Cassie Kellner [00:00:01]:
Welcome to The Bloom Effect. I'm your host, Cassie Kellner, former chairside assistant turned team coach and founder of Everbloom. This podcast is all about the real stuff. Honest combos, leadership lessons, and the heart behind thriving orthodontic teams. If you're ready to grow, lead and bloom, let's dive in.
Cassie Kellner [00:00:22]:
Welcome to The Bloom Effect. I'm your host, Cassie Kellner. I am so. Oh, I cannot. Ryan. Dr. Ryan McComb is my wonderful guest today. I am so thrilled that you're here, Ryan.
Dr. Ryan McComb [00:00:39]:
I'm very excited to be here as well. Thank you.
Cassie Kellner [00:00:42]:
So, Ryan, we met. Oh, my gosh. 2018. 19.
Dr. Ryan McComb [00:00:49]:
19, like, nine, eight years ago, was it 2018, something like that? Yeah, a long time ago.
Cassie Kellner [00:00:54]:
I feel like I was pregnant. So that's, like, how I gauge my life at this point. Like, I. So I'm pretty sure it was 2018, by the way. This is so off subject. I don't even know if you remember this, but when I was having my second baby, I had a girl. You sent me a Mori baby.
Dr. Ryan McComb [00:01:15]:
Oh, we did? Yes.
Cassie Kellner [00:01:16]:
Do you remember this?
Dr. Ryan McComb [00:01:17]:
Yeah, I do remember this.
Cassie Kellner [00:01:18]:
You sent me a Mori baby package, which, like, I've sent it to everyone I know when I got that. Oh, my gosh. Also, those sleep sacks changed my life as a mother.
Dr. Ryan McComb [00:01:31]:
Yep.
Cassie Kellner [00:01:33]:
I. I was blown away. The packaging, all of it. It's like it came in a box that, like, the iPhone comes in that you don't want to throw away, but you're not sure what to do with. Anyway, I. I remember. Oh, gosh, I don't have sleep sacks anymore. My kids are much older than that. But anyway, we met nearly 10 years ago. It's very vague. I just absolutely adore you and your practice and your team. And so I always start the podcast. Ryan, with. Who is Dr. Ryan McComb?
Dr. Ryan McComb [00:02:11]:
All right, so we'll go way back. I'll start at the beginning, and then we can decide what gets to stay in and what doesn't. So I was born on a farm in Ohio, and actually, when I was 2, we moved to South Florida. So I actually. I claimed Florida as home, grew up in South Florida, and then went to school at Emory University, where I majored, oddly, in Spanish literature. Didn't know what I was going to do. And then in my final year of college, I thought I was going to be a lawyer. I thought I was going to be an investment banker. And then as I was approaching graduation, I was like, I don't want to do any of that. And so I just started exploring careers. And one of the people I spoke to was one of my dad's good friends. His name was Dr. Ludsford. He's an orthodontist in South Florida. And he was the only person I spoke to who when describing his career was just profoundly positive. He had nothing bad to say about his career, he loved everything about it. And it sounds insane, but literally after that meeting I was like, great, I'm going to be an orthodontist. And from that point forward I started working to become an orthodontist. So I went to like a post college program at University of Pennsylvania to do the science classes because I hadn't done any of them. And then went to Harvard for dental school and post Harvard went to UCLA for residency. And I always had a dream of living in la. I don't know where it came from, but in my mind I just envisioned LA and wanted to be there. And so when I was applying to residency I was really dead set on ucla. I applied other places, but UCLA did early entrance where they, you know, if you get in, you get in and then that's it, you don't apply anymore. So I got into UCLA and basically the minute I set foot in la, I knew that I was going to stay here essentially forever.
Cassie Kellner [00:03:56]:
Yeah.
Dr. Ryan McComb [00:03:58]:
So I live in Venice beach, which is amazing. Graduated from. Yeah, it's incredible. It's bright and sunny almost all the time. It's a little chilly actually, but it's, it's, it's beautiful.
Cassie Kellner [00:04:08]:
Yeah, but chilly for you in LA is.
Dr. Ryan McComb [00:04:11]:
I was before this podcast my kids are on. So I have 5 year old twin boys and they are on summer break right now. And so we strolled. One of the beautiful things about Venice is that we walk everywhere and we walked to our local coffee shop, restaurant and we were sitting outside and it's like 70 degrees and sunny and we moved inside because the kids were cold and I was laughing with the waitress because I was like, these are true LA kids, but it's a nice life out here. So I graduated from residency in 2013 and when I finished residency I did what I think most, most orthodontists do these days, which is I worked in a lot of different offices and got a lot of good but interesting experience. So I worked for a corporate chain. I worked for kind of a multi location, multi specialty practice. I worked in a general general dentist office doing ortho twice a month, things like that. So I learned a lot about what I wanted to do. I learned a lot about what I didn't want to do. And, and in, I would say starting in 2013, I began thinking about opening my first practice. And from the moment that I always knew I would open one, but from the moment I sort of committed to it, I would say it took about two years until we opened our doors in late 2015. So my first location in Culver City, which is for those who aren't from Los Angeles, it's a really cute kind of neighborhood town that's very much central and part of la Sony Pictures is headquartered there. So there's a lot happening. But it also has a very suburban residential feel with lots of kids and everything like that. So felt like a great location for my first practice. And so 10 years ago, in November of 2015, we opened the doors to the first location. I'm skipping a million different things. I got married. In the meantime, I have two, I have five year old twin boys. And now two years ago we opened our second location. So I have two locations now. And we are in the process of, of negotiating a lease on a third location. And so I'm sure we'll dive into all those details there. But I would say that's, that's me in a nutshell. Outside of professional stuff, I, my husband is French, so I just became a French citizen. We spend three to four, we travel to France three to four times a year so that the kids get exposure to French culture. So we very much have a life that's rooted in Venice, but trying to make it as French as possible as well. And so, yeah, I mean, one of the big things for me is also, I don't want to say work, life, balance, because I think you hear it a lot these days.
