A Tale of Entrepreneurial Grit in Oral Healthcare | Dr. Josh Everts

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In this episode, we learn about Josh Everts' journey as the founding physician partner of OMS360. Josh discusses the successful multi-site practice he and his partners built and the thorough due diligence process they underwent in selecting Shore Capital as their private equity partner. On a more personal note, Josh shares how he as a leader realized that he needed to step back as the business grew in order to allow his team and the business to grow and flourish.

Transcript

Introduction

Michael Burcham: Welcome to Microcap Moments, a podcast from Shore Capital Partners that highlights the stories of founders, investors, and leaders who have taken on the challenge of transforming ideas and small companies into high growth organizations. The journey of building and scaling a business takes one down many unexpected pathways.

It's a journey where we learn from our mistakes, fall down often, but have the entrepreneurial grit to pick ourselves up and persevere. Within this series, we will share these stories of success and failure, of the challenges and their rewards faced by those who dare to dream big. And through their lessons learned, we hope to inspire others who are on a similar journey of becoming, growing and leading.

In this episode, Anderson Williams will be talking to Josh Everts, an oral and maxillofacial surgeon who built a thriving multi-site medical practice throughout Alabama and Georgia.

Dr. Everts joined the Shore Capital family in 2021 as the founding partner for OMS360. Josh is an influential figure in the oral surgery field and is passionate about driving positive change and empowering professionals in the realm of private equity and dental service organization integration. With extensive experience in both clinical practice and business management, Josh specializes in helping oral surgeons navigate the evolving landscape of corporate dentistry while maintaining their clinical excellence and autonomy.

Josh completed his undergraduate degree and dental school at the University of Iowa. He then completed medical school, a general surgery internship, and his specialty training as an oral and maxillofacial surgeon at the University of Alabama School of Medicine. He and his wife Carlin, along with their three children, reside in Alabama.

Josh Everts: My name's Josh Everts. I'm an oral and maxillofacial surgeon. Practice in multi-site specialty practice in Alabama and Georgia.

A Bit Of A Planner

Anderson Williams: And can you say how you started in your career when you got out of med school and all of the seemingly infinite training you've been through and the decision to start a business or what other options were on the table early in your career?

Josh Everts: My story kind of goes back even further. I'm a planner. I really am. I always want to know what's next and where I can go from here. And that journey started in high school, really, honestly. And I learned through personality assessments and any tests I could take to tell me an answer to what the future holds.

Owning a business, being an entrepreneur, but also the field of medicine was something that might intrigue me. Spent a lot of time shadowing people, spent a lot of time with my dentist, with some oral surgeons, with some plastic surgeons, with ENTs, with people in the industry, and even going into college knew that I wanted to go into dental school.

So, made up my mind really, really quickly. I'm not really sure what gave me the clarity and the foresight, but I'm grateful for it and grateful the Lord gave me the ability to be able to be skilled at those things along the way. We don't always know ourself that early, but I think as I marched through undergrad and dental school, I learned more and more how much I loved both the medical aspect and the dental aspect, and the business owner aspect of oral surgery.

Kind of has a nice blend of all of those things. My decision was really solidified when I went on mission trips during dental school. I fell in love with what we get to do as surgeons and ways we get to do it. And that kind of helped me live that out in real life and find ways to use those things before the hypothetical occurs when you're trying to choose a residency.

So that was really the most powerful part about my experience that gave me at least the tangible real-life experience that felt like this could be a reality for me just in terms of oral surgery itself.

Intension And Focus

Michael Burcham: In the following segment, Josh shares with Anderson how he got started in the business of an oral surgery practice.

From getting an SBA loan, getting started, and even a side hustle to get his business off the ground. Take note of Josh's comments about learning to give up some control and not trying to make every decision. It's a great lesson of learning to focus and to spend your time on the right things.

Anderson Williams: How did you get started, right?

It's one thing you've been through all of this school to become an oral surgeon. To my knowledge, none of that included business school. So, tell me about how you even got things off the ground in those early days.

Josh Everts: My decision to practice oral surgery had a large part in the fact that I could own a business.

