[00:00] Bryan Hyde: Welcome to the Phoenix Business Brief podcast. I'm Brian Hyde. Today I'm joined by Dr. Monzer Shekali. He is a dentist and has a practice that we're going to be learning a little bit about here in South Phoenix. But let's, first of all, let's learn a little bit about your journey. You do not have a typical story when it comes to explaining how you came to do what you do. So first of all, tell us just a little bit about who you are and what you do, and then let's examine that, uh, that pathway toward getting there. [00:32] Dr. Monzer Shakally: Sounds good. Well, thank you for having me and for the introduction. A little bit about me, uh, I was born and raised in Syria. I moved here to the US when I was 17 years old. I came here as a refugee. I was, uh, in the war in Syria. Many people probably know a little bit about that. I was in a revolution there, and I was exiled and made my way to Egypt. Eventually, I ended up in Iowa, of all places. So Did my— I lived there for about 10 years, did my undergrad and dental education, and then did a little bit more extra training after that. And then we moved, me and my wife, we moved here to Phoenix, and I've been practicing for a little bit over 4 years. And I started this practice from scratch about 2 years ago. It's not in what you would consider the nicest part of town, so to speak. It is Uh, Southern Avenue and 48th Street, right where Tempe turns into Phoenix, right in that South Phoenix area. So, um, very, you know, blue-collar area, lots of Hispanic population. We are in the parking lot of a Food City. Um, we're in the same plaza there. So it's called Southern Smiles. It is mostly, like I said, catered towards Hispanic patients. Our split is about 50/50. And we have somewhat of a different business model, and I'm happy to explain that a little bit more. And like I said, I wanted to guide this conversation both from a business side of things and as a patient side of things. So where should we go from here? [02:08] Bryan Hyde: I would be very curious what steered you in the direction of dentistry in the first place? It sounds like you had some wide open possibilities. Why did you choose this? [02:19] Dr. Monzer Shakally: Well, that's, that's a great question. If you are an immigrant or maybe the son of an immigrant, there's a joke that we say to each other is that you have 3 options. You can be a doctor, an engineer, or a disappointment. So, that's the joke I tell my patients. But in all reality, I do come from a family of medicine. It's so, it's the family business, so to speak. My brother is an endocrinologist, sister is a pharmacist, uncle is a ENT doctor. My mom was actually a dentist as well. So I had really a lot of different opportunities when I came here to the US because in Syria, you can't be a lawyer, can't be a finance major, can't be a marketing major. And those were things I had to consider. And in the end, I'm very happy I chose dentistry. It's truly something that I consider a vocation of mine. I think it's a great career, especially in times of uncertainty like this where people are worried about their jobs. That's, you know, I'm definitely not worried about that at all. Great work-life balance. I work 4 days a week. I make good money. And, uh, at the end of the day, my success is patients that are healthy. So ultimately, it's a win for me and for when the patient— for the patient. It's not— my win doesn't mean, you know, people getting screwed over or getting sold something they really cannot afford and shouldn't have. My success leads to better confidence leads to longer living, leads to happier lives. So it's very rewarding, very mentally stimulating. I also work with my hands. So a lot of people that have, you know, desk jobs have side hobbies on the weekends to do something to stimulate their hands. So it really combines everything. It's a career I recommend for a lot of people. I think it's an amazing vocation. So that's how I ended up being a dentist. It's mostly family and then Luck and eventually a very happy decision. [04:16] Bryan Hyde: Tell me about some of the challenges that come with starting a dental practice like Southern Smiles from scratch. I mean, so I don't gather that equipment is— that's a pretty serious investment, right? [04:28] Dr. Monzer Shakally: Correct. I mean, there are certain challenges with starting a startup that are the same as every other practice, every other business. Cash flow from the start, getting more staffing organization. So those are the same challenges that I'm sure every business owner has faced. In terms of dentistry specifically, it really is a very extremely capital-intensive business. So you have to invest a large amount of money upfront for the plumbing of the office, for the sterilization equipment, for the x-rays and the computer systems. So it's a very, very heavily it's very heavy costs upfront. Along with that, the most expensive thing in my practice is my license ultimately, because that's 10 years, almost half a million dollars of debt to get into. So that's the additional thing is that you are starting from a very large negative