How A DSO Grows Through Education And Digital Workflows

We speak with Dr Andrija Petar Bošnjak about leading clinical standards across a 16-location dental group spanning Croatia, Slovenia, and Italy, and why dental tourism has shifted from cheap fillings to complex full-arch work. We also dig into what actually keeps quality high at scale: education systems, fast support for clinicians, a real group culture, and the discipline to go fully digital. 

• how Adria Dental Group operates across 16 locations and three countries 
• why Italian patients travel to Croatia for complex reconstructions 
• how Croatia’s private dentistry culture fuels training and quality 
• Andrea’s path from academia to clinical director leadership 
• building an internal academy with webinars and monthly training 
• visiting clinics to solve problems quickly and keep teams motivated 
• using a medical board to align lead clinicians and move decisions 
• balancing clinical autonomy with private equity financial goals 
• switching to digital workflows, zirconia, milling machines, and in-house labs 
• the growth lesson: build a true group mindset, not a loose network 
• practical advice: remove owner bottlenecks and hire finance support early 

If you require any help, don't hesitate to reach out to the Samera team at www.samera.co.uk. We are all here to help you!

Thank you,

The Samera Team

Transcript

Welcome, Andrea, And Her Day

Speaker 1 0:16

Right, hello everybody, and this is Arun Mehra here on the DSO podcast today. And I'm delighted to have today Dr. Andrea Petterboznak on the call today. Hi Andrea, how are you doing? Hi, fine. How are you? I'm good. I'm good, thanks. So Andrea, where where are you today? Where are you? Where are you based? I'm actually at home. You're at home, yeah? Yes.

Speaker 0:40

Finally, so where's home for you? Home is uh well, I'd say Zagreb, the capital of Croatia. Well, just a small village outside of it.

Speaker 1 0:48

Okay, and so just give me a rundown of your day today. What what what where did you go? You said you traveled a lot today to me earlier. What have you been up to?

Speaker 0:57

Well, today I visit the I visited the clinic, our one of our clinics, which is located in Ljubljana, Slovenia, the capital of Slovenia. I did a few patients there. Then I jumped over to Maribor where I where I had a little lecture uh with with some I'd say postgraduate students and and and uh the likes, and then I went back home. So that was the full day. Okay. Started pretty early, around seven o'clock.

Speaker 1 1:28

Okay, so all right, fair enough. And so now you're you're the clinical director of Adria Dental Group, is that correct? Yes, yes, yes. So what does that what does that actually entail? What does that actually mean?

Speaker 1:39

Well, actually, it means overseeing the all the clinical uh all the clinical things that have that are going on in our clinics, and we currently have actually 16 locations in three countries, so Croatia, Slovenia, and Italy, uh, with around 150 dentists. Okay. Uh the same amount of dental chairs, dental units. Yeah. Around I think there are 180 uh uh dental assistants and the same the same amount of dental technicians, and the whole group is around, I think, 720 plus something uh employees. Most of most of the people are employed in the group.

Speaker 1 2:29

Okay, so 720 people across about 16 locations. So it's quite a large number. Each of your clinics are probably quite big. Am I right in saying that? How many how many chairs would a typical clinic be with?

Speaker 2:41

A typical clinic would be between 10 and I'd say 10 and 12 chairs. We only have one clinic that has four chairs, that's the smallest one, and the biggest one has 23.

Speaker 1 2:55

Wow, okay, 2023 chairs. Okay, so yeah, so I'm I'm based here in the UK, and that's quite a rare to have anything with even more than 10, to be honest with so when you're saying 23 chairs, it's like more like a hospital, I guess, as opposed to just uh a dental clinic, correct? Yeah, yeah, yeah.

Speaker 3:10

Well, it's well, it's not a hospital, it's it's really a dental clinic. Okay, and it it uh serves mostly uh Italian patients that come for a day visit. So they drive from Italy, it's located in Rijeka, and they drive for a for a day visit, do what they can do in this one day, and then they go back home.

Speaker 2 3:31

Okay, okay.