Cassie Kellner [00:06:46]:
It's played out.
Dr. Ryan McComb [00:06:46]:
Balance isn't really a thing when you're an entrepreneur.
Cassie Kellner [00:06:49]:
Right.
Dr. Ryan McComb [00:06:50]:
But what I will say that I do is I am very aware and I've always been very intentional about the fact that I want to be present for my kids to the greatest extent possible, knowing that that's just having, let's say, three hour intervals where I am really, really present. And I want to stay healthy. So I make sure that I balance my work with working out because I'm going to be better with my team and better with my patients if I'm feeling healthy and well. And so I've created a life where the essential things are not stripped out. I'm working all the time, but I'm also making sure that the things that allow me to live a good life, good being healthy and you Know, present when it. When it. When needed. That's really critical to me. So we can. We can dive into all that more in the future.
Cassie Kellner [00:07:39]:
So. Okay, wait. I've known you a long time now, and, like, this is, I think, the best part of this podcast for me at least, I was just telling you, like, I'm really fulfilled in this is one. I did not know you grew up on a farm. So I grew up in Northern California in a small farming community. So Farmville, USA. Like Calusa Shout out. Calusa California was agriculture, everything. I mean, it's so. Even when my husband went there for the. My husband's from Connecticut. I currently live in Connecticut. But when he went to Colusa for the first time, he's like, where are we? Is this California? Like, what. What is happening here? Second part. My mother's side is French Basque, and My mother is 100% French. My grandparents immigrated here, and my mother was born here, but then lived in France until she was in the second grade. My mom and I, in 2018, went to Basque Country, totally traced our roots, and it was like the most incredible experience. But I had no idea that your husband was French. And I don't speak French.
Dr. Ryan McComb [00:08:56]:
I wish.
Cassie Kellner [00:08:56]:
Are you kidding me? And Basque is a whole different, you.
Dr. Ryan McComb [00:08:59]:
Know, I'm officially fluent, at least according to the French government now, so it's exciting.
Cassie Kellner [00:09:05]:
That is so impressive. Oh, my gosh.
Dr. Ryan McComb [00:09:07]:
So doing practices and stuff like that. So.
Cassie Kellner [00:09:10]:
Yeah, no big deal, right? Your spare time.
Dr. Ryan McComb [00:09:14]:
Yeah, yeah, yeah. All that spare time.
Cassie Kellner [00:09:18]:
So something that was so powerful when. When we worked together and continue to connect and work together is I was so. And I've told you this multiple times, so this is not going to be shocking to you. I'm so blown away and. And it's such a sometimes rare, which is actually really sad. I'm so blown away at the. The culture that you have built for McComb Orthodontics in allowing individuals to be who they are and to create a safe space, a space where people are seen, valued, and heard. And I think now more. More these days, right. In the last 10 years, we've flipped it because. And I talk about this a lot. It was so, like, patient, focused, centered, you know, in orthodontics that I think a lot of forgot about our teams and we forgot to. To connect with them. We forgot to do all the things with our teams to make them feel valued in their positions and their roles and practices. And in my opinion, Ryan, you're one of the first practices that I saw that focused. So Wholeheartedly on that. How did that. Was that just innate? Did that just come? How did that happen? Was it like, yes, this is what I want. Was it organic?
Dr. Ryan McComb [00:10:50]:
That's a really good question. Thank you for saying that, and thank you for observing it. I definitely would say that is the pillar of our practice. And I actually think it's something that was there from the very beginning. It was an intention that was set from the very beginning. I think that before I do something, kids is another example that I'll reference in a minute. But before having kids, I was very intentional in how I wanted to show up as a parent and what I wanted my life to look like. And obviously, there are wild cards that come into play that aren't in our control when it came to opening a practice. The thing that I told my first hire had no ortho experience. Her name was Stephanie. She's amazing. We're still in touch. I told her that I don't care how much money we make in the practice. I don't care how much our patients love us. I mean, I do care about those things, but if we have those things and we are not happy as a team on a daily basis, then we're failing, and there will be exceptions. So when I say on a daily basis, meaning more so than not, but if we cannot come into the office and get excited regularly, then we're doing something wrong. I don't want to have an office where my team is not thriving and where I don't feel excited to go in. And so all of the decisions that I make in the practice and the way that I structure things are very much team focused. Knowing that the patient part is a given. Like, we have to offer exceptional patient care, and we have to offer an exceptional patient experience if we want to grow as a company. So that's almost like that's entry level.
Cassie Kellner [00:12:27]:
Yeah.
Dr. Ryan McComb [00:12:27]:
And on top of that, I want a team that wants to be there every single day. And I want a team that's curious to work through challenges. I want a team that wants to grow. I want a team of people who have character and integrity. And when we sense that someone maybe doesn't have those things, it's probably not the right fit for us. So I would say that the key feature of the people who are on our team, or make it on our team, are people who want to continue learning, people who want to dive deep when things come up and want to work through them, don't want to brush them under the table and think they never happened and accept that like mediocrity in life and mediocrity in the way that we work is not fun. Like it's not okay. And so stagnation to me in business is one of the worst things that could possibly happen. And I'm not saying we've never experienced that, but when we do, we push through it. And so it's a very specific intention of starting with, I want to go into my office and be happy. And if I want to go into my office and be happy, my team needs to be happy. And if I want my patients to be happy, my team needs to be happy.