And so, I actually did take a few business classes in undergrad. My dad was smart enough to mention to me, maybe it's helpful to take some economics and some accounting. Had some baseline information on that, but luckily, we got connected with some of the right people along the way. And one of those people was a consultant we worked through with coming out of residency who helped us do some demographics and understood a little bit about what it might take to set up the beginnings of a practice just in terms of its structure. Went through a process of an SBA loan and building a new building.

And then actually got a very fortuitous connection in that while starting our practice, my partner understood that we weren't going to be able to maybe financially support our families if we didn't have a side gig, uh, and that side gig actually just turned out to be associating at another oral surgeon's office.

We started with a combination of both private practice ownership and a group practice associateship. That grew into a great relationship. We really had a great time learning his aspect of the business, the older surgeon, and that grew into an opportunity to buy his practices. So, we bought his practices after a few years and kind of naturally evolved into what is our group practice model over time.

Anderson Williams: And as you did that, give me a sense of the timeframe from sort of getting out of school to acquiring those practices, just a sense of the pace at which this was unfolding.

Josh Everts: Slow, it did, it took a while to really grasp what was happening and just as much give me a sense of how each role was developed inside of the practice.

I think it's really important to understand if you're going to put somebody in a position what that position entails. Part of that was also my inability to give things up as a practice owner, you really want to have control so much so that you do more jobs than you maybe should, but that was a great lesson in how do I then engage the person that is going to take that task and give them the correct expectations and responsibilities and tools and resources to do that in a way that benefits the organization as a whole.

I spent a lot of time the first three, four, five years doing all the jobs and probably messing it up more than it needed to and slowing down the progress more than it needed to. But it was part of the natural learning process. And after three, four, five years, I was able to finally step back from a few of those roles, put the right people in the right place.

And amazingly enough, when I got out of the way of the business, it had a chance to grow and breathe and move on. But without that experience, without those trials and errors and the testing process and the feedback loop that occurs when you're very small and you need to make nimble changes and you're trying things out and testing things gives you a better sense of why you do what you do.

So that was really beneficial those first five years of kind of struggling through the early phases.

Anderson Williams: And that letting go is a lot easier said than done, right? You've poured everything into built starting and then growing. But then at some point you've got to reevaluate your role in this thing you've built.

Right and I'm just curious, how did you do that? And how did you overcome that desire or need to control those things? Like what was the trigger to make that transition? Because honestly, that's where the business has an opportunity to mature, and your talent has an opportunity to grow in your ability to step back and kind of shift your own role.

But again, how?

Josh Everts: A lot of self-assessment and reflection and realizing that I didn't have enough time in the day to do all of those things. There's a great quote, it talks about the myth is that there isn't enough time and then it's actually there is enough time, there isn't enough focus with the time that you have.

You win by directing your attention towards better things. And I think that mindset shift allowed me to realize I can be better spending my time and attention and focus on things that I'm highly skilled and qualified to do and enable the people that are highly skilled and qualified to do the things that they can do at a better, efficient pace, a more effective manner.

That was somewhat of a maturity issue for me just to realize that I may not be the best person suited for this task. And that's not always an easy thing for a surgeon to recognize. I think we get a little bit of a complex coming out of residency, which is necessary in the sense that we need confidence.

We need to be able to perform our task unwavering in a way that instills confidence in those around us. But that can bleed over to areas where we maybe have false confidence and don't quite have the skills and abilities that that physician needs.

Adapting To Lead

Michael Burcham: Next, Josh and Anderson talk about the differences in the mindset of a surgeon versus how Josh had to adapt to lead a business.

From making decisions with little to no emotion, and primarily based on fact, to dealing with the reality of human emotions in running a business while ensuring that individuals are heard and part of the solution. I found the way Josh describes these differences to be very insightful.

Josh Everts: Surgical residency can be intense, long hours, high stress environment, high pressure environment. You need to be able to make clear, concise decisions without emotion and often circumstances, and do so in an environment that does not provide a whole lot of positive feedback. And so, you develop a pattern of very systematically undergoing a decision making process, implementing that decision, and moving forward regardless of the setbacks, and then assessing the situation, making a decision, implement those changes.

And so, it becomes a little robotic to a sense, which is on purpose. You need to have a pattern of thinking that occurs almost spontaneously so that the stresses of those things around you don't implement your ability to make that decision. That is not how things happen in business. And learn very quickly that when human emotions are involved, there's a lot of adaptation and decision making on the fly.

