Episode 81: Expanding Pediatric Dentistry Access Via Anesthesia Entrepreneurship w. Dr. Navin Goyal

This week, I talked with Dr. Navin Goyal about his practice in anesthesia for dental practitioners. As many people may forget, dental work can sometimes require anesthesia as well. Dr. Goyal, along with his company SmileMD, are making it easier for dentists to get professional anesthesiologists into their clinics quickly, so that they don’t have to send their patients to hospitals.

Justin (01:02):
And in certain urban areas, there can be months long or in some cases, years long waiting lists for procedures that need to happen in a hospital exclusively because of the anesthesia care that has to be provided. So Dr. Goyle has a really interesting business, really impactful, and I had a great conversation with him. So I hope you enjoy listening to today’s episode as much as I enjoyed this conversation as always. Thanks for tuning in hello and welcome to episode 81 of APM success. I’m very pleased to be joined this week by Dr. Nevine Goyal. Dr. Goyle is a board certified anesthesiologist who in addition to his clinical anesthesia work founded a dental anesthesia business a little while ago. And this is something that I’ve long been interested in trying to understand. And I’m really excited to be talking to Dr. Coyle today. Welcome to the show. Thank

Dr. Navin Goyal (01:52):
You very much. I’m really happy to be here.

Justin (01:55):
For starters, maybe just give us a flavor for your background just professionally and clinically.

Dr. Navin Goyal (02:00):
Yeah, so I, you know, went to medical school. I grew up in Ohio and Columbus and went to medical school in Cincinnati and did my residency in Chicago at the university of Chicago and loved it, loved the city of Chicago, loved residency, very intensely liked anesthesiology. And one of my old classmates actually told me that I was the only person that said I was passionate about anesthesia, which usually is not in the same sentence, but I ended up doing a private practice back in Columbus and was part of a large hospital based organization for 13 years became medical director of one of our hospitals, a few years into it, which taught me a lot of leadership, taught me a lot about the boardroom and where the physician plays a role. And then I ended up doing some angel investing, which got me exposed to some entrepreneurs and gave me sources of inspiration that I really never tapped into. And as I got to know, some of these entrepreneurs, it really started broadened my mindset of what a person can do, put your mind to it. You can leave the comfort of a, of a job or some stable kind of pathway and pursue a passion that you feel is your calling. So pretty soon after in 2014 I co-founded a company with two other close friends who are anesthesiologists called smile MD, which is a mobile anesthesia company.

Justin (03:25):
So awesome. So maybe for starters, talk a little bit about your, your transition from residency into clinical practice and picking the private practice that you ended up working with for so long. How did that transition go for you and what were the things you were thinking about at that time? Yeah. So

Dr. Navin Goyal (03:41):
When I was finishing up residency, I knew I wanted to go into private practice academics. Wasn’t my thing. I was ready to just do some work and, you know, obviously better comp packages and academics was, you know, at some point that’s all residency, you get a lot of these didactic, great people, but not necessarily people who just want to practice. And I felt like that was, I was ready for it after all the journey of, of anesthesia. So I picked a private practice in Columbus that was known to be a great practice. It was very broad. And especially coming out of residency, you want to do every case. You want to continue to do a lot of the same, you know, a broad array of cases. And it had that had multiple hospitals, surgery centers. They did hearts, they did a lot of different things and it seemed like a perfect fit. I was one of the few who left my class and did not do a fellowship. Our chairman along with, it seems like everyone in academics scares the heck out of you to do a fellowship to specialize because, you know, someday there’s going to be so many doctors and things that you have to compete with, which I don’t think will happen. I don’t think will ever happen, but I was a rebel and I went straight to private practice.

Justin (04:56):
That’s funny. And it worked out okay. It seems like

Dr. Navin Goyal (04:59):
It worked out okay. I’m actually glad I didn’t spend another year training. I, you know, I joined the private practice and as many know it’s a learning curve. It was stressful, but the practice was great. And after a couple years after you, after I passed the, you know, the oral boards and you know, you have more time now on your plate. That’s when I started to think about, okay, what should I do with this freedom?

Justin (05:22):
Yeah. So tell me about that. And it’s funny, cause I know a handful, maybe it’s just because of how I’m wired. I’m an entrepreneur and I love thinking creatively about business and opportunity and how do we solve problems? And I, maybe I just attract these people, but I seem to have at least a handful of anesthesiologist, friends who have this similar inclination. So talk about how that started for you and what happened at that time. Yes.

Dr. Navin Goyal (05:43):
So I read the newspaper, the wall street journal every single day. And I found myself veering towards the business section. And I, I really was, you know, I get my energy from other people and inspiration. So, so when people talk in an, you know, inspirational manner or music or people that just seem to exude inspiration, my energy just goes to another level. And so I found myself reading about the stories of entrepreneurs or reading about companies who went through so many obstacles and they got acquired or went public or had some crazy impact of a brand that I can relate to today. I also felt like the books I was reading, which I never read books grown up outside of the necessary school books. My parents always told me to read and suddenly at the age of, you know, early thirties I have some time and I start reading and I really start to enjoy reading. And once again, I start picking more entrepreneurial stories, books on business books, on how companies got built. And it just seemed like an interest to me.

