Joe Feldsien on Why PDS Health Bet on the Mouth Body Connection Before Anyone Else

If you pulled out your crystal ball and you're looking 10 years from now, where do you see this ending up? We're gonna have 3,000 dental practices in 10 years. We'll have 500 medical practices. Our cost to marketing is the lowest in the space. It's going lower. We're gonna have one more layer that is going to allow patients to see everything that's going on in the version of an app. I've been blessed to be here to see our ten year plan come to fruition. Reality, however you wanna say it over and over and over. A culture of exc execution is what has led the way for us to be able to arrive where we are today. Welcome back to the Dental Economist show. I'm your host, Mike Huffaker. If you're getting value from the show, please take a moment to like, subscribe or even better, leave a review wherever you consume your podcasts. It genuinely helps us grow and bring more interesting conversations like this one to you. Today's Guest has spent 22 years inside one of the most innovative DSOs in the country, PDS Health, holding roles across clinical technology, professional partnerships, and most recently, building something the dental industry has never really attempted before, a fully integrated medical dental business unit. Joe Feldstein joined PDS back in 2004. Coming from 11 years in sales and marketing at 3M, he's worked across clinical excellence, leadership development, technology enablement and professional partnerships. Then in 2024, he took on what might be the boldest role in modern dentistry, standing up PDS Health Medical, a primary care organization designed to operate alongside dental practices with shared clinicians, shared systems and and shared patient records through epic. He launched it, he built it, and just last month he transitioned the presidency to a successor. So he's got a very fresh vantage point on what it takes to build something genuinely new inside a large organization. Joe, welcome to the Dental Economist show. Thanks, Mike. It's good to be here. Thanks for the time. Yeah, absolutely. I was looking at your background and I got excited because you, you started your roots were in sales and as a sales guy, I always appreciate watching just where a sales career can take somebody. And so I'd be curious, you know, when you think back at that time that you spent at 3m, was were there any learnings, takeaways, things that you carried with you throughout this journey that you've had at pds? Of course, there's a lot. There's two things that really come to mind though, when I hear that question. The first was I was young in my career I was 25 years old when I joined 3M. And, you know, certainly there are some excellent mentors that I had. Two in particular. One was named George Alto, still may be in the dental industry for Henry Schein today. And the other is Jeff Lavers, who had a storied career at 3M. But those two gentlemen had a real impact. George introduced me to Stephen Covey way back when in the 7 Habits of Highly Effective People. And I wish I was great at all seven. But the one that has stood the test of time is seek first to understand. And so that whole ability to take in what the customer is giving you and then read between the lines as to what means value to them was central. And so I just. I absolutely loved that. Like I said, it has stood the test of time and has really helped me move forward there. I think the other piece of it, you know, is really, again, when you are providing value to your customer, the product sells itself. And one of the big things that I learned at 3M, and it's really what caused me to actually leave 3M, is how do I solve problems for the customer? If my product can solve a problem, one of their chief limiting constraints, chances are I'm going to create a customer for life. I'm going to create somebody who's advocating for two things, my product and me. And that has. That was my career at 3M. And that's really what brought me to PDS, is I spend a lot of time with independent, private, practicing dentists, and I saw the frustrations that they experienced. And a good friend of mine showed me how their P and L worked. And so when I started to understand how the P and L worked and I saw the opportunity that presented them, and then I saw the things that challenged them most, I'm like, this is an incredible opportunity. And then that's how I met Steve Thorne and John Thorne and pds, and that seemed like a natural fit. Yeah, let's take a step. Even back before 3M, how did. How did you end up in dental? That's great. You know, it's so interesting. You look back at different times in your life, and to me, it couldn't be any more clear than a calling. Like, literally in sixth grade, I was playing football, but I was on the sidelines. I got pushed in the back, I landed on my helmet, my front tooth went flying out. Okay. So, funny thing about that is my dentist fixed my tooth. And then way back when that thing turned yellow about five times before I finally got a good permanent, he goes, you should Be a dentist. You should be a dentist. And the whole time he's fixing my front teeth, you know, I've got this diastema. And he's looking at it and he's like, oh, no, diastemas are cool. I have one. See mine? And so I'm like, yeah, it doesn't look so