And when you've made one decision for one employee, those do not always reapply to the next employee for that next decision. So being able to step back and understand you need a personal relationship, you need to know that there's emotions, and those emotions have years of background built into them.

And trying to gather a deeper understanding of what's at stake as opposed to a pre prescribed answer, a surgical treatment plan, if you will, to business related and staffing related issues. It creates a very sterile environment and a very distant environment for your staff. And that distant environment is then connected to your patients.

Your patients don't feel that same connection to. So, it did take a while. And I can't tell you there was a specific time and place that led me to that realization. But when you keep on hitting a wall, you start to realize you need to do things differently.

Anderson Williams: And say some about how you invested in that, right?

I know you're an avid reader. I have a small book list from you that is in the queue and greatly appreciated. But what did you do in that critical time when you started to hit that wall? To not just have the aha, but to be able to chart the way forward.

Josh Everts: One thing I've always focused on, and I'm not sure when I was really introduced to it, but a philosophy called Kaizen, and it's a Japanese philosophy that was implemented at Toyota in manufacturing and then it's been processed through lean practices. Talks about continuous improvement and realizing that small changes and identification of waste or stressors or inefficiencies can lead to the ability to slowly but surely improve things across lots of different avenues.

Well, I love that part. I love being able to tweak something and move something and give something a little bit of an edge and thinking about that 1% improvement everyday compounds over time. But the other part of that philosophy that I maybe ignored until it reared its nasty head was, you need to allow the decision-making capabilities to be driven down in your organization for that to occur. And for real Improvement to be made anybody in the team needs to be able to bring up an issue that's occurring and that takes real communication. That takes real feedback.

It takes empowering people to be able to speak up and identify things and then feel like they're being heard in a way that's going to affect the things that they're discussing. And so, I think what was initially a philosophy that served me well just on a personal level, I needed to listen to the whole philosophy and understand that you can't just do that from a top down perspective.

It really, for it to work, somebody needs to be able to stop the assembly line. And that's the person who's on the assembly line dealing with the problems day in and day out. And that gave me a chance to realize that there's more than what I see. And to be able to connect with that is a personal connection.

It's not a surgical connection or a medical connection. It's very personal.

Scope And Scale

Michael Burcham: In the following segment, Josh shares how his practice has grown and the approach he used to build a very successful multi-site business.

Anderson Williams: Give us a scope and scale of your practice that you ultimately built.

Josh Everts: After starting our private practice and then joining as an associate with the senior surgeon at a couple other locations, took us a little while, obviously, to gather the understanding of what it might take to bring those organizations together.

When we did that, we honored the business model that he had created, while in parallel operating on our private practice in a way that give us a almost like a testing ground. There's a little lab where we could try new things while preserving the way that he practiced, which is a much more typical way to practice.

So in our newer practice, we developed certain models that might create new efficiencies, patient conveniences, things that might go outside the normal realm of how an oral surgeon might practice today, while understanding whether or not those were truly effective and giving them time to develop and understand.

And then over time, after we had owned other practices for a little while, we decided to roll in one or two of those at a time to see whether or not we could make that same transition with an older established practice. And that was great practice for us to understand what a multi-site portfolio company like OMS360 might require when it comes to merging and implementing best practices across lots of locations.

We used that experience to then start up a De novo. That De novo required us to have more surgeons, so we recruited a great associate and another God given blessing. We couldn't have done that without the right person in the right place, and I think we got very lucky with someone who was very growth oriented, wanted to be a part of the team, and taught us a lot about making sure that that step is critically curated.

That if you can understand who the person is, what their motivations are, where they want to go, and make sure that's in alignment with what the organization is headed towards. There's a lot less resistance in what that partnership and that teamwork is going to achieve. And he stepped in lockstep right from the start.

And the changes we were able to make at the De novo really skyrocketed our growth faster than either of the other practices that we had owned and operated. So having a practice we started, a practice we merged with that had multiple locations, and then a brand-new practice with a new surgeon, kind of started to give us the perspective of what it takes to do each one of those things, and how the playbook looks, and what the growth plan looks like.

And so that kind of set us up for, how do we expand this? How do we move this to the next level?