Building Scale Through Dental Tourism

Speaker 3:32

Because Croatia is pretty strong in dental tourism, especially uh thanks to the very close location to Italy. And in the beginning of 2000s, it was really an explosion of both clinics and and patients coming over because the quality of uh Croatian dentistry is very high. And uh this is something that Italian patients uh uh fairly early they recognized that, and they were they have been using it ever since. So for the for the last I would say 25 to 30 years, there has been a substantial number of Italians crossing over the border, driving to Croatia, uh getting their teeth done uh at that time in the beginning for just a quarter of the price. Today the prices are pretty much similar. And what we have seen in the last year and a half, that we have a major switch from at that time small works, you know, like fillings or or small prosthetic works. We are now mostly doing full arch reconstruction, big reconstructions, uh makeovers, things like that. So this is this is something that our group has been focusing on.

Speaker 1 4:47

Okay, so so historically people would go move to go to Italy, go for come from Italy for for cost and quality, but now the cost is irrelevant, they're just coming for quality and and bigger ticket, higher quality, more complex treatments, correct?

Speaker 5:01

Yes, yeah, yes, because you know, uh well, since I since I visit this clinic uh fairly often, uh I now see patients that of course uh they come back, you know. So after I uh two I think two Saturdays ago I was there, and there were like four or three or or five patients that came back and they wanted their work done again. Okay, because they've they've done it, I don't know, in 2001, 2002, 2003, and now it's time that they change it. So they just come, they just come for for the quality that they have been experiencing for for the this amount of time.

Speaker 1 5:41

So, what what why do you think Croatian dentistry then you may be biased in your opinion, but what why do you think it's seen as a such a strong thing, say, from Italian customers? What what what makes Croatia different?

Speaker 5:54

I would say uh, well, for that for this answer, I have to go a little bit back in the history and uh just give you an overview of of the Croatian uh health health system, how it's organized. You have like a public sector and you have private sector, meaning that you have a lot of, especially dentists, who uh just uh just uh serve patients who pay out of the pocket. So they have no connection to the to the uh uh Croatian insurance fund that uh is part of the public health sector. So this is this is a group of of doctors, of professionals who some somehow wanted to stand out from the standard or or or I don't know how to say, but the the normal, so to say, uh health sector. So they were always looking for some education, they were always investing in in themselves, and naturally with the well, there was a small amount of private dentists even back in Yugoslavia, but since since the 90s and the breakup of Yugoslavia, uh people were always looking towards the West, and I I know stories of people who are who have now already retired, like my mom. They were always uh looking for some congresses or or education somewhere in in Germany or Italy to go there to learn new things and then implement them in Croatia. They were even smuggling material. I don't know.

Speaker 1 7:27

Or is your mother was your mother a dentist?

Speaker 7:29

She's well, she's a retired dentist.

Speaker 1 7:31

Retired dentist. Okay, so let's go back to that. So that what is was that uh a main reason for you to enter dentistry because of your mother, or what was the reason you entered dentistry?

Speaker 7:40

Well, I was I was I was thinking I was between medicine and dentistry, and then I realized well, dentistry is something that once you finish, you can get your head into it and and work immediately with with because my grandfather was a medical doctor, and I remember his stories with with all the postgraduate studies and things like that. So this this was somehow boring, uh, and maybe it seemed too much for me. And uh, I've seen my mom working because she worked at home and she she was she also had her her uh private dental office, and I've seen that that's something that you really very quickly start seeing what you're doing, yeah. Okay, so then but then I realized I will never work with her. That was also important.

Speaker 1 8:29

Yeah, working with your parents is never easy, I think. So and so you so obviously you trained as a dentist, you've now now you're a clinical director overseeing, as you said, 150 dentists in a large growing DSO or dental group. How do you manage what's the difference between you before when you were working as a perhaps as a pure full-time clinician to now managing a large group of clinicians? How have you found that transition?

Speaker 8:58

Well, I've never been a full-time clinician, I have to tell you. Because uh I started my career at the university and I worked there for 10 years, and then I went from the small assistant to the vice dean. Okay, and then uh I somehow realized that this was not the environment that I will uh spend my whole life in. Yeah, and then I moved to private dentistry, and I was ready to abandon my academic career, but then another university in in Croatia called me to work as their part-time uh lecturer, and I've been doing this ever since. So that that was in 2009. So I'm I was always connected to the academia a little bit, so uh I was always you know balancing maybe two, sometimes even three jobs, because at one time I was uh at two universities at the same time.

