The Group Dentistry Now Show: The Voice of the DSO Industry – Episode 8

Our podcast series brings you dental support and emerging dental group practice analysis, conversation, trends, news and events. Listen to leaders in the DSO and emerging dental group space talk about their challenges, successes, and the future of group dentistry.

In this episode, John Bettencourt, Special Markets Manager at A-dec, provides his expertise and advice for emerging dental groups and DSOs when choosing dental equipment for de novo and acquired practices. Find out why price is not the most important factor when choosing dental equipment for your DSO. To contact John you can email him at

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Bill Neumann: I’d like to welcome everybody to the Group Dentistry Now show. I’m Bill Neumann, and I’m always happy to have new guests here and in particular somebody that I’ve known quite a while in the dental industry who is well known throughout the industry, not just in the DSO space, but dental industry veteran, worked for a dental distributor for 25 years and is now working in special markets for A-dec, I’d like to welcome John Bettencourt to the Group Dentistry Now show.

John is the special markets manager at A-dec. He said he’s been there for three years. He is responsible for developing strategies, programs and relationships for the company’s North American special market sector. His particular expertise is in building key customer and vendor partnerships. John works directly with DSO groups and also the dealer networks to identify opportunities to improve efficiencies, suggest scalable dental equipment solutions for growing DSOs and emerging dental groups, and to provide education to the entire dental team. Under John’s leadership, A-dec has steadily gained market share in the DSO space year over year. So again, welcome to the show, John.

John Bettencourt: Bill, thanks for having me. It’s always a pleasure and I love when you’re dating us both when you mentioned those long extended timeframes.

Bill Neumann: I’ve been around for a while as well, so yeah, I can definitely feel your pain, but it’s good experience. Wealth of knowledge.

John Bettencourt: For sure. For sure. Yes.

Bill Neumann: Why don’t you give us a little bit so we now have a little bit of background on you. So tell us a little bit, I think most of our audience probably knows who A-dec is, but maybe some don’t, so why don’t you give us a little bit of rundown on A-dec?

John Bettencourt: You bet, Bill. So A-dec is a leading dental manufacturer worldwide. We’ve been in business for over 55 years. We’re in 100 countries and over 1,300 employees, and we’re very proud to say that we still build our equipment here in the US. Actually we’re based in just outside the Portland, Oregon area.

Bill Neumann: Yeah. And if anybody’s ever had the opportunity to go out and see the corporate headquarters, it’s a beautiful place, beautiful part of the country, and a really wonderful opportunity if you can ever get out there to see what A-dec has going on.

John Bettencourt: Yeah, it is a special place. It’s a special manufacturing facility too. So yeah, welcome everyone.

Bill Neumann: We’ve got some questions here for John, and this is new for us, so we really, we talk a lot about a lot of different things in the DSO and the dental industry, but we really haven’t talked about equipment specifically, so John’s going to share his expertise, knowledge on equipment, and really what that means to emerging groups in DSOs and why that’s important. So maybe we’ll start with some advice. So if I’m a small group and I’m looking to purchase dental equipment or am a DSO that’s large, and whether I’m Denovo or whether I’m through affiliation, what would be your advice when choosing dental equipment?

John Bettencourt: Bill, that’s a great question. My advice would be we have to look at the big picture of things, not just the initial price tag. Sometimes we might get lost in that. You’ve got to consider the hidden costs you don’t see on that price point. What is the ongoing maintenance involved, repair, replacement of products, the expected lifetime of the actual equipment.

You also have to consider the human costs of things. The unreliable equipment is frustrating and stressful to the dental team. It also gives patients a negative kind of feeling when they walk in and they have to wait longer because they have to move somebody from a different room or a room is not working, whatever that might mean. So it does leave a negative impression in that particular location for a group.

And you have to look at the big picture, like I said, but you also have to look at what we call cost of ownership, right? And Bill, I’ll explain that. It falls into three different buckets. So you have your initial acquisition costs of the actual equipment. That’s what’s on the invoice. That’s what you’re writing the check for. It’s very important. We all know that, but you also have to look at the operational costs, which is the second segment. What does it cost to get somebody up to speed? What is the cost for liability? What is the cost for, like I said, onboarding folks. That’s the second bucket. And then obviously the last bucket is the maintenance part of it, so what’s needed to maintain the equipment over the lifespan of the equipment? So when you’re looking at that and you’re looking at the big picture, think of those things in three different buckets.

Bill Neumann: And is there a relatively easy way to break that down? Is there a way for you to evaluate what the cost would be for an emerging group or a DSO so they can understand that? Because you’re right, when you think about it, normally you first got to what’s this going to cost me initially, but there are the other costs that you mentioned that are equally if not more important in the long run.