Justin (06:54):
I’m curious, you talked about being inspired. Are there any particular people or particular stories that you remember that had inspired you to pursue this business track?

Dr. Navin Goyal (07:04):
Yeah. Th th there’s a lot of people that inspire me, but you know, I was reading the books of Elon Musk and Steve jobs, and I know a lot of people know their story, but when you really read about them, I feel it really humanizes people because we know these big brands and these people on a stage. And when you really hear that they were sitting there and thinking about, Hey, I really want to do this. And they lost their job. They got kicked out, but then they kept doing it. And you’re like, that’s just a stubborn person who thought they were right. The world didn’t know it. And they were not afraid. They had courage. So for me, that to me is so inspirational. I mean, it, it, it, it, it takes courage to be in medicine, but it’s a different courage after we get into medicine, medical school. And we let’s say get our ticket, right. Nothing’s guaranteed, but a ticket into a U S medical school is a big deal and we can kind of relax for a second. We have to get work done, but we feel very comfortable. So to leave a area or a stage of discomfort takes courage and it takes something to pull you out of there. To me, there was, there was something there that made me feel so alive. Yeah.

Justin (08:19):
So one of my favorites that I read somewhat recently was shoe dog by Phil Knight. I just read it too. Yeah. A couple of months ago, the founder of Nike and I just found it to be, so it does, you know, you use that word humanizing, and I think that’s a great word to show the fears, the anxieties that were crazy rollercoaster of building the Nike brand and how you go from, you know, and when they were making shoes in like the sixties and all that was required for him to like go up and down through Japan and try to find factories. And it was just a fascinating story of him, you know, working to actualize this vision. And I, you know, I don’t do anything with apparel professionally, but I found his story. It’s super motivating and inspiring.

Dr. Navin Goyal (08:59):
I totally agree. And one of the things that resonated with me from that book, yeah. There was a lot of points in there, but initially he was selling another brands shoe. And, and to me, that’s what entrepreneurship is. That’s why I always tell people, just move forward on something you’re passionate about it. You don’t have to decide what it is yet. Just do something and you will learn and you will kind of pivot and you will turn. And one day you might be this brand one day. You might not, but you will be wiser and you will not regret it. So I really, I had no idea that’s how we started, but it’s really interesting. That’s, that’s the fun of entrepreneurship.

Justin (09:35):
Totally agree. And it’s funny, you know, you mentioned the golden ticket, so to speak of a med school admission, and it’s true. Like your path can be very, very, very defined as a physician, if you kind of want it to be, and you take that traditional path through med school, through training and then into practice there’s a certain, you know, at guarantees the floor, so to speak, like you’re never going to make less than X number of dollars. You’ll always have a prestigious profession and you can kinda relax a little bit as far as the, the striving for that next thing. And I’m curious, you know, for you, it seems like you got to a point where you, that was not desirable anymore, where you’re a few years into your anesthesia practice and you were the safety wasn’t desirable or, or perhaps it wasn’t as intellectually stimulating and you wanted to continue to strive and continue to think critically and solve problems and go after something new. So tell me about how that unfolded.

Dr. Navin Goyal (10:31):
Yeah. So the, the definition of a golden ticket is very different to me right now. So there is a price for safety. So even, even if you work so hard and you get into medical school, which I thought was the end all be all, you still pay a price long-term for being in that stable position. And what I, you know, you become so specialized and kind of tunnel visioned that you lose confidence and skills and time to focus on other aspects of your life. And I’m in my early forties right now. And maybe it’s just, it’s because it’s phase two in my life, but there are so many things in life outside of just your career outside of just treating a patient. And even if you mean well, and you want to help people, there’s so many things going out on, out there outside of a hospital or surgery center where we, as physicians can be helping.

Dr. Navin Goyal (11:26):
And that’s actually where I have this physician empowerment philosophy that is not in the scope of a hospital or a practice. It’s what fish physicians should be doing outside of our clinical practice. But there’s really not a way to do it. There’s not even a way to even think about it yet. So I’m, I’m S I’m starting to bring up content and talk about how we should be thinking about it without feeling guilty, by the way, because you actually have physicians who say I’ve worked so hard for this job, and now I’m actually not very fulfilled. I want to go spend time here. My perspective is we become physicians to help people. And we are only provided one vehicle right now, which is mainly clinical practice, but there are other vehicles that I want it to be mainstream to make us a more kind of comprehensive physician that’s fulfilled, sustained

Justin (12:19):
Could not agree more. And this is a message that we’ve heard a lot on this show is that it’s my personal, super biased belief that, you know, the, the most empathetic, idealistic others centered people in our society, many of them go through med school, and those are the people we w we need to equip and empower to lead, to make decisions, to be as involved as possible in policy and institutional organizational leadership, et cetera. So I think we’re basically, we were coming at this same idea from two different angles, and I could not feel more strongly about that. And so I’m curious in that vein, you know, you became aware of this opportunity with smile MD, talk about sort of your journey into dental anesthesia and how that unfolded.