Speaker 1 9:53

Okay, but but now you you're obviously a clinical director, 150 dentists you have to oversee. I guess having that academic background probably helps you in terms of managing the clinical uh workflows and clinical expertise. Is that right?

Speaker 10:10

Yes, because we we uh we are working very heavily on on the education. We have also uh set up uh the academy, our academy, which has uh uh like a webinar data bank where we put all the you know recorded stuff that people can look at it at any time, and we also organize quite a lot of uh lectures for our for our dentists, hygienists, assistants, technicians. So I think that at least once a month there is something happening in in the group. So uh so my academic background and and the things that I have learned as as a as a lecturer, as a teacher, I've tried to implement this really strongly into the group because I think that's that's very important. And I we've seen we've seen some uh really great uh career breakthroughs and developments in this short span of I'd say four three years. Some people have really excelled uh being backed up by by the group and by the sure by the idea.

Speaker 1 11:17

Sure. And just out of interest, you you run in three countries, you have to deliver these in three languages, or is there just one common language for all these?

Speaker 11:24

No, no, no. Luckily, I speak I speak quite a lot of languages, so I can manage, yes. And I also had to I had to uh get my diploma recognized in Slovenia and in Italy as well, in order to to be as a support there. But uh uh we are a small country, so learning foreign languages is something that we are very used to. If someone would drop you in one of our clinics, which is close to close to Italy, uh in the middle of the day, you'd you'd think you're in Italy because everybody's speaking Italian. Really?

Speaker 1 12:00

Yeah, so how so how so how many languages do you speak? You're gonna put me to shame here now. So I speak five. Wow, so English, Italian, Croatian, Slovenian, do you a little bit, yes.

Speaker 12:12

Yes, a little bit of French and a little bit of Spanish.

Speaker 1 12:15

Okay, wow, okay, so man of many talents.

Speaker 12:19

I don't know, I don't know if we mentioned German.

Speaker 1 12:21

Yeah, I did say German, you speak German as well, yeah.

Speaker 12:23

So yeah, yeah. Well, German is basically my second mother tongue because okay. Uh also due to the fact that we're very close to Austria and Germany, yeah.

Speaker 1 12:32

Very close by, yeah. Okay, okay. So now looking at your role, you've been, as you mentioned to me earlier, you've been in the role a few years as a clinical director. What what what do you what do you foresee? Well, what are your current challenges and what do you see are the challenges coming up ahead for a group like you?

Speaker 12:50

Well, at the moment we are we uh we haven't had any acquisitions in the in the past year. Okay. So we have now consolidated most of the most of the things that we have that we have uh projected to do in the last year because we used it for for these consolidations. And uh what we are now uh looking at is uh definitely growth. Okay, growth in in a sense that we we want to offer our patients the best. Well, we are pretty good at what we are delivering, but we are just uh trying to excel in that and and in order to uh invest in new technologies and invest in new protocols to uh deliver our patients the best possible treatment that they they can have. Because uh also also because uh quite a lot of these clinics were uh very much oriented towards foreign patients, we have somehow managed to turn this around in order to build our local patient database, and we are really growing strong, and we have more and more because Croatia is a small country, and Slovenia is also a small country, so people are now flocking to our clinics because of the uh uh experiences and and the people that because this is I think the the most pro the most important thing in in dentistry, once you have a good experience somewhere, you will go around and and and talk about it. So uh we have more and more people coming because they the clinics were recommended by former patients, and also all these clinics have been uh around for quite a long time, 10 plus years. Yeah, so everybody now knows the names. And one other thing that I would like to mention that although we are a group, we are still we are basically uh uh treating it as a house of brands because some of these names are so well known that that you really have to just build build it further.

Speaker 1 14:51

So that so you keep your local practice names and the local clinic names in the area, okay? Yes, but they're still part of a group, and so you have the power of the group in terms of oversight and um brand not branding, but in terms of buying power, that type of thing. But you keep that as brand, yeah.

Speaker 15:07

Okay, this this is uh especially just to go back what you asked me for what my greatest challenge is uh uh regarding the education. Uh, without the support of the industry, we couldn't do much. So as a group, we are really now recognized, and uh our our uh industry collaborators are really much into it in into uh giving our doctors the best possible education. So we're really using it, maybe a little bit abusing it.