cool, Doc. And so, right, he's convincing me, I kid you not. Ten years later, I'm selling 4.3M, and I'm at Hawaii and my doctor is up in front of the audience talking about veneers, and guess what? No more diastema. And that's how it all got started. And literally, yeah, I didn't even know I was going into dentistry when I had the opportunity to interview for 3M. Uh, I didn't know it was dentistry. I just knew it was 3M. And I knew it was an opportunity to get my career started. And that's how I know it's a calling in hindsight. Yeah. Yeah. Well, speaking of calling and career journeys, you know, you. You spent. You've worn a lot of hats at pds, clinical technology, professional partnerships, and now medical integration. Is there a through line in how you think about your role in your career journey, or have they all been genuinely different jobs? Well, the through line goes back to that comment that I made about 3M. So, as you know, 3M is built on one of their pillars is innovation. It's a really big deal. And so I would characterize it this way. They innovate products that add value and jump, if you will, the value proposition to customers, to patients, whatever it might be. Right? And so that was incredibly attractive to me. We had the smallest marketing budget and yet we had the deepest R and D. And so innovation was core and I loved it. When I came to pds, I saw the innovative things that Steve Thorne was doing. And since that time, he's got this. As you. We're all familiar with growth curves of companies, right? They go up and then they start to ebb. Every time, you know, as a company is going up the growth curve, there are continuous improvements, right? Small things that need improvement, that increase efficiency or increase effectiveness. But so many companies get to the top of the curve and then they continue down because they fail to innovate. Right. What Steve has done a masterful job of is you can't be innovating all the time, but you've got to innovate at the appropriate times. And I know we're going to talk about some of those innovations, but if you ask me, one of the reasons that I left 3M is I came across Sarek and one of my Patterson buddies goes, you got to check this out. And I knew I wasn't going to stay with 3M long term because to be honest with you, we're Southern California Southwest people. And I wasn't going to go back to Minnesota. My wife did a tour of duty up there and that was one was enough. And so I knew we were going to leave. But then I saw this thing and I'm like, wow, that is a digital impression material and that is a digital lab. This thing is going to be cool. So one of the things that I did when I came with Steve, I go, hey, I really think we ought to check out cerec. I know that it pencils well from a financial standpoint, and I know also that it addresses a lot of the issues, a lot of the constraints that we face in, in our offices daily in terms of broken temporaries and things like that. And so the through line for my career has been innovation. Whenever there is an innovation to happen at pds, I tend to be there at the cross section. I tend to play a role and I always try to help connect the dots and how this works for patients, providers, and, frankly, profit. What was the footprint or the size of PDS when you first joined, when you first met Steve? Yeah. So PDS was 65 offices, primarily in Southern California, and we were doing about $100 million in business at the time. Okay. And you know, you talk about how innovation is really a driver for you. When you first met Steve, were you able to get a sense even then that what was being built was going to be something special in the space? Yeah, yeah. What really stood out to me were really, I would say, three things. Number one, it was very clear that this wasn't a branded solution. So all of the practices were locally branded to the community where they were founded. Right. So that was number one. Number two was Steve had a vision for partnership. He didn't need it all. He wanted partners because he knew that as he had right partners, he could scale the business faster. So that means he had to give up a little bit of control and a little bit of the financial long term benefit in order to reap a far more scalable and rapidly scaling product, if you will. So those would be two big things that I saw early. And then he was, I was always asking questions, always listening, always going, what's next? What do you think? Where's it going? And that was before I knew him, you know, as A boss? Yeah. Yeah. I mean, there's a lot of innovative and unique things about pds, and we'll. We'll get into PDS Health Medical here in just a second. But one of the things is financial structure. And when you look at the DSO landscape, certainly out of the top 10, and I think out of the top 20 from. From my list, PDS is the only that does not have private equity sponsorship. How does that allow the way that you all operate to be different and work as almost a competitive advantage for the business? Well, I think the first thing is it's obvious the buck stops at Steve. Yeah. Right. And so he doesn't have to look over his shoulder. He doesn't have to give board approval. He knows if it's a good month or a bad month. He knows what we have to do. He works with our CFO closely, you know, to ensure that we're pulling