Pediatric Dental Practice in Houston, TX
Guest: Thomas Allen
Topics: Healthcare, leasing
Chris Ressa 0:00
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Welcomed to retail retold everyone. Today I am joined by Thomas Allen. Thomas is the CEO and founder of practice Real Estate Group and practice transition group. I’m excited for him to be here. Welcome to the show, Thomas. Thanks for having me, Chris. Thomas, tell everybody a little bit more about who you are and what practice Real Estate Group and practice transition group does.
Thomas Allen 1:37
Yeah, so I’m Thomas Allen. I’m live here in Austin, Texas, born and raised in Texas, founded practice Real Estate Group almost eight years ago, and about a year after that founded practice transitions group. On the real estate side, we exclusively advise healthcare tenants in there, where they should open new locations and handle the negotiation of the real estate acquisition, whether that be a lease or a purchase for them. We also develop or purchase two or three projects a year alongside our clients or for our clients. And then practice transitions group. We broker the sale of healthcare practices. And it’s been an awesome business. It’s been a lot of lot of fun had a really good year this year. And yeah, that’s where we are.
Okay, what did you do before this?
Yeah, so I graduated from college, I went to the University of Texas here in Austin in 2008, which, you know, was not the best time to be graduating school due to the great financial crisis. And I got a job though working for a high net worth family in Dallas leasing, they own a couple million square feet and kind of Class B C retail, mainly in DFW but quite a bit around the country as well. And I was leasing their portfolios one of their in house leasing team members. And as I was doing that, the only people that seem to be leasing space, and calling the signs were doctors, and a lot of them were calling without brokers or agents helping them. And so I started exploring what that would look like, and found a company that was doing it that was a little smaller, and joined up with them. And they were actually based in DFW as well. And work worked for that company for a couple of years. And after a couple years decided I was gonna go go out and do this on my own. I saw some opportunities that I wanted to capitalize on and left Dallas and went and started wrapping this thing up in Houston and Austin have grown it from there.
Excellent. So I’m curious a little bit more about your day to day so if I understand this, right.
On the transition group, you’re like
you’re helping and consulting and brokering the business operations deals, the medical practices and the real estate side you’re just making real estate deals will simpler correct.
So we’re the we’re you know, Dr. Seller practices like we actually have a sellable asset, a lot of them and right now, there’s still a ton of doctrine a doctor sales, you know, the doctors retiring or wanting to move to another city, or she’s tired of being a business owner. Sometimes they’ll sell their practice to another another doctor. Other times there’s there’s a big P roll up going on in this world and consolidation, especially in the dental and that side of things. And we are help we are packaging their business operations through their practice. syrup into a concise, pretty easy to read marketing book and, and taking that and shopping it to the different corporate buyers that might be interested in those practices and getting the seller the best deal possible. And then on the on the real estate side, we’re 95% tenant rep. helping doctors either renew their lease start new practices, and we’ve built our own proprietary in house demographic competition system that can pinpoint where they should open new practices. And we’re helping them identify those locations and security real estate, we, you know, we this year, we’ll do about 120 real estate transactions on behalf of doctors, and about half of that is on behalf of startup practices. And the other half is, you know, we’ll call them all corporate groups. But that can mean that for locations or with clients with over 100 locations. So we’re, you know, we’ve got 11 brokers or agents on the real estate team. And then on the on the transmission side of the business, we have you know, three agents and about 887 employees. So we’re, you know, students, can we start as just me in 2014, I guess. And, you know, we’re up to 25 people now. It’s been, it’s been a, it’s been a fun journey.
Sounds terrific. Let me ask you a little bit more about what’s going on in healthcare and healthcare, real estate specifically.
So I’m curious 120 deals, what do you think today? How much of those are going into retail properties?