Dr. Navin Goyal (13:09):
Yeah. So initially it started out as a few dentists coming up to myself and my co-founders to, to ask about services and their dental practice. High-End, you know, dental practices. They spend a lot of time effort marketing it, and they said, it’d be great if, you know, anesthesiologist came to my practice and provided sedation for these fee for service cash, pain patients. And initially our thought was, wow, we’ve never thought about what happens in the dental practices. I feel like the, the medical dental world is just a big wall. It’s just completely separate. But really, if you think about it, oral systemic health, that’s one spectrum it’s actually should be more closely related than we allow it to be. So after we thought about it and I, I attribute us moving forward to having co-founders, if I was alone, I might’ve said that sounds cool. I’ll look into it now. That sounds like a lot of work, but I have two other co-founders who are very close friends. So the trust is there, the excitement is there, and we all decided to move forward. And that required looking for licenses, supplies, medications, going through scenarios of, you know, all the good and bad stuff that can happen. That’s our job, obviously. And then we moved forward and we did our first case probably several months after we decided to move forward and, and, and took off from there.

Justin (14:33):
So I’m going to ask a series of dumb questions because I’m not even a physician. And so some of this might be obvious to some of the listeners, but maybe okay. What types of procedures in a dental office require sedation? Yes.

Dr. Navin Goyal (14:47):
So, great question. There’s, there’s a spectrum of, and so at a high level, there are procedures that require hours of sitting still in a dental chair. So at the least there are some patients let’s talk about adults right now that want to just feel a little more relaxed or want to be pretty sleepy, because they don’t want to sit and think about what is going on in their mouth. It’s, you know, there’s an anxiety to that, which is,

Justin (15:14):
It makes me anxious. Just hearing you describe it. I’m one of those people. Yeah.

Dr. Navin Goyal (15:18):
W w w and there’s a lot of people like that. So how do we enable comfort and safety in a dental office? And the, the dentist wants to give the best experience to their patient, and we want to make sure the patients get their care. So that’s, that’s one example. And then the, you know, if you look at kids, if a kid needs to get a tooth extracted, let’s say there’s some, you know a rotted tooth that happens in plenty of kids in this country, actually around the world. I’m a five-year-old kid, and I need to get a tooth extract, and it’s going to take 30 minutes. Well, a kid will not sit in a dental chair, right? So they will need to usually go to a surgery center or a hospital to have anesthesia undergo the procedure and come back.

Dr. Navin Goyal (16:05):
So smile and D would come out and do a full general anesthetic on this patient, or get them off to sleep safely, let the dentist, or proceduralists do their procedure. And then we wake up the kid recover and go back home. And so we get to avoid utilizing the operating room, which should be used for, you know, sterile procedures and things that need to be done in the hospital. This is something where they usually go to the hospital for anesthesia. So we’re taking that out and we’re taking that element out, and we’re saying, we’ll bring anesthesia to you and enable procedures that can be done that do not need a sterile operating room.

Justin (16:49):
Is it common, or has it been historically for dentists or other dental specialists to use, you know, board of anesthesiologists to do these types of things? Or is that, is that required or are there other anesthesia providers that have been involved or that are, yeah.

Dr. Navin Goyal (17:06):
Yeah. So every state is different, but basically there are dentists that do that themselves. They get a sedation license and do it themselves. They bring another dentist who’s done an anesthesia training or residency. So there’s dental anesthesiologists that do it. And then sometimes they call an anesthesiologist. I mean, I’ll be honest that I think our field of anesthesiology isn’t as familiar with doing that, but the more folks we talked to, if you have a friend or you get exposed to it, and you’re able to do that, or you want to do that, let’s say in a different phase of your anesthesia career, some people do that, but it’s definitely unknown. And the more we discovered this, we’ve been doing this for seven years now, there is so much opportunity to bring us the same standards we see in a surgery center or a hospital.

Dr. Navin Goyal (17:58):
And there were three regards to safety and protocols and a team and S and equipment versus, you know, a solo practitioner coming into a practice, having everything, and then not even having a, you know, an assistant or an extra set of hands. There’s so many things that can happen. And that’s what smile and D essentially is, is been building is a foundation protocols, a team patient risk stratification. Does, does it belong here? Should they be going to the hospital? We have a governing board, we have peer review. So we’re actually bringing the processes of a surgery or a hospital into office-based anesthesia, which is, which is, you know, taking a lot of money and a lot of time and a lot of intention to do it, but we feel like, you know, being an anesthesiologist and being safe, that’s the only way to do it.

