Las Vegas Orthodontist Receives 7x ROI from Facebook Ads – Here’s How

Welcome back to OrthoPatients! Keaton Walker sits down with Dr. Nadim Guirgus of Mountain View Orthodontics, Las Vegas Nevada for an amazing interview on how his practice was able to 7x their investment with OrthoPatients! If you’re interested in how to create a successful practice through social media, the importance of team communication and being intentional about marketing then this interview is for you!

If you’d rather listen to the video you can watch it here.

NOTE: Join our Social Media Kickstarter for Orthodontists Course completely free for more in-depth training on effective social media for orthodontists!

Here’s the transcript from the call:

Keaton: Hi, Dr. Guirguis. Thanks so much for jumping on the call today.

Dr. Guirguis: Sure, Keaton. Thanks for having me, man.

Keaton: Yeah. Thanks for being here. So, we’ve been working together for about a year. Dr. Guirguis is based out of Las Vegas, Nevada, and he runs a practice called Mountain View Orthodontics. Why don’t you just tell us a little bit about yourself, personally, your family, where you went to school, and then your practice as well, how long you’ve been in business and when did you start?

Dr. Guirguis: Yeah, definitely. So I was born and raised in Egypt but grew up in Las Vegas since elementary school, basically, so I’ve kinda called this home. I’m married. My wife is also a dentist. We met in dental school here in Vegas. I’ve got two little ones, a six-year-old and a four-year-old, so it’s a party. Yeah, I did my dental training here in Vegas and then did my specialty ortho training in San Francisco. Practiced out in California for a little bit, and then relocated back to Vegas, bought a practice in 2015 that was owned by a doctor who was working part-time, was living in LA and kinda commuting. And so he wasn’t wanting to keep making that trip anymore, so he ended up transitioning out. And I took over the practice and renamed it, and here we are, six years going strong. Yeah.

Keaton: And your wife, does she own her own practice as well?

Dr. Guirguis: So she is the general dentistry as an associate for about seven years, and then now she’s specializing in pediatrics. So that’ll be her next step. So she kinda took a step back and focusing on kids dentistry over adults now.

Keaton: Well, that’s perfect for your kids.

Dr. Guirguis: Yeah, yeah.

Keaton: Free dental treatment their whole life.

Dr. Guirguis: That’s right.

Keaton: That’s great. Cool. Awesome. So tell me, you bought the practice in 2015, tell us about how you kind of got started in marketing. So walk us from 2015 to 2020 when we started talking, then we’ll transition to how the last year has gone.

Dr. Guirguis: Yeah. So the time I took over the practice, like I mentioned, the other doctor was… It was a satellite practice for him, meaning he didn’t primarily practice out of here, and so he was seeing patients like four days a month. It was a really small practice. And I had the mindset of, “I’m from Las Vegas. I know all these doctors here. I went to school here. I grew up here. I’ll just show up, and it’ll be busy.” And I think you learn things the hard way, but I think a practice that doesn’t have much momentum and much of a footprint as a challenge. And so my first year, I just showed up, started treating patients. I’m like, “Oh, the phones are gonna ring. That’s how it works, right?” And then you kinda step back, and you’re like, “Alright, well it’s not really what I thought it was gonna be.”

Dr. Guirguis: And then, so we started getting more into the community and kind of talking more with the dentists and kind of establishing those relationships, and slowly started to kinda ramp things up. And then, didn’t do a lot of online marketing as far as non-organic. Organic, we’d post things and try to be active on social media, and I think that’s big these days. But until we started working together last year, that was the first time we really ventured out to try online marketing and stuff. And the biggest thing I think I’ve seen is just people know who we are. We’re kind of… Your face pop’s up everywhere. And so my neighbor’s like, “Yeah, I saw your Facebook.” So that’s pretty cool, and I think it’s just one of those where people have to know you’re there to come to you. You build your reputation, but the more they kinda see you, I think, it just… It’s pretty powerful.

Keaton: Yeah, it’s so true. Another interview we just did, Dr. McKenzie out in Canada, she says there’s just these huge orthodontists that have been around for years, and she’s kind of this smaller start-up. And once we started running ads, everybody recognized her, which is… Like the brand recognition, although it’s not as measurable as like, “Okay, how many did you start this month?”, it’s huge, and it’s something that’s gonna compound over 10, 20 years instead of just being like, “Okay, we got more revenue this month,” but are we getting a foothold in this market where we’re gonna be able to sell down the line or bring in patients just because they’re like, “Oh, I need braces. The obvious choice is Mountain View Orthodontics, ’cause I see their ads all the time.”

Dr. Guirguis: Yeah.

Keaton: That’s really cool. But as far as before we started working together, it was just relationships, just talking to dentists and in the community there.

