Anne: Hi everybody, it's Anne Duffy and welcome to Dental Entrepreneur, the Future of Dentistry's podcast. I'm so happy you're here today with us and I'm very excited to share my guest with you today.
But let me tell you a little bit about him. Ian is the co-founder and CEO of ICON Dental Partners and National Multi-Specialty DPO. previously co-founded the DSO Project and WEO Media. A published author and industry speaker. Ian has been recognized as a top CE leader by Dentistry Today for five years, and writes regularly for dental publications.
Fun fact, he enjoys distance running, completed 30 marathons or longer races. Hello and coming up on 20 years as an entrepreneur. It's been a crazy ride. Ian McNickle, welcome to our podcast today. It's so nice to see you.
Ian: Hey, thanks Anne. Yeah, it has been a crazy ride for sure, but fun.
Anne: It has been a crazy ride for sure.
And you know, I've gotten to know you over the last year or so. You just graced our beautiful cover of Dental Entrepreneur, the Future Dentistry's, spring Edition.
Ian: Yeah.
Anne: and sent some of your team members to our Dental Entrepreneur Women's Retreat, and they're all amazing. one thing I'll say is they all love you.
I mean, it's like they really have loved what they're doing. They, grabbed onto the passion and the culture of what ICON is providing for dentists in the US and yeah, where Icon is gonna go, from here. But I love that you've built something really special.
Ian: It's a good, it's a good company.
We're pretty excited about it.
Anne: Yeah. Yeah. But I wanna go back for our listeners today, because a lot of listeners are thinking, you know, golly, I'm working for somebody. I'm in the grind. I'm not really being fulfilled and Maybe I wanna start my own business. And so I ask you, Ian, like, why did you become an entrepreneur?
Ian: That's a good question. Yeah, it's interesting. You know, I started out,I got my undergrad in mechanical engineering and worked in the high tech industry for about 10 years. And, you know, in that environment, I mean, it's a great place to start a career. It's,really fast paced, high pressure, 24 7 manufacturing type stuff, and you learned a lot of great skills, but it's a meat grinder.
And it's huge corporate companies, right? And so I just always had a passion to really kind of lead teams and build things. It was very creative and it was hard for somebody like me with my kind of ambition and creativity to be able to do that in a corporate environment, you know? so I just decided, you know, I'm just, youwanna do this before I get too old.
And I was, thinking in my early twenties. I was looking at one of the older engineers who's an old guy around 50. I'm 52 now, right? So, but I, back when I was in my twenties, you know, fifties seemed really old and I was like, man, that guy is grumpy. He's sad, he's just waiting to get laid off.
He's just miserable. I'm like, it's gonna be me in 20 years if I don't do something different. And so I just decided, you know, really interested in business. So I got my MBA. From the University of Washington, and just a few years after that, I just, cold Turkey, quit and decided to become an entrepreneur and done lots of companies since then.
But, I don't know, I just really had a passion to, to kind of create and, kind of set my own path. So it's been a crazy 20 years, but I'm glad I've gone through it.
Anne: I love that, you know. Um, how old were you when you decided to pull the plug and start your own journey?
Ian: Uh, let's see. I would've been 34. that's young. So it's been 18 years, almost 19 years. Yeah.
Anne: Yeah. That's kind of young. 'cause I, my husband quit his corporate job. He was in the chemical industry, and decided to start his own company, but he was 41, 42. Mm-hmm.And so youwere a young man to like, say, okay, I've had it, I wanna make my own decisions corporate. Is wonderful, but sometimes depending on the boss or the people around you mm-hmm. You have thethere's a ceiling, whether it'syou're a female or a male, in the corporate world, because your, destiny is controlled by other people and as an entrepreneur
Ian: Yeah.
Anne: Who's in charge, right? You are.
Ian: Yeah. and you know, I had some great bosses. I really did. some of my first few bosses were really wonderful guys. but I had some pretty bad ones too, which,helped, you know, make the decision to move on. But, being your own boss is certainly a part of it.
I think also just the ability to create problem solve and just kind of the adventure of it. entrepreneurship as you know, is such an adventure. It's just what's around the next corner and.my dadhe was a school teacher and he and I are very different in a lot of ways, but he was a big game hunter.