the levers that we need to pull. I'll let you know that we're probably not the most profitable. But if people go out and look at, you know, the different. The Moody's and those folks that actually evaluate debt and they look at the size of our debt, the fact that we're not overly leveraged, if they look at our ratings, we're the top rated on both of those solutions. And we've got some good things happening right now as we're basically refinancing our debt. Our performance is allowing us to drive down our debt, the cost of debt again. And so I would tell you this. Even though we're not private equity, we're incredibly gritty. We don't take losing money well. We're frugal, but not cheap. And again, that partnership thing that I referenced earlier, that goes beyond just the clinicians. And so Steve has used partnership as a vehicle across the enterprise, including operators, to help just perpetuate his mind, our culture and what we do. So I would say that that private nature of what we do, it keeps us tight as a culture. We're not beholden to anybody else. We don't have to look outside. We don't have to look, frankly, beyond Steve for answers to critical to critical issues. And I think, you know, one of the things that you would see, too, is as we went through the pandemic, when this team went through the pandemic, it was incredibly inspiring how they addressed it, because, again, we didn't really have a backstop in that case, it was us. We fail, we're done. And this executive team just did an amazing job of navigating that. Well, and so the other thing though, that it does is it allows us to take on some risks. It allows us to do things like the epic build, which was not small and it was time consuming. It allows us to take on experiments, and we use that word specifically and intentionally to do things. Medical is a perfect example of an experiment coming up now on almost a decade, but now starting to demonstrate the benefit of what that is and what it looked like and how it's going to perfectly align with the needs of the consumer of the future. So those are just some examples. Anything else that I can add to that or any questions? No, I think that. I think that's great. And so 22 years ago, 65 practices, it's hard to even keep track any longer. I think last I heard, and it's was 1180 something, 1190, growing at a clip of 100 plus per year. Does that all track that? Jives. That's perfect. That's exactly where we are and growing fast. Yeah, no, it's very impressive. So take me back then to the beginning of PDS Health Medical when Steve's like, hey, we're going to build a primary care business. What was your initial reaction at that time? Well, I think it was, you know, it was my reaction and I think it was the reaction of many at pds. They're going, why? Why would we do that? They're worried about the scope of our business getting beyond what we can actually effectively manage, you know, and yet Steve is really good. The whole Wayne Gretzky thing is what he's getting good at. Where's the puck going? And I think what he saw that most of us didn't see as clearly is he saw this issue with primary care. We knew that access was a big problem. We knew that the shrinking workforce was a big problem. We also knew that a lot of the primary care physicians out there are employees, not owners. So when he does that math, he's like, okay, well, from a consumer standpoint, it's going to come together and I'll tell you more about that in a second. But even from an industry standpoint, in terms of what is going on with the professional and what is the opportunity with the professional. And Steve would go, I think I can make this work. Now let me back up a second as to the connection with the consumer patient, if you will, and you can find all of this stuff on Steve. But he had a, a family issue way back when that I think caused him to wait, to go, wait a minute, what is going on? You know, in people's body that that creates surpriseness. We hear about people passing before their time. And he had one of those situations and he just started digging. He dug into his own DNA. He dug into what was going on. And what became apparent to him is that the mouth plays a very, very in chronic inflammation in the body. And inflammation is what we see all over the place as the root cause of so many of the diseases that we deal with, with heart attacks being the number one. And he connected those dots and then started to see where the technology was going. He's like, okay, this is going to come together. If we do it right, if we use our infrastructure, if we use our culture, if we use our operational intensity, we can build something that integrates into the dental environment and create a solution that is really hard for others to follow. So, anyway, a little bit longer than maybe you're looking for, but that's how I think about it. Yeah. So when you're standing this up, you're building something new inside what is already a large organization. What were some of the hardest operational problems that you needed to solve that you really had no roadmap for because nobody had ever built this before. Yeah, no, absolutely. And I think the big thing is, you know, when we created or built EPIC for dentistry, that was a three and a half, four year journey to get EPIC instance out of the box, into the PDS instance