Dr. Guirguis: I mean, we dabbled in Google Ads, things that… I always kind of did it myself, and so just sort of blindly throwing the ideas out there and seeing what happens and not tracking that stuff as well. It’s just kinda hard to monitor when it’s not organized, but we did have a lot of patients, and they would… Word of mouth is big, and that’s still a really big part of our practice, I think, when you treat people right, they send their friends and family. And then we have dentists that we have relationships with, and we work together. But then there’s the random, “I found you on Google.” And we try to build our online reputation, reviews, and I think all that, it’s all… Everything counts. It’s all important. But never any direct marketing, putting ourselves out there for patients to see us.

Keaton: Yeah. So then how did we… Remind me how we originally came in contact. I messaged you, right?

Dr. Guirguis: Yeah, I think… And it’s funny, ’cause I get messages like once a week from someone like, “Hey, I work with… ” And my thing is I’ll talk to anybody, ’cause everyone’s just hustling, they’re doing their thing. And it’s the same thing. If people don’t know you, they don’t know what you’re capable of, and so I’ll take a call with anybody. And so we just started talking. And for me, it was just getting a good vibe. I think we kinda hit it off pretty good, it’s easy to talk to and kind of told you what my vision is. And I felt comfortable, so we… Nothing to lose, you just try it, and I think it’s been a pretty good relationship.

Keaton: Oh definitely, definitely. You’re definitely one of the most easiest clients we’ve ever had to work with, because you…

Dr. Guirguis: I don’t complain too much.

Keaton: Maybe ’cause you know what you want. You tell us, and so we do it. And there’s other doctors who, it’s just difficult, because they expect the world but they don’t really know how to get there or what they want to do to get there. So I’ve loved that about our relationship. You’re just like, “Hey, get this done,” and we get it done, and we’re all happy.

Dr. Guirguis: Yeah.

Keaton: So it was just kind of the vibe then. Was there anything specific about what we talked about that made you feel like we were the right choice over anybody else?

Dr. Guirguis: I mean I think this is more of like personally, how I interact with people. I’ve talked to other people that, like I know the sales pitch and the close is coming. I used to work in sales. Everything you do is sales, even if it’s healthcare, at the end of the day, you have a product, someone’s a buyer for your product, but I don’t like the whole like, “Well if you start today, we do this, and then we start the next 10 minutes. It’s not how I operate. I’m never one to be like… That’s just on a personal note. Aside from your actual content value you bring, but just… I like to process things. I don’t like to make rash decisions in business. When you run a business, you can’t just be like, “Oh let’s try it. Let’s just go… ” That’s not how I roll. So that was important to me just on a relationship level.

Dr. Guirguis: But I mean, I think you guys approach is cool. I see a lot of ads, and a lot of times you just scroll through it. And so I think, something engaging, like the calculator idea, I think, was cool and people wanna kind of play around with numbers that’s something more engaging. People just wanna play with it and see. And so, even if it means, someone clicks on it and doesn’t go any further, when they see it 10 more times in the next month, then they might be like, “Well, let me just see, let me just jump through it”. And so I think, people seeing it and coming back through, even if they didn’t fully click through and stuff, and I mean, I think that I’ve seen it, so I think it’s good, it’s working.

Keaton: Yeah, and I was looking at numbers right before this call, so since the beginning of… Yeah, since the beginning of the year, we’ve had over 600… 602 people go through and 84 of them have completed it, but there’s 526 people in there, who are gonna get re-targeted by the ad because they did it, and then, when it is time for them, because only 3% of any given market is ready to buy, they’re gonna come to you and they’re gonna be like, “Oh yeah, I messaged someone a while ago, let me search for that orthodontics in my Messenger inbox,” and then, they find you and then they continue from there.

Dr. Guirguis: Yeah, I had… It’s just a fun story, I had a patient call our office and she’s like, “Hey, I’m scheduled to get braces tomorrow at this other office, but I saw your ad pop up, and I was just curious like, what you guys are all about and stuff.” And it turns out a good friend of mine had liked our ad. He just saw it. Sponsored post popped up on his feed, he liked it, just cause it’s me, and he’s supporting a friend. And then he’s a mutual friend of that patient, and… So, he’s like the link between us. And so I’m like, how did you… What made you try to change it up a day before you have to get your braces on? And she’s like, “Well, I saw that my friend liked your post, so I figured you were legit, ’cause he knows you.” And so, she came in and she started treatment with us and just… It was just funny how that… So, that’s even related to her clicking on our ad. It’s just, she saw someone like our ad that she knows, so… And it’s actually like watching my neighbors and friends and family see the post and stuff, and they’re all liking it and sharing it, I mean, it’s pretty cool.

Keaton: Yeah, it’s amazing. And I love… Like, the comments can just be your own social proof. I have a doctor out here in Utah that everybody comments like, “Oh, Dr. Thompson is my favorite”.

Dr. Guirguis: Yeah, yeah.

Keaton: “He’s so cool”. And then, if you’re probably getting similar to things on you ad…

Dr. Guirguis: Yeah, yeah.