John Bettencourt: Yeah, for sure. So reliability, in my opinion, that to me is going to pay off on the long run and in the short term. Equipment that works consistently day after day, it keeps the operatories full, it keeps the clinic schedules running on time, running smoothly, staff working optimally; you’re going to get production, and that’s just the facts. When things go well, it all pays off from a production standpoint.

So think about it before you buy, how durable is the equipment. That’s something you need to consider. What’s the expected lifespan of the actual equipment? Is it designed for the extra demands of a DSO? That’s something that I think is really, really important we don’t talk about as much.

Bill Neumann: So when you’re looking at costs, take a look at the reliability factor and really consider that as the key to making that decision because it is a big decision. It’s one of the most expensive things that you would … really when you buy something, it can cost quite a bit. But long-term reliability, how long are you going to have it, how long is it going to last, and then of course you talked about the maintenance factor as well.

Bill Neumann: So in a DSO setting, since you’ve spent the last three years really focused in special markets now, what do you notice as typical? So what’s different about the DSO setting and why is getting the equipment so critical to really a DSO and in emerging groups, so a smaller group that’s maybe just outfitting a couple of operatories or maybe a new location that they build out. Why is that so important to them?

John Bettencourt: Yeah, so I get asked that question quite a bit, the differences between your solo practice and why things are a little different for groups or emerging markets and how that ties into equipment, but that really comes down to how much the equipment is used, Bill. So that’s probably the biggest difference is when you look at the hours of an organization, a group organization, not like the private practice where they might be open from 9:00 to 5:00 four days a week. Group practices are open from 7:00 AM to sometimes 10:00, 11:00 PM and sometimes on the weekend. So the demand on that, the different users that come in and use that equipment. Obviously that’s really important and it puts some strain on the actual equipment, so quality, reliability, those are key factors, specifically for groups. Similar to dental schools, right? There’s a lot of wear and tear that happen with those dental students. Dental students, there’s probably no one that puts a hurting on dental equipment more than those kids, but DSOs are a close second, again, because of all the things I just mentioned. So there’s multiple users, there’s longer hours and all those different things, and 57 out of 62 roughly dental schools in North America choose A-dec, and even on those tight budgets, they recognize reliability just pays off.

John Bettencourt: The other thing if you fast forward, what does that mean to new grads coming out? They’ve probably worked with our product before. There’s some familiarity with our product going into a group that has it or going into a practice that has it. It helps some to the onboarding and again, they feel very comfortable. It’s amazing with a lot of these students coming out, the culture is very important where they want to go. They want to have a good culture, they want to have the work life balance, and we hear that quite a bit, but they also want to go to an organization that has quality equipment and has great technology, and I think that’s where we play a big part in this space.

Bill Neumann: Yeah. That makes a ton of sense. We’ll go back to reliability again and then of course, familiarity. So when you’re talking about the dental schools, I think most DSOs would admit that turnover is a big issue, so if they come into an operatory, into a system where they’re at least comfortable with the products and the equipment that they have at the DSO, and also it might be a good recruiting tool. So when you really take a look at this, there’s a lot of reasons why having something you’re familiar with, of course, from a reliability standpoint.

So let’s talk about this next question’s really intriguing. I want to hear how you define this. So ergonomics, we hear ergonomics a lot in the dental industry, and I’ll be the first to admit, I think I might understand it, but I probably don’t know all that ergonomics encompasses. So why don’t you tell us a little bit about that and then of course why is it important really for a DSO to even be concerned about that?

John Bettencourt: Yeah, so great question, and you’re right. That term, as you know, Bill, gets used quite a bit. When we develop new equipment, we really like to take the philosophy of working back from the patient. The comfort to the patient, to the operator when they have to come in and see a clinician. Our equipment is designed in a way where clinicians can get healthy posture. That’s really important. The design of our thin backs and those type of elements that go into manufacturing and designing our equipment along with the head rest and proper positioning from that perspective. For example, our chairs allow doctors and operators to get underneath because of its thin back, so regardless if you’re a 6’2″ operator or if you’re a 5’1″ hygienist or whatever that might be, you want to be able to not cradle that chair. You want to be able to slide your legs underneath and keep your arms elevated, not above your heart but within a comfortable range and not making a lot of class three and four movements.  So those are all the things that come into the realization of how equipment’s designed and why it should be that way. It’s really to help prolong the life of the dentist. We want them healthy. Proper ergonomics keeps the staff healthy. It keeps them healthy, and they’re able to practice longer. As you know, it’s important for groups. You mentioned this earlier, but turnover and those type of things. When they’re in an environment where they can come in and not deal with neck, back and shoulder pain, it’s a big deal. It absolutely is a big deal. As a matter of fact, 60% of dentists complain about some type of shoulder, back or neck pain. So if we can provide that equipment to keep them healthier during the day and treat their patients better in that patient experience and keeping the staff happy, that’s what we aim to do, and that’s how our equipment is designed and focused, and everything’s kind of around that ergonomic factor.