The Right Partner

Michael Burcham: In the upcoming segment, Josh shares his journey and the impact of the 2020 pandemic in deciding to explore a partnership with private equity. Josh spent a few years talking to nearly 30 potential partners and organizations to set in place the future growth path of his business.

Anderson Williams: So, given that you had already built a multi-site practice, what were your considerations as you looked at potential partnership with private equity? What other things did you consider? Just give us a little bit of sense of your thinking about selling your practice.

Josh Everts: That's a great question. I'll maybe back up just a minute and tell you why we even broached that subject.

I think we probably all can agree that 2020 was stressful. And so, the process of furloughing employees and deciding on safety protocols and patient tactics to manage and mitigate ever changing regulations was exhausting. My wife does not like me when I'm watching the news cycle continuously. I didn't like myself very much at that period in time.

And coming out of it, I realized, just like I realized early in my life cycle, I needed a different team in place. I need to be able to have better support systems for my staff. And I don't need to be the bottleneck for a lot of these decisions. And so, my partner and I sat down and had serious conversations about is this something we are willing and able to develop internally to create higher level employees and systems and departments that supports the growth that we've already achieved in a way that continues to grow it that way?

Are we satisfied with the growth we have, and we want to stabilize or even contract a little bit to manage where we're at and be more responsible with what we have? Or is there a model outside of that that might continue to progress the momentum that we've got going on? So, after a failed attempt to hire some people coming out of COVID, couldn't get a lot of people who didn't want to be virtual.

And we had a little bit of a difficult time finding the right talent development in our local area. We got introduced to the model of a management support organization or dental support organization from some friend of ours. It's actually a local organization that approached us, that educated us a whole lot about the structure of these types of organizations.

Ultimately, that was not the right association for us, but it gave us an opportunity, my partner and I, to see us in a future we'd not really even materialized in our own mind, right? We really had never put ourselves there. And in all honesty, if you would have looked at our five-year goals heading into 2020, one of them was to understand the DSO space and beat them at their game.

We wanted to achieve what they were doing, and we were doing a pretty good job of it. Four practices in, only ten years into practice, and so once that kind of aha moment set in that you don't have to fight it, maybe you can join it and still be part of the same growth, it started to parallel that same thinking we thought about earlier in the practice about maybe I'm not the best one to be doing this in all avenues.

Maybe there is a way to implement a team approach, a partnership, where you can bring in the talent necessary to continue the growth and maintain what you've done and maintain the vision that you have. So, we spent the next year, year and a half talking to anybody and everybody. I think we talked to more than 30 different organizations that spanned direct investors, private equity, dental service organizations, single specialty, multi-specialty, and even just smaller investors that were looking to invest capital in terms of growth.

All those have their benefits and their drawbacks. Ultimately, we decided that we wanted to be part of an oral surgery specific specialty organization. And so, we narrowed our focus to those and whittled our focus down to about four or five groups that we were worth entertaining offers and really sitting down and looking to what life would be like after a partnership.

We noticed very quickly that they were very different. Again, this is a space that none of us get access to until we do, and then it becomes overwhelming very quickly. And so, getting a crash course in how DSOs, MSOs work and how the investors work behind the sidelines and how you as a potential partner work beyond that was great.

I really enjoyed the process of asking the questions and getting the answers and understanding that there's layers upon layers of how these things work and how they flush out over time. And so that gave us the chance to really develop our priorities. I don't think we really had those before we really were open to the conversation and allowed those conversations to take place.

And so, we've developed the priorities and those were really how do we maintain the current culture that we have in our practice? How do we continue to guide that ship in a way that lives out the journey that my partner and I have dreamed of? And then how do we make it just as if not more financially advantageous for us as both a business and as business owners but also for our staff and the families that we're responsible for?

All those things lined up really nicely with Shore Capital. That was ultimately our choice was to go through a partnership with Shore Capital. This was at the beginning of their venture into oral surgery and so we got to be one of the founding partners with their oral surgery organization, OMS360, which was also very interesting to me.

And I desired that as an oral surgeon who started a practice. I like the entrepreneurial aspect of it. I don't mind the trial and error and the sticking points. I actually feel like that's fun to be a part of because you learn a lot in that process, and you get to take a lot of pride in the fact that you've helped create something.