He spent four years in Africa hunting elephant and Cape Buffalo and all kinds, I mean, crazy stuff.I definitely get my kind of adventurous. mindset from him, but we just express it really differently. I have no interest in getting trampled by elephants, you know? Oh my God.
But, um,yeah, so I think that's where I get it, is my dad'skind of creative spirit and adventurous spirit, and so I just am doing it differently.
Anne: Well, the verve for life, right? Yes. I mean, to your point about when you see people, and I've, done the same thing, Ian, when I've seen hygienists is, I'm a hygienist, you know, 46 years in clinical, and I see that they have been working the four or five days a week for 40 years, and they're just hunched over.
They don't like it. I'm like, there's something about having more other than just the grind of going to work every day after 40, 50 years. Yeah. And the fact that it's, your own and your own ideas, but you started from scratch, so yeah. You started Weo Media.
Was that the first company that you started?
Ian: that was the first, I would say larger company. I started a small consulting company before that and,was a fractional executive on a few companies. actually was president of a Canadian gold mining company for a while. I mean, I did all kinds of crazy stuff in my early, early days.
Anne: Is an entrepreneur for you? I mean, come on. That's what they do.
Ian: See what stick. Yeah, it was. I've got some stories. I'll tell you what, but, um, yeah, wheel Media was the first, I would say successful company, that we launched that in 2009 and it's still going strong today. But yeah, that was my first one.
Anne: Yeah, that it is. 'cause I know a lot of people that had worked for WEO and they loved it and it'sa great company. Every entrepreneur's dream, I think, is to build something that somebody else sees something in and wants to buy it, and then you can move on to the next thing.
think about your background as a mechanical engineer, because I think that's a big part of dentistry. And the fact that you've got your MBA. So tell me, you know, some of the highs and lows of what you've experienced as an entrepreneur. Seems like you are perfect for the dental industry, and I know that you have loved it, but what are the highs and lows?
Tell us a little bit about that.
Ian: Yeah, I think, you know, going all the way back to weo, you know, some of the highs when we finally, I think, cracked the code on how to really grow that company. That was exciting. We had six, seven years of just exceptional growth and, you know, won some national awards.
It was a really fun, exciting time. More recently though, I would say with Icon, you know, it's interesting the process to build this is actually similar. I took a very similar approach to building we and Icon. And it is kind of business 1 0 1, it sounds simple, but a lot of people don't really take the time to do it.
So when I started weo or co-founded weo with Corey and Mark, I spent a lot of time just asking doctors, you know, what are you looking for in a marketing company? you know, and this was, you know, back 2000 9, 10, 11, right. And they were like, they're a handful of,website companies that were national, had lots of clients, but they were all templated website solutions.
Mm-hmm. No one was really a full service agency at that time.And so, you know, back then it was really common. You'd find somebody on like Craigslist to shoot a video for you and your front desk person would do some Facebook posting and you'd get a templated website company from whoever's at the Dental association.
This is a scattered shotgun approach to marketing, and so we were really one of the first companies to integrate as a full service agency, and that was one of the things that doctors told us. Say if we could go to one company for one stop shop, that would be really nice if we could have monthly contracts instead of being locked into annual contracts.
Transparent reporting, like what are you actually doing for us? 'cause marketing companies are famous for sending, yeah. Like here's your data, you know, here's your website traffic and phone calls. But with zero explanation what they actually did for the month. Right? And so I just took all these complaints and gripes and took it back to my,partners and my team and just said, Hey, here's the opportunity to build something.
Let's build what people are asking for. Right? And so that's the same approach I took with Icon, you know, in the early days of Icon, I spent 18 months. And I interviewed over 200 doctors, you know, specialists and mostly general dentists. And I would ask 'em questions like, you know, what would appeal to you about group dentistry?
What kind of things stress you out about private practice? What would you like to delegate? Where would you like help? You know, stuff like that. Mm-hmm. Given that onion back, but then also the flip side of the coin was like, what things you know would prevent you from wanting to join a group. What horror stories have you heard about groups?