Justin (18:49):
Yeah. Is it, so I’m just picturing a dentist, you know, doing an extraction on a kid or something, and maybe being licensed to do sedation, whatever that means. And whatever that training entails is that, is that in itself safe. And is that common practice, like, is that happening at most dental practices out there? Or how many of all the dentists in America, how many are using a team like yours to do anesthesia on their higher risk patients?

Dr. Navin Goyal (19:14):
It’s not common at all to use a team it’s happening all over the country, where dentists are still doing their own sedation. And it’s been kicked up to a certain eyes of associations and, and kind of the legal world where I don’t see that happening. I mean, you know, back in the day before the field of anesthesiology was created, right, surgeons were doing their own anesthesia in the operating room and the field of anesthesia was created. So now you have at least the pres I call them the proceduralist or the surgeon, and then you have the anesthesia provider. And so when you go to the dental world, that has not happened yet officially. So we think based on what we’ve seen, there are a lot of scenarios where you’ve seen where a really well-known dentists with great practices and a great reputation who do sedation in their own office, even if it’s for adults and it’s mild sedation, even some other backup drugs and equipment that they were required to have were expired.

Dr. Navin Goyal (20:17):
They were hidden in a, in a room somewhere. And you know what I have to say that, you know, the dentist doesn’t wake up, start this practice to even worry about that they shouldn’t have to, but I think there needs to be some standard where there’s no fear liability, or most importantly danger to the patient or themselves. So we’re trying to, once again, just bring that standard. I mean, I left medicine, so I don’t envy the red tape or bringing that red tape to anywhere, but I think there should be a foundational standard. And that’s what we’re trying to do in a, in an efficient manner.

Justin (20:51):
Yeah. And I was doing some reading on this a little while ago, trying to understand, like, what is dental anesthesia? Cause it was still totally unknown to me. You mentioned that basically firewall between the dentistry and medical world. And I was kind of bumping into that. And I guess there was a case in California where a kid died during a tooth extraction and there wasn’t, it was, they were, I guess it was like a sedation case where the dentist was probably doing it themselves and maybe they didn’t have the infrastructure there to be able to provide appropriate care. And then it was like legislation and, and there’s, it’s been, as you can imagine, when things get to this level, there’s like lobbying groups and well, we’re going to cut off access to care if we create standards so high that most dentists can’t, you know, attain that and it’s going to create other unintended consequences. So can you talk a little bit about how, how you sort of process this tug of war between dentists who want to be able to treat everyone as the need arises and also at the same time they want to provide appropriate care? Where’s w where do you think the sort of the right where’s the middle ground or, or where’s the, where should we land in this conversation?

Dr. Navin Goyal (21:59):
So going back to my original conversation of, of how anesthesiology started, you know, before we knew or had these high safety standards, surgeons were doing anesthesia and then doing the surgery. So it’s a, it’s a different level of procedures, but in the end, you are, you know, if I’m a dentist in California and I have a small kid come in and we’re talking to three-year-old kids, and by the way that this this happened, I can’t believe I’m forgetting the, the law that was passed, but this happens, this doesn’t just happen one time and got kicked up. This has been happening. And what I have a real issue with, especially being a parent is if I walk into a dental practice, of course, I trust my dentist, whatever is told to me, whatever’s offered there. It makes sense. You, you just, as a consumer, as a parent, you think there is a standard.

Dr. Navin Goyal (22:52):
I think there needs to be all parties that are educated, and we’re, we’re trying to do that and smile and D trying to talk, and we’re talking with a lot of different people, policy makers, et cetera, just to say, we shouldn’t be doing this for, for anyone. And this has nothing to do with market share or anything like that. We want to enable everyone doing procedures to continue doing it, but they should be focusing on their procedures. If they need anesthesia, you should have a third party person. And every state’s different who that is. He should not have the same person sedating a patient and doing the procedure. The fact that I even have to say this in 2021 sounds crazy. And yeah, so I mean, th that’s it, we have to have that discussion ASAP. We need to implement so everyone. And if I’m a, if I’m a, in a smaller town and I’m hearing this and that dentist says, I just want to make sure my business is not affected by the way. I agree with them, but we have to make sure there’s a safe standard. And so we need to invest in solutions, need to get everyone on the same page and bring our anesthesia folks who we have a good amount of folks in hospital practices, et cetera. And how do we best utilize them to help them? I mean, that’s what we need to do.

Justin (24:10):
Yeah. I mean, as somebody who goes to the dentist and also as a dad, I’m thinking all these, like all these questions that I’m now going to be asking the dentist that I never even knew idea to ask before.