So, all of those things together led us to make the decision we did, and we're a year and a half in, and it is what I thought it would be, which was part of the research that we did, and it's fantastic. I couldn't be more happy with our decision.

Michael Burcham: Now, nearly two years into this partnership, Josh shares how his experience has been thus far.

Listen as he describes some of the more intangible benefits of being part of a larger organization.

Josh Everts: You take for granted in residency the collegiate atmosphere that you have and the collaboration and the people that you have access to, and when you come into practice, even a group practice like ours does, you live in a little bit of a silo.

It can be lonely at times. You don't always have the people available to you that could mentor you and lead you in the way that you might need to be led. Felt like over the years I made a lot of decisions I didn't know whether I was qualified to make. And you obviously get qualified over time real quick, cause life has a way of teaching you those things in real time.

And so, until we partnered, I didn't understand how important it would be to connect myself to oral surgeons outside my practice. I knew I would enjoy that; I didn't understand how much I would enjoy that. I think all of us have understood now, now that we're part of this partnership, that that's most definitely something we want to continue to evolve and create greater access and expand upon because I think we're just at the beginning stages of what that can be in the form of a doctor advisory board that has real life consequences for how the private equity firm interacts with the specialty as a whole.

In the form of mentoring relationships where people outside your practice can feed into you and you can feed into them through the form of sharing of best practices and understanding how people are doing it across multiple landscapes in multiple areas. And then just back to COVID risk mitigation, there's safety in numbers.

And I think when you at the end of the day can realize it's not just you in all of this, whether you're a single practitioner or, you know, a key member in your group practice, there's a lot of comfort in knowing that you've got an entire team now. And that team is, starts to be your family, just like your local practice is your family, and that's helpful.

It's very helpful just from a mental health standpoint and ease of transitioning from one phase to the next.

Anderson Williams: And in that process, Josh, I'm sure you had some thoughts yourself and I'm sure your colleagues wrestle with it, but can you speak a little bit to the perhaps concerns or misperceptions around private equity in this space and how that's played out for you in this first year and a half?

People have a lot of beliefs founded or otherwise about what private equity looks like. But can you speak just a little bit about your experience? Maybe if you had some concerns, how those have played out or otherwise.

Josh Everts: I think when we make the decision to pursue our professional venue, whether it's academics or private practice or group practice, we immediately justify that choice and we create comfort in that we've made the right choice.

And in order to do that you somewhat vilify the alternative. And when you do that, it's a pretty strong reaction because you need to continuously almost reaffirm the fact that you've made the right choice. And when a new opportunity comes in place, they're already the villain. Whether they liked it or not, or whether they earned it or not, you've created that inside your mind because of the decisions you've made over time.

So it doesn't have to be private equity. It could be any number of things. Change is hard. Change is tough when it comes to a new model of doing business and I think will naturally have a wide scope of people. Those that tend to be the loudest are the ones that are against. And so, we hear a lot of voices about the things that can go wrong.

And those things definitely can go wrong. And I don't mean to make light of the way certain operations manage themselves, but no different from walking into a Walmart versus walking into a Nordstrom's. They're retail stores. They're very different experiences. You can say the same thing about private equity.

You will not encounter two private equity companies that run themselves the same way, and the way that they run themselves is the critical aspect of whether or not that's a partnership you want to be a part of. I had a little bit of a cheat sheet because I got to know a key member of one of Shore Capital's other private equity companies, Southern Veterinary Partners, and so to watch his journey from a founding member to a recapitalization and everything in between was a great insight into what are they really like, what really happens after partnership.

And I think those are the key questions you have to ask. I think money can be distracting and the financial component is obviously one of the main reasons people make a decision to do this, but it shouldn't be the only reason. And so there needs to be a long list of reasons against or for joining with an organization and those need to be backed up by the culture and the responsibility of the organization itself.

Critical Advisory Role

Anderson Williams: And I think you as a doctor would have concerns potentially about 'are they going to define how we practice medicine' and 'what autonomy do I have to my expertise' and all of these other things. But you are both a founding practice, but you're also a board member. You're playing a critical advisory role and kind of a liaison role with some of the other doctors.

Talk a little bit about why that matters in terms of dispelling and showing early and often that we're going to approach this differently as a platform than maybe you've heard about before.