Right. And so over the course of 18 months and a couple hundred conversations, I really got to drill down into specifically what were doctors looking for. And because, I had the luxury of,taking my time building it. I didn't have to have an income on day one, you know,so we just took our time and just reallydesigned it from the ground up.
And my co-founder, Jeremy Dixon. He's a general dentist, you know, and Jeremy built his first DSO group back in 2005, six timeframe. He did that for like 10 years. So Jeremy's one of the OGs in the space. I
Anne: say the OGs. Yeah.
Ian: Yeah. He's been doing it for 20. It was, I mean, he was building groups before it was even called DSO and before even DPOs were even a thing.
And so we're A DPO, which is, you know, different. But, it's been an interesting process. So, know, as I interviewed all these doctors, it really helped me kind of come up with a lot of innovations to the business model and solve a lot of problems. That exist. 'cause sometimes doctors don't really know.
and frequently I'd say they don't know the questions to ask. And I get this all the time. I talk to doctors all the time, almost every day I'm talking to new doctors about Icon and I kind of explain the whole model and everything. Like, ah, this sounds amazing. Like I don't know what questions I should be asking you though, and I get that all the time.
And so I said, well, here's some other things that you should know about. Right? And so I kind of go through and they always appreciate it, but it's because I've just had so many of these conversations with doctors. I know what they're concerned about. And so it really helped us to be able to implement this stuff.
and we've done it with the freedom of, you know, we don't have investors at this point and we won't need investors probably for years. And that's really given us full freedom to really design this, how it should be built without the interference of people putting dollars above everything else.
You know, we are not putting dollars above everything else. The dollars will be there. We're not worried about that. Right. We're focusing on. Taking care of our doctors, treating them as true business partners and not employees. And then taking care of patients, right? Giving the doctors, empowering the doctors to take great patient care.
And there's a whole, bunch of stuff beyond that. that's kind of the genesis. And so I would say, to answer your question, at the highs have really beenwhen you figure out what your customer, in this case, what our doctors are looking for, and you can figure out a way to give it to 'em, that's just a super exciting thing because then the sky's the limit.
that's to me, really cool. We,we've built a company that is, I think, going to grow rapidly because we are offering doctors really what they're looking for, I would say almost exactly what they're looking for, many of them. So,
Anne: yeah. you didn't guess about that. I you're very part in that, you know, so often I think entrepreneurs, we,you know, hang up the phone and we say, okay, I'm gonna start something without doing any research.
Yes. Tell our listeners the difference between A DPO and A DSO. Some people may not understand that.
Ian: Yeah. So certainly. so A DSO dental support organization or dental service organization, it kind of goes by both acronyms. that's really what people think of when they think of group dentistry or corporate dentistry.
Traditionally in that model, you know, the DSO is buying the practice, the doctors becoming an employee, basically, of the DSO. In many cases, the DSO will take control over the practice staffing. So the team members, the office manager, hygiene, et cetera,those people can be hired or fired at the whim of the DSO.
pay and benefits a lot of times can be influenced or entirely set by the DSO. I mean, it's illegal for a nonclinical entity to tell doctors quotas and this and that, you know, you have to do this many crowns and bridges. Yet a lot of 'em really heavily try to do that with. You know, the feeling is bonus Susan, the feeling.
Right. And then you're not supposed to do that kind of stuff. But you know, the DSOs are kind of well known for doing that type of approach. a lot of times they will limit the choices on, you know, say, oh doc you have clinical autonomy. No problem. As long as you order from this formulary and use this lab and this supply company.
And like, that's not autonomy. so it's like, you know, when Henry Ford started, Hey, you can have any color car you want as long as it's black, you know? Yeah. Um,same kind of approach with these DSOs. And so A DPO takes a very different approach, a dental partnership organization.
So, and in our model, we've taken it even several steps further than the other DPOs I've seen out there. So what we do is,when we partner with the practice, you know, we're not actually buying the practice itself. We're just buying nonclinical assets, equipment, goodwill, branding, stuff like that. So the doctor continues to own their EIN, the LLC, you know, the S corp, whatever the entity is.
And then that entity, of course, owns the patient records and charts. And so we build a, alegal firewall between the clinical and nonclinical. So that icon has no ability to influence any kind of clinical decision making, which services to provide, you know, which labs to use supplies, like that's all very clearly defined in our,legal paperwork and also in our legal structure.