standpoint. So it's more difficult to obtain funding. And then Really, it's the idea that you're— it takes a long time to build that trust because dentistry is not like, oh, you have a broken AC, let's fix it. A lot of it is you're trying to convince somebody to do something they cannot see. A lot of times it doesn't hurt. It's very expensive. They have to take time off of work. They have to lay back and be shot up with needles and drills. So it's a very hard sell. And depends a lot on trust, and trust unfortunately takes time to build and easy to break. So you don't really see any return for a long time and high liability, the whole thing. The other thing that I would say that is really unique to medicine and dentistry as a startup is that a lot of practices do not have control over their pricing. So My labs, for example, they can tell me next month, hey, everything has been going up, inflation is going crazy, we're going to increase the cost, how much we charge you to make you a crown by 5%. Obviously, I can shop around to different labs, but ultimately, every lab is going to feel that the same, and they're going to pass it on to me. In other businesses, you just pass that cost on to the customer as much as you can minimize it. But in dentistry, For— and we'll get more into that aspect of corporate dentistry and whatnot, but pricing is somewhat controlled by the insurance companies. So if you have somewhere— if you have a situation where your prices are constantly going up, and prices are going up crazy, I know people kind of don't understand this, but I mean, every time we order, things are like up anywhere from 20% to 50% sometimes. And then your insurance reimbursement, not only is it not going up. In some cases, it's going down, actually. So you have that huge squeeze that's taking place, and that is a huge challenge for dentistry and medicine in general, really. So I would say those are really the biggest challenges faced in the start for me. I decided that that wasn't the route I wanted to take. I wanted to be able to use the quality labs I wanted. I wanted to be able to use the quality materials. I wanted to hire good employees. that all speak Spanish. So unfortunately, those people are smarter and they cost more. And I wanted to be able to warranty my work, which is something that a lot of places don't do in dentistry. As a result, I had to have control over my pricing. So for us, most of our patients are just patients that are uninsured that just pay cash or financing or whatever they want. We do have a number of patients that have insurance if your insurance has out-of-network benefits. Ultimately, patients come to me For a combination of reasons, it mostly comes down to trust. Whenever we do surveys, it's trust and good work. It's not really the price. But that's kind of where I would start. What do you think? [08:40] Bryan Hyde: You know, I'm curious, you know, from the patient's viewpoint, how do you connect up with your, you know, initial, you know, base of clients? Where you started from scratch? Where everybody needs a dentist, you know, but how do your clients, how did they find you? [08:59] Dr. Monzer Shakally: That's a great question. I mean, we spend a lot of money. So when you have an insurance-based business, like insurance-based dentistry or medicine, being in network with the insurances is kind of your marketing to a certain extent. It is a very extremely costly marketing where they have you by the neck and can't really It's the most expensive form of marketing, but it is marketing nonetheless. So for us, when we weren't really relying on that, we had to rely on a lot of different things. We've done basically all we've done: Google Ads, local service ads, direct mailers. We've gone to fairs. We've gone on the radio. We've—I mean—at the beginning of days, I would go a week without seeing a single patient. We simply would put our a table outside my office, and the people walk into Food City. We would talk to them. We would go to the neighboring businesses, give them. Free toothpaste, toothbrushes, talk to them. So, you know, with time, ultimately though, our best resource and marketing referrals are internal referrals, word of mouth, because ultimately, like I said, the trust is really what matters. So we really lean super heavily into that at this point. But keeping track of where the patients are coming from and ultimately how much how good of a fit they are for the office is something that I can discuss on how we're keeping track of that with internally built CRM softwares and all of that. [10:27] Bryan Hyde: But I'm curious what, what you look for in, in patients. I mean, do you— go ahead. [10:38] Dr. Monzer Shakally: Yeah, no, you're, you're touching on a great question. I am very selective with the patients I take in, so my initial consult includes a interview portion. I joke with my patients, it's kind of like a speed dating session where we chat about what do you do, where are you from, are you married, what do you consider, and trying to really poke at any preconceived notions that they may have about dentistry. Have they been screwed over in the