Dr. Navin Goyal (24:19):
Oh yeah. And unfortunately, there’s a lot of folks who just don’t know even what to ask. Okay. You offer anesthesia here. Okay. Your, your, you know, sedation is going to be for my kid or whoever they sign and that’s it. So there’s really not even a, and that’s, it’s been that way for a while. So maybe it’s really hard to change that mindset in the world of dentistry. I think the newer grads, as well as in the dental schools in the dental anesthesiology programs, they’re bringing that awareness and training there, but there’s still a whole generation of practitioners out there that are still utilizing the older ways, which I, which are not safe.

Justin (25:01):
So what does that dental anesthesiology track look like? Is that like a, a dental degree, you go through dental school and then there’s like a, a bolt on like a fellowship or residency in anesthesia specific dentistry. Yeah.

Dr. Navin Goyal (25:13):
Yeah. And we actually have some dental anesthesiologists that work for us and smile and D it’s actually, you know, I never knew they existed before as well, but I, I gave a lot of respect to their training. So they are dentists. They got their dental degree. Some of them been practicing for a while and decided they want to do dental anesthesia. And it’s about a two year residency. Many times it’s in the medical residency programs. And after that, they are able to do dental, anesthesia and various practices. And so their training is in hospitals and offices, and then they end up practicing in offices. So it’s actually a great thing. And once I think it was just made official as a, as a whole track or as a profession a few years ago. And so that being recognized as showing progress that that’s needed. And like I said, the younger folks coming out of training in dental school, I believe are getting used to a, another anesthesia party being there to do the anesthesia. So I think we’re on the right track. I’m just worried about the patients today and tomorrow that don’t have that, you know, knowledge of, of what should be done. Yeah.

Justin (26:26):
Yeah. Part of me wonders, I always, I love trying to understand like economic relationships in different contexts and who’s paying for what and how much and what that means as far as the model. So I’m, I’m just thinking through this and thinking, well, if I’m a dentist, I’m doing a procedure, you know, if I’m doing this sedation, presumably, and I, I don’t, I shouldn’t presume I have no idea, but I’m guessing there’s like a couple of line items on here’s the things I’m doing for the patient, if sedation or anesthesia is part of that there’s as a build service, I would imagine. And so what does it mean that first of all, I think that probably like less of dental care is, goes to the insurer compared to if I got a surgery. And then if there is an anesthesiologist doing my sedation or, or another, another person in the room, how does that impact cost and billing and what the dentist actually gets for their services?

Dr. Navin Goyal (27:23):
Does it, yeah, actually I think a good, a good exercise is to take a step back and look at patients need care. And right now we’re not even hitting a standard with certain practices and certain kids. And so something happened and things are happening, you know, devastations, what is that worth there? There’s not a price on that. So, so I would say that another thing is if a kid needs anesthesia and it can be done in the dental practice, what is that cost savings of time saved and transportation to that hospital or surgery center? There’s, there’s certain kids in Ohio that are waiting 12 months for dental procedures to be done 12 months because they need anesthesia. And there’s not much room in the operating rooms. And I’ll tell you, especially, you know, during COVID, there’s been a big stress on hospitals. And so there are States that have kicked out the dentist from the operating rooms.

Dr. Navin Goyal (28:20):
So now if you’re a kid in Michigan and you need to go to a hospital to get anesthesia for your procedure, you don’t have a place to go. So think about that on the cost of the system, but what if we were in Michigan tomorrow and we hope to be in Michigan soon, then we are, are able to take care of the patients in the practices and not even, you know, most of them don’t even need to go to the hospital, think of the cost savings on that. So I think we should take a more systematic approach versus adding a line item of anesthesia this cause. And, you know, I understand cause I’ve been in these conversations in the hospital where, you know, you have a radiology radiology group, who’s, you know, the radiologists were doing their own sedation for MRI. And now they’re saying, well, we need to add a line item about anesthesia, you know, for anesthesia, what does that, what is that going to do?

Dr. Navin Goyal (29:12):
And I say, we’re not asking the right question here, the risk we’re doing right now, and the way we’re doing it is so prehistoric, let’s take a step back in the end. We need to invest in the safety of our patients, which will, you know, if we’re just looking at numbers that will be cost savings down the road, but we need to do things right. And then we need to do things efficiently and economically, I do believe in cost savings. I don’t believe in adding more line items, but we just need to change the way we’re looking at. It

Justin (29:37):
Makes sense. And I’m thinking about myself, like dental, whenever have a dental problem. It’s not something usually that you want to wait even an hour to have taken care of, let alone months and months. And