And so, other things about, the DPO model, we treat the doctors as true business partners, right? So a lot of these DSOs, what's really common in DSOs is you will have different levels of stock. So like there's a holding company, parent company at the top. Sometimes there are what we called regional or joint venture kind of subgroups or sub DSOs.
And then there's practice level stock of course, as well. And so what a lot of times happens is these DSOs, they'll give a doctor evaluation. some of that will be cash. Some of it'll be stock. Well, the stock is usually a combination of some holding company and then some at the lower levels. The reason that investors like to structure it that way is the holding company is the,level that typically gets much better financial returns.
And so the more of that they can keep for themselves and the more they can push doctors down to the other forms of stock, it just increases their returns. So in our model, we only have holding company stock. So every single doctor at Icon, the only stock they have is holding company stock. Wow. Super lucrative for them.
And we also structured it. So, you know, originally we were thinking, okay, well, you know, have investors and, you know, we'll allocate maybe 50% of the shares for them, maybe 40% for the docs and 10% for the management team. And we came up with a pretty clever way to grow the company without the need for investors using a lot less leverage than most groups are using. That's a whole separate conversation, but what that allows us to do is not need investors for quite a long time, for years. So that 50% we were going to allocate for investors, we gave all of it to the doctors.
So at Icon, the doctors literally own 90% of the holding company, which is unheard of. it's extremely generous on our part. And again, the reason we did that is the number one problem I was trying to solve when I was designing icon was how do we recruit and retain great doctors? That is the number one problem.
Yes, strategy matters, management team matters. All that stuff absolutely matters. I.But I could have a brilliant team and I could be a genius and I could have all this great stuff. If I don't have good doctors, I just have an idea. I don't have a business. Right? So you really gotta make it all about the doctors and we, it's not just lip service.
with us. We really built it into the model. they controlled the board of directors. That was the other thing is when I founded the company, I controlled the whole company, right? So I voluntarily give up control of the board. And so currently today we have six people on the board. Five of 'em are doctors, and then me, I'm the only non-doctor on the board.
And so. Yeah, we structured a lot of things in our DPO model so that it's fantastic for doctors the way we've structured it, and it can't change unless the board is gonna approve these changes. And so like in the future when we bring on investors, and this is where a lot of DSOs make a mistake, is they bring on investors early in the process.
A lot of times there may be doctor led groups who that's great for clinical, it's not so great from the business side of things, and they get taken advantage of by investors who are far more savvy on the business side. I've been a business person for 20 years. I've built a lot of companies and so I.
Jeremy and IIS is not our first rodeo. It's not even our fourth or fifth rodeo. We know what we're doing and so we structured a lot of things to be at a level that it cannot be changed by investors. For example, not to get too technical here, but when you have an operating agreement in a business, you can set voting thresholds for like majority vote, super majority vote unanimous vote.
And so the things that we do not want changing that the doctors love, we set those at thresholds that investors can't simply do with their own voting ability. They would have to get the doctors to agree with them in order to do something major like that.
There's a bunch of stuff we built into the DPO model that we have. That's not only extremely good for doctors, but it'srock solid. Itcan't be changed unless the doctors agree to change it. So a lot of cool stuff.
Anne: Well, that's when they start to say, uh, this sounds too good to be true.
Ian: Yeah, I get that all the time.
Yeah.
Anne: And, and yet
Ian: it is, take a look the other thing I love about what you're doing, it's full transparency.
Yes.
Anne: and there's no surprises. I mean, I,the heartbreak for me is when I hear a doctor that has sold his practice and his, put his life into it. It's his baby, if you will.
Mm-hmm. And the family's baby and all that. And then it just. goes off the rails. And they end their career feeling frustrated and distraught and diminished honestly. And that is so sad after a lifetime of serving patients and the community in our profession it's gotta be a win-win.
And it sounds also Ian, that you vet your doctors just as much as they're gonna vet you.
Ian: for sure. we really are looking for partners, who are, open to collaboration. like a lot of times, most of these groups out there, they have minimum thresholds.