Cassie Kellner [00:13:43]:
Yes.
Dr. Ryan McComb [00:13:44]:
And from that will come success.
Cassie Kellner [00:13:48]:
Yes. And you know, I've said this often and if, if you focus on your team, it will trickle down to your patience. You know, if you focus on the happiness of your team and, and really nip the toxicity because it happens. Let's get real. I mean everyone, come on, we're human. Things happen, messy moments happen. But if we can focus on the team, the happiness, the well being of our teams, then, then that will trickle down to your patient experience. But if you have, I'm sure you've seen it plenty of times, especially working prior to opening McComb Ortho, going into somewhere where you're like, oh, this energy is wild. Everyone can feel it everywhere. Patients can feel it, parents can feel it, guardians can feel it, reps can feel it. I mean we, everyone can feel that energy. And so I, I love that you set this intention. Have you seen it to where it starts to feel messy and then you nip it or you have conversations and you see the shift again?
Dr. Ryan McComb [00:15:02]:
Yeah. So definitely. And I think maybe I should clarify what I mean when I say kind of team happiness and that and that. I think a lot of people hear that and think that what I'm saying is like you need to pay them a ton of money and you need to give them bonuses and you need to treat them to a million.
Cassie Kellner [00:15:16]:
Thank you for this.
Dr. Ryan McComb [00:15:17]:
And while I do think that making sure that you're doing fun things and small gestures to show your appreciation, I would again put those as entry level. Like you want to make sure your team is well paid for your area. I'm in la. It's different here. Every everywhere is different. But like, you know, our salaries need to be competitive or people are going to not want to be with us. So you don't need to overpay but you need to pay at that level that is competitive where people can live a good life. You want to show appreciation in even the smallest of ways, in the way that you thank people when they do little. I thank my team for handing. Literally when they hand me an instrument, it's just built into my brain to. To say thank you. And I don't even think about it. But as opposed to having this expectation that they are going. I do expect that they're going to do things well, but I also acknowledge that they are doing those things well, even the small things. And what I would get at with team happiness is I think what's more important than those sort of entry level things is the continued education, continuing to train your team not only in clinical skills or administrative skills or sales skills, as if it's your. If it's your TCs and your TCs are salespeople, regardless of what you like. To me, TCs sales team, absolutely getting them those skills so that they feel confident in their role. But for us, one of the big things has also been life skills. And so, as you know, very early in our practice, we brought in a life coach. Her name is Christine Brondyke, and we've been working with her for probably nine years. I want to say, like the second year in my practice, we started to. She's amazing. She's. She's. We. We love her. My team has her on speed dial, basically. She's been an amazing resource for us. And I've told so many people about this, this idea that, you know, our teams, we. We come. Even taking the doctors, like, let's, let's be honest, you know, as doctors, we're bringing our entire life history into this practice that we're building.
Cassie Kellner [00:17:18]:
Yeah.
Dr. Ryan McComb [00:17:18]:
And it's complicated and we're taking on the financial stress and all of these things. We want it to be perfect, and it's not always going to be perfect, but we have. And, you know, we're going to have to work through it. But one of the things that we need is, I would say, emotional support and knowing that we need that. Our team also needs that and our team needs to know how to work through some of these things. And so when I say a happy team, it's beyond the. Beyond the pay, beyond all of that. It's acknowledging that humans and people are complex. And, you know, I think a lot of my colleagues who are orthodontists have had access to, let's say therapists or coaches or whatever in the past. A lot of our team members never have, but we know how valuable it is to us and it's equally valuable to them. And so I think it's I would recommend anyone starting a practice or deep in a practice to think about having a co. I mean, there's. There's business coaches, but then there's coaches who help guide you through kind of the messy stuff that's always going to come up regardless of how amazing your team is. And that's something we've been doing from the very beginning.
Cassie Kellner [00:18:25]:
Yeah, I mean, Christine and I, you know, had the. She was our very first episode and we discussed the drama triangle and how powerful it was. And like, I had an absolute. When she first told me about it a million years ago, I had like a physical reaction where I was like, oh, yeah. Oh my. As a coach, consultant, team member, like sister, I. I had all these things that were like, okay, I've been participating in this for my entire life and I still do and I'm figuring it out and. But I agree, you know, listen, I firmly. And I, I will shout this from the rooftops. And I firmly believe in therapy. I think it is a wonderful, beautiful thing. More importantly, I think the things that Christine provides is self reflection. It's so hard as adults. Right. Like my kids are 4 and 6 and I'm like, to get these kids to self reflect is like the craziest thing I could possibly ask them at this age. But as adults, we have. So there's so much that happens in our lives to bring us to a certain point, whether it's our childhood, the way that we were raised, our college experiences. And so sometimes it's much easier for individuals to go, hey, my fault. Sorry, team. That was. That. That one's on me. I'm. I will fix it. And then other team members who will never admit fault because they feel like it's a sense of that they're putting themselves down or that they're not good enough. Right. And I think that that's a beautiful thing for people like Christine and what Christine does for your practice, to be able to bring that in and have true moments of real, raw self reflection.