Keaton: When people see that, it’s just like, “Oh, this guy’s legit. Let’s do it.” Well, what a story with the… You just snatched that one…

Dr. Guirguis: Isn’t that random? Yeah. [chuckle]

Keaton: It was like a stuff in basketball, you just stole it and whatnot…

Dr. Guirguis: Yeah, I was just like, “Okay, come on in, we’ll take care of you”. [chuckle]

Keaton: I love it. And so have you noticed like, ebbs and flows and was it like, right off the bat, things were really strong and then it stopped a little bit, or it was slower when you started, and now it’s ramped up?

Dr. Guirguis: We started at a weird time. We started mid-February, February 14th, I think, and then we closed our office down less than four weeks later, but it actually… I think people were stuck at home and so, the internet became more powerful than it already is. And so, I think, that presence on the internet, people kinda, seeing us, and they’re sitting around like, “What can I think about? I got nothing to do. What about my teeth? This ad looks cool”. So we actually got a lot of pent up demand. We started dabbling with virtual consults during the time that we were shut down and we still do that a little bit. I prefer in the office to get that full experience, but people were doing virtual consults while the office was shut down. I got the kids playing outside, playing soccer in the backyard, screaming and I’m over here talking to a new patient.

Dr. Guirguis: So, I thought… It’s been pretty steady for us. Every once in a while, we’ll get a lull, and I think that’s what you guys are pretty good about. We kind of circle back, and you guys touch base a lot, and so we’ll choose the image up or change the approach, and we tried some different stuff. And some things work better than others, but it’s good to constantly evolve and change, even it’s just a image or the verbiage, just so it’s something new to catch attention. So, I think we’ve been pretty steady overall.

Keaton: Yeah, it’s awesome to hear, and it’s so true that we… I mean, when COVID hit like a month after we started working, right? I remember it was March 15th and we… Our billing cycle is like we bill a lot on the 1st and the 15th.

Dr. Guirguis: Yeah, yeah.

Keaton: So, we got all this revenue on the 15th and then, the 17th is when everybody shut down or something like that, maybe the 18th. And I was sure that I was just doomed. I was like, “It’s over”. And then, everybody took… Was holding their breath and then a week later, everything was fine, it was actually better, because so many people are spending more time online.

Dr. Guirguis: Totally, you gotta ride it out, get past that first bump up here and then just keep going.

Keaton: And here we are a year later, right? And it’s still working. So cool, so cool. And then, what have you… I remember in your… You filmed the testimonial video for us, a few months after we started working, and you said, “They’re really good at tracking everything”. What have you enjoyed about the tracking we’ve done? And then have you done your own tracking when it comes to ads or have you just felt like, “Yeah, this is really working because of everything that’s going on?”

Dr. Guirguis: Well, I mean, yeah, I have… I track where consults are coming from and conversion percentage of different sources and stuff. This is like my OCD number stuff. So I like that you guys have the Google sheet, and I could just do a quick summary and you guys will send me weekly updates, like “Hey, you had this many click-throughs and stuff”. But that’s been the biggest thing. I think we converted at a really high rate the first year. I think it’s normalized a little bit now, we’re converted probably 60% of people that showed up, which I think is high for cold leads. And now we’re close to 30 to 40, 35, 40, depending on… Which is, the volume is still good, so it’s not bad. And so I think that sounds more normal for… Because Facebook is not… People aren’t searching for ortho on their news feed and pop… So, it’s a little different than when someone’s looking for something. But it’s been good we’ve been able to attract that stuff, just like… That’s the whole thing with when you’re investing in something, you want to know the ROI and kind of what you’re getting.

Keaton: Yeah. And do you have… Sorry, a couple of questions. The first one was… You said you track conversion rates from different sources, right? So what have you noticed? Do you have the numbers from Facebook on you right now?

Dr. Guirguis: I can in about 30 seconds. Let’s see.

Keaton: Yeah, let’s check them out.

Dr. Guirguis: Yeah, I do. So this year, we’ve actually had, in the office 24 patients. And then nine of them have actually started treatment. So averaging about three starts a month or so. Then last year was right around the same average, but it was… The conversion was a little bit higher, we didn’t see quite… So, we’re seeing more volume of patients now, then we’ve gotten pretty good at streamlining the leads and calling them and following up and everything. I think that’s a big part of it. People are ready to go when they’re clicking on it, so we’ve been pretty good about follow-up.

Keaton: Yeah, that’s kind of the next thing I wanna dive into, but one other question before we do. Tell me about consult, are you double booking the consults, because so many people are no-showing? Have you found anything that’s been helpful in not getting them to no show, or did you just kind of accept that risk and run with it?

Dr. Guirguis: I think every market’s different. I saw another orthodontics that’s just posting on a thread the other day, or do a podcast about especially Facebook-specific leads, and he made the comment that every market’s different, and they were saying they had like 24 no-shows in one week of tons of leads, and we haven’t had that. There’s days where it happens, but I think, for the most part, people are coming through. We definitely have some. I think the biggest hurdles with those leads that are found through online marketing, one is commitment level. Some of them play around with it, and they’ve has some that no-shows, and they will message us again the next week on the same messenger and like, “I want to consult.” And we’re like, “Hey, we just talked to you.” So I mean, I don’t double-book fully, I stagger a little bit maybe just to kinda like half double-book, if you want, some of them.