Bill Neumann: That makes a lot of sense. As far as ergonomics and clinical efficiency, talk about the connection there because efficiency’s important to DSOs and groups.

John Bettencourt: There’s no doubt. So if your clinicians feel comfortable, if they maintain a healthy posture, they’re going to work longer. Equipment that helps teams work together more proactively is going to produce more productivity. So without leaving the room or your eyes off the cavity, that’s all going to increase your efficiency, so it fuels profitability and growth, and those things are important when you have people waiting in that waiting room and every room is booked, so how can you provide, again, the best dentistry that you can and keep your patients rotating through. Efficiency is a function of furniture as well, so it’s not just your chair and delivery system, having everything around you within an arms reach, like I mentioned before, not having really dramatic movements to reach for materials or instruments, those types of things all come into play. And just to kind of broaden from outside the operatory, same thing with sterilization, so lay out of sterilization, the ergonomics of how to get to it, what to grab, what’s dirty, what’s clean, bringing that back, and that’s what we can do to help. A-dec is we’re designed around good economics and it’s to maximize efficiency. That’s what we’re trying to accomplish.

Bill Neumann: That’s important thing to consider. I think capital expense, so this is the other consideration. So with equipment, any equipment really, especially when you’re scaled as a DSO, it can be a major capital expense. So how do DSOs make the decision and how do they feel confident about making a decision when it comes to purchasing equipment? Yeah. So first is what’s the manufacturer’s reputation? Are they known for quality? So all of the things we just talked about, Bill, quality, efficiency, ergonomics; that all plays into that factor. Secondly, what kind of support are you going to get after the sale? We look at equipment as not a transactional event. It’s not a disposable product. Equipment is a long-term investment.

John Bettencourt: So warranty is the minimum you should expect. Do they have good customer service? That’s another factor. What is that support after that you can make a phone call and get some basic things taken care of over the phone? The other thing too I highly recommend is talk to technicians out there. There’s technicians in these locations all the time, and ask them what do they think? What are the brands? What’s most reliable? Which ones are designed to easily maintain and install because for groups, getting that installed, building out Denovos, as you know, it all has a time factor and it’s usually either moving a different location or adding another location. Those things all come into play. Do they provide training and support for the installation, troubleshooting and maintenance and those types of things. Those are all key factors. Another consideration, are they going to have parts down the road? Sometimes those are the things that obsolete a package of equipment or a piece of equipment is, yeah, it’s great for the first few years and all of a sudden you can’t get parts for it, and you kind of forced yourself to having to replace not just a chair or a unit, but now replace a whole operatory. So those are all things that I think are really, really important to take in consideration, specifically and especially for groups, regardless if you’re an emerging or if you’re a large or a national group. It’s really important, and it’s a key factor.

Bill Neumann: Yeah. All really good points, and you talk a lot about if the parts become obsolete and you’re replacing chairs or operatories, and multiply that if you’re a group buy X amount of locations. That could be a major capital expense. So it’s not always about just what that initial cost is. Get back to reliability and a brand that’s well known and is going to be here for the long haul. But if I’m DSO … Here’s the but. But if I’m a DSO or an emerging group and I’m going to sell in five to seven years, wouldn’t it make sense for me to just go out and say, “You know what? It’ll be somebody else’s problem then,” so why should I really buy A-dec when I can buy something that might be less expensive?

John Bettencourt: Yeah. And that’s, again, a very common question. It’s not unusual, Bill, but it all goes back to the principle of reliability pays off, longterm as well as short term. If you’re going to go out there and invest in equipment that you’re only looking at very short term like that, it isn’t like all of a sudden, that fifth year and then you start to have issues with your equipment. If you don’t have equipment that is built for longevity, the chances are you’re going to have issues from day one is probably more likely that. Does that make sense?

Bill Neumann: It does.