Speaker 1 15:39

Sure, sure, sure. But if you go back to now your wider team, you told me earlier that some of the clinics, average clinic size is around 12 chairs, some go up to over 20, 20 plus chairs. Um, and you've got offer full discipline of of treatment. Historically, it was dental tourism, but now you're offering not only that, but also to the local market, correct?

Speaker 16:02

Okay, yes, well, some of the clinics were always well were were built by the local patients. Yeah, some of them uh relied heavily on on dental tourism, but but when COVID struck, this was really a blow because some of the especially the clinics uh in the western part which were working with Italians, they closed overnight. Yeah, and but they have all managed to switch to to the local uh population and the local patients. So in some clinics, you still have a lot of foreign patients, but in most of them it's it's either 50-50 or or domestic patients uh uh in in bigger percentage.

Leadership, Retention, And Group Mindset

Speaker 1 16:41

Okay, all right. And so you've seen the growth of your group over the last few years, okay. And what I've seen in so many DSOs is that culture and leadership are paramount um in such an organization. What do you do? What do you do as an individual? What do you do as a group to firstly keep team motivated, retain team, um, encourage team, develop team? What kind of things do you do?

Speaker 17:06

Well, uh the most important thing that me personally that I do is is that I find also very important is visiting the clinics.

Speaker 2 17:15

Okay.

Speaker 17:16

So when you go over there, you talk to them, uh you discuss the challenges that they have, you you solve their problems quickly. This is very important. For example, we had a we had a uh uh in one of the clinics, one of one of the one of the colleagues, she uh uh had to switch the aligner system that she was using. So uh so we organized it, we organized it practically the education in in a week. She went over there, did the education, started implementing it. And when next time when I visited, she was so thrilled, she was really happy, and she she really said, This is this is uh what now I feel the power of the group because I was able to uh get myself organized, go there, do the education, and and implement it in immediately. So this is something that's that's really uh working as a group, but you have to act fast.

Speaker 1 18:11

Yeah, okay, all right. And so as a as the clinical lead in in the group, um you're so heavily reliant, obviously, on great, not good clinicians, but great clinician clinicians in your team. You mentioned earlier that you've obviously got a lot of you do a lot of training and and webinars and academic type of um training, but how how else do you manage to keep the the lead clinicians engaged? How else do you retain them?

Speaker 18:40

Well, I think that we are lucky to have a very a very motivated team uh among the the uh lead clinicians in the in the clinics. They're fairly young and they they see the potential and they see the uh they see the power of the group. I think that's the most important thing. Uh one thing that uh that we started from the early beginning is uh we set up a medical board. So we have a group of, you know, like a think tank where we discuss some things. Sometimes it's just a few few WhatsApp messages or or or a quick call, but we seem to we seem to communicate very, very heavily and to discuss uh the things that are at hand so we can move forward.

Speaker 2 19:29

Okay, okay.

Speaker 1 19:29

Now it's interesting you mentioned a medical board, okay, that you have, um, and obviously of lead of lead of clinicians, experienced clinicians, but obviously a group has got investors, okay, and there's always people like me on the other side, the accountants, the money people, okay. And in some groups I've seen, there's always been an element of tension, or the the the the finance team aren't happy with what the clinicians are doing, or vice versa. How do you manage that situation in in such a group?

Speaker 19:59

Well, I have to say, well, uh, because our our group is uh private equity backed, so of course, of course, uh the financial aspect of the group is very important, but I I again I think that we are very lucky because all these clinical leads also have a sense of financial responsibility. So they always uh balance very, very uh skillfully between you know uh the they and they need not to be on on different sides, but the something that the clinician wants and what what is financially uh acceptable. So we always we always try to discuss these things, and uh, but also uh once uh the clinic clinical side presents the arguments and and and really uh uh gives the reasons why something should be done in a way that it should be done, it's always accepted. So we have we have we have quite a freedom in in deciding. And one thing that that also attracted me to the group is that that the investors and and the and the and uh the backup from the private equity, they were always very uh straight in uh in uh saying that the quality will never be put in question.

Speaker 1 21:22

Yeah, okay. Over the years I've met groups where people have said that, and unfortunately it changes, okay.