of epic. Prior to that, though, we had another four years trying to build other vehicles that were going to allow us to scale. So we had a good understanding of what to build, and they did a great job. And they continually improve it. Right. In medical, because we thought EPIC was medical and that's where it is. And that the instance of EPIC for primary care was going to be right on. Or like, okay, take it out of the box, turn it up, and, you know, we'll use all eight cylinders. Yeah, not so much. Yeah. So we've really spent a lot of time, I would say, improving. I wouldn't say perfecting yet, but I would say we've spent a lot of time on really helping EPIC become a vehicle that reduces administration for clinicians, that allows us to more accurately capture the patient engagement. And then probably one of the best things about what we do at pds, we have a whole innovations department. They created an ambient listening tool for our medical professionals. What that allows them to do is again, capture the engagement bill appropriately and leave the practice a half an hour after seeing their last patient, while seeing a volume that allows us to basically get to a profitable Level. Yeah. So there are these thousand plus dental practices now. What does it look like in the future with the primary care component? How does that tie together? Where, where do you view the need to continue to integrate and have those services being offered tied to your dental practices? And, and where is it like it's standalone dental, but we still take this mouth body connection approach. Yeah. I think the key thing is, you know, where we're really going to go well is, you know, across the PDS enterprise, you've got different owner doctor partners. Some of them really, I would say, understand, buy in and have created deeper connections with their patients related to the mouth body connection. That's where this will start. So we're going to go where it is embraced. The good news is we've got a long line of owner doctors that are saying, pick me, pick me, pick me. So the opportunity for us to scale medical is really not limited by that. Yep. Okay, so that's the good news. We're going to go where we're wanted. And again, when you think about access to care from a primary care standpoint, it is really hard for patients to get in to see their primary care. Yeah. So that, that would be the, that would be the first way that I would respond to that. Yeah. How, how do you think about the mouth body connection overall from an education perspective? When I think about the, the whatever it is, I think it's half of adults don't see a dentist regularly. I think it's becoming more broadly understood the connection between oral systemic health and, and overall health and, and PDS has certainly been the pioneer, I believe in even coining the term, you know, the mouth body connection a number of years back. But there's still, I think, a gap in knowledge for a lot of just consumers that are out there that are either not seeing their dentist, are not aware of these connections. What role does PDS believe that they have to play in the education of the general populace to help understand the importance of this, to ensure that they're taken care of properly? Yeah, I think it's, I think it's a great point. So number one, you know, I think to whom much is given, much is required, we look at that, we are now stewards of this information and we've got just gobs and gobs of studies. So I think that if you look at us, and I'll just kind of use a term of pioneering, we've been pioneering this for a long time. One of the things that we are doing now to propagate this and to propagate the idea of integrated primary care in dental is we're spending a lot of times with large health systems. Okay. So you can only imagine, I'll just use broad terms, but like the dignities of the world, the Adventists of the world, all of these large health systems, they're also suffering from a lack of primary care. They're looking for solutions and they're looking for partners, and they're talking to us. So the first thing that I would say is they understand better than the general population the integration between the mouth and the body. So that actually gives us a platform to touch more people more frequently. And so the reason that I bring it up is we're actively looking for those partners because they have larger platforms and they can help us propagate this message secondarily. Even though PDS practices are all individually branded to the community, there is a through line through all of Those and the SmileGeneration.com so the Smile generation is growing in its impact, growing in its relevance to our patients. Right. And as they're coming into our environment, two things are happening. The smile generation is informing what they should expect for their visit. And then secondarily, what is happening, they come into the practice and it doesn't look just like white walls and, you know, nice sheer, you know, videos and things like that. It literally says mouth, body, connection. It ties the dots together. And then that just courses all the way through the examination. And then the last thing that I'll say is we're working now on what's called engagement in the gap. So there's so many great vehicles to help patients understand what they experienced, to