Dr. Navin Goyal (29:50):
And this, you know, this problem, sorry to interrupt that we opened up in Illinois a few months ago and that same kid who’s waiting 12 months in Ohio is waiting up to 24 months in Chicago. And so now let’s think about it. I have a rotted tooth. I’m six years old, I’m in pain. I can’t focus. Can’t concentrate. I don’t want to eat. So then you go into so many other issues outside of literally torturing a kid. And this is in the United States of America. This isn’t a commercial for a third world country that we all focus on. This is in our backyard. This is in Chicago, Illinois, which is one of my favorite cities in the world. And this is happening. That is pathetic. So, you know, and this is where the real Neveen’s coming out. I left my practice because I want to start impacting physician minds, healthcare minds, business minds, political minds, to start paying attention on using time money in people on taking care of people. We are not doing that. And the hospital system I left and so many other hospital systems, they’re building fancier towers, they’re getting more specialized, they’re getting more staff. And then they’re complaining that, Oh my gosh, you know, it’s a little bit slower. I have all this overhead. Well, you do not need that overhead people. Aren’t getting basic care, diabetes, weight, I mean, education, you know, all these things. So I can go on this forever, but

Justin (31:17):
You’re preaching to the choir. So tell me, you know, D describe your business. And I, a hundred percent agree, like bringing anesthesia into the dental offices in that environment where hospitals and ORs are already maxed to, to provide the care at the point of need. Just, it just makes all the sense in the world. So tell me about how your company functions.

Dr. Navin Goyal (31:39):
Yeah. So if there are dental practices that need our services, we will have anesthesia days. So it has to make sense for us to bring a whole care team out. We bring an anesthesiologist, a recovery room nurse, and usually a paramedic as part of our care team. We bring our anesthesia machines, supplies, equipment and a whole set of standards and policies that we do. So no matter what office we go to, everyone’s on the same page of how we, you know, do, do various things, which I think is very important in the, in the field of anesthesia and the field of trying to minimize mistakes and risks. So once a office schedules with us, we get all the of patient information. We screen them, make sure they’re the right patient to be done at an office. And we go there and we, we bring our whole care team out and we have a full, you know, day of, of taking care of patients.

Dr. Navin Goyal (32:34):
And many of those patients were, you know, waiting for a long time, get to a hospital or surgery center. So we minimize that. We go to the community. So if it’s two hours out and rural Ohio, we, we go there and bring our whole team. So now the patient and their families don’t have to spend a whole day or even stay in a hotel one night or motel one night to go to the hospital. And then we take care of the patients and we discharge them after we feel like they’re ready. And the time saved, if you can imagine from going to a hospital and waiting there, you know, everything. Yeah. So we’re saving so many things. And we, in my opinion, we’ve offloaded a procedure that the hospital doesn’t even want. You know, again, ask the state of Michigan, the state of Michigan kicked out all their dentists a few months ago.

Dr. Navin Goyal (33:24):
And we get calls from them that we would love to have your services here. That’s a big issue, but the problem, we don’t want it to get to that problem, but this is happening. This is just in dental. And so if you apply that to procedures in general, that do not need to be done in a hospital or an operating room that needs to be sterile and have X amount of staff. Doesn’t it make sense to enable these procedures elsewhere, especially in offices, where they’re near their communities, you have offices that a lot of people it’s their brand, and they’re so proud to the dentists or the, you know, any physician who has their own practice. No one wants it. You know, another thing I didn’t bring up is they don’t want to leave their practice. They don’t want to travel to the hospital and wait for the, or schedule and waste a whole day and take care of two patients. So in this scenario, and I’ve been involved in a lot of different business ventures. This is a rare when, when, when, whenever we’re walking in, everyone seems to get it. Everyone seems to get something out of it and everyone seems to buy in. And so we’re just trying to get more people to the table to really educate them on. This is what we think we should be doing. It makes perfect sense. It makes me think this should be happening immediately

Justin (34:44):
Everywhere. Why isn’t it already? Well, this is, you know, we’re, we’re, we’re growing, we’re getting the word out right now.

Dr. Navin Goyal (34:49):
Well, you know, last year we were in one state and now we’re in three States. So we’re, we’re expanding and you know, great shows like you’re doing right now, the ability to educate people on what we’re doing and why we’re doing it. I mean, I really think our colleagues in anesthesiology really will, would embrace that. And we’re starting to get that. It was, you know, seven years ago when we were trying to recruit and recruit anesthesiologists to do cases, it was tough because people were like, wait, what is this? Now we have applications coming in saying, we love this office-based practice that give us a lifestyle where I don’t have calls or weekends. I’m taking care of ASA one and two relatively healthy patients and an office setting. It’s very different, but I think there’s a, it’s a great pathway for a career for our future of,

Justin (35:38):
So when you’re working with a dentist office, would you do like one procedure day, a month or two a month, or, and try to batch them, is that kind of how your team was?

Dr. Navin Goyal (35:46):
We definitely like to group them in in one day. So if we have, you know, four or five patients and they can do it in one day, that makes sense. And some, some practices are busier than others. Some call us once a week, some calls twice, some calls once a month, we have that flexibility. So it totally makes sense for them and us. There’s not a pressure or a contract that binds us to say, we need to be here X amount of time. So we’re trying to make it as friendly as possible. And for there to be such a small barrier for them to call us and say, this is a, Hey, I need your services.