About 80% of our business now is going into retail properties? Wow,
that’s incredible. Yeah. And and when you first got in the business, what do you think percentage was of like, of like, medical
is grown probably 40 50%. So I but it used to be 40% Going into retail properties, right, and earn about 50. And then it’s grown about 50%. So 75 80%. Now, the only what’s happened is, as people have wanted, as consumers, I’ve gotten so used to everything being so convenient and easy on all these health care providers have had to shift and move out to the, to the population and things growing urban areas. And retail typically offers the best opportunity for that to get in some of these growing areas. On top of that, the way people shop, you know, we all shop online. And our theory is and it’s been proven, is that most people are, you know, I need to go see an optometrist, or even an ophthalmologist or even an EMT like we have an EMT who you work with, or a dentist or a vet. And I’m going to get online and find out. You know, who takes my insurance or where they’re located near me. But I’m also one thing I’m going to do is if I see the same sign all the time, when I go do that Google search, or I might see that dentists or that vendor, that EMT might need to go see I’m going to google them and make sure they look legit, since I’ve seen them 50 times. That’s how I’m going to, you know, lean towards towards going to so there’s still an important part of online presence, but that visibility and access and convenience is is so key.
Yes. So I what I like to say to is one of the things we’ve done some healthcare systems deal as well as med tail deals in our properties that we own. And one of the things I like to say all the time is, you know, in the in the mid 2000s, the health care industry basically made a decision that anything that doesn’t require an overnight stay, we want out of the hospital, it is too costly to do this. And the second thing we want, we’re gonna get out of the hospital. We want it to be as close to the consumer as possible in the closest real estate to the consumers retail real estate. And and then what have you seen since like 2010 is just like an urgent care in every shopping center in America now because that’s the that’s what healthcare in America wanted to do. So I think that’s the other piece of it too. I don’t know what you think of that.
Totally agree that from from the corporate hospitals side, the the, the costs for delivery of care is definitely a driver. And then I say that as we’re also still we’re about to purchase a an office building in Houston and convert it to an MOV and part of the driver that is that it is directly across from like a a super fast growing Hospital has been invested. It’s invested $250 million into its growth over the last four years. But even as that happens, there still needs they want to get some The services off their campus and, and be more still more convenient for the consumer and the lower cost of care. So we know that they’re about to move all the services off the canvas, and we’re going to be the most convenient building for them. And we’re already talking to them, and some of the other affiliated physicians with the hospital are going in this building. So
totally, really interesting stuff. And how do you think I was educated once? So I’ll give you my take? How do you think health care fits into the mix of a shopping center with traditional retail and food? What are your health care providers? Think of that? And what do you think of that?
You know, that’s, that’s a great question. I mean, our health care providers, a lot of them that are going into these centers, they love it, because they’re like, Hey, we’re going to, we feel like our patients won’t mind coming to see us because they can come see us and then hop over and get lunch, or do a little shopping or even some of the practices that are focused on kids and maybe more teenagers than kids like, Hey, mom can drop like an orthodontist. Mom can drop the kid off. And and they can, they can have the appointment mocking against shopping done. And then some of our clients that are that are kind of on this new age, new age of medicine is maybe the wrong way to say it. But customer consumer experience oriented, you know, we have some clients that are whether they’re dermatologists, they build like super nice offices in the shopping centers, because they feel like the consumer will come in and spend more money if they’re in like this really nice setting on the interior, like they’ll spend 250 bucks a foot on their finish out, right? Or we’ve got dentists that build movie theaters and their waiting room and stuff for patients like they are actually driving traffic to the shopping center. That’s good for the other. Other tenants, the other tenants obviously drive traffic, but then add, you know, Mom or Dad, see the health care business in the center. Now, we do still run into, you know, who is at Ross will always have restrictions on medical and so will we see loads have them so there’s still some of these big box stores that don’t, that don’t see them as beneficial.