Josh Everts: I think most practitioners, medicine, surgery, whatever it may be, can agree that our primary focus is patient outcomes, patient care.

And I think if we get distracted from that in a way that reduces the ability for us to provide quality care, whatever it is, medical, dental, surgical, if the business interferes with that decision making capability, it's doing a disservice to the specialty. When it comes to protecting the physician's ability to maintain patient care. It takes checks and balances.

It takes drawing of boundaries and deciding upon steps to put in place in order to make sure that that maintains itself. It's not as easy as saying we're an organization that protects physician autonomy. And so, to be part of an organization that has doctors on the board, not just has doctors on the board, I'm on the board and I know that this is true.

They look to us for confirmation that this is appropriate for the specialty. They want to steer clear of anything that affects the physician's ability to practice their specialty, and they want to do it in a way that enhances their ability to practice, as opposed to distracts from. And I think to hear that in their language on a monthly basis. Every time we'd come across a critical decision.

How does this affect your ability to deliver care? When those questions are asked enough times, you start to realize that they're serious.

Michael Burcham: In this final segment, Josh shares with Anderson some of his lessons learned and insights since becoming part of Shore Capital.

He also shares great advice for colleagues in his industry who may be considering such a partnership.

Anderson Williams: What are a lesson or two that you've learned in the last year and a half?

Josh Everts: You know, the whole concept of selling your practice has a lot of smoke and mirrors around it. And I don't feel like I have sold my practice, quote unquote, when I partnered with OMS360.

And I think that's a mindset shift for some of our surgeons to understand that our organization wants you to continue the way that you practice and the culture you've exhibited inside your practice and your ability to make decisions and direct your growth. And they are here to empower that.

I think the concept of partnering with a DSO or private equity organization is in the twilight of your career, why don't you cash in, get something out of it, coast, don't worry about a thing. You just focus on your surgeries. We'll take care of the rest. And although that's part of what OMS360 wants to offer, we want to be able to allow you to focus on your surgeries. We also need you to be a part of an instrumental part of your practice.

And that was the reassuring part to me. And I don't think that's the same across all DSOs. I think that's maybe a differentiator is that we are truly looking to partner with surgeons that are still wanting to be a part of their practice. They care about their practice. They care about their staff. They care about the way things are implemented.

And we want to be gasoline to that fire, an accelerant to that growth.

Parting Advice

Anderson Williams: So, based on that and based on your experience, what advice would you give or wisdom would you offer someone who's just in that early stage where you are doing your research about what are the various avenues? What advice would you give that surgeon or group of surgeons as they consider their own options for growing their practice, partnering, getting additional investment?

Josh Everts: Yeah, even a step before you think about it, I think your organization needs to decide on your priorities. What is important to you, both personally and professionally? Where do you want to go and how do you want to get there? That may or may not include a partnership. So, before you even think about it, I think understanding where you're at and where you're headed is priority number one.

Secondly, become educated. Having conversations is different than engaging in contract negotiations. And so, for a long time, I think I was real nervous about sharing any information about what we were doing with anybody, which leads to a lot of dead ends and very little amount of communication and education.

And the more I was under the assumption that people actually do want to know about you, and they want to share information about them, it kind of opens up a whole nother world of maybe there's other ways to do things and it doesn't hurt to learn about them. And so, information gathering most definitely includes a long process of access to lots of organizations, lots of topics, asking lots of questions. Take your time.

This is not an exercise in fear mongering and making a decision because you're forced into doing that. And then finally, making sure that what you started with is what you end with. Are those priorities and those goals and those aspirations exactly what the organization you're going to partner with will also head towards?

And are you headed in the same direction?

Michael Burcham: This podcast was produced by Shore Capital Partners. With story and narration by Michael Burcham. Recording and editing by Andrew Malone. Editing by Reel Audiobooks. Sound design, mixing, and mastering by Mark Galup of Reel Audiobooks.

Special thanks to Dr. Josh Everts and Anderson Williams for an incredible interview.

This podcast is the property of Shore Capital Partners, LLC. None of the content herein is investment advice, an offer of investment advisory services, nor a recommendation or offer relating to any security. See the Terms of Use page on the Shore Capital website for other important information.

Parting Advice