Dr. Ryan McComb [00:20:23]:
Absolutely no. 100%. And I think what you said about acknowledging when we're at fault, for example, it's something I try to model for my team all the time. And literally yesterday was in a meeting with my ClinCheck Coordinator who helps with all of our digital flow, and a case was pulled up and we were looking at kind of where it was at and I was like, oh, who? What? What did we do there? And I was like, it's probably me. I pro. You know, like something. And she was like, actually it is And I was like, okay, you know what, I'm sorry. Here, we're gonna, we're gonna fix that and let's move on. Like, we've got it, it's not a big deal. And I think to show them that, and it's funny because I think especially team members who have worked elsewhere before, they're really terrified of making a mistake with me. And I tell them, I was like, you are going to make mistakes. What's important to me is that when we make mistakes, we recognize them and we think about, okay, what can we do? What systems can we put in place to make sure that we minimize the likelihood not that this will never happen again, but that we minimize the likelihood that that is going to happen again. And I think if we keep doing that on a regular basis, our practice is going to get better and better and better and our team is going to feel safer. And when our team feels safe in their skills, in their roles, that's when we are truly thriving.
Cassie Kellner [00:21:41]:
Yeah. Because if you do not create a safe space, you will have mistakes that people try and hide. And to build a, and to build a business, a company, multi location practice off of not creating a safe space where people are hiding mistakes, there's no room for growth or you're able to scale and it only brings toxicity.
Dr. Ryan McComb [00:22:04]:
Absolutely, absolutely.
Cassie Kellner [00:22:06]:
It's just, it's. Yeah, it's wild to me.
Dr. Ryan McComb [00:22:09]:
I think that a lot of offices have a culture of fear unintentionally meaning I agree. Members are afraid to make a mistake. Team members are afraid to recognize that they don't know how to do something. And so they're pushing past their skill limits or whatever it might be. And with the drama triangle, for example, one of the things that Christine talks a lot about is you. There's the hero, the villain and the victim. And in an office, for sure, there's almost always going to be the hero who's overperforming, doing too much. And what Christine says, which is so wild and we see it in our lives, is that if you are in the hero role, and I, for example, when I opened my practice, I was such a hero to everyone, I was going to swoop in and save the day on everything but what it creates it. If you are a hero, you're going to create victims and you're going to create people who aren't able to solve problems for themselves. And the idea is that the more you can step out of the hero role, the more you're working to empower people to be at the same level as you. And so in my practice, that's one of our core philosophies, is how do we all stay on the same level, knowing that obviously, as the owner, I have more responsibility to do certain things, but when it comes to decision making and work in certain areas, making sure that we aren't trying to step in and do more that that than we should, because we're going to create a discrepancy. And the minute you create that discrepancy, that's generally where the drama starts to come into play.
Cassie Kellner [00:23:33]:
Oh, yes.
Dr. Ryan McComb [00:23:35]:
This person says that this person isn't doing enough. This person says that this person is, you know, overperforming or taking their role or they'll make them into a villain or something like that. And so, yes, and that's where it starts. And. But that's also where it gets interesting. And on our team, it still happens. Not that that never happens, but we recognize it. And then what we'll do is we'll come together and we'll say, let's talk about this. Why? Why are we running into this situation? And it often simply has to do with a misunderstanding in terms of roles, who should be doing what, what the expectation is, and so on.
Cassie Kellner [00:24:09]:
Yeah. Clarity is everything.
Dr. Ryan McComb [00:24:11]:
Yep.
Cassie Kellner [00:24:11]:
Also something Christine talked about in I always. I have lived in hero as a consultant. I've also lived in villain. Let's get real. When I try and push a new process or a new, you know, and they're like, we don't, you know, and then we. We build it out and they feel good about it. But I was like, oh, I'm hero a lot. And she's like, y. Cassie, that's not a good thing.
Dr. Ryan McComb [00:24:31]:
No, exactly. We think hero sounds great, but it's not.
Cassie Kellner [00:24:34]:
It's not.
Dr. Ryan McComb [00:24:35]:
Yeah. What I would say, I think most doctors I know tend to be heroes for a while and then they become villains. Because what happens is we hero our team, and then when they don't do something right, because we're a hero and we're paying them well and we're doing all this stuff for them and they're not doing what we think they should be doing, we get upset. And that's when we become the villain and we start to kind of blame them. And. And one of the things that I think I've talked to you about before is, and I read this very early on, and I'm going to butcher the quote, but basically it has to do with the fact that anytime something is going wrong in a practice, ultimately we have to question Whether it's a management issue, meaning, like, ultimately it rests on management. And I really do find that anytime I have conflict in my office, anytime someone is underperforming, that's a bit of an exaggeration because I do have a few exceptions. And we can talk to that, of course, but it generally has to do with, did I give them the right structure? Did I truly train them to do that? Did I put a system in place where they're. So they can track it so easily and they can measure their performance and their results so they know whether or not they are performing well or not? And usually when there's an issue, the answer to that is no. And therefore, it comes back up to management. And the minute that I start to. Or I work with my managers to create a system for that person to be able to thrive in that specific task or role, everything flips. Especially if we follow through. Because the other big mistake that I think a lot of people make is they accept that it's a management or a systems thing. They create the system, they give it to that person, and then they walk away and assume it's going to happen. And you can't do that. Just like with our kids, like, we create a boundary or a system, and if we tell it to them, great. But if we daily or weekly reinforce it. And I'm not comparing a team to kids, but I think that there's a lot that we can learn. I've learned a lot from parenthood when it comes to creating the right structure. Like, your team needs boundaries, they need systems, they need understand. Like, they need to understand exactly how to operate in order to succeed. And I find that, like, the more I give that structure to my kids, the more they thrive with my team, the more I give that structure and those systems, the more they thrive. And we have a tendency to think. Like, when I first started, I was like, my. My team's amazing. I trust them. We say trust a lot. Or we. I used to say trust a lot. I trust them to do it. It's like, well, I do. I trust them as people. But that doesn't mean that they don't need a solid, strong manager who gives them solid, strong systems and then helps them ensure that those systems are flawless until the manager steps away. And even once you step away monthly, you still check in on those things. When you do that, I feel like most things, most issues disappear.