Justin (36:22):
Got it. And so tell me about, you know, the applications that you’re getting, like who, who is who’s interested in joining your team. What’s the profile of those either physicians or CRNs or whoever it is.

Dr. Navin Goyal (36:34):
So we, we use physicians right now, physicians and dental anesthesiologists. And we actually I’ll tell you it’s all over the board. We have folks who are middle of their practice and want to change. We now are starting to see some young folks who see the opportunity to practice. Like they imagined how practice would be because you know, the, the word’s out that some hospital practices are, are, are a lot, it’s a lot to take in. There’s a, there’s a lot of baggage. There’s a lot of sick patients. There’s a lot of things that aren’t necessarily the greatest for a hospital practice, especially after you have your learning curve. And you, you feel like you got your big cases out. Now let’s put a little bit of a lower stress model in place. And we have folks who are closer to retirement, who just want to slow down a little bit and pick their hours and pick their days and do that.

Dr. Navin Goyal (37:27):
So we’re starting to see a variety. Now, if we had this interview three years ago, I would not be saying that I would say it was more folks who had done some locums, maybe had a part-time private practice and just had extra time. And they wanted to do some shifts with us. That still is the case, but that was our main probably app applicant. You know, your typical applicant now where it’s, it’s all over the board. And, you know, we look forward to growing. Cause I really think we’re onto something, especially in light of, of COVID where a lot of folks had more time to think. There was a lot of head, you know, headbutting between hospital administration and physicians and healthcare staff in general. And I think to me accelerated what physicians are in a hospital, which to me is looked upon as labor force.

Dr. Navin Goyal (38:20):
I, you know that in the end, we never want to think about it that way, but you have really highly skilled, intelligent, credible people who are placed in a position where their jobs are on the line. If, if they need a cut staff or they don’t have enough PPE. So, you know, you’re, you’re lower on the totem pole. That to me is unacceptable, but it’s the reality. That’s how physicians are looked upon within a hospital system. I saw that years ago and that’s, it, it, it kills me to be to see that. And so I’m trying to number one, help with awareness of that, because unless you’re aware of it, you will not change. But I think, you know, bringing that awareness and then bringing options of what we can do as a, you know, as physicians in society, what can we be doing to be at the table to make decisions? And it’s not within the it’s now within the vehicle that’s provided to us. We can’t just climb up a hospital ladder and say, okay, I want to be at the table where decisions are made. We’re not even, we don’t even know where that boardroom is. Trust me on that.

Justin (39:28):
What what has been the most challenging part of building this company?

Dr. Navin Goyal (39:33):
I mean, I think the most challenging part of entrepreneurship and business is everything takes longer. And we see these successful brands and businesses out there, and many of us do now realize what they went through and how long they went through it. Right? We are seven years old. The smiling Dee is seven years old and it feels like so much longer. And we’ve been through so much. There were times we were sitting at a table and we said, should we continue? This? We’re like really slow right now, but we decided, look, this is going to take awhile. We had to pinch ourselves, remind ourselves, you know, give each other the optimistic views sometimes to just say, let’s keep going. We’re not risking a lot. Besides our time, you know, our reputation who cares, where we’re starting to venture people fail. And, and, you know, we had a risk our money, but, you know, in the end you just need to keep going. So that’s probably the challenge is that everything takes a lot longer than I anticipated. And even knowing that now it still feels long.

Justin (40:35):
Are there any regulatory or legislative types of challenges or like red tape or any, anything like that that causes problems for you to try to get into other States or do these types of procedures with dentists and, you know, going back to that firewall that we mentioned before, where like the dentistry and the medical world, maybe the laws aren’t made to accommodate dental anesthesiologists.

Dr. Navin Goyal (40:58):
So I’m going to ask you a question you’re in the United States of America with the U S healthcare system, and you want to take care of a patient utilizing medications in a, in an office that still, you know, requires a dentist or still allows a dentist to do their own sedation. So you, you tell me if, if there are obstacles and a lot of paths to navigate, if you had to guess,

Justin (41:27):
Yeah, the question answers itself, doesn’t it? Yeah.

Dr. Navin Goyal (41:30):
There are. And we’ve spent a lot of time when I was, when I was saying we’ve spent a lot of time, money and intention on building the foundation. A lot of it is that as well, outside of protocols and equipment and processes and good people, by the way, we’ve had so many great people join the team. There are so many ways to navigate this. And then when you open up in a new state, they have their own set of rules. Oh. And stakeholders who we would need to talk to. So, absolutely. And it’s literally why we have a governing board. We have compliance officers. We have a lot of folks that just work on that.

Justin (42:08):
How was this received in the dental community? Are, is it, do you find that most dentists are receptive and like welcoming or is there like a territoriality that, that makes it a challenge to introduce these ideas?

