Sarunas Perminas is the managing partner of the VIC clinic in Vilnius, which has 11 chairs, and the ADENTA clinic in Riga, which has 13 chairs. He is also the head of MED GROUPE, which is a distributor of STRAUMANN GROUP, 3SHAPE, and BOTTIS in the Baltic countries, with a total of 8 companies under its umbrella. Additionally, Sarunas is the author of business courses titled "Personnel Management and Treatment Processes in the Clinic" and "Finance Management in the Dental Clinic."
We asked Sharunas about the secrets of running a clinic and business expansion and the role of Cliniccards in these processes.
We inquired with Sharunas about the strategies for managing a clinic and expanding a business, and the role of Cliniccards in these processes.
"Cliniccards is the top clinic software available. While perfection is not attainable, we found everything we needed in this system."
What advice would you offer from your experience in the dental industry to help a small dental office expand into a larger clinic?
"When people ask me how many dental offices to open to start their own business, I always advise them on how many NOT to open. Having three or fewer offices does not constitute a business; it is more of a comfortable workplace where the owner can easily and fully manage all processes. A company should ideally start with four or even six offices."
However, more seats can bring more chances of losing money due to inept driving and more expensive mistakes. When counseling clinics, I frequently observe how the owner of two offices with a sluggish management style expanded to four, and subsequently could no longer cope. In a clinic with four or more offices, active management is essential.
What should the clinic owner, who is a doctor, do in this case? Is it important to continue practicing medicine or is it worth transitioning into a management role?
Six years ago, when we started, my partner and I had 13 chairs and an annual profit of 150,000 euros. At that time, my partner asked me if he should continue to practice as a prosthetist, as he was earning no less than a clinic manager. He was considering whether it made sense to transition fully into management. My response was that if we were going to stay at the same level, there was no point in stopping the practice. However, if we were to expand, I promised that we would be able to earn a million euros (which is what happened last year). I also noted that the amount of management work would grow exponentially as we expanded.
To be an effective manager and leader who guides and motivates the team, it is not necessary to entirely give up medical practice. Working in a clinical setting for at least a couple of days is important, as a former doctor may not have as much influence otherwise.
So, is it still necessary to combine the roles of a doctor and a manager?
Yes, there are three main reasons:
How can you tell if a small business is ready for expansion?
I think it's not so much about understanding, but about deciding. Do I want to expand? Do I enjoy doing it? Am I willing to put in the time? Am I willing to take risks and make mistakes? In six years, our clinics have grown six times, and this didn't happen by accident. It was all part of the plan! We knew what we wanted and planned how to achieve it. We decided to grow.
I once asked an acquaintance of mine why he doesn't open his own clinic and instead continues to work as a hired doctor, even though he's a really skilled surgeon who performs a thousand implants a year and receives referrals from all over Latvia. He replied, "I already opened a clinic and I don't want to do it again. I live a wonderful life: I close the office door at five o'clock in the evening and forget about work. I go to my children, to the manor, and rest. I'm living! I already have enough money, but running a clinic is a headache." Each owner must honestly answer for themselves what they truly want. Managing people and working with other people's hands is much more difficult than doing the work yourself.
Is this trend specific to dentistry, or is it part of a larger business trend?
This applies to any business: working with people is always more difficult. As the founder of the business I worked for said in 2002, when I complained to him about the problems and hoped that they would decrease over time: "Sarunas, small business – small problems. Big business means big problems." Problems will never disappear; you just learn to live with them and solve them more effectively. That's what you have to face.
What do you enjoy most about being a manager?
I resonate with the message in Jordan Peterson's "12 Rules for Life". According to him, having a goal prevents unhappiness, and life is a balance of order and chaos. It's important to find a balance between the two – not completely in chaos or in complete peace. I've realized that I enjoy working with people and solving problems; it can be tough and exhausting, but that's the life of a manager. It's not for everyone, but I find it fulfilling.