Cassie Kellner [00:27:17]:
Yeah, you're creating clarity. Without clarity, what do you have? You know, I think putting a system in place and having clarity and also going Back to it. Going back to the system, because the system can break, by the way.
Dr. Ryan McComb [00:27:34]:
And then it's going to break again. I tell my team, I'm like, we're a startup. We're 10 years in, we're still a startup. I'm probably always going to say we're a startup because the world is changing so fast right now that every month, week, every week, month, year, whatever, something new is happening. And it's like we're going to change that system. And my team in the beginning hated it because I would always adjust and change things. But I told them, I was like, if you're going to thrive on this team, you have to accept that I'm going to create a protocol or you're going to create a protocol. We're going to create it together and we're going to try it. Some of them are going to work and some of them aren't. And if they don't, we're going to get rid of it and we're going to do something else.
Cassie Kellner [00:28:11]:
Yeah.
Dr. Ryan McComb [00:28:11]:
And they laugh now because they know that that's what's going to happen. But it's just going to make us better because we're ab testing. We're like constantly testing things.
Cassie Kellner [00:28:18]:
I mean, look where this industry has gone. How could we even continue to evolve if we didn't do exactly what you've said? Like, okay, so you've mentioned that many team issues lack from true management or clear expectations, but can you share a moment? The mo. A moment. Was there a moment when it became like crystal clear to you? On. Because you started with one, right. And now you're at a team of how many?
Dr. Ryan McComb [00:28:50]:
30.
Cassie Kellner [00:28:52]:
Okay, so was it always your intention? That's wild. Isn't that wild to say out loud? Like, can you take that in?
Dr. Ryan McComb [00:29:00]:
No, it's, it's, it's, it's an interesting feeling and it's, it's amazing and exciting and I don't know if the question you were going at was, did I always envision having a second practice and a team of 30, but I did not. I envisioned having one 12 person team with. I set certain goals and then I hit those goals and I was like, actually, well, so this is a bit of a pivot and we can go. Tell me if there's a question. But I so much of what I'm doing, it's, it's for me and it's for my team. We're orthodontists and again, we want to do excellent orthodontic care. But what I also realized very early on in opening my practice is that I love my team. I want them to have opportunity to grow. I want to grow. And if I have one practice, like, you know, someone's going to become an Office Manager, someone's going to become a Clinical Coordinator, and then what next? And I actually love the idea of keeping a team long term and helping people grow in their careers.
Cassie Kellner [00:29:58]:
But.
Dr. Ryan McComb [00:29:59]:
And so the thought that there would be no room for true growth for those people beyond salary raises didn't sit well with me. And so a lot of the reason why I was inspired to think about bigger picture growing to multiple locations was to create more opportunities for my team. And of course, there's more opportunities for me, and I want that as well. It gets more exciting for me as we grow. But I wanted to create room for my team, who I found to be thriving in this. You know, Taylor is one of my core employees right now. He. When he joined our team seven or eight years ago, he joined as our Concierge, Front Desk Concierge. He was a barista. He was an English major. Amazing person. And he was like, I'll be here for a year. I was like, great. Like, you're amazing. If we can have you for a year, we'll have you for a year. Here we are, eight or nine, whatever years later it is. He's now our Chief of People who is doing such amazing work, helping our team kind of navigate career growth. And he's the point person when conflict in the office arises. He's learned a lot from Christine Brondyke. So to see the career that he's crafted and that he loves the industry that we're in and working with us, when he thought, like, he's so good at it. Yeah. And you know, Kristine, who's been with a different Kristine, Kristine Boncales, she's been with us for a very long time. Same thing. You know, she started with us, she was doing a little bit, and now she's running a lot of our operations. And so it's been very cool for me to see. Had I not opened a second location or had the prospect of opening a second location, I would never have been able to retain those people because there's only so much that they could have grown. And so for me, a big piece of growth is simply, I want to see growth in the team that I've created or that's. That has joined me. Um, so that. That's what excites me, truthfully. Like, if someone asks, why are you building more practices? It's not because, you know, I want to have five practices. I do. But I want to have five practices because I want to have opportunity for my team to continue to grow. I want to be challenged to create systems that work across five practices. Because going from one to two was insane in terms of systems revisions and what it required. And I guess getting back to that question you asked, when did it become crystal clear that, you know, that was the case? I would say it's become crystal clear like, 400 times over the last two years. When we opened the second practice, just seeing how critical the logistics were, how critical the team working together was, how critical. Having a team of people who are curious to change. Because when you go from one location to two, even though it doesn't sound like a big jump, you're changing the entire essence of your practice. Yeah, it doesn't. It. I still feel like our practices feel kind of like mom and pop in each location. But from an organizational standpoint, you have more managers. You have all of this other stuff going on. And so you really need a team of people that wants to grow and wants to learn, and not everyone wants that. And those people actually naturally will fade off, you know, or slide away, and that's okay. It's actually a great thing for them and a great thing for you. But, yeah, there have been a lot of lessons lately.