past by a dentist? What happened exactly? So I really tried to get to the bottom of Is this a person I can communicate with? And when we are communicating, are we finding a lot of agreements in there? And is there— yeah, how close their reality is to mine. If somebody comes to me and they tell me that their dentist, their last dentist was the worst dentist in the world, or they tell me, I hate dentistry, a lot of dentists really want to avoid having that conversation. For me, I will not move forward until I understand why they're saying this. And a lot of times the patients have a good reason for it. Those are patients that are maybe somebody I can work with. If they just are— the best green flag is when they say, I had a bad experience in the previous dentist. Okay, where did you go? I prefer— I really don't want to bash them. What did they do? I really don't get— you have to really dig deep to get that person to speak negatively of somebody else. Those are going to be a very green flag type of patients. If they tell me the last Dentist was bad, and the one before him was bad, and the one before him I sued them, and they they they want me to make they made me a denture that was you know already cheap, and they thought it was expensive, and it didn't you know you couldn't eat corn on the cob with the denture. So expectations sometimes might not be there. So I'm just very straightforward. If they're extremely antagonistic as well, whatever everything is like. Pulling teeth with them. If they're disrespectful to my team at all, that's an immediate one where I just say, look, thank you for coming in. I'm not going to charge you for the consult. Your X-rays are all yours, and you took time out of your day to come in. So here, at least you get this. It's a $495 cost for the X-rays and exam and all that. They're all yours, free of charge. Good luck. So For me, really, I would rather be not busy, which is really not an issue anymore, but I would rather be not busy than have somebody that will make my life miserable. Because in dentistry, really, the liability is extremely high with treatment. And so I'd rather know from the initial phone call, this is not going to be a good fit, rather than after I've done 2 implants and 3 crowns on them. [13:31] Bryan Hyde: You know, I think about something you said earlier too about, uh, trust and the role that it plays, you know, in, in how you run your business, how you relate to your patients. Um, the best dentists that I can think of, you know, as I think back to the ones I've had throughout my life, absolutely, it was the ones I trusted, the ones that I knew. [13:50] Dr. Monzer Shakally: Yeah. [13:50] Bryan Hyde: They, they could tell the difference between fear or pain in my eyes, you know, if they were drilling on it, on a tooth, or It, it, but like you mentioned, it takes time to build that. So, um, where do you, where do you start when it comes to the trust building? [14:04] Dr. Monzer Shakally: So trust is, yeah, something that is very difficult to build sometimes, but takes— it's very easy to break. It takes time. It relies on a lot of different things. A lot of it, like I said, is how much agreement do you have with this person? We ultimately like people who we agree with, um, and we like people who are genuine. So I, I don't try to fake my interest in somebody. If somebody I'm really not interested in, I'm going to try to figure out why. If I can't figure out why, I'm just— I'm not interested. But in terms of trust, and this is really going to get to the crux of the issue of medicine and dentistry in the United States currently, 80% of dental offices in Arizona are corporate owned. So are you still with me? [14:50] Bryan Hyde: Yes. [14:52] Dr. Monzer Shakally: So they're corporate owned. There's the big ones that anybody can tell that they're corporate, like Aspen Dental or Western Dental. You can see a big sign. Everybody knows that they're corporate. And corporations have gotten smarter because they know this is not something— a lot of people are wary of corporations in their medicine and their healthcare. So what they do is that they buy these smaller practices like mine. They keep the name, they keep the market, the website separate, and they pretend like they're not corporate. So you don't know. The only way you know is every time you go there, it's a different dentist, it's a different team. that's how you know. And for those places, a patient goes there and it's a new dentist, so they tell them something, and then next time it's a different person. So that's what really makes it difficult. So we get a lot of free second opinions. The only free thing we offer in my practice, a free second opinion, if somebody has gone somewhere and they want to get a second opinion. And some of the stuff I see are really— it's sad. I'm sad for the profession. because there is private equity is really where it's coming from. And lots of patients are being told things that they don't need. And this is not just something I'm trying to make people fearful of, but it's something I've experienced in my personal career. My first job out of dental