But I would tell you, I will tell you that that’s not necessarily the case. They just want the leverage because I’m in the waiver business. I go and get waivers all the time. So I I think there’s prevailing sentiment that healthcare belongs in retail centers. I was actually there was a deal that we did with the health care system, they bought, like 30 local mom and pop practices. And then they’re like, now we got like 30 leases, how do we consolidate these into one building? So ended up being a vacant retail box they had. And we had we had was 31,000 foot box, no, bring all these different things in there. Britain was only like 4000 Urgent Care, it was neurology there was a bunch of stuff because they had all these different practices in the marketplace. And I’ll never forget,
at the time, this is in the mid 2000s. The retailer was like, listen, we’ve got two issues. We usually work with you guys. But we’ve got two issues. One, sick people don’t shop and to the parking. And so the head of real estate for the hospital system goes, let me get on the phone with them. And typically we don’t do that and kind of like negotiate both on our own. But she was pretty sure I want to get on the phone with this retailer. So she did. And she says And so she’s like what are your issues, Mr. retailer? retailer says, well, sick people don’t shop. And she goes, I agree. Guess what? 90% of my customers are healthier than yours. Guaranteed. And so that was like enlightening. She was like you know, it’s not just sick people coming. There’s people coming for preventative maintenance, wellness, all these things and checkups. physicals like they’re not just sick. Like that’s a misconception. I was like, wow, that is fascinating. And the second thing was the parking we ended up setting up she goes No problem. If I valet the parking over here, will you agree the person was like yeah, so she did and so that got solved it was nine months and we try and get this she got her phone and got it done in like 10 minutes on a call. So it’s pretty pretty crazy. But But yeah, that was one of my experiences in the mid 2000s of it. Okay, I want to pivot to section we call clear the air I got three questions for you ready?
I’m ready. I Thomas.
What is one skill you don’t possess but wish you did?
You know, one thing that I and this is a skill I can acquire but I’ll wait I wish I just had it right now I wish I was like one of those master spreadsheet builder, manipulator database people, I’m pretty I’ve gotten pretty good at it being self taught and like I, I weirdly kind of enjoy it I, but I have my operations partner, Dave is just like amazing at it and it makes me jealous. And I don’t think I’ll ever be on his level. But I plan on taking a class here soon. I’m really trying to try to get better at it. But I also think it can be such a powerful skill to have in decision making and analysis. It’s just a nice skill to have. Yeah, being
an Excel was cool. Okay, number two. What is one thing most people agree with? You do not?
This is the whole work life balance thing that people try so hard to chase? I? Yeah. And look, I I’m definitely guilty of having having the balance be way too heavily towards work. And I’ve got a five, a four and a one year old kid at home, a great wife, I’m very thankful for it. So do Am I still trying to achieve some sort of balance? I still think that yes. But I think when you’re early on, you’re trying to get something going and you’re trying to get your career going, trying to get a new business off the ground or trying to grow a business. Trying to sit there, you’re just you’re lying to yourself, and you think there’s gonna be a balance. And that’s probably not a popular opinion. But I still don’t think anything replaces just rolling up your sleeves and, and working hard.
Yeah. What I like to say is rather than focus on that, I like to say that the reality in life, if you want to be successful at one thing, work, whatever you need periods of intentional imbalance need to go all in on. And if you don’t go all in, don’t expect success, you need to sometimes actually have an intentional imbalance. Balance is like, you kind of okay.
And a lot of things. So I tried to take like work and my family. And I don’t focus on anything else. It’s like work and family. And I tried to go all in on those two, and get everything else out in my intentional imbalances on those. And there come sacrifices with that along the way. But that’s how I like to put it
is a great way to look at it. I actually I agree with that.
Okay, last one. When’s the last time you tried something for the first time?
You know, I’m such a creature of habit that, gosh, this is a hard one. I’m a creature of habit. I didn’t trust him first time in a while, I guess this kind of kind of said, and kind of talking about the imbalance. I’ve I really, I’ve done similar to you, I’ve thrown out most everything else other than work and family. I am taking my kids to Disney World here in a couple months. And that’ll be the first time I’ve ever been there. So I guess that I guess I got something coming up in the future.
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Let’s move on to the story. You want to talk about a dental practice that you were there from start to finish in Houston, Texas. Take us away the mics yours. All right.
