prism blog and the Patient Prism Academy video library feature hundreds of dental industry experts presenting recommendations and examples for leading and growing your dental practice, multi-practice group, or DSO. We have many videos providing advice for entrepreneurial dentists. We invite you to schedule a Patient Prism demo at a date and time that is convenient for you. 

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