How do you know when it's time to grow, and how do you actually go about doing it?
We should not strive for an unattainable ideal, but rather our only goal should be to continually move forward and develop. But how can we do this?
I have a rule that I call the "one percent improvement rule": You can always find something to improve, even if it's just by one percent. With this approach, it's impossible to get stuck at one level because it entails constant evolution instead of seeking a revolution. This distinction is crucial.
Everything can be improved, from patient reception to treatment procedures to phone etiquette and more. By consistently making small improvements, your company could undergo such transformation over five years that it becomes nearly unrecognizable. In management, this concept is known as "aggregations of marginal gains" – an accumulation of small improvements. The development path of a clinic follows this approach, as revolutions and sudden changes don't typically resonate well with doctors. The nature of their work leaves little time for contemplating innovations, as their focus is primarily on treatment. This is precisely why I prefer to introduce changes gradually, one step at a time.
Are there any service improvement strategies that always result in a positive impact on the customer?
For the patient, a positive experience is primarily about receiving good treatment. If we provide excellent care, the patient will recommend us, which will lead to a full schedule for the clinic within two years. However, it's important to note that while a high-quality filling may be what defines "good" for the doctor, the patient also values quick appointments, a comfortable reception, minimal waiting times, and good communication. Therefore, I would recommend starting the service improvement process by focusing on the initial consultation, as its quality can significantly influence the patient's experience at the clinic and the extent of their treatment.
By the way, we chose Cliniccards specifically for its medical functionality. I tested over twenty different programs developed by managers for doctors. Cliniccards, made by doctors for themselves, offers the most convenient communication between doctors within the program. This seamless transfer of information between specialists was the deciding factor for us, enabling us to move to a new stage of development.
It can be difficult for some clients to progress to the next stage of development and may have to shut down. What are they lacking?
They simply do not have sufficient funds. Running a clinic is an investment, and it's distressing to see someone lose money when the decision to close is made.
Why is there a lack of funds? Firstly, it's due to incorrect pricing. If the treatment is priced too low, there won't be enough money to cover the costs. What constitutes fair pricing? It's imperative to have a clear understanding of the clinic's financial situation, regardless of its size.
The owner must always be able to track how much each doctor earns, and the amount of work performed. It's also important to keep track of the expenses for each doctor and office for each period. Functional software like Cliniccards can help with this and provide insights into which prices should be increased and which procedures should be added.
Another reason for closing clinics is usually poor work organization and lack of service. Even if one doctor works well, without a decent team, there is a great risk of losing clients. It is necessary to analyze all stages: how the clinic accepts patients, provides consultations, performs treatments, and communicates.
Is the unsuccessful launch of the clinic due to a management error?
The most significant management mistake is assuming that everything will work out on its own – that all you need to do is find a location, and both doctors and patients will come. In reality, the owner must engage in marketing efforts and strategize on how to attract patients to the clinic.
What has the biggest impact on profitability?
There is a crucial factor known as a business model. If the owner is unable to clearly articulate the business model, the business is unlikely to succeed in the long run. A business model is the solution to the question "how do you make money?"
The business model of a dental clinic can be defined as follows: (maximum profit per hour – minimum costs per hour) x maximum number of hours.
Here are some tips to improve the clinic's performance:
- To maximize profit per hour, consider setting the highest possible market prices and providing more expensive services.
- To minimize costs, focus on reducing non-medical operating expenses by working harder and aiming to fill the clinic with more patients.
- To work the maximum number of hours, increase the number of patients and consider expanding the clinic.
It's important for the owner to continuously seek opportunities to enhance the clinic's operations.
Which Cliniccards tools help you the most in organizing the work of the clinic?
Cliniccards has a very well-established patient examination system and communication between doctors, making it the best on the market according to these criteria. Among the recent updates, I would like to highlight the dental formula and the improved treatment plan. We also actively uze financial and operational reports. We already have some suggestions for their enhancement and would be happy to assist in implementing them in the future.