Dr. Guirguis: But then there’s definitely been days where they all show up, and they’ve been good patients and started treatment. And so, I think the other kind of challenging part is, some of them haven’t been getting their dental stuff regularly, and so they see ortho, “I want my teeth straight”, but maybe they need to get the dental side. And so those ones may actually show up, but I’m like, “Okay, I can’t really… ” Not all of them are in horrible shape health-wise, but some have been. But there’s ones you’re just, “Maybe get a cleaning and just make sure you’re all good,” and they do it, and they follow through. And so, for the most part, the ones that show up are committed pretty well, haven’t been too hard to chase around and stuff.

Keaton: And do you have them sign a contract and be like, “Hey, sign this. Down payment. And then go get your dental work done.” or you just say, “Come back, when you… “

Dr. Guirguis: We’ve done both. I think it depends on how… I kinda read it per patient too. I don’t put anything in their mouth as far as starting treatment until they have the clearance from the dentist but there’s the ones who are super motivated, and we help them schedule a dental visit. If the don’t have a dentist, we’ll call someone while they’re in the office that we have a relationship with and then get them on the schedule. For those ones, we can at least get the records and stuff done and kind of get them planned.

Dr. Guirguis: Then there’s ones that I kind of feel like maybe need a lot of work or aren’t as motivated, and I can tell that, and I don’t wanna waste their time or commit their money and have to refund it or go through that whole thing. So, I know how that feel like if they’re into to it and they wanna do, we’ll take care of their health, which is the important part. Some don’t see the priority, so they’re kind of just like, “Oh, I just want them straight, so I’m not gonna go go through all that.” I know that’s kinda the vibe, then it’s not worth it. It’s like a false commitment also, for something.

Keaton: Yes, I love… This goes back to what you were saying earlier about our sales call, right? You’re definitely not that like, you know, “If you sign up today, we’ll give you $1,000 off.” That just rubs you the wrong way, and I’m the exact same way, and that’s why I don’t do that. Every time somebody asks me about sales, ’cause I coach some other agency owners or whoever, I’m just like it’s so case by case. You just have to read the situation, and that’s why you’re a human, not a robot. I’m not gonna read the script, because it just depends on the person and you have to get to the root of why they’re having that issue. But if you can read it and be like, “Nah, this just isn’t the right thing for either of us.” You’d be much better off just saying no to that case, because then you don’t have to refund the money and deal with that headache.

Dr. Guirguis: Yeah. I’ve learned that. I hear a lot of the other orthodontist or more experienced orthodontists like, “You’ll never regret a case you didn’t start.” And like, man, there’s been ones where we dodged that just wasn’t… Whether it’s expectations or just a lot of different things. It’s a relationship, it’s a long one, too. And so, you can’t be short-sighted with the goals of growing and getting starts and like revenue and stuff, ’cause it’s not worth it.

Keaton: It’s so true. Wow. Amazing. Tell me about your follow-up process and what you found most effective, and what were you doing at the start and now what you’re doing?

Dr. Guirguis: Yeah, so I’m maybe hands-on to a fault. We’re a small operation. I have five team members and so we’re a smaller operation. And so they probably hate me ’cause I’m always like, “Hey, do you see that woman come in?” ’cause it all goes to my phone. And so if it’s my day off, they’ll tease me because at 9.00 PM, someone chimes in and hits up the messenger, and I’ll start replying to them and just saying, “Hey, let’s get you scheduled and… ” So my goal is, if we’re in the office when it’s like during business hours, we’ll just try to call them right away as soon as they… I also do the numbers within an hour, but I do them within 30 minutes. And it’s not always feasible. But if I see it pop-up, most of my team are like, “Yep, you’re talking about for Joseph? Yeah, I already called him in.” I’m like, “Okay, cool. You guys are good.”

Dr. Guirguis: But then there’s times when they didn’t see it coming through, ’cause they’re not refreshing every five minutes, and they’re working, which is great ’cause that’s what they’re there to do, right. And then, if it’s after hours, a lot times I’ll just engage with the patient. I can’t schedule things to be on our schedule software, but I can see all the schedule and know when the openings are and everything. So a lot of times I’ll find a spot for them and give them an option, and maybe get some of their information while we’re right there, at least maybe rule out some stuff if they haven’t been to a dentist. But at least like clear out what we do and stuff. So that’s been the biggest thing. And then if we don’t get a hold of ’em, we’ll leave a voice mail, we’ll send an SMS follow-up. Anyway, I’ll get a pile up of the ones we didn’t get a hold of, and we’ll kinda scroll back sometimes, and sometimes they’ll just find us and they’ll just message us back after… We’ll let them go, and they’ll come back a year later or a month later. Yeah, re-targeting stuff.