So the story that I’m going to sell is pretty. The where the story ends up in the success this doctor has that amount of success isn’t necessarily typical of every single doctor that opens up a practice but kind of the whole Getting started is is so typical. The we held this year. I don’t know the exact number but I’m gonna guess we’ll do 60 To 7050 to 70 Somewhere in there for sure. First time practice owners. And when these people are starting their practice, you know they’re typically 28 to 37 years old. Hold there, they’re both male and female, you know, kind of 5050. You know what they care about, they want to, they want to appear to be successful and smart. They care about business and financial security, they there’s something driving them to want to be their own boss. And in that age group, they also typically have young kids and they’re there, a lot of our clients are first or second generation Americans, and like just failure is not an option. And they’re, you know, their fears and pain are our selecting a bad location that makes them unsuccessful. That’s why they’re with us. They typically have somewhere between 206 $100,000 of school debt that they’re also paying. And but something is driving them to open their own practice. And so I’ll never forget this, I got referred to this pediatric dentists actually, she was referred by friend of hers, who we had worked with. And she, she kind of fit all these things. She had a school debt. She was about to get married and wanted to have a kid there, cut her deals, like I get this practicums I want to have a kid and like 1824 months. So she’s like, I got this, go into the night, start my family. And so they come come to me, and we will get to work. And we identified this awesome location in a kind of neighborhood strip, in a Houston suburb that was growing. And she also she was pretty confident herself was like, I think I’m gonna do well, I want to take a little bigger space, the most my friends take. So you know, most of the startup pediatric dentists will take 20 503,000 square feet, she said she want to take 400,000. So challenge one is, you know, some of the big banks have very good lending programs for startup doctors, but you kind of have to fit in this box. And it was like our your startup pediatric dentist, and your credit score is above 700, we’ll give you $450,000 Back then now it’s like 600,000, just because costs have gone up. And well, for her to take 4000 feet, she really needed like $600,000. So I go. But keep in mind, she also got a couple 100 grand in school debt. And she also just bought a house. And then a lot of times there’s people that don’t necessarily have a ton of liquid cash in the bank either. So I wouldn’t found kind of this alternative lender that we use. Like I said, alternative sounds like they have some crazy high interest rate or something, they’ll just kind of work on these a little bit outside the box deals to give her $650,000. So we’ll get the lending done. So then we start negotiating the lease, and it’s a smaller strip center, high demand area. Sure enough, another pediatric dentist shows up wanting the spot. So we have to go beat that one out. And my client did it because she was taking 4000 feet the other would only take 3000 But and we ended up paying like maybe another buck and rent and taking 30 bucks a foot and TI allowance instead of 40. But she believed in the spot numbers to the spouse can be great. She deleted herself. So she’s she opened up. And from day one, she just had patients just rushing through the door. I think her like third month she did like 150k in revenue or something. Which is amazing. But we we talked about all the sudden she’s open Well, in the meantime, the middle there. So what are we doing? This is what people don’t think about when they see these business pop ups, we get the money. So now she has to go find a contractor who can build it, then an architect who can design it, and construction delays. So you’ll get the loan, then you gotta negotiate the letter of intent and negotiate the lease. And this is somebody that’s never even thought she had just bought a house like this process. And then the build out for these these doctors is complicated and expensive. So back then during that time, her build out was probably 95 ish dollars a square foot. Nowadays, it’s up to 120 bucks a foot so they’re investing tons of money complicated construction. Sure enough on this deal. I clearly remember something happened with the electrical panel on the building. And all of a sudden they didn’t have 400 amps that she needed to run her office. But luckily we negotiated a really good lease for using our team of good attorneys that focus on medical and had a good medical contractor review it and we’d had warranted in the lease that she would have 400 amps of electricity. And so the landlord ended up having to cover that cost but delayed things for weeks and This is all while she’s trying to order equipment, right? So you walk into these, these spaces you don’t realize, like, there’s, you know, a few 100 Grain of equipment in there to start out with that you have to choose from, like 50 different options. And they do have great dealers that can help you choose and help you get there, get it installed. But there’s seven dealerships you know which dealer to go with. So, you