support them between visits with what is going on. And then there's some other things that I'll talk to you about here in a little bit that we're going to be doing to further propagate that. But it's super important to us and we do feel the responsibility. Yeah. When I first got. When I first joined planet DDS about 7 years ago, and I was still figuring out what carries meant and trying to understand all the vernacular and definitions I'd heard. Even then, people were talking about what PDS was doing, and it was kind of viewed, I think, with a little bit of skepticism oftentimes, like folks would be like, I don't know, maybe, maybe they're a little crazy over there. I don't know that that's the, the fit or the direction that the industry is going to take. You know, we. We're just going to focus on the dentistry piece and I think, you know, some of, some of the skeptics might say, like, look, dentistry and medicine, they've been separate for 150 plus years, maybe for good reasons. Different training, different billing, different liability, different patient behavior. What, what's your best an to those skeptics? Well, I think what's really exciting for us is it's really two things. One, and they're right, dentistry is a great space. First of all, you can't do virtual dentistry. Even in Covid, the emergencies had to come in and dental surgery had to be done, and you can't do that virtually. So that is such a great pillar, such a great platform for any business. You have to have the brick and mortar, right? But what we see happening and what's really cool is it's this convergence, right? So there's so many people out there and you've seen them names like Dr. Mark Hyman thrive. There's just Stephen Gundry. They've all got their platform, their wellness platform. And people now want to move outside of just managing chronic disease. They want to get to the root cause and the thing that they're discovering. And regardless whether it's Hyman or Gundry or anybody you would talk to, they're like, hey, guys, just so you know, the mouth, it's attached here, it has a big impact on this thing and a whole host of other things. So as that's coming together, the other thing that's happening is we believe, and I'll coin Steve's term, saliva's the new blood. Okay? So salivary diagnostics are becoming more and more telling, far less expensive, far less invasive. And we can do them with greater frequency to tell patients how they live. And whether you're wearing an Apple watch or whether you've got some other kind of wearable. There you go, right? You're tracking what's going on because you're like, you know what? I don't know if I'm going to live any longer than I'm supposed to live, but I certainly want to live well with the life that I have and the years that I have remaining. And I think that is one of the best things about what we're doing at PDS is again, Steve, seeing all these things come together, we're going to have a great brick and mortar solution that is going to scale like crazy. We're going to have tele. Telehealth, right? Teledentistry. We're going to be able to help people that way. And then we're going to have one more layer that is going to allow patients to see everything that's going on in the version of an app. And even in that app, there will be some AI accommodation that come along patients. So you wake up in the middle of the night and you don't feel quite right. First thing you might do is you might just check with your app, saying, hey, I've had these things going on. I don't feel quite right. You know, what do you think? And your AI tells you, well, Mike, I think you're going to be okay. You know, take a couple of aspirin and then tomorrow morning, you may want to call, you know, Dr. Kikwani over there at Tempe Modern Dentistry, and he'll help you out or something like that. But that's very real and we're going to be able to provide some of the best of what the Dr. Hyman's and the Dr. Gundry's have. But we're going to have a brick and mortar outlet for everybody who still needs to see the dentist. That's why we're excited. Yeah. Is Tempe Modern Dentistry one of your practices? Yeah, I drive by it all the time. This is fantastic building. I'm actually looking for a new dentist, so maybe I'll have to pop in there. So there you go. I've got some suggestions for you. I'll give you more than one. Okay, fantastic. So correct me if my number's wrong here, but you now have 14 primary care practices, is that correct? 15. 15. We've got a couple more that'll open this year. Okay, so how do you know that it's working? What is. What does success look like at this stage? Yeah, I think a couple of things. Right. So one of the reasons that I joined pds, as I mentioned earlier, was just the fact that I felt the calling to come alongside of clinicians. So, as I mentioned, there is a lack of access to care and there's a shortage of clinicians. Our clinician turnover right now this year is going to be somewhere in the 5 to 10% range. So we're really retaining, and I'm talking about MDs, we're retaining docs. And the best indication is the people that are coming on board to serve our patients are referrals from our existing clinicians. That's a big deal. Right. So that's a big indicator for me because it tells me that it's sustainable and scalable. The second thing that's big, and by