Cassie Kellner [00:33:13]:
So can we talk about that? Can we talk about going from one practice to two and, like, what that felt like? What happened there? What was your biggest shocking surprises that. That. That happened when you went from one to two? Because it wasn't the intention. The intention was just to have one location. McComb Orthodontics. And then McComb Orthodontics turned into two, and now almost three.
Dr. Ryan McComb [00:33:39]:
Yeah. So there's a lot to unpack here, so you're gonna have to. You're gonna have to help me stay in the lane. So. All right. So going from one to two. Someone told me this when we first opened the second location, and they were like, going from 1 to 2 is like going from 1 to 10. And it's totally true. So for people out there who. We'll talk a little bit about what it's like to open one, and then for those of you thinking about opening two, I wouldn't change it for the world, but I. You can reach out to me directly, too, and I'm happy to chat more about it. It's a very different world. And so I would say one thing was. Was team. There were. We had the. The same Team members for, like the first seven years of our practice, everyone stuck with us. Every now and again, someone would move away or whatever. But we had very low team turnover. When we opened our second location in that first year, I would say 70% of our team turned over, let's say. And that was the result of the change in going from this single small location to being a bigger group. And the dynamic changed a lot. And some people didn't love that and other people did because they saw the growth potential there. I will also say, and this is, I don't blame myself or say, think that I necessarily did anything wrong, but when you open a second location, you. Some of the time that you were spending on that first location is taken away. So I wasn't as present at the first location for a while, and I felt the effects of that. And I've spent the past year reverting that. And especially with respect to team culture and the connection that my team felt to me. Because at the end of the day especially, I think even when you probably when I have five practices, I still think that my presence is going to be critical. Not because I think I'm this important person, but I think that a team needs someone that they look to and see as a leader. And I'm working to build a team of other leaders. But at least right now, my team still sees me as that person and they want to. And I'm happy to be that for them, that they get excited to work for, that they get. Because we have such a great relationship that they want to offer great care to our patients because they want to help me succeed and I want to help them succeed. There's sort of this mutual relationship, and what I would say is going from one to two. It was a little tricky balancing that because I was so focused on building a second practice, which is a lot of work, that some of those little details that, at least for us, are critical because my patient, my team's happiness is critical to me. We are like super, super intense around making sure every patient has a good experience. And if a patient doesn't, and again, that's. It's a reality every practice, you will have patients where there's a disconnect or something is missed. But when that happens, we are very, very intentional about making sure we try to navigate that with that patient and fix it. We don't accept that someone is going to be unhappy and stay that way. I think that we can solve everything if we are creative and if we're open to, you know, thinking like Maybe we missed something there and we can make it better. And so some of, like, those things because they're so important to me. When I started to work on building the second one, some of that slipped through the cracks here and there, and we had to work to recalibrate. And so there's an element of when with one practice, you can be super, super clear and all of your time is right there, but then you have second. At least for me, I don't want a second one if it's not as perfect perfect, but if it's not as well, run. And if my team does not feel the same camaraderie and enthusiasm and excitement as they did with the first one. So right now we are, I would say over the last eight months, we're recalibrating in a really positive way where I'm hypercritical too, by the way, meaning, like I. From the fact that when I say we slipped, we were. It was still awesome. Like, our. Our patients were super happy. Our team was, like, good overall, but not as good as I wanted everything to be. And so we're working to get it to that with two. So that's one. That is one of the big challenges of two. The second one is around. I would say that the world of opening a practice has changed dramatically over the last 10 years, and I was not quite ready for that. So. And again, this might vary from location to location, but I think overall, let's just say the US is generally the same. Some rural areas may be a little different, I don't know. But in LA in particular, my second location cost, my first location, I would say I took out practice financing, you know, bank of America loan. It was about $600,000, which was, like, felt reasonable. My second location was $1.3 million. My second location. Both locations are really beautiful and nice. The second location is kind of next level in terms of the esthetic and the way that it looks. And so I definitely invested more. But construction costs have gone up. The cost to open a practice has dramatically gone up. The other thing that's changed a lot is we are an aligner. Heavy practice. When I opened my first location, we were not. I would say we were probably doing 20%. Let's say now we're 80 to 85%. So the financials of starting an aligner practice are very unique and very specific. And so I would also be very happy to talk to anyone who has questions about doing a startup, because I think most startups, especially in cities, but I would imagine even in rural Areas are going to be pretty aligner heavy. And the traditional financial models that people give you don't, don't make sense for an aligner practice. The good news is that aligners like we grew our practice so much because of aligners.
Cassie Kellner [00:39:35]:
Sure.
Dr. Ryan McComb [00:39:36]:
And so I actually think it's an amazing business model. But the first three years of an aligner practice are going to be very different because on top of all of your regular expenses, which are going to be greater now than they were even 10 years ago, you have the aligner lab bill. And I think a lot of people forget to or don't quite know how to factor that into their cash flow plan. And again, taking responsibility. When I created the business plan for my second practice, I stupidly, to be honest, used the business model for my first practice and just kind of assumed.
Cassie Kellner [00:40:09]:
Like that's that rinse and repeat. Right.