Keaton: I think your story reminds me of this guy. He was running, actually, WhatsApp ads, not Messenger ads. But it’s… Facebook owns the whole ecosystem now. So he’s going to WhatsApp, and he was like, “I just respond between reps in the gym. I do… I’m bench-pressing, and then I respond to a client and sign them up.” And I think that that’s a huge benefit of this type of marketing, right? Because the dental stuff, sure, other stuff can happen that way ’cause we’re also connected, but it’s basically just having… Telling patients they can text you directly because you have it on your phone, where they’re just messaging the business, right? And because you…

Dr. Guirguis: But I…

Keaton: Sorry, go ahead.

Dr. Guirguis: Obviously, I wanna maximize my investment. We’re spending effort and money, you guys’ time, you guys’ fees, for us to do all that, and we’re spending money on the ads, and so if you don’t respond ’cause it’s 5:01 and you’re like, “I’ll call them tomorrow,” they might have clicked on two other ads by tomorrow. And so I just feel like, “Why don’t I be present?” I think it speaks something if we can respond quickly, like “Well, do you want that?” And then, two, just when they’re into it, and they’re excited about it, I think you have more of a chance to… You just wanna capture that lead and let them experience your office by getting a hold of them and introducing yourself and starting that rapport. So the sooner you can do it, the sooner their attention span is still locked in with you.

Keaton: Yes, exactly. I was just writing a script for a video yesterday. If somebody submits all that information, what do you think they’re doing two minutes after they’ve submitted it? Probably scrolling social media. So, continuing to do that. So if you follow up there, you strike while the iron’s hot, your likelihood, some studies say, it’s like ten thousand times more likely for that person to respond if you hit them up within those first five minutes. And you as the business owner, your employees, you can’t really expect them to do that all after hours unless you’re paying them somehow, but…

Dr. Guirguis: Right.

Keaton: It takes too long.

Dr. Guirguis: Gotta do it yourself sometimes, yeah.

Keaton: Yeah. Sorry, what was that last bit? I didn’t hear it.

Dr. Guirguis: No, I just said you gotta do it yourself sometimes, it’s all good.

Keaton: Yeah, yeah. Exactly. So I’m interested in your… Also your approach with your team. You said you have a small operation. Do you wanna get bigger? Are you happy where it is now? Tell me about it, and then also just your general practice philosophy, and happiness, work-life balance, all that.

Dr. Guirguis: Yeah, we’re a small team. They all work really hard, but we’re growing a lot. I think this has been even another big leap in growth compared to what we thought was a big leap last year even with COVID. And so I just got off the phone, I was doing a phone interview with another team member before our call, so I was like, “I’m already on calls all day, so let’s do it.” And so, yeah. I think there’s been days where we’re getting a little bottlenecked just ’cause we are booked out on consults.

Keaton: Nice.

Dr. Guirguis: We’re seeing 8-12 patients a day on consults, and it’s… These are all 10 or 12 show up, that gets a little crazy. And so that’s part of it, I think. Work-life balance… I’m a small business owner, obviously, even though it’s healthcare stuff, I try to disconnect when I’m at home and spend time with the kids, but there’s always something to do. Today’s my day off, I’m not seeing patients today, but I’ve been in the office since 8:30. I don’t know when I’m gonna leave ’cause I got things to do. So I think… Work really hard now and try to get things automated a little bit more and get team members that can help you carry things forward and get them in place, and that’s what we try to do. And I’m a little hands-on, like I said. And I’ll scale back slowly, but they… I always find it funny when I’m like, “Hey, did you get that lead?” They’re like, “I’ve already called them and scheduled them.” I’m like, “Okay, I need to chill out.” But…

Keaton: Yeah. [chuckle] No, I have the same problem. So funny You feel like you need your hands in the pot the whole time. Very, very tough.

Dr. Guirguis: Yeah, then she’ll go like, “Dude, we got it. Chill out.” I’m like, “Okay, cool. I know you guys got it.” And so…

Keaton: That’s cool. So one thing that I found in talking to a lot of orthodontists at the… Something that is actually fairly common that we’ve tried to just nip in the bud recently, is we’ll get on the call with the doctor, they’ll be like, “Yeah, that sounds amazing. Super cool, let’s do it.” And then we talk to the office manager, and they’re like, “Oh, the doctor signed up for another thing? What is this? He didn’t tell me any… ” So what do you do to maintain communication? And then also, how have you hired… ‘Cause it sounds like your team’s tight knit and you enjoy all of the people on your team.

Dr. Guirguis: Yeah.

Keaton: That’s something I feel like a lot of offices just skip over ’cause they’re understaffed or they just can’t find people that wanna work for them that are gonna be all stars. So, what have you found in that realm?