the way, we're going to have a partnership model in the medical space just as we do in the dental space. Justice and aside. The second thing, though, is if you take a look at the performance of our integrated practices on the dental side, by and large, these are in our top 20%. So we have, you know, big awards. We have, literally, for the 22 years that I've been here, we've had an award ceremony and we have Office of the Year, Most Improved Office of the Year, and then De Novo Office of the Year. Well, that number keeps getting bigger. And when you get that award, it's more meaningful because you're one of thousands now. But just as an example, two offices de Novo Offices of the Year literally are dental medical integrated practices. So they're right up there in the top tier. And. And in addition to that, they are also offices that are in the list of Office of the Year, so one of thousands. So those things are happening. I think the other thing that we tie to success, and I know not all DSOs do, but we're huge on continuing care. If patients are coming in, we're meeting expectations, they start treatment, they come back and they refer, we win. That's exactly what's happening. Then as a result, what's happening is the patients that are over here on the medical side, they're coming over here on the dental side. Almost 40% of our new medical patients are making it over to the dental side. Other DSOs are watching this. Is the PDS model something that the industry can adopt more broadly, or is it a bet that only an organization with PDS's scale and resources can make? Well, I'd say that it's not for the. It's not easy. And I will tell you that the insurance and the payer space is far different than dental. Far different. Okay. So you've got to be aware of those things. I actually believe, and I'm going to say this out loud, I believe dental operators are more adept at doing more with less than medical operators are. I've had both, and I find that our PDS operators do far better than when I bring in somebody from the outside. It seems like the medical field likes to throw bodies at problems. We don't like to do that. And so if you're highly leveraged, I doubt whether you're probably going to take this path. And if your private equity group, you know, is thinking about turning you in, three to five years, probably aren't going to choose this path. But I do think that there is room. I do think there is opportunity, and I think, I think others will follow. I don't think A lot will follow. Yeah, I want to talk about technology for a bit because you've mentioned Epic, Epic wisdom, the build out of the software specifically for dental practices, which really did not exist as part of Epic's portfolio before. And you know, we've talked about a lot of firsts for pds. You know, PDS has done many things. I'm in the first one to do it. You've also been the first one to add a scale of a thousand plus practices, do a core system of record replacement. And so, you know, I looked at that and I think it's just a. Is incredibly impressive. But also there had to be so much heartburn throughout that process. It's. It's a cultural shift. It's a change management nightmare. I think people would say, going from, I think at the time it was QSI moving into a new product that you were co developing that likely had gaps in where you wanted it to be as you were rolling it out. How did you all determine that that was the right path to take and then set yourselves up for success in implementing at scale? And what I think was actually, all things considered, a relatively short period of time as well. Yeah. So I think again, as I mentioned earlier, we've got this continuous improvement engine that's always at work in the background and then every once in a while we'll do an innovation. That innovation has created muscle memory for us in terms of project management and we would call it program management. Way back when Steve went to digital X rays and that was a big shift for everybody. And those digital X rays included interaural cameras. When I came on board in 2004, we went from paper charts to digital charts. When I talk about stress, we had people literally scanning paper charts into qsi and it was like, oh my goodness. So we hired people. That's all they did all day long was scan charts. But it was done very methodically and very systematically. And every time we've done it, it's just we put a turn on it and we've gotten better. And so that digital transfer is huge. I would actually say moving from paper charts into digital was harder than moving from QSI to epic, if you can imagine that. Yeah, yeah. So that's the first thing, the other piece. And maybe you want to go down this path. Our first month on Epic in our pilot offices was April 2020, if that rings any bells. Yes. Yeah. Right. Right in the. Right when lockdown first started. In the thick of it. Yep. It was crazy. And there was a lot of learning. I mean, it was, the platform was okay. It certainly isn't what it wasn't what it is today. Right. But even just the change from QSI and the DOS based commands to a Windows based environment and then Epic is known to be a little click heavy, you know, if we're honest. And it was far more click heavy then than it is today. But that was a lot. There was a lot. The key thing in all of it, again, I talked earlier