Speaker 21:30

But it's great to hear that uh yes, but uh one thing one thing that uh I also heard when when when when the private equity appeared in Croatia, oh they were saying uh the prices will go down, they will uh start using uh uh materials of less qual uh lesser quality and things like that. But it didn't happen. It didn't happen. We are still managing to maintain uh the quality, uh we are still using uh premium materials, and I have to say we are among the the most expensive clinics in the country.

Speaker 1 22:04

Sure.

Speaker 22:05

So our prices are not low.

Going Fully Digital With In-House Labs

Speaker 1 22:07

Sure, sure. But I think it I think that goes back to then finding the right partners to work with the clinical team with the right private equity team. When that works, it's it's it's such a uh great to see, but there are occasions when it doesn't work as well. Yes, of course, of course, I can imagine. Yeah. So I suppose okay, we've been talking for 20 odd minutes already now. I don't want to take up too much of your time today, but no problem. It's very interesting just to hear what you're doing. But you mentioned earlier technology that you're implementing into your clinics. What kind of technology is that AI related? What kind of stuff are you doing?

Speaker 22:41

Well, uh, when we when when the group was founded, uh, just I think out of 16 clinics, now I think that only two had a uh well, maybe one and a half, I would say, had a the digital protocol. Now all the clinics are using the digital protocol in all aspects of of of the clinical workflow. Okay, so we've switched, we've switched in in a year and a half, we've switched to basically not using any impression materials. Okay, and we have been we have had producers calling us what's going on, you're not ordering any impression materials, but we're basically not using them. We don't need anymore, yeah. Yes, and uh what what we've seen, but we've done this clinic by clinic, that we well, some of them already were uh very heavily into zirconia works, but we have somehow managed to switch all of them to more zirconia works, and especially now with the with the with the uh with the development of these digital technologies in the lab and uh the the milling machines. I think we currently have more than 30 milling machines in all the clinics. In all the clinics, okay. And with with the big reconstructions that we are working, we are now slowly but surely switching towards titanium uh bases with zirconia over it. And uh this is something that's more or less been done in the same way in all the labs, because we have also we have nine labs in the group, okay, and they are also uh communicating very, very frequently and also helping each other and and uh looking for new solutions and uh uh discussing uh cases. So it's really it's it's really a buzz uh also among the the people in the labs.

Speaker 1 24:39

So interesting. So that the lab is a large part of the business, by the same.

Speaker 24:42

Oh yes, the lab is the lab is we we have uh well our biggest lab is 1200 square meters big, it's 70, 70 technicians. Wow, okay, and it has uh two 3D printing machines. I think that they have more than 10 milling machines, so it's it's it's like it's like a factory, really.

Speaker 1 25:04

Yeah, okay, interesting. So wow, so so it's hand in hand the technology, the labs, the clinicians, the investors, all kind of singing off the same hymn sheet here.

Speaker 25:14

Okay, yes, they they have some the investors have have somehow identified uh where to put their money, yeah. 3D scanners, uh milling machines, uh digital technology. So this is something that's that's really turned around some of the clinics really, really strongly.

Speaker 1 25:35

Okay, all right. So now just kind of um just your viewpoint, really. I think we I've I'm I've I'm fortunate enough to know many dental group owners, met many over the years, some doing well, some not doing so well. What what's the one mistake you've seen many groups make, though, in your experience and your expertise over the years?

Speaker 25:56

Well, I I I wouldn't say I haven't I I've spoken to some of the clinical directors because I've met them. Uh, I think that uh one thing that is that is uh very challenging, and that I wouldn't say it's a mistake, it's just the fact that uh the when the clinicians are not employed, the doctors are not employed, so they basically working for themselves. Yeah, and when there's no when there's no I would say group group sense, yeah. If if if if you know what I mean, that they they they that they uh sense that they belong to a group, uh then it's not moving forward.

Speaker 1 26:37

Yeah, interesting. So it's that culture, isn't it being part of something, correct?

Speaker 26:41

Yes, yes, but because now now after these four years, for example, today I had a uh I had a situation in one of the clinics, there was a patient that needed to be uh uh a surgical, uh they had to place some implants, but there was no free uh doctor. So we called the doctor from another clinic when he finished his shifts, he she he went over to the other clinic and did these two patients. So this only happens if you if you feel that you belong to a group.