John Bettencourt: Yeah, so even if the equipment breaks down, it isn’t working, you’re not generating income from it. Again, you’re not getting a good return on your investment no matter what the initial cost was. If you saved a little bit up front, remember on those three ways to look at the cost of ownership, yeah, you’re saving a little bit on the acquisition costs, but you’re sure as heck paying a whole lot more in that operation on that maintenance costs. And we as A-dec absolutely appreciate that there is budgetary limitations, and this is one thing that I want to make sure that your viewers, Bill, understand is we have a portfolio of products. We are obviously, like I mentioned before, a leading manufacturer of quality products, but we also have a full spectrum, and you’re not lacking on any type of quality from our flagship product to our basic product. What you really are not getting really is just maybe some creature features and benefits, but you get the same reliability, you get the same longevity, so that’s really important for us, and that message is really important.

John Bettencourt: We have custom tailored programs for groups of all sizes, and that’s really important to understand because for us, it’s not about the short term; it’s partnering with organizations for the long-term. Again, regardless if you’re just starting off with just a few locations today and you don’t plan on having 100 in 10 years or whatever that might be or if you’re a really large organization, it’s about partnering with you through the good times and through the growth times, so that’s really important to us.

Bill Neumann: Talk to me a little bit more about the partnership. So, there are A-dec territory managers out there, you talk about service and support and how important that is, so tell me a little bit more about what that team can bring to the table for somebody beyond … Once they purchase the equipment, what can they do for you?

John Bettencourt: Yeah, so that’s another key differentiator for A-dec. We have the largest, and sometimes largest isn’t the best, but we have the largest, and selfishly, with true humility, I think we have the best sales force out there, and that’s important because, again, it goes back to that after the sale support. It’s a huge advantage for us. We put a lot of focus on our territory managers, which have, by the way, I think an average of about 12 year tenure with us, and there’s 70, which is a close to three times more than probably any other equipment manufacturer out there today. But it’s really working with those individual locations, regardless if its ergonomics like we talked about or if it’s helping with lighting, what lighting means and how we can help not strain from that perspective. It’s seating. It’s what we call Angles of Access also with just a program we put together to help doctors communicate with the assistant and how to position to maybe help from limiting, again, reaches and stretches and those things that we see that can cause some health issues. So that’s what we do. Our TMs are out there. They’re helping these groups, they help the individuals within the groups, and we’re pretty proud of that. Every single one of our territory managers are ergonomically certified, so they have certification that allows them to go and give CE. Same thing with lighting and our Angles of Access programs. So that’s really important, and the feedback and the experience while I’ve been focusing in this space here has been really, really positive because we are helping them physically, and we’re helping the teams, and for us and for the teams, it’s really been a key differentiator, like I mentioned, for us.

Bill Neumann: Well that’s great to hear. So that’s really the sales, the service, the education after the fact that the field, the territory managers can do. Once a DSO or an emerging group works with you, they decide A-dec is the way to go, and it’s not just, “Okay, here’s your equipment and we say goodbye.” You’ve got a whole slew of service opportunities, education and support there after the sale, which is important because not everybody has that.

John Bettencourt: Yeah. Well our company was started by an engineer, and the vision was how do we make the dentists’ life better? How do we make products that are better and make them the best? That’s how we operate today, and we’re here to help. Like I said, it’s through the short term and the long-term.

Bill Neumann: Yeah. Well that’s important to keep in mind. So last question for you. You’re at a lot of DSO and emerging group meetings, shows throughout the year and also dental shows, just general dental shows. So if I’m an emerging group or a DSO, I’m able to see you at one of these meetings and actually have a chance maybe, at some of the larger shows anyway, to actually touch and feel the equipment.

John Bettencourt: Yeah, you’re right. I do go to several DSO specific shows, both in every segment, the emerging, the larger national group shows that are put together and a few of the large shows. The next one I think is New York. I think that’s probably going to be the next one that I’ll be at, but you most likely will see me or one of our territory managers at those. But yeah, Bill, I really appreciate it. Anything that your viewers, if they want to get ahold of me, I know that you’re going to be sharing my information, but I’d love to meet them at one of these upcoming shows would be fantastic. Thank you.

Bill Neumann: Thank you, John. Well actually that’s a great lead in, so John, can you just give us your email address, and then we’ll actually for the viewers … So for the listeners, they’re going to need to hear it, and then for the viewers, we will post your email address, but what’s your email address, John?

John Bettencourt: Sure. It’s

Bill Neumann: Okay. Well that’s great, John, and thanks again for the information. I really appreciate it. I learned what ergonomics really means and heard the story behind A-dec and know that you and I both have a tenured career in the dental industry.

John Bettencourt: It’s always great talking to you, Bill. Thank you for having me on.

Bill Neumann: Thank you, John. Really appreciate it.

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