about the opportunity for us to scale medical. We're going to start where we are wanted. We're going to start where we have the best opportunity to succeed. And that's what we did with epic. We went into offices where owner doctors were like, I want to get into the mouth body connection more deeply. I want a broader health history for the patients that I see so that I can help them navigate the root causes causing them problems. Today. That's where we went. That's where those folks demonstrated the greatest perseverance, the greatest patience and, and best source of feedback to make great improvements to the platform. Yeah, yeah, yeah. That's key is you have to find the practices that are already bought in on the premise that are desiring what the outcome is going to be and recognize that, yeah, there's going to be some, some bumps in the road on the way. So 2020, April 2020 was first install. When was project completion? Yeah, literally it was probably 24, 25, about five years in. We had every practice, existing practice on Epic and we did it generally by geography. So it was a lot easier for us to go into a geography train everybody up, say, okay, you guys are all each other's buddies now let's move this forward. And again, we did it. By and large, we started in Southern California where our base is the strongest. Our advocates were the strongest, our partners were the strongest. Most bought in. They demonstrated the success that was possible and from there it cascaded throughout. One of the things though, that far fewer people think about or know though. And it goes all the way back to the question about private versus private equity. Private doesn't mean that everything is a gift. It doesn't mean that, you know, Steve basically sucks up all the costs and basically everybody else gets a free ride. All of these practices paid for their instance of epic and all of the new practices pay for the new installation of EPIC that they're going to experience going forward. And again, not inexpensive, but we all are bought in together on the impact that this is having. And so we're all paying appropriately and accordingly for the cost that comes with it because we believe that the value far exceeds the cost. Now, did you wait to start standing up the primary care practices until the EPIC project was complete or were those running concurrently? Yeah, so I would say that the pilot or the experiment that we had going that was on QSI initially, we didn't move off of QSI really until the EPIC installation was pretty much done. And then we moved from QSI Medical to EPIC Medical because it made the most sense for us to do. And so I would say, yeah, we finished the job when it came to EPIC installation on dental and then we went there on the medical side. Now, you said you're going to go where you're wanted, but if you pulled out your crystal ball and you're looking 10 years from now, where do you see this ending up? You know, sounds like the model is working. You have very clear ideas about what you want it to look like, what success looks like, what does this look like at scale? What does scale even mean? Yeah, I think it's great. So if you look at our 10 year plan, we're going to have 3,000 dental practices in 10 years. We'll have 500 medical practices integrated in those. And I don't think we're going to go into many more states. I would say strategically and selectively we'll expand into some states, but what we really want to do is where we've got a presence in a market. We want to expand, we want to become the choice for patients in those markets. And density has always been a driver for us. We're pretty dominant in Southern California. We want to continue to make that part of who we are in other markets as well. And so I would say that that would characterize it. You know, maybe 3,000 practices, 500 medical, fully integrated, and then again, not a lot more states, but a lot more density and in some cases dominance in some of the MSAs that we participate in. How many states is PDS in currently? 24. 24. Okay. What are some of the other benefits that you get from geographic density? Well, I think the benefits that come with it, you know, I would say number one is you build a reputation in the clinical community. And I like that because, you know, we're starting to see more dentists want to partner with pds and that's really key for us to scale. And so when we get into a new market and we're a relative unknown because of our reputation over there, but not necessarily our reputation here, it takes a minute. Right. And generally what we're trying to do is we're trying to go into underserved markets. Well, they're underserved for a reason. Not a lot of clinicians. Right. Once we get going and one stock see what our platform can do for them and for their patients, then they're like, oh, I got to go over there. Because again, how they do from a lifestyle, including time in the practice, leadership development, but also financial outcomes is far better than what they could do on any other platform, frankly. But it takes us a minute to get started there. And so I think clinical is big from a density standpoint, certainly as the smile generation becomes well known and patients experience CBCT same day Sarek Comprehensive specialty word of mouth really carries the day. I now have marketing