You gotta have, this much revenue and this much size and these kind of geographic locations. And we have some of those types of concepts. But I'm far more interested in the personality of the doctor than I am their numbers. Because I've built a super strong team at Icon, our executive and management team is just,incredible.
So we have a really good ability to come into a practice and help them improve over time, productivity, margins, grow revenue, et cetera. But numbers we can change and improve. the core person, I can't change that. Right? So we wanna make sure that we're aligned on our vision and values.
We're really big on values. we have monthly reviews about our values with the whole company. We'd actually just did one yesterday. so we're really big on vision and values alignment. And so when I'm talking with doctors, yeah, of course I'm asking them about, operatories and revenue and we're gonna analyze EBIT and all that good stuff.
But I'm also just trying to gauge. The interactions, right? I'd much rather have a doctor with not a lot of cash flow, but potential. And they're coachable and they're excited, versus a doctor who's maybe got some great profitability, but they're just a jackass. I.They're God's gifted dentistry with a huge ego.
I would never partner with somebody like that. I don't care what your numbers are. I don't want to partner with you. Go somewhere else. We're building the culture is the secret sauce of any company, and you have to protect that more so than anything else. and the irony is like where are these investors a lot of times get it wrong.
'cause most investors have never built a company. very, very few investors have ever actually been an entrepreneur built company. Scratch built a company. That's
Anne: right. Yeah. So they
Ian: don't know what they're doing. Honestly, they think they're a lot smarter than they are. They know spreadsheets and that's honestly all they really know.
And so when you are an entrepreneur and you've built companies from scratch, you understand if you've built good companies, the most important thing is the culture. you've got to be able to maintain that above all costs. but if you do, the culture is what drives the performance.
Mm-hmm. Right? The teamwork, the collaboration, the chemistry, all that is from the culture. And those are the ingredients that drive performance. And so what I tell our, team all the time. It's like, look our top priority is keeping our doctors happy.
That is our top job. Second profitability. Yeah, let's grow ebitda. Let's do all that good stuff. But subordinate to that is keeping our doctors happy. And at Icon, we actually have what we call an ininverted org chart. So typical org charts. You got the CEO atthe top, and then the executives and all that stuff.
And then middle management, then at the bottom of the org chart of the practices. And that's what you're focusing on.And we're just the opposite. So as CEO, I might actually at the bottom of our org chart. I'm the low guy in the totem pole, is how we structure it. So my job is to support and empower the rest of the management team so that they have the tools, processes, know-how to support the practices and the doctors.
So doctors and patients and team. That's the top of the org chart for us. And when I meet a doctor, 'cause like, okay, I'm the CEO, I'm the founder. Like, okay, he's the big cheese. No. I said, look,I tell doctors all the time, I am not your boss. I am your business partner. You are in charge of clinical, we'll handle the nonclinical.
It's gonna be a team. If we're gonna collaborate, we're gonna talk about stuff. we'll make agreements together, we'll make decisions together. And so it is a business partnership. And so, yeah, technically I'm, I'm in charge of a lot of stuff. I get that, but that's not how we run things. And a lot of things in our documentation and legal agreements, it's structured that way too, where we can't do a lot of things that a lot of groups can do.
Like Italked to an office manager and a doctor yesterday up in Seattle. And the office manager, she'd worked at a group in the past and she's grilling me with questions. Right? It's like,so how are you gonna set our pay? Like,I have no influence on pay. That'slegally, I can't affect that.
You know? Andwhat about our work schedules? Are you gonna make us work different hours? I have no legal ability to influence that. That's a hundred percent for the doc, right? And so I'm just going through all these questions. She's like. Wow, okay. This sounds pretty good, you know? And so if you can make the officer managers happy, that's,a good sign.
Right. So, no
Anne: kidding.
Ian:
Anne: No kidding. And I love that she's gonna take an ownership of the practice as well, and,and a good office manager will do that. designed by listening. What doctors want and it is working.
And I mean, again, if there's somebody out there that's listening and they're,just either burnt out or they wanna grow and they,really just wanna do great dentistry. With a good team to support them, that's gonna support the team they have right now. I mean, it's honestly, it's, a no brainer uh mm-hmm. To icon and, your support team. 'cause I mean, I, know a lot of the. People on your support team, and they're just good people. And we say this, you know, good people, find good people. And that's how you're building icon. You know, and this has been a pleasure. I,I learned a lot today, and I, there's astill a little bit more in the article in DE that we haven't, spilled.