school, you kind of have to take what you have. You have $500,000 in debt. So I went to a practice that was one of the largest corporations in the United States. And I remember the way that it's set up, and this is— it comes down to also a problem from insurance, is that I was stuck between 2 options. Either I make money to be able to pay my bills barely, or, or I don't. Um, and if I had to make the money, I had to screw patients over. It wasn't something I really was able to sleep well at night. Um, and the last straw was the manager, who is not even a dentist but works with the corporation, had me in a room for a meeting and said, every new patient that comes in needs to get diagnosed with a crown. [17:02] Bryan Hyde: Wow. [17:03] Dr. Monzer Shakally: But not everybody needs a crown. Doesn't matter. Every new patient needs to get diagnosed with a crown. Well, good luck. Good luck, but no thanks. And that was the reason I started my practice 2 years out of school. Most of my dentist friends do not have their practice at this time, and practice ownership is going down. So the Number one, I tell my patients if or friends, maybe even a different state, is really ask who owns this practice. Is the owner operator there where if you you can expect to see them in in five to ten years? You can expect to see them there unless they they get hit by a bus, and their reputation is on the line every day they go there, where it's the quality is something that you really care about. Or is that a place where you'll— that's a temp dentist that you'll never see again? Are you having people switch every time you go in there? It's different people and different dentists. That's a huge red flag. I would say really pay attention to that as a patient. That should be one of your first things. How do you choose a dentist? [18:18] Bryan Hyde: No, it's been so long since I've had to choose one. I've almost forgotten. But no, what you're— what you're saying makes, makes perfect sense. And I, I have one final question I want to ask you, and this is just, you know, for, for your own sake. Feel free— you can feel free to toot your own horn here, but what is your favorite kind of feedback to get from, from a patient? Ideally, what, what do you want to hear your patients saying back to you? [18:43] Dr. Monzer Shakally: What do I want patients to say back to me? Honestly, In order to get to that point where they're giving us, hopefully, I mean, I guess they can give us feedback at any point, but really a patient that is appreciative of what I do. Dentistry is not an easy profession. You are essentially doing the things that handymen are doing inside a tiny space, looking over and it's like putting a door in, but that door screams at you if you touch it wrong. Anxiety is really something something that is extremely high in dentistry, obviously. And as a provider, you ultimately absorb the energy of anybody you are around a lot. So if you're working with a bunch of people that are always pissed off and angry, you're going to become an angry person and kind of flip out in your family for the smallest reasons. And in dentistry, we absorb a lot of the energy of the anxiety, which is why dentistry has a very high suicide rate. So I would say the feedback that I really enjoy is when somebody is telling me, hey, I appreciate you taking the time to spend with me and educating me. Nobody else has done that in the past, and I trust you. I trust that they refer their friends and family. That's really the best feedback. We also appreciate when somebody is being constructively giving us feedback. There's issues that happen in business always, and in life really. So it's a matter of how do you respond to those. So any feedback is encouraged. not always going to be implemented. Sometimes that feedback may lead to, well, it sounds like we're not the right fit for you. But I would say feedback in general is always good, and we encourage our patients to do it. We do a lot of patient surveys. We do a lot of that. [20:31] Bryan Hyde: Again, we are talking with Dr. Monzer Shekaly. He's the founder and dentist at Southern Smiles in South Phoenix. What's your website for people who want to check that out? [20:41] Dr. Monzer Shakally: It is ssmilesdental.com. I don't love the domain name. You can probably search Southern Smiles Phoenix, and that Pops up a little bit easier. But yeah, smilesdental.com. It's a it has a lot of my my work that I've done, and you can see the stories behind those people, how it's transformed their life. Our slogan is is transform your smile, improve your life because I truly you can see it in the pictures. So check that out. It's a website I built myself, so I take great pride in in the hours I spent getting it to where it is now. You can apply. You can book an appointment directly. You can request more information. You can see if you qualify for financing if you're thinking about doing something, a bigger treatment or need some emergency work. So— [21:28] Bryan Hyde: Okay. Thanks again. We appreciate you joining us today on the Phoenix Business Brief podcast. [21:34] Dr. Monzer Shakally: Appreciate it, Brian.