What happens when a health tech executive laid off abruptly from his job tries to do the right thing by getting dental coverage for his family through the insurance exchange, spends extra on premiums for what he thinks is robust coverage, shows up for his dental appointment with his wife and four kids only to discover that his insurance has a six-month waiting period that means all five family members' visits are out-of-pocket, stands at the front desk as a puddle on the floor realizing he just got bills for thousands of dollars he can't afford to pay, and then hears the front desk lady almost whisper "we have this thing called a membership plan that would save you a lot of money"? Josh Rich does exactly that, and the moment he learns that a membership plan would have cost less per month, provided more value, included everything immediately with no waiting period, and applied all discounts right away, he can't believe he'd never heard of it before—and realizes that this is exactly why membership plans matter. Over 70 million Americans don't have any dental coverage at all. Membership plans are cheaper and better than individual insurance plans for uninsured and underinsured patients. And they're far more profitable to the practice than PPO patients or cash-pay-only patients. That personal experience becomes his north star when he joins Clerri, the dental industry's leading membership platform, after 15+ years in health tech (starting at Solution Reach as employee 106 at a company that grew to 800 employees, learning the dental and eye care markets, and watching firsthand how the right technology transforms provider practices). In this transformative conversation, Josh reveals the staggering financial impact of converting cash-pay patients to membership patients: a 76% increase in visit frequency, 176% increase in treatment acceptance, and 2.6 times fewer no-shows. He walks through why Clary's multi-layered team approach (dedicated onboarding specialists, long-term support reps, patient-facing renewal teams) drives higher enrollment and renewal rates than competitors. He shares the most underutilized membership growth strategy: positioning the membership plan as an employer benefit for small businesses in your community (retail stores, coffee shops, trade companies) who aren't offering dental to their employees—creating a pipeline of highly profitable, loyal patients. He explains Clary's groundbreaking integrations coming soon (including a native partnership with Cherry Patient Financing that shows pre-approved financing amounts in real-time so practices can help patients say yes to treatment), and most powerfully, his golden nugget: don't do practice ownership alone—lean into partnerships, relationships, and advisors who've been down the road before, because getting to where you want to go is best done surrounded by people who believe in you, not in isolation. This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. As Denae powerfully illustrates in this episode, having a clear vision for what you're building—both personally and professionally—is what separates practices that thrive from practices that just react by default. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. But as Denae emphasizes, marketing is just one lever to pull. You also need leadership, systems consistency, and communication frameworks that empower your team to make your practice work for you instead of you working for it. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a college student working at Barnes & Noble for $7.95 an hour sees a newspaper ad for an orthodontic assistant position (no experience necessary) paying $10/hour, takes the job in Columbus, Ohio, quickly moves into clinical coordinating across four locations, gets the opportunity to open an orthodontic practice from scratch with an orthodontist (and learns everything about designing and managing a practice on the fly), then goes to graduate school for a Master's in Healthcare Administration (essentially an MBA for managing hospitals), works in hospital-based dentistry associated with teaching hospitals and residency programs, and realizes she can take enterprise healthcare techniques and apply them to private dental practices?

Erin Glending does exactly that, and after starting her consulting company in 2014 while still working in hospitals, she makes the full transition to consulting full-time during COVID when hospital systems became unmanageable, recognizing that private dentists suddenly needed the same systems, protocols, and reliability frameworks that hospital systems had been using for decades. In this incredibly practical and eye-opening conversation, Erin introduces the concept of High Reliability—a system developed in aviation, nuclear power, and the military, adopted by enterprise healthcare, but almost completely absent from dental practice management—and reveals why the difference between a thriving multi-seven-figure dental practice and one stuck at $50K/month production has almost nothing to do with clinical skill.

Most powerfully, she reveals that the entire culture shift of high reliability starts with one radical idea: problems that happen are NEVER people problems—they're always system problems—which means if you have an underperforming team member or lots of errors, you don't retrain or PIP the person, you redesign the system so that the error can't happen regardless of who's in the room. If you've ever wondered why some practices have teams that seem happy, engaged, and energized while others have constant turnover and burnout, why some doctors can work fewer hours and make more money while others work themselves to exhaustion, or what the real difference is between a practice that feels like it's running on talent versus one that runs on design, this episode will completely transform how you think about systems, culture, burnout, and what it actually takes to build a reliable, sustainable dental practice.