know, we’re, we’re very connected in that world, it can make good referrals to verify people that we’ve worked with. And that’s also all while she’s still working, you know, two or three days a week and another practice to keep keep income coming in the door. So, it’s, it’s a really, you see these little doctors offices for these startups pop up in your neighborhood. And you don’t realize that that was like, nine months of stress and work on these doctors trying to make 9000 decisions. And if this doesn’t go well, like they’re going bankrupt, right? Like this, it’s not like if this doesn’t go well, I don’t know what the alternative but they’re just defaulting on their loan and filing bankruptcy. So they’ve got everything all, you know, four years of they worked extra hard in college for good grades, plus, you know, four to 10 years of additional medical, dental training, all wrapped up in this this practice. So I just said immense respect for them for doing this. It’s it’s not a not a given. That being said, in eight years of doing this, we’ve had one client fail. So if you choose the right location and get the right team around you, your chances of success is phenomenal. When actually, to wrap up that story, we talked about the PE firms rolling up practices, this practice has now done amazing. And the docs had a few kids since then, and wants to spend more time at home, and less time managing staff and payroll and chasing insurance companies and everything that goes along with owning your practice. And she has actually come to us and we’ve been working to partner her practice into a PE backed entity. And she is getting paid many millions of dollars tomorrow. So she went from just trying to start a practice to making many, many millions of dollars. And she is going to be able to teach she’s going to roll some of that purchase price into this Pe back deal. And it can it will grow. In this transaction. She’s going to keep getting to work there. They’re going to help her hire an associate. And she’s going to get spend more time with her husband and kids. It’s just an awesome.
Who knows. That’s amazing. So there’s a lot there. Got a bunch of questions. Oh, good. Got a bunch of questions. So there’s a lot there. That was great story. Kudos to her. I love that she’s still has a job, she’s going to be working there. If they’re going to get to pay a good salary, she’s going to be able to spend more time with her kids. She’s probably got some cash out the door that you get the pocket and some cash live she’s still owning the business. And if they grow it, she’ll hopefully be able to do that the actual participate in those profits what a win win for her. So a couple questions what pediatric dentures dentistry?
How? I know, on the traditional retail side, what are some of the use mentioned good location? What are some of the good analytics and research that goes into this side that this is a good location? Outside of the fundamental real estate stuff? What are the what are the the healthcare stuff?
Um, you know, we do look at the insurance mix the payer mix. So you we have data where you can look in an area and figure out where these people in commercial insurance versus government, which simply ties to incomes, right. But not always, sometimes there’s some lower income areas. You know, I think you’d like an area east to Houston, where there’s just a ton of like, blue collar workers at these big oil companies that don’t make a ton of money, but they got great insurance, right. And so there’s the payer mix. I mean, my big belief, and it’s no big surprise, it’s just, hey, how much population is there? Is it growing? And what’s the ratio of whether it’s a pediatric dentist or a dermatologist or an orthopedic surgeon or plastic to to the population? Like where’s there an actual need?
Yeah. So So what about one of the areas I think I’m curious about is competition. Would you know, when do you say like, this is a little bit oversaturated? No. Healthcare’s got a lot of runway and there’s so much it’s like, doesn’t feel like it could get oversaturated. But
well, it definitely can. I mean, it depends on the specialty type, or what type of doctor it is. And it depends on if they’re referral. So like, if you take a, I’ll go back to the pediatric dentists, like I like to see one per 4000 Kids 14 and under in a capture area. But if you go like, dermatologist, you might look for one dermatologist for every, like 10,000 people in an area. But that can also change, it can be a little less if there’s like a ton of Family Physicians that can be referrals to them, you know, so you’re but we this one really neat thing we’ve developed is ways to map all these providers out and really get heat maps going based on different ratios. And so like an orthodontist, you might look and see that hey, is there, there might be a couple orthodontist right there, but they’re like 70 dentists in that capture, they’re referring to orthodontist like you can ask for more the dice, you know. So there’s, there’s there’s all kinds of ratios, we use a
couple more questions that are big questions, there’s probably no right answers. I just want Thomas’s opinion. Not in dental and just healthcare. Why are there not more like Aspen and Pacific dentals out there that like grow, given the demand for health care that grow like retail chains?