Dr. Navin Goyal (42:22):
So for the most part, very welcoming, we are enabling their procedures. That’s how they look at it. And there’s, there’s a few that didn’t understand it. Or if they’re been doing sedation for years on adults and they don’t want anyone else, I don’t see them as you know, them seeing us as a threat, but just, no, I’m not interested. I’m good. But there are more and more dentists. And as I was telling you, the young folks that are coming out of training, they’re used to now having anesthesia services that they got used to in training. And so they welcome it. We get calls from all around the country that if, if we’re in that state, yet they say, Hey, smile on D over here. Yet we get calls all the time. And so the ones that have been on the fence are nervous to say, Hey, I always send my patients to the operating room, or I just send it out and refer it out.

Dr. Navin Goyal (43:13):
Once we start educating on what we do, and we have an anesthesia day there have our first smile on D-Day there. By the end of the day, they’re usually very, they appreciate the process and how serious we take it. Because I think in the end, the first thing that comes to mind is comfort in liability. And as soon as we come in and do our thing, take our time and educate, talk to the patients, talk to the parents, they feel at ease. And then they realize how much more efficient their day was. And then they realized that they don’t have to refer out. There’s so many wins for that dentist. And so if they give us the opportunity to prove that it’s, it’s good. And, and, and, and we see that changing already not

Justin (43:59):
To mention the wins for the patient and

Dr. Navin Goyal (44:02):
Absolutely which, which if you’re the dentist, you know, the, the patient is your client or the patient is your customer. Right. So, yeah. Ha you know, win-win win.

Justin (44:12):
This is a, I want to wrap up with this last question, and I appreciate your time today, Dr. Coyle. I, of course I haven’t asked this question on the show in a long time, but I really, I want to ask you in the context of your business, because as you mentioned, you know, blood, sweat, and tears, the things that go into this, the moments of doubt when you’re in that room with your two partners, and you’re like, Oh my gosh, like another dentist just on us. Can we, is it even worth trying again tomorrow? Can you maybe just tell a brief anecdote and take us to a moment of either significant challenge or that you pushed through, or a moment of like renewed resolve, where you were faced with her particular hardship and where you were able to sort of renew your own vision for your company in the future that you wanted to see manifest here, where kids don’t have to wait two years to get a tooth extracted and how that played out in that particular scenario that sort of enabled you and your partners to keep on pushing forward.

Dr. Navin Goyal (45:04):
Yeah, sure. I think early on when we were doing fee for service adults, we were very sporadic and, you know, we treated it like a side gig initially. And when we got really slow, we were really thinking about, Hey, should we pause this for a while? Should we just stop it? It’s, you know, we can maybe think about this later on, but we’re really slow. We’re putting a lot of time on a lot of phone calls. And my, my buddy Thurone who is a pediatric anesthesiologist and he was working at the local children’s hospital. He called us and he said, you know, we can, but just so you know, the, the, the surgery center here that does the dental cases is backed up nine months. He’s like we could be doing a lot of these cases at these offices. We, we, we, we know we have something here.

Dr. Navin Goyal (46:05):
Why don’t we really consider that? And so for me personally, and I think for, for both my co-founders, it became a moment of this is something bigger than just providing some sedation for some adults who can pay cash. This has a social impact, a healthcare impact and access to care impact. And I think that rejuvenated us, and it got us through a lot of tough times. And that’s where in general, the businesses that I’m involved in and invest in and build are impact driven for people, something that benefits people. And we have a lot of access to healthcare, access, to education, access, to clean water. And yes, we’re talking about the USA, not even starting with other countries yet. So I think if it’s a purpose driven organization that will get you through a lot of hard times, you will hit hard times. You will hit obstacles. And when you do, it becomes maybe easier or maybe justifiable to keep going.

Justin (47:11):
And it shows in that moment that you picked the right partners, too, because if you get into a business or a venture, someone is entrepreneurial is you. You’ve definitely interacted with these people out there who want to start a business because they want to make money. And that’s great. And, you know, in a capitalistic society, economic benefit, and for solving a problem is the right way. That’s the right way for it to work. But when things get tough money, money is not enough in that gut check moment to get you back on the horse and keep riding in the direction that you know is the right direction. So I think that just speaks a lot to the vision that you have and that you share and the real the constitution of your partnership and their shared vision for that. And I, I mean, I’m inspired just hearing you tell this story. So Dr. Goel, it’s been a pleasure hearing from youth today about smile MD, thanks for joining us today on APM success. Justin, thank you so much. It’s been a pleasure talking with you, and I appreciate all that you’re doing and getting the stories out. So our anesthesia colleagues I’m sure appreciate

Justin (48:15):
It as well. So thank you for having me. If you liked what you heard this week, head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you want it to leave a review in iTunes, that also really appreciate thanks for using some of your valuable time to join me today on APM success.