Dr. Guirguis: Definitely hard. I’ve been really fortunate. The people we have are really great. Some of them were referred by other people I know, and that should be a good way. We’ve gotten a few people with cold leads where we put out ads and stuff. I think I just go off… I think I’m happy that everyone… With the follow up for the marketing, I tell everyone they’re all onboard. They’re excited to grow too, I think, in the… They share in the accomplishment. I think that’s big part of it is not… That’s an ownership thing that they take, which is big. One of my team members has the app on her phone, and she’ll joke and be like, “Dude, go to bed,” ’cause I’ll be texting someone at like eight… Whatever. And so she’ll call me out as a joke ’cause she’ll see the messages pop up. But I appreciate that she sees them, and she’ll respond to people, and she’ll just want to do that even if it’s not at the office. I don’t expect that, and I told them, “Hey, when you’re not here, you don’t have to do stuff.” She does it more for follow-up, but that just tells me that they care, which is great.

Keaton: Yeah, amazing. I think it’s all about that expectation upfront, right? Because the interview you just had, if that person, if they get the wrong idea about what it’s like to work in Mountain View Orthodontics from the interview, then the whole relationship is gonna be shot. And so I assume that you’ve done a great job of just setting that expectation upfront. And then is there anything you do… Do you have weekly meetings? How do you get the whole team to stay on the same page?

Dr. Guirguis: We do quarterly meetings, which… You always hear this stuff about how meetings are just a waste, so I try not to do too much, end up just talking to people for an hour and…

Keaton: Oh I’ve done that.

Dr. Guirguis: Yeah. So I think, with me, I just try to have open communication and I tell them… I walk the walk with it. So I’m not gonna tell you, “You could talk to me about anything,” and then you tell me to bite your head off or tell you not to bring it up. So I try to do that if I ever feel like something needs to be addressed that’s maybe festering, where I know it can lead to some tension between people or something. I also address it with everyone in the group in a mature way, in a constructive way. I think it’s like a family or a relationship, there’s gonna be times where you don’t agree on something or someone doesn’t like the way something was done or said. And so I think… I told them to approach me with anything, whether it’s, “Hey, I don’t like the way you do this.” or “Could we try something new?” I’m always open to that. I always consider everything, I try to let them take ownership of stuff when they can, and that goes a long way.

Keaton: Nice.

Dr. Guirguis: But communication is the biggest one, just that we can talk about it and be able to share all that stuff so no one’s holding something in and having an issue later.

Keaton: They’ve gotta feel safe with you as their boss and then with one another, because that’s the… We are all… For confidentiality reasons, I know somebody who came out of an orthodontic practice just because it was so toxic and all the girls… Usually, it’s like the doctor is a guy, maybe the doctor is a girl… It’s all girls working there, and they’re just ready to bite each other’s heads off all the time. And so yeah, I think that’s great. And from my interaction with you and my team’s interaction with your team, it’s just been really positive. So, great job there.

Keaton: Yeah.

Keaton: One more… Couple more questions, actually. First one is, are you doing any other type of marketing besides Facebook and Instagram?

Dr. Guirguis: No. As far as actual paid marketing, that’s it. I’ve considered dabbling back on Google Ads, maybe on a more organized front with someone that knows them just to diversify a little bit. I think it’s a different market from each way. I think part of it too is based on the ROI. So as I see ROI, that it makes it… ‘Cause one of my biggest hesitations is it’s not cheap to do online mar… You can do it cheap, maybe, but you hire an agency, they have their fee for their time and what they’re bringing for you to pay for the ads and stuff. And so then, one of my biggest concerns was like, I’m always asking, during ROI, give me a number, and then part of the… Now I have some numbers ’cause I have my own data. And that company is like, “Yeah, you get a two, three-fold ROI if we do a really good job.” And I’m like, “Well, that sounds okay, but that’s a lot of money to get a person to start every couple of months,” or whatever. So people wanting $6,000 a month, it just sounded crazy to me. So I’m more open to the idea now, so if I… I’m considering diversifying trends in Google, just to see how we do on that and that capture different audiences. But I can see that as long as something is working, I’m always happy to invest and try to grow and… We’ve had some growing pains which I’m not complaining about. We’ve had…

Dr. Guirguis: We probably almost doubled what I was hoping for growth for consults and stuff this year, which we’re trying to figure out how to do that and manage it. That’s why we’re hiring more people and a good problem to have, and so we’ll keep it going.

Keaton: Nice. And what happened this year, specifically, do you think it’s just a combination of a lot of things?

Dr. Guirguis: I think it’s like a snowball effect where repetition is like… I think it took a couple of years, like I mentioned, the first… I said what we did for marketing the first year, and I remember one of my team members who was like “Hey, we need to get some more doctor approach, like go take a basket or something in some offices.” I’m like, “Yeah, here’s some money. Go do that.” Zero plan, zero strategy. And so I think… My son was born three days before I bought the practice, so there was a lot going on that’s… And then you’re overwhelmed taking over a practice, you don’t know the people, the team, the patients. So the first couple of years, just put my head down and did ortho, which is great, that’s the part I like to do the most.