Speaker 1 27:10

Sure. And and therefore, in in the way you're set up, are your dentists all employed by the group? Okay, so they're actually employees as opposed to most groups that have things like associates where yes they have a kind of a distant relationship with it. You're right, they're kind of self-employed, so that culturally does change things when they're part of something, they're not uh thinking about something else, they're part of the whole organization, which I think you're right, and that leads into the whole culture, and that definitely leads into how you lead the team. Oh, how interesting. Okay, so that that's is that quite common in Croatia to have groups like that, or is it um no?

Speaker 27:46

We are the only we are well. I think there's only one other that is mixing medical and dental together, but we are the only dental group.

Speaker 1 27:57

Okay, that has that kind of employment type of angle to it.

Speaker 28:00

Well, most all the well, most of the doctors uh in Croatia are employed. Okay, but but they are also owners, so you know there's yeah, yeah, yeah, yeah, yeah. Yeah, okay.

What She Would Change From Day One

Speaker 1 28:12

Okay, so now just kind of wrapping this up. Um if you were starting again, starting your career again, or starting or starting a dental group from scratch today, okay, uh, with everything that you know now, um, what would you do differently in the first 12 months? I would get rid of the owners. Okay. Yeah, okay. Former owners. Yeah, former owners, yeah. Okay. As quickly as possible. Why, why?

Speaker 28:41

Because I think uh in a clinic in a clinic that is that has substantial size, the owner is not so important anymore. I mean the business goes on, it doesn't matter who is the owner.

Speaker 2 28:57

Yeah.

Speaker 28:58

So just uh removing or or just putting him aside or or or giving him uh some other thing to do than manage the clinic that he has built, uh makes you uh uh gives you gives you free space to reorganize the clinic in in a way that you want it to be reorganized. And you have to reorganize because it's not one entity uh anymore, so it's part of something else.

Speaker 1 29:26

Sure. Okay, and then right one final question, Andrea. Um, if a dentist is listening to this tonight and wants to make one change tomorrow morning to start building their own, building their group bigger, better, uh higher performing, what's that one thing they should be doing, in your opinion?

Speaker 29:44

They should hire someone who will take care of their finances.

Speaker 1 29:48

Okay, all right, okay.

Speaker 29:51

Because not I I don't think that well, some of the some dentists are really good into finances, but most of them focus too much on the clinical work and love the clinical work too much in order to have time, space, and the energy for for the managing part. So hiring and finding someone who will manage the clinic, who you will discuss it with, that's the most important thing if you want it to grow.

Speaker 1 30:19

Yeah, well, I agree, and I think I echo that as an accountant myself. I think I've seen it. I my my I married a dentist, I'm still married to a dentist, and her biggest weakness was the financial side, and that's how I started off my business from her weakness. Um, so it's very interesting that uh you see the same thing as well, even though it's a good idea. Yes, definitely, definitely.

Speaker 30:39

Because today there that there's so many things that you have to take care of in the clinical part that you basically don't have the time for for this as well.

Speaker 1 30:48

And like and the clinical time is yeah, as you said, it's it's getting harder and harder and more complex, and yes, technology and all these things are evolving, so you need to have good people, business people around you to help you.

Speaker 30:58

Well, and if if that person is then uh has the the has the the uh the emotional part to to understand what dentistry dentistry is all about, then you have a perfect match. Yeah, yeah, okay.

Final Takeaways And Goodbye

Speaker 1 31:14

Well, amazing. Well, thank you so much, Andrea. I think I've taken up 30 odd minutes of your time this evening. Um, it's been a real pleasure to have you on this podcast. Um, you've obviously got a wealth of experience, uh, wealth of knowledge, and uh thank you for sharing your insights today. Well, thank you for inviting me.

Speaker 31:33

Thank you for inviting me. It was really a pleasure to talk to you, and uh I hope to see you soon somewhere live again.

Speaker 1 31:40

Absolutely, we'll see you soon. I'm I'm sure I'll see you soon. Um, uh whether it's in Europe or if you're coming here to the UK, you just never know where we are. And uh actually, we may even be coming to Croatia on summer holidays, actually. So if I am, I'll I'll let you know where I am.

Speaker 2 31:54

Yes, yes, great, great for coming.

Speaker 1 31:56

Okay, uh well, lovely to see you. Okay, I'll let I'll just stop this now.