Yeah. So,please go to our spring [email protected] and look at that. And then I also wanna ask you, there's probably somebody listening like, you know what? They're working the grind and they're thinking, Hey, what can I do to be an entrepreneur? So what would you tell your younger self and what advice would you give to someone that wants to impart on entrepreneurship?
Ian: Well, actually, you kind of said it earlier. So the biggest mistake I see entrepreneurs making. Is they get an idea like, oh man, Icould do something really well, right? I've got this really creative idea, and they focus on the idea and like, oh, this is amazing and I'm gonna get programmers or this or that.
I'm gonna build this great widget or this great software and it's gonna do these amazing things. And they have no idea if the market actually wants it. I've taught some entrepreneur classes in the past. And it's like, look the things that you have to consider are, what are you good at?
First of all, like, where is your core strengths? Right? Where are your
Anne: strengths?
Ian: And then what does the customer really want? And then can you deliver that? Right? And so, for example, I, Ikind of use a silly analogy. It's like, do you think there's a market for $5,000 automobiles, new automobiles?
You know, like, that's a great idea. There's a huge market demand for it. Check two of the three boxes, but can you deliver that profitably? No, you can't, right? you can't have a great idea and not be able to deliver it. And vice versa. You can have a great idea, but if the market doesn't want it, so you have to check all three of those boxes.
And that's the biggest mistake I see them making is not spending the time to do that. Voice of the customer, interview them, talk with them, say, Hey, I'm thinking about building this. Here's my concept. What do you think? And go and talk to potential customers. And ask them these questions and that will really give you feedback.
Like, yes, I would be interested in that, but I wouldn't pay more than X for it. Well, if that's not enough money to do that profitably, then maybe you need to keep thinking about what you want to provide, right? So I just see that all the time. Either they're building something that the,marketplace doesn't want, or they have an idea, but they can't deliver it at a price point that the market would pay for it.
or they get an idea, but it's not something in their core competence. You know, I have lots of great ideas. I can't execute most of 'em ''cause I, they're so far outside of my expertise, I don't know how to do 'em. So I. Stay in my lane and do for that? Not yet.
Anne: Okay. So you know how to bring the right people together.
So I, Ican't wait to follow your career. and I love that too. I hope people are listening because, you know, we don't want you to take your nest egg and just throw it into an idea that it's just not gonna work. No.
Ian: No. And,
Anne: but as a, entrepreneur spirit, sometimes you have to go through a couple iterations, and so if you've got an idea, do your research.
Right. I mean, how long did you say you,talked to doctors, that was a year and a half year and a half Yeah. Before
we started building anything. Yeah. Yeah.So everybody thinks it's, it's so easy, but it's simple. It just ain't easy. do it. If you've got the spirit and you bring the right people around you know, one of our core principles of do is start and don't stop.
And yes, uh, you know, we continue to do that. So. Thrilled to get to know you better. I can't wait to follow you. And I hope that if you're listening and you wanna change up your career path, give Ian a call. How do they get in touch with you?
Ian: yeah, good question. Yeah, just go to our website, you know, icon dental partners.com.
Just do a search for that. You can find us, or you can hit me up on LinkedIn either way, whether it's a doctor who's looking for a potential partnership opportunity or is just an entrepreneur looking for some advice, I'm happy to chat. I, I lovetalking about this stuff.
Anne: Well, I'll keep calling you then, because Ivonne, I'm always on that rollercoaster. So lovely to see you. And, if you're listening and you're a woman in dentistry, please remember we're getting our retreat underway. It's gonna be fabulous. 250. Amazing Women in Dentistry will be gathering in Charlotte, North Carolina, November 13th through 15.
Wow. So we'll just see you there. This year. We're pulling out all the stops for this retreat. It's our seventh annual retreat and we sell out every year. So get your ticket, and most importantly, everybody who's listening, keep doing you. Thanks so much, Ian McNickle. I'll see you on the road.
Ian: Thank you.
Anne: Bye.