Dr. Guirguis: But then you have to look and like, “Hey, I’m running a business, how do I strategize to grow and stuff?”. And so I think the last few years, we’ve really been more intentional with our community involvement, how we interact with our patients, how we start relationships with doctors, and now the online marketing part of it. So I think as that keeps going, you have to manage the growing pains and find the roadblocks and the little bottlenecks and smooth them out. But we’ve been managing it really well. Like I said, I’m not ever gonna complain about growing too fast. We have to be able to keep up with it, so you’re not wasting opportunity, you’re not losing that experience for the patient or not having it be what it should be if you’re doing it too fast.

Keaton: Yeah. It’s so true though, it’s just this small, simple things you do every single day. Focusing on this system, alright? Let’s fix this and automate this, so it works every single time. Let’s train this team member to know this. And when you’re not having tons of turnover with your team, that helps as well.

Dr. Guirguis: Totally.

Keaton: So, yeah, that’s awesome. Super happy for you. And 2021, I think, hopefully it’s your year. Sounds like it is already.

Dr. Guirguis: It’s going good so far, man. Yeah.

Keaton: [chuckle] Great. So then the last question here, if you could give yourself a piece of advice… Your son was just born, you started your practice, what would you go tell yourself six years ago about running a practice, and what would you have told yourself to do in that first year?

Dr. Guirguis: You have to know what you’re doing, so you got a lot to learn. I think a lot of it came with experience, so I think it’s hard to sum it up into one thing, but I think, just being proactive. You have to have a plan. It wasn’t like I was completely clueless, but there’s just so much that goes into it, and how to establish those relationships and how… You have to have a vision, a plan. And so I think, with me, I was being more reactive in the beginning, like, “Oh, numbers are down. Let’s go do this.” And then I think I was a lot more… And I think part of it… With growth, comes more revenue, which gives you more flexibility to do things.

Dr. Guirguis: So that helps give you more comfort to do stuff, so that comes with time too. But it was the weird situation ’cause I bought a practice that already existed, but it was such a small, or skidding operation that… I think trying to get control of that and turning it into what I wanted it to be first, was part of the… Also, it wasn’t like a startup in the sense that I can do everything from scratch exactly how I wanted, so I have to change things versus building, which is a little bit challenging. So yeah, I would say just being proactive and having a plan. Now I can literally go through and know, “Okay, what numbers do I wanna hit? How do I do that? If I’m converting this many people, how many consults do I need? How do I get this many more consults a month?” You have to have a plan. Okay, how are you gonna… Back in the day, I’d be like “Okay, we wanna grow 10% this year.” Cool, that’s great, and then nothing happened. I’m like, “Oh, that didn’t work,” but I didn’t do anything. I just made up a number. Now I can actually have a plan about why I wanna get to a certain number, how we’re gonna get there, and then reverse engineer all the way down to what we do on a daily operation to achieve that.

Keaton: Yeah, I love that. And I think, for whoever’s out there that this might be helpful to, I was talking to Dr. Tyler Coles, who runs six location practice in Arizona, and he was like, “What you need to do… ” I was asking him about… ’cause he used to run an agency, “How do you motivate yourself?” He’s uber-successful, one of the most successful practices in Arizona.

Dr. Guirguis: Yeah, I heard him on the podcast before or something. Sounds familiar, yeah.

Keaton: He’s great and he’s just… He’s whip-smart. He knows every single number, he knows all their profitability. They cut out Invisalign out of their practice because he was like, “It’s not as profitable as braces.”

[overlapping conversation]

Keaton: And so, like, “We’re just doing braces, and we can be more profitable with braces, so we’re gonna lower the price even more.” And just that kind of stuff where he does really well, but he told me, “Set a goal for the amount of money you wanna put in your bank account each month, and then work back from there.” And that… Even that personalizes that growth, ’cause 10% growth, great, but what are you gonna spend it on? Are you… Is that all going to marketing or is it all going to the team or whatever it is. But when it’s like, “Hey, this is the salary I wanna give myself,” it becomes much more powerful, and you’re more motivated every day to get up and make that plan and execute it.

Dr. Guirguis: Totally.

Keaton: Love that. And then I did have one more question. Let me think of it here. Yeah, so if… What would you tell someone that’s on the fence about working with ortho patients and… Oh, sorry, this is actually… Let’s get to that question one more… After this one. So in your first year… I’ve been curious, ’cause I’ve talked to a lot of startups. I think a lot of people find us, orthodontists, our ads reach them towards the end of residency or as they’re being an associate, and they’re looking to start their own practice, and they’re like, “Yeah, I wanna do this, but budget’s really, really tight, and I’m not really sure.” And I tell them the price, and they’re like, ‘I don’t think so.” And I’m like, “Yeah, I don’t know if this is the best place for you to be putting your money right now either.” So what would you tell someone, especially in that first ramping up phase? What should they be spending their attention on most and their money as well?