So you’re saying why in the health care side as opposed to dental or not?
Morphe? Yeah, exactly.
Mainly, because once a group gets going, let’s say they get to 510 1520 locations. Normally the hospital system
by some consider buyer is Yep, sense. Makes sense?
Yeah, that’s that’s a lot of the reason you’re seeing it physical therapy right now. Yeah, there’s, yeah, ATI, they’ve been. They’ve been rolling those out across the country, the DERM side, there’s a huge PE consolidation going on there. But they’re just they’re not rebranding them or anything. That’s the only remember, there are some groups out there that you just don’t realize our groups. You know, they don’t bring them the same. Once you see them like Pacific dental too, but But yeah. Yeah, heartland, the hospitals are gobbled up a lot of the health care. But like there’s, but there’s like paint, paint management’s a big roll up going on right now. It’s like there’s a P county that owns, you know, a couple 100 pain management clinics. But that’s the other thing. A lot of their stuff doesn’t go to novo. Right? It goes more acquisition, driven than than de novo.
Got it. All right. Well, that was good. That was a great story. It was really appreciate you answering the questions and beginning at the end. I think the last thing I would ask you. I think because we’ve dealt with so much in short retail and dealing with E commerce. What’s your take on telehealth and the future of telehealth?
We, I’ve talked about that with a lot of doctors I, other than so I had an experience recently I didn’t hear a great. So I have a busy person, I say, I’m just kidding. I have a telehealth option within my BlueCross BlueShield or wherever you’re going to call this telehealth guy. And he’s like, oh, yeah, you probably have an ear infection. Let me just try to write you this like really benign antibiotic type thing because I’m too afraid to do anything without actually looking in your ear. And so I do that I fill the prescription within like, a day or two. I’m just like, there’s no way this is gonna get better. So then you go, then I go into the urgent care. And what do you know it was cleared up in three days. So like, telehealth I don’t guess there’s a place for it. I’ve also had good experiences with it. But if you’re actually like not feeling well or hurting, like they’ll only do so much through telehealth because they’re I think their friend liability things right.
So makes make sense. Yeah. Okay. We’re gonna move on to the last part of the show. Call it retail wisdom. Are you ready? I’m ready. All right. I got three questions for you. Here we go. Question one. What extinct retailer Do you wish would come back from the dead?
Blockbuster? Just pure pure sentimental, though I spend probably more time my wife wants to get on me every Friday night spend like 30 minutes flipping around,
trying to find something else. I think every family’s like watching the trailers going up rotten tomatoes or having to be on their phone looking at the previews. and my website is 45 minutes. Are we going to watch anything
faster than blockbuster?
Question two, what’s the last thing? Over $20 You bought in a store?
Who once again creature habit, dress shirts, buy from the same store? What store? Pinto Ranch is what it’s called. It’s kind of a local, Texas. I kind of wear these cowboy shirts that get about Pinto ranch can’t find anywhere else. Excellent. Finally,
last question. If you and I were shopping at Target, me and you Thomas and I lost you. What I would I find you when
you find me there in the light pretzels Starbucks area because I’ve been wanting to get out of there. I was sitting there having a Starbucks when you walked around, putting on a lawsuit that targets for those great stories I always joke about it’s like CVS, you go in there putting spin ad spin like 25 bucks. I feel like every time we go to target, which is like three times a year to leave my wife. I think we’re going to spend 30 bucks and we spent 300 units. But yeah, I probably just found me hanging out with him while we were there.
Excellent. Well, listen, Thomas, this has been great. I really appreciate the time. Thanks so much.
Yeah, thanks for having me, Chris. This is fun.