that rolls up to me and my responsibility. Our cost to marketing is the lowest in the space, it's going lower and it's only because we're executing better and meeting the expectations of patients. So that's another piece. I'd say the last piece that we're working on and it's definitely coming, is the partnership with the payers. The more dense we are, the more we can get a favorable and I would say fair reimbursement for the services that we provide. And that's exciting and I think that's good. I think that's healthy. I've got to pull on a thread of something you said just a couple minutes ago when I was asking about what the future looks like in 10 years and you said, well, our 10 year plan. Is there really a 10 year plan? Are you all thinking that far out when you're trying to determine where things go? We are and we have been and I've been blessed to be here to see our ten year plan come to fruition. Reality, however you want to say it over and over and over. And yeah, we absolutely do. And I wouldn't say that it's rocket science, but it definitely sets some targets, it talks about some hows. And I think Steve would almost be to the point where he would give it to somebody else and say go for it. Because having a plan is great. But then it's like that whole Mike Tyson, until somebody punches you in a jaw right then what are you going to do? But essentially what he would say and what he tells our team every day is our culture of execution is what has led the way for us to be able to arrive where we are today. And it will also determine our ability to hit the next ten year plan. Yeah, no, I mean execution is obviously the critical component, but even just having the vision to Think that far ahead, I think is very unique. And I talk to folks and they're like, well over the next 12 months, or maybe it's over the next 18, some folks have some vision, two or three, but 10 is pretty unusual that it's actually a thought to think so long term that you give yourself the time to set yourself up for that success as well. Especially in today's day and age where it feels like everything needs to be immediate and done tomorrow. And it seems pretty unique that. And I think it's part of what sets you all apart is the fact that you actually put in place plans and are willing to march towards them over a period of years when you know that it's going to drive the out the right outcome for you all. A couple last questions. I want to be very conscious of your time here. You mentioned a couple mentors at the beginning of the conversation. But when you think about building organizations and kind of your career path, who's had the greatest influence on you, how you think about things, how you think about business and how you operate as a leader. Yeah. Well, you can include this or not, but my faith is who I am. So I'll just say that, I mean, if I'm just blunt, the teachings of Jesus have most influenced who I am, how I think, and that's created the foundation for me. So otherworldly, that's where I would go, you know, in this world. Obviously. I think Steve Thorne has had a pretty big impact on how I think. I think his mentors have also impacted me pretty directly. You know, people like Scott Beck, if you don't know that name, Scott is our vice chairman of the board. He's done some pretty incredible things over the course of his, his lifetime. He's had great influence on me. I've had the fortunate opportunity to engage him at least monthly and, and oftentimes more regular than that. Those guys have been, have been key and critical. I mentioned George Alto from 3M was very, very much there. Jeff Lavers, I just saw a lot of practical relationship building and influence building through him. Jeff, you know, everybody talks in threes. Jeff always spoke in twos. He goes, joe, nobody can remember number three, don't give it to him. It's two. Right. And then, then of course you've got, you know, people like Stephen Covey and Jim Collins, you know, good to great books like that. Patrick Lencioni, I still listen to his podcasts on a regular basis. I find that to be very insightful, very helpful. And then there's another gentleman who actually works very closely with us here at pds, Henry Cloud. He's got the book series called Boundaries. That's right. Yes. He's excellent. He helped us build our leadership structure. We have our own leadership school leadership structure. He's formative in that. And I've had the blessing of spending a lot of time with Henry and just a wonderful person. So those are, those are a few names that have really been and helpful in my career. Yeah, that's fantastic. We could do, I think, an entire episode on just the last three minutes of what you answered because there were so many different strings to pull. Their conversations have about those books, approaches, mentors. But we'll have to save it for another time. Joe, I really appreciate you coming on the podcast. Very much enjoyed the conversation. Thank you. Absolutely. Mike, my pleasure. Thank you. A lot of fun. The Dental Economist show is brought to you by Planet dds. To find out more about how cloud based dental software by Planet DDS helps unleash dentists and their staff to focus on patient care, visit www.planetdds.com. stay tuned for upcoming episodes by following wherever you listen to podcasts. Thanks for listening.