Dr. Guirguis: I think, systems. You have to bring in new patients. But I was… One of my hesitations too with marketing is that fear that, “Okay, I’m actually gonna get that phone to ring by doing whatever I’m gonna do and then we’re gonna botch it or we’re not… ” The team members aren’t trained to handle the call or follow up the lead, and it’s not like you’re gonna ruin everyone. Some calls that you handle correct are better than no calls, but I had that tipping point where I was like, “Okay, at some point, you need to learn on the go, but you also have to have systems in place and know how you answer calls, how you schedule.” Have verbiage, have scripts, have a way to… So that you’re not… ’cause what you don’t wanna do is spend a lot of money on marketing when your revenues are small and your cashflow is limited. And then you’re not maximizing that return on investment. That was really, really… I think that was… I struggled with that for years in terms of like, okay, my team is still training in certain things Or I need a new team member in this role. And I was worried that I was gonna invest this money and then not maximize it. And you can’t let that cripple you where you’re like, I’m never gonna be ready, ’cause you’re never gonna be perfect, and there’s always gonna be growth for team members, until somewhere, I took the plunge, and I was in a better spot.

Dr. Guirguis: I had some established team members that knew how to handle it, how to bring them in, how to have a good experience from the first phone call or the first reply to that lead all the way up to getting them into treatment. ‘Cause if you mess that up, people… I’ve had people call, we missed their call, and we called them like an hour later, they’re like, “Oh, I already have another consult somewhere.” People are not necessarily… Unless they’re like, “Hey, my brother went to you, and he said you’re the best in the whole planet, I’m not gonna go anywhere else,” that’s a great lead, but that’s not all leads. Now, with online presence in general, they’re gonna look at your reviews, but we have a 4.9 rating on Google with 100 reviews, but so do five other offices within five miles of us.

Dr. Guirguis: And so you need that to at least vet that you’re legit, so they can consider you, but they might call three of you guys in a row, and if you don’t answer the phone or you don’t answer it correctly, they don’t feel that obliged. So I think that’s a big part of it. It’s like, get your systems in order and prioritize how you wanna build your practice. But I just think, inevitably, online is just… Online presence, whether it’s organic or paid, you have to have that, because at some point, even if they don’t start with you today, they’re gonna keep seeing you. Whether you’re just being active and posting and… If you have time, maybe if you can’t invest in an agency, if you have got the time to do it and learn about it, you can read a hundred web pages about how to do some of the stuff. And maybe it’s not what you do best, and that’s why there’s people who do it for a living and do a good job. But just get comfortable with it, but find a way to streamline it so that you’re not wasting those leads of opportunities.

Keaton: Love it. So you’ve gotta have a team, a practice that can handle the marketing before you start spending on it?

Dr. Guirguis: Yeah.

Keaton: Yeah, awesome, really good. And I couldn’t agree more. I love that everything you’ve said today has come from… It’s obvious it’s just from personal experience. There’s no course you can take on how to be the most successful practice.

Keaton: Hard knocks, man.

Keaton: [chuckle] Yeah, the school of hard knocks. Love it. Well, cool. Yeah, this is the last question then, if someone was on the fence about working with ortho patients, what would you tell them?

Dr. Guirguis: Nothing else, just try it. I don’t know if every market’s the same and every person’s experience would be the same. I’ve had a seven-fold ROI, which is, I think, really good in any kind of marketing, from all the articles I’ve read and all the guys I’ve heard. Now, I’ve had other people pitch to me or talk to me even after we’ve worked together. I still take calls but I don’t take them very seriously anymore, just so you’ll know that. But if you’ll tell me, “Here’s what we do, we can get a three-fold ROI.” I’m like, “Well, I’m already getting seven-fold ROI, and we have a system in place, and… You guys are really good as far as working with people. During COVID, you guys helped me split up my payment just to help the cash flow while we were closed.” So just from a customer service standpoint, you guys are cool, you respond really well, and it goes really personal. But just investment-wise, it’s been really good. So worst-case scenario, it’s not as good for you and it’s not a good fit, I’m sure not everybody meshes. But for our market, at least, and for the strategy you guys have put in place for our area, it’s been really successful with patients, so.

Keaton: Love it.

Dr. Guirguis: I’m a fan.

Keaton: Yeah, that’s where I was. I remember I took a phone call in the middle of COVID last year, and I was just like, “Look, it might work, it might not. And it works… 89% of the time, everybody’s super excited about how it works. But some markets are just really tough, and if somebody tells you that it’s not tough, and they can get you a 10X ROI, and it doesn’t matter, they’re lying.”

Dr. Guirguis: Yeah.

Keaton: And I’ve loved that it’s worked with your market, that’s… It’s just… I can’t tell you how happy I am that story you said about snatching that consult or that start.

Dr. Guirguis: Yeah.

Keaton: Just from the Facebook ad and then all the brand recognition you’ve gotten, that’s meaningful in the long term for me as a business owner, for you, for your team. And so… Anyways, just thanks so much. You’ve been awesome to work with and thanks for hopping on the call today.

Dr. Guirguis: I know. Thank you guys, man. It’s been great.

Keaton: Yeah. Well, thanks so much.

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