Dr. Ryan McComb [00:40:11]:
And also I, when I opened my first practice, didn't really understand orthodontic cash flow and the fact that revenue tends to come in over the course of the two years because, but it worked because I was working at another job and it was such a low cost startup. The second one, even though we had amazing cash flow from our first practice, the second one, I very quickly realized not only was it expensive to build out, but we're doing, you know, let's say 30 to 40 aligner starts in our per month in our first year of practice. That's an extra 30 to 40 grand per month in expenses that you have to take into account in your cash flow plan. And I think that a lot of people don't do that and don't actually recognize what that means in terms of the point at which you hit profitability again. I think the beautiful thing is aligners help your practice grow. But in order for people to succeed in that model, they really need to have an accurate cash flow plan and know how much working capital they need. And so the second piece, the second big learning with that second practice was understanding the true financials of a startup in this year. Like in, in 2025.
Cassie Kellner [00:41:22]:
Yes.
Dr. Ryan McComb [00:41:22]:
And startup knowing that in most places you're going to be doing a lot of aligners and making sure your cash cash flow plan makes sense. So that's been a really, it's, it's been a challenge, but it's been fun. I feel like I've had to become a CFO at this point.
Cassie Kellner [00:41:36]:
Sure.
Dr. Ryan McComb [00:41:38]:
Going into the third one, I have a crystal, crystal clear revenue model, cash flow model, all of that stuff, which has been a challenge to Make. Because even when I went out into the consulting world and was asking accountants, no one had good models, so we had to create them of, like, what do collections look like in the first two years? And then what are expenses going to look like? And does that make sense? And if it doesn't make sense, where's the money going to come from?
Cassie Kellner [00:42:05]:
Yeah, you know, it's so interesting to me because you hit these monumental moments where you're like, okay, now we have to figure this out together. There's not really anyone to help me here. Or at least they're not speaking the language I want them to be speaking. And you've done such a beautiful job, Ryan, at. At really figuring it out. I. I want to go back to also, because I have to be honest. I don't know if anybody has this. How did you come to the place of putting someone in a position in a role where his role is chief of people? Because I feel like that's a rarity and people will probably like, Cassie, you skipped over that. What is chief of people? And what does this mean?
Dr. Ryan McComb [00:42:57]:
Yeah, that's a great question. We've always, It's. We kind of laugh at it. On my, My management team, we've always loved titles, but I think titles are important.
Cassie Kellner [00:43:06]:
I love a good title.
Dr. Ryan McComb [00:43:07]:
100%. I love a good title. I think it helps your team, even just in terms of being aware that they have an important role. But the truth is, Taylor is really a Chief of People. And what I mean by that. So I look at. I. I'm. I'm reverting back to now looking at the orthodontic industry specifically. But I would say for like, eight years, I ignored everything everyone was doing because I wanted to kind of pave my own way.
Cassie Kellner [00:43:31]:
Oh, I love this.
Dr. Ryan McComb [00:43:32]:
I learned in the beginning, I learned a ton of stuff from some amazing people. Anil Idiculla, Dr. Kravitz. These are people that I remember from 10 years ago when I was opening my practice. They were the most generous in offering advice and giving tons of information. And I learned so much in the beginning. And so I think I spent, like, three years just, like, soaking things up from those people. And I'm so grateful that there are people like that out there who are willing or were willing to share, and I'm sure they still are. But, like, I took so much in, and then I hit a point where it was. There was. When I first opened my practice, there were a lot of Facebook groups starting and things like that, and I just found that there were so Many different ideas and opinions coming from everywhere that it was confusing things. And I actually just stopped it all and I said, what do I want to create and how do I want to create it? And ignored that. Ignored the ortho industry essentially and focused on what are they doing in tech. A lot of my good friends in Venice are tech CEOs and things like that. And I love to look at kind of what they're doing. They're growing companies super fast. It's a different world. But one of the roles that exists in tech and other things is a chief of people, which is not hr. HR is, you know, I don't want to. HR is super critical and important, but HR is more people work and making sure that you're following the rules and laws and all of that. A chief of people is me recognizing that the core of our success is in our team. I need a successful team in order to succeed. And if I want a successful team, either I need to or someone on my team needs to make sure that my team is navigating life and navigating work. Well. And I don't have time to do that because I need to practice on. I need to focus on systems and growth and things that really only I can do, at least right now until I have a, you know, someone doing like higher level operations.
Cassie Kellner [00:45:34]:
Yeah.
Dr. Ryan McComb [00:45:35]:
So it came from this idea that on a daily basis there are things coming up and most offices, those things just keep coming up and are never acknowledged. And they're building and building in our office. My team knows that the minute that something comes up, they have permission to either go direct to the person that the thing is coming up with.
Cassie Kellner [00:45:57]:
Yes.
Dr. Ryan McComb [00:45:58]:
Or if they need support in it, they can go to Taylor or they can go to me. I still exist as that person as well. I had one of my Financial Coordinator recently came to me directly because she said, I'm having this issue, I need your help working through it. And we worked through it. And so I'm still present for those things when needed. But. But Taylor does so much of it for me and I feel like he's great at that role because he worked alongside me for seven years before taking on that role. So he knew a lot of how, I think. So when I leave for France for two weeks, I trust that if something comes up, he can think in the way that I would want to think about an issue. And that's incredibly important to a team. And so I think it's just this idea that a chief of people comes from the perspective of we need Someone to make sure that our team feels like they're thriving. That's it. It's as straightforward as that.