This episode is brought to you by Marketing 32—the only dental marketing team with a performance guarantee where if you're not growing, you don't pay. Marketing 32 is truly invested in adding value to your practice and working with doctors they know they can over-deliver for. As Denae powerfully illustrates in this episode, having a clear vision for what you're building—both personally and professionally—is what separates practices that thrive from practices that just react by default. Marketing 32 helps you build the patient acquisition piece of that vision through strategic online presence, content creation, and growth campaigns. But as Denae emphasizes, marketing is just one lever to pull. You also need leadership, systems consistency, and communication frameworks that empower your team to make your practice work for you instead of you working for it. If you need help with marketing and growth, reach out at marketing32.com for a quick 15-minute discovery call to see if it's a good fit.

What happens when a mechanical engineer spends 10 years in high tech, quits cold turkey in 2005 with no great plan, builds a small consulting firm with his grad school roommate, pivots to start a dental marketing agency in 2009, focuses exclusively on dentistry by 2011, works with a general dentist who built a traditional corporate DSO from 2005-2015, watches that doctor exit and get bombarded by other doctors asking him how to build a group, becomes partners with that doctor's consulting company in 2018, spends years learning the DSO model inside and out, and comes to a profound realization: the DSO model is fundamentally broken—like a taxi service where the customer experience is terrible but the incumbent dominates because there's no alternative?

Ian McNickle does exactly that, and by 2021-22, instead of building another DSO, he interviews over 200 doctors across an 18-month period, asking them what stresses them out about private practice, what they'd like to delegate, what would attract them to join a group, AND crucially, what horror stories they've heard about groups. He also talks with investors, attorneys, accountants, and investment bankers to understand how to build something legally compliant, attractive to capital, and actually good for doctors. In 2024, he officially launches Icon Dental Partners as a DPO (Dental Partnership Organization)—not a DSO—with a radically different structure where the doctor's clinical autonomy, team employment control, work schedule flexibility, and branding all remain completely in the doctor's hands, while Icon handles HR, payroll, recruiting, IT, cybersecurity, marketing, financials, bookkeeping, accounting, leases, and legal.

In this eye-opening conversation, Ian reveals why DSOs concentrate too much power at the holding company level (where investors can change agreements and eliminate autonomy), how he decentralized Icon's structure so that what defines a doctor's control is in individual agreements that NO board change can touch, why he made his board majority doctors so they have a real seat at the table, and how Icon offers doctors the best of both worlds: the culture, control, and branding of private practice PLUS the negotiating power, expertise, centralization, and potential financial upside of a group.

Ian McNickle started his career as a mechanical engineer in high tech, spent 10 years there enjoying the work and management positions, but felt an itch to be an entrepreneur. Around 2005-2006, he quit his job cold turkey without a great plan—he admits in hindsight it was a dumb move, but when you're young and ambitious, you just go for it. He and his roommate from grad school started a small consulting firm in the northwest for a few years, then in 2009 partnered with another person to start a marketing agency. By 2011, they decided to focus exclusively on the dental industry. He built that company for many years while also getting to know dental practices as clients. One of his former clients was a general dentist who had built a dental group using a traditional corporate DSO model from 2005-2015. When that doctor exited his group, other doctors started asking him how to build a similar group. That doctor started a consulting company and approached Ian to be his partner in 2018, knowing Ian was an entrepreneur who understood the dental industry. From 2018-2021, Ian split his time between the marketing company and the group consulting company, learning deeply about the DSO models. What he realized was that the DSO model is fundamentally flawed. Doctors don't typically like it, it's not necessarily better for patients, and team members don't like it either. He compares it to the taxi industry—a terrible customer experience dominated by an incumbent with no alternative. But whenever you have that situation where customers aren't happy, there's an opportunity for disruption and innovation.