Cassie Kellner [00:46:58]:
It's so, I mean granted, let's, let's speak even to the people that have very small boutique practices and don't have a team of 30. Right. I still think that this role, it's monumental to practices. You have so many different personalities and cultures and dynamics and I think that it's really, really important to again, Taylor is the safe space. Right. I mean to create the well being and the safe space. And so for him to be able to manage the people and understand what's going on and help fix it with it. Sounds like the mentorship of Christine Brondyke too.
Dr. Ryan McComb [00:47:41]:
He's regularly call her and having sessions with her to learn and navigate. Definitely.
Cassie Kellner [00:47:47]:
You know, everyone has different levels of like emotional intelligence and how they react or don't react to individuals. I just, I think it's such a wonderful thing. I also think that, you know, I'm not saying it would take seven years to trust someone, but I do think it's when Taylor said to you, hey, I'm going to be here a year and you're like wonderful, I think you're great, we'll keep you for a year. And this, this position evol into what it is today, I think it speaks volumes to you and to Taylor. Right. Maybe he didn't want to grow into that position and there was something totally on his life plan that he wanted to do but then, you know, he decided to stay in this and it really fulfilled him. I think that what's so important to Ryan that you've said today is you've taken yourself out because there's so much comparison in this industry where people may go on a Facebook group or they go to a study club or the. And then they'll leave going. That was supposed to make me feel better.
Dr. Ryan McComb [00:48:50]:
Yeah. Oh, it's totally the. It was the same effect as what social media with our friends has on us. So you see your friends Bali and you're like, I should be in Bali. And if that same thing was happening in these forums where I'm sure maybe it's evolved because I, I'm. But like everyone's going to post the best of everything, they're going to share all of their successes. And so it's a really easy way to create this feeling of I'm not doing something right. And it hit a point where I wanted to just like choose what I was learning. I wanted to be inspired by people and ideas, as opposed to, you know, feeling like I'm doing something wrong if I'm not doing that. And also, I think there's oversaturation of ideas. Like, if you have. If you're. If there's too much going on, how are you going to focus on what is actually critical to your practice? And one of the big things that I've done over the years is, like, I want to strip our practice down to the greatest extent possible. How do we simplify our offerings again, to the extent that we're serving our patients and their needs? How do I simplify our system? Like, so much is about simplicity. And I was just getting way too much by overindulging in those things. And that's why I love now podcasts coming out. I mentioned I'm listening to some other orthodontic podcasts where, like, it's. They're distilling these key ideas. And most of the people that are going on, they're inspiring, and they're inspiring with the ideas that they're sharing. And so now I'm opening myself back up to the industry, but in very select ways.
Cassie Kellner [00:50:12]:
Yeah. And as everyone should. Right. Like, choose what. What really resonates with you. And I'm not saying don't go to a study club meeting. I'm not saying don't go to the meeting. Don't, you know, don't do all the things. But I would say from a coaching consultant perspective, go in there going, okay, I'm going to take, like, five key things that are going to really. I'm going to. I'm going to hear all the things. I'm going to hear. I'm going to have a task list of 400 things when I leave this meeting. But I'm going to choose the top five that really resonate with my team.
Dr. Ryan McComb [00:50:48]:
Totally. And are authentic to your practice. What I found is that often people can start to lose authenticity if they try to replicate or copy everything that they see out there, even from a practice. Like, even from a technique standpoint.
Cassie Kellner [00:51:02]:
Oh, yes.
Dr. Ryan McComb [00:51:03]:
I don't do TADs. I don't want to. I think they're amazing. I respect anyone who does it. I refer patients who I think would benefit from TADs to other local orthodontists who do it. And it's just, they're not for me. They're not for our practice and our systems, but that's okay. And I think that most people would have this tendency to be like, I have to do it, but if I started doing them in our practice, it would change everything about how we're operating. And I think it's. It's a small but subtle example of is this right for me? Is this right for my practice? Is this how I want to practice? And I think that goes any system, any clinical system, any administrative system, whatever it might be.
Cassie Kellner [00:51:40]:
Yeah, absolutely. Ryan, I have taken up so much of your time. I cannot thank you enough for being here with me and being so open and authentic. And that is really, that's what this podcast is all about, about the messy middle and how people got through it and the shocking moments as business owner and an orthodontist to go. Huh? I went from one to two practices and this was a wild ride that I was expecting. Thank you for being so honest and being you and sharing all of these wonderful tips and your story with. With our listeners. I cannot. I cannot thank you enough.
Dr. Ryan McComb [00:52:27]:
Very happy to chat with you. And I feel like we could have chatted for like, five more hours so.
Cassie Kellner [00:52:31]:
I could keep going.
Dr. Ryan McComb [00:52:32]:
More to come.
Cassie Kellner [00:52:33]:
Absolutely. Please, please, more to come. Thank you so much, Ryan.
Dr. Ryan McComb [00:52:38]:
Thank you. I'm really happy to be here. And we appreciate all the work you've done to help us because I first met you when you came into our practice and helped us get everything in line so well.
Cassie Kellner [00:52:48]:
Thank you. Thank you so much. Thank you for joining me on the Bloom Effect, where we keep it real, keep it growing, and always keep it team first. If today's episode sparked something for you, an idea, a shift, or just a reminder that you're not alone, take a second and share it with your team or a fellow ortho leader. Be sure to subscribe so you never miss a convo. And if you're loving the show, leave a review. It helps more practices find us and join the movement. And if you're ready to bring this kind of energy into your practice, visit discoverbloom.com to learn more about working together. Until next time, keep leading with heart, keep building